Evaluation of drug administration errors in a teaching hospital

<p>Abstract</p> <p>Background</p> <p>Medication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. We aimed to determine the incidence, type and clinical importance of drug administration errors and to identify risk factors.</p> <p>Methods</p> <p>Prospective study based on disguised observation technique in four wards in a teaching hospital in Paris, France (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. Main outcomes were number, type and clinical importance of errors and associated risk factors. Drug administration error rate was calculated with and without wrong time errors. Relationship between the occurrence of errors and potential risk factors were investigated using logistic regression models with random effects.</p> <p>Results</p> <p>Twenty-eight nurses caring for 108 patients were observed. Among 1501 opportunities for error, 415 administrations (430 errors) with one or more errors were detected (27.6%). There were 312 wrong time errors, ten simultaneously with another type of error, resulting in an error rate without wrong time error of 7.5% (113/1501). The most frequently administered drugs were the cardiovascular drugs (425/1501, 28.3%). The highest risks of error in a drug administration were for dermatological drugs. No potentially life-threatening errors were witnessed and 6% of errors were classified as having a serious or significant impact on patients (mainly omission). In multivariate analysis, the occurrence of errors was associated with drug administration route, drug classification (ATC) and the number of patient under the nurse's care.</p> <p>Conclusion</p> <p>Medication administration errors are frequent. The identification of its determinants helps to undertake designed interventions.</p

Chronology of prescribing error during the hospital stay and prediction of pharmacist's alerts overriding: a prospective analysis

<p>Abstract</p> <p>Background</p> <p>Drug prescribing errors are frequent in the hospital setting and pharmacists play an important role in detection of these errors. The objectives of this study are (1) to describe the drug prescribing errors rate during the patient's stay, (2) to find which characteristics for a prescribing error are the most predictive of their reproduction the next day despite pharmacist's alert (<it>i.e</it>. override the alert).</p> <p>Methods</p> <p>We prospectively collected all medication order lines and prescribing errors during 18 days in 7 medical wards' using computerized physician order entry. We described and modelled the errors rate according to the chronology of hospital stay. We performed a classification and regression tree analysis to find which characteristics of alerts were predictive of their overriding (<it>i.e</it>. prescribing error repeated).</p> <p>Results</p> <p>12 533 order lines were reviewed, 117 errors (errors rate 0.9%) were observed and 51% of these errors occurred on the first day of the hospital stay. The risk of a prescribing error decreased over time. 52% of the alerts were overridden (<it>i.e </it>error uncorrected by prescribers on the following day. Drug omissions were the most frequently taken into account by prescribers. The classification and regression tree analysis showed that overriding pharmacist's alerts is first related to the ward of the prescriber and then to either Anatomical Therapeutic Chemical class of the drug or the type of error.</p> <p>Conclusions</p> <p>Since 51% of prescribing errors occurred on the first day of stay, pharmacist should concentrate his analysis of drug prescriptions on this day. The difference of overriding behavior between wards and according drug Anatomical Therapeutic Chemical class or type of error could also guide the validation tasks and programming of electronic alerts.</p

L'effet in vitro, du calcium dans les eaux de boisson, sur la cristallisation oxalo-calcique

La première mesure prophylactique à proposer aux sujets lithiasiques, quelle que soit la nature chimique du calcul, est la cure de diurèse qui consiste à augmenter les apports hydriques de 2 à 3 litres par jour. Dans cette étude, nous suggérons de déterminer s'il existe un lien entre la nature calcique de l'eau de boisson et le risque de formation de lithiase oxalo-calcique puisque ce type prédomine dans la région Ouest d'Algérie. La cristallisation de l'oxalate de calcium, en absence et en présence d'eaux de boisson de différentes qualités chimiques, a été suivie par turbidimétrie. La solution sursaturée en oxalate de calcium, de force ionique de 0,15M, a été préparée à partir de solutions de chlorure de calcium (CaCl2) et d"oxalate de sodium (C204Na2) de concentration respective de 4 et 0,5 mM. L'incidence de l'eau de boisson sur la cristallisation de l'oxalate de calcium est calculée sous forme de 1 % appelé taux d'inhibition. Nos résultats expérimentaux montrent que toutes les eaux testées (minérales, de source, ou de ville) ralentissent d'une manière remarquable la cristallisation de l'oxalate de calcium. L'eau très faiblement calcique de Baïkal (16,1 mg/l) possède un grand pouvoir inhibiteur sur la cristallisation oxalo-calcique (80,58 %) ; elle retarde la croissance des cristaux d'oxalate de calcium puisque le temps d'induction passe de 0,6 mn en absence d'eau à 3,3 mn. En revanche, l'eau de source de Chafia très calcique (673,68 mg/litre) inhibe la cristallisation de 43,26 % seulement. Le temps d'induction étant faible (1,3 mn), la croissance des cristaux d'oxalate de calcium n'est pas aussi bien retardée qu'elle l'est en présence des autres eaux. Par ailleurs, une recherche de corrélation entre la teneur en calcium des eaux testées et le pouvoir inhibiteur de ces eaux a été entreprise. Il en ressort que le calcium dans les eaux de boisson a une incidence très faible sur le risque de cristallisation de l'oxalate de calcium. Ainsi, cette étude montre clairement que les eaux de boisson ont un effet préventif sur le risque de cristallisation de l'oxalate de calcium, principal constituant lithiasiqu

Factors associated with hospital admission and adverse outcome for COVID-19: Role of social factors and medical care

International audienceBackground: Beyond sex, age, and various comorbidities, geographical origin and socioeconomic deprivation are associated with Coronavirus Disease (COVID-19) morbidity and mortality in the general population. We aimed to assess factors associated with severe forms of COVID-19 after a hospital emergency department visit, focusing on socioeconomic factors. Methods: Patients with laboratory-confirmed COVID-19 attending the emergency department of Béclère Hospital (France) in March–April 2020 were included. Postal addresses were used to obtain two geographical deprivation indices at the neighborhood level. Factors associated with hospitalization and factors associated with adverse outcomes, i.e. mechanical ventilation or death, were studied using logistic and Cox analyses, respectively. Results: Among 399 included patients, 321 were hospitalized. Neither geographical origin nor socioeconomic deprivation was associated with any of the outcomes. Being male, older, overweight or obese, diabetic, or having a neuropsychiatric disorder were independent risk factors for hospitalization. Among 296 patients hospitalized at Béclère Hospital, 91 experienced an adverse outcome. Older age, being overweight or obese, desaturation and extent of chest CT scan lesions > 25% at admission (aHR: 2.2 [95% CI: 1.3–3.5]) and higher peak CRP levels and acute kidney failure (aHR: 2.0 [1.2–3.3]) during follow-up were independently associated with adverse outcomes, whereas treatment with hydrocortisone reduced the risk of mechanical ventilation or death by half (aHR: 0.5 [0.3–0.8]). Conclusion: No association between geographical origin or socioeconomic deprivation and the occurrence of a severe form of COVID-19 was observed in our population after arrival to the emergency department. Empirical corticosteroid use with hydrocortisone had a strong protective impact