Medication errors at hospital admission and discharge in Type 1 and 2 diabetes

International audienceAIMS: To assess the prevalence and characteristics of medication errors at hospital admission and discharge in people with Type 1 and Type 2 diabetes, and identify potential risk factors for these errors. METHODS: This prospective observational study included all people with Type 1 (n~=~163) and Type 2 diabetes (n~=~508) admitted to the Diabetology-Department of the University Hospital of Montpellier, France, between 2013 and 2015. Pharmacists conducted medication reconciliation within 24~h of admission and at hospital discharge. Medication history collected from different sources (patient/family interviews, prescriptions/medical records, contact with community pharmacies/general practitioners/nurses) was compared with admission and discharge prescriptions to detect unintentional discrepancies in medication indicating involuntary medication changes. Medication errors were defined as unintentional medication discrepancies corrected by physicians. Risk factors for medication errors and serious errors (i.e. errors that may cause harm) were assessed using logistic regression. RESULTS: A total of 322 medication errors were identified and were mainly omissions. Prevalence of medication errors in Type 1 and Type 2 diabetes was 21.5% and 22.2% respectively at admission, and 9.0% and 12.2% at discharge. After adjusting for age and number of treatments, people with Type 1 diabetes had nearly a twofold higher odds of having medication errors (odds ratio (OR) 1.72, 95% confidence interval (CI) 1.02-2.94) and serious errors (OR 2.17, 95% CI 1.02-4.76) at admission compared with those with Type 2 diabetes. CONCLUSIONS: Medication reconciliation identified medication errors in one third of individuals. Clinical pharmacists should focus on poly-medicated individuals, but also on other high-risk people, for example, those with Type 1 diabetes

High-resolution evaluation of recent bank accretion rate of the managed Rhone: A case study by multi-proxy approach

International audienceWe determined the sedimentation rates near a managed embankment on the Lower Rhone for the second half of the twentieth century. This was carried out using a combination of chronological indicators (137Cs, 241Am, dendrochronology and archived data) and sedimentological measurements. A high-resolution chronological sequence has emerged from these data sets. The average annual sedimentation rate of 14 cm has increased progressively over the last 50 years, and at a much faster rate than observed elsewhere on this river. This is probably due to a combination of factors such as the size of the river, abundance and coarse texture of the solid load, and local impact of river engineering works. We also studied hydrological and sedimentological characteristics for a number of flood events. © 2009 Elsevier B.V. All rights reserved

Using the clinical information system and self-supervision to rationalize the need for antibiotic stewardship: An interventional study in a 2000-bed university hospital.

To describe the usefulness of electronic medical records (EMRs) and a computerized physician order entry (CPOE) system to support and assess an antimicrobial stewardship programme (ASP). At the study hospital, infectious diseases specialists supervise antimicrobial prescription when solicited by physicians in charge of patients. From January to October 2015, treatment days of antibiotic prescription, supervised or unsupervised by infectious disease specialists (SAP or UAP, respectively) in all wards, except intensive care units emergency department, bone marrow transplantation units, and paediatric units, were calculated. Embedding recommendations on carbapenem indications as a checklist into the CPOE system, a self-administered ASP was implemented in 2017. EMRs were reviewed to determine global compliance with carbapenem prescription guidelines (combining introduction of therapy and 72-h assessment) before and after implementation of a self-administered ASP in departments with a low SAP rate for these antibiotics. Among 16 090 prescriptions extracted, 19.9% were SAPs. Three patterns of prescription were identified. The first pattern (amoxicillin-clavulanate, ceftriaxone) was characterized by a high UAP rate in every department, the second pattern (cloxacillin, rifampin) was characterized by a high SAP rate in every department, and the third pattern (broad-spectrum beta-lactams) was characterized by heterogeneous distribution of SAP/UAP among departments. Carbapenem prescription was reviewed in five departments with a low SAP rate for carbapenems over 6 months: 94 before and 107 after implementation of the self-administered ASP. Global compliance with guidelines increased significantly from 22% to 37% (risk difference 15%, 95% confidence interval 2.3-28.5%; P=0.02). A clinical information system may help to rationalize antibiotic stewardship in a context of scarce medical resources. Mapping of antibiotic prescriptions and self-supervision are efficient, complementary and easy-to-implement tools

Pharmacist intervention to detect drug adverse events on admission to the emergency department: Two case reports of neuroleptic malignant syndrome

International audienceNeuroleptic malignant syndrome (NMS) is a rare but severe adverse effect of antipsychotic drugs

Development and validation of a Score to Assess Risk of Medication Errors detected during medication reconciliation process at admission in Internal Medicine Unit: SCOREM study

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Bon usage des médicaments chez le sujet âgé

International audienceDrug-induced adverse effects are one of the main avoidable causes of hospitalization in older people. Numerous lists of potentially inappropriate medications for older people have been published, as national and international guidelines for appropriate prescribing in numerous diseases and for different age categories. The present review describes the general rules for an appropriate prescribing in older people and summarizes, for the main conditions encountered in older people, medications that are too often under-prescribed, the precautions of use of the main drugs that induce adverse effects, and drugs for which the benefit to risk ratio is unfavourable in older people. All these data are assembled in educational tables designed to be printed in a practical pocket format and used in daily practice by prescribers, whether physicians, surgeons or pharmacists.Les effets indésirables médicamenteux représentent l'une des principales causes évitables d'hospitalisation chez les sujets âgés. Un certain nombre de listes de médicaments potentielle-ment inappropriés chez les sujets âgés a été publié et il existe de nombreuses recommandations internationales pour le bon usage des médicaments par pathologie, et par tranche d'âge. La présente mise au point précise les règles générales de prescription des médicaments chez les sujets âgés et résume, pour les situations cliniques les plus fréquemment rencontrées, les médicaments sous-utilisés à tort et à recommander, les précautions d'emploi à observer pour réduire les effets secondaires des principaux médicaments pourvoyeurs d'effets indésirables et les médicaments dont le rapport bénéfice/risque est défavorable chez les sujets âgés. Ces recommandations sont synthétisées dans des tableaux didactiques conç us pour être imprimés dans un format de poche et être utilisés au quotidien par les prescripteurs quel que soit leur domaine d'activité, médicale, chirurgicale, ou pharmaceutique

Introduction

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