Pharmacological thromboembolic prophylaxis in a medical ward: Room for improvement

To evaluate the adequacy of pharmacological thromboembolic prevention in the medical ward of a university hospital, we performed a retrospective study in 227 consecutive inpatients. The presence of risk factors, and type, length, and dose of pharmacological prevention were documented by chart review. Only 22% of the 153 risk patients received adequate prevention, whereas 38% of the patients at low risk were given pharmacological prophylaxis. The high prevalence of over- and undertreatment is an indicator of less than optimal care. Quality of care interventions, such as the development of local guidelines, might improve the appropriateness of pharmacological thromboembolic prophylaxis in medical inpatient

Transmission de l’information liée aux médicaments entre un centre hospitalier et une policlinique universitaires en Suisse : panorama et perspectives de continuité des soins

Résumé Objectifs : Identifier les barrières à la transmission de l’information entre le Centre hospitalier universitaire vaudois et le Service de consultation générale ainsi que la pharmacie publique de la Policlinique médicale universitaire, situés sur un même site géographique, et proposer des outils pour améliorer cette transmission. Méthodologie : Cette étude descriptive a accompagné rétrospectivement le parcours de patients hospitalisés en 2006 et suivis régulièrement à la policlinique (médecine générale et pharmacie). Les sources d’information consultables ou non par la pharmacie et jugées utiles à la validation d’ordonnances ont été cartographiées. Résultats : Seize patients ont été suivis. Les informations administratives sont informatisées et accessibles à tous. Les dossiers médicaux sont encore majoritairement manuscrits, non partageables entre médecins et pharmaciens. Ils sont toutefois numérisés dans une base d’archivage accessible aux médecins. Certains services de l’hôpital ont un système de prescription informatisée. De son côté, la pharmacie de la policlinique gère les profils pharmacologiques de ses patients avec un logiciel non partagé informatiquement avec les médecins. Deux outils faciles à mettre en place sont proposés : un message automatique avertissant la pharmacie de l’hospitalisation de l’un de ses patients, pour permettre une transmission du profil pharmacologique au médecin et un accès à la lettre de congé pour améliorer la prise en charge des patients sortant de l’hôpital. Conclusion : La transmission d’informations est partielle entre les médecins de l’hôpital et de la policlinique et inexistante avec la pharmacie. Deux outils sont proposés pour y remédier. Abstract Objective: To identify barriers to information transmission between a university hospital, Centre hospitalier universitaire vaudois, a general medicine service and the community pharmacy of a university outpatient clinic, Policlinique médicale universitaire, sharing a same geographic site, and to propose tools for improving pharmaceutical care. Methods: This descriptive study was retrospectively following routes of patients hospitalized in 2006 and having regular follow-up in outpatient clinic (GP and community pharmacy). A map was made for information sources, usually available or not for the community pharmacy, and considered as useful for pharmaceutical validation of prescriptions. Results: Sixteen patients were followed. Administrative information is computerized and available for everybody. Medical charts are mainly handwritten, not shared between physicians and pharmacists. However, they are scanned to an archive database available for physicians. Some hospital departments run a computerized prescription system. In outpatient clinic community pharmacy, patient medication database is managed by a software not available for physicians. Two tools easy to implement are proposed : a pop-up if a patient followed by the pharmacy is admitted to hospital, to allow pharmacist to contact hospital physician for medication history transmission and an access to discharge letter to improve prescription validation process after hospital discharge. Conclusion: Information transmission is partial between hospital and outpatient clinic physicians and is absent with community pharmacy. Two tools are proposed to improve this transmission. Keywords : seamless care; information; hospital; outpatient clinic

When fever, paracetamol? Theory and practice in a paediatric outpatient clinic

OBJECTIVE: To determine how medical and nursing staff treat feverish children and compare the findings with their theoretical knowledge, evaluating how they might contribute to fever phobia in parents.Setting: Paediatric Emergency Department. METHOD: In the first step, we analysed prospectively the files of all children having consulted the Paediatric Emergency Department with a history of fever or of body temperature above 38 degrees C during a 2-week period. The second step consisted of evaluating knowledge and perception of fever of doctors and nurses using a questionnaire. MAIN OUTCOME MEASURES: Prospective study: final diagnosis (viral, non- invasive bacterial disorders, invasive bacterial disorders), site of measurement and average temperature. Evaluation of theoretical knowledge: definition of fever, site of measurement, evaluation of the child's clinical state, antipyretic drug choice. RESULTS: A total of 114 children under 5 years of age were enrolled and 24 caregivers (12 doctors, 12 nurses, 90 of the staff) responded to the questionnaire. The results showed good consistency in theoretical knowledge, but an excessive fear about cerebral damage was also shown by doctors. This belief likely contributes to the transmission of fever phobia to parents. In contrast, analysis of children management showed that fever was often under-treated, especially by nurses and even more so by parents. Paracetamol remained the first-line antipyretic drug yet was often administered in insufficient doses. Non-steroidal anti-inflammatory drugs were seldom used, except by parents (16 of all the children). Contrary to literature, the favourite route of administration was the rectal one. Physical methods like sponging were largely used by nurses, despite the uncertainties in their real effectiveness and their known side-effects. CONCLUSION: Our study showed that the management of feverish children was globally correct in the Paediatric Emergency Department, but several improvement measures have been taken (e.g. tables of normal and abnormal ranges of temperature, recommended temperature measurement techniques, dosage regimen of antipyretic drugs, guidelines to parents), justifying the implementation of a pharmaceutical follow-up