PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-25 (40)
 

Clipboard (0)
None

Select a Filter Below

Journals
Year of Publication
2.  Before-and-After Study of Interruptions in a Pharmacy Department 
Background:
Few data exist on interruptions in the drug-use process in hospital pharmacies and their effects on patient care.
Objective:
The primary objective was to compare the hourly number of stimuli received and emitted (i.e., generated) by pharmacists and pharmacy technicians before and after implementation of measures intended to reduce interruptions. The secondary objective was to evaluate the impact of the corrective measures on 4 specific stimuli.
Methods:
This before-and-after cross-sectional observational study was conducted in the main dispensing area of the pharmacy department of a Canadian university hospital centre. Stimuli received and emitted by pharmacists and pharmacy technicians were counted before (2010) and after (2012) implementation of corrective measures designed to limit interruptions. The effect of corrective measures on targeted stimuli was measured with a t test.
Results:
Data were collected during a total of 93 randomly scheduled 30-min observation periods: 62 periods in 2010 (n = 2663 stimuli) and 31 periods in 2012 (n = 1217 stimuli). The average hourly stimulus rate (± standard deviation) was unchanged after implementation of corrective measures: 85.9 ± 22.2 in 2010 and 78.5 ± 20.1 in 2012 (p = 0.06). However, a significant decline was observed for many individual stimuli, including the number of face-to-face nonprofessional conversations among pharmacists (4.4 ± 4.2 in 2010 versus 1.2 ± 1.8 in 2012, p = 0.003).
Conclusion:
Despite the implementation of corrective measures, there was no statistically significant change in the hourly stimulus rates from 2010 to 2012. Other studies are needed to better characterize the nature and repercussions of stimuli, distractions, and interruptions.
PMCID: PMC3583790  PMID: 23467669
hospital pharmacy practice; drug-use process; interruptions; distractions; stimuli; pratique de la pharmacie hospitalière; processus de distribution des médicaments; interruptions; distractions; stimuli
3.  Environmental Contamination with Hazardous Drugs in Quebec Hospitals 
Background
Since publication of the US National Institute for Occupational Safety and Health alert on hazardous drugs in 2004, many health care organizations have reviewed their procedures for handling hazardous drugs. Occupational exposure may occur when handling, compounding, or administering a drug considered to be hazardous, at any stage from storage to waste management.
Objectives:
To describe environmental contamination with cyclophosphamide, ifosfamide, and methotrexate in pharmacy and patient care areas of Quebec hospitals.
Methods:
Sixty-eight hospitals were invited to participate. At each hospital, 12 prespecified measurement sites (6 each within pharmacy and patient care areas) were sampled once (midweek, end of day). The samples were analyzed by ultra-performance liquid chromatography tandem mass spectrometry to determine the presence of the 3 drugs. The limits of detection (LODs) were 0.0015 ng/cm2 for cyclophosphamide, 0.0012 ng/cm2 for ifosfamide, and 0.0060 ng/cm2 for methotrexate.
Results:
Twenty-five (37%) of the hospitals agreed to participate. Samples from sites other than the 12 prespecified sites were excluded. Overall, 259 valid samples were collected between April 2008 and January 2010 (147 samples from pharmacy areas in 25 hospitals and 112 samples from patient care areas in 24 hospitals). No hospital was using a closed-system drug transfer device at the time of the study. The median (minimum, maximum) number of sites per hospital with at least 1 positive sample for at least 1 of the 3 hazardous drugs was 6 (1, 12). A total of 135 (52%) samples were positive for cyclophosphamide, 53 (20%) for ifosfamide, and 7 (3%) for methotrexate. The median (minimum, maximum) concentration in positive samples was 0.0035 ng/cm2 (below LOD, 28 ng/cm2) for cyclophosphamide, below LOD (below LOD, 8.6 ng/cm2) for ifosfamide, and below LOD (below LOD, 0.58 ng/cm2) for methotrexate.
Conclusions:
The levels of environmental contamination with 3 hazardous drugs in this multicentre study were similar to or below those in most published studies. Periodic measurement of surface contamination is necessary to ensure that current practices limit occupational exposure to hazardous drugs.
PMCID: PMC3517787  PMID: 23288952
occupational exposure; environmental monitoring; cyclophosphamide; ifosfamide; methotrexate; hospital pharmacy service; exposition professionnelle; surveillance environnementale; cyclophosphamide; ifosfamide; méthotrexate; service de pharmacie d’hôpital
10.  Perspective sur les ruptures d’approvisionnement de médicaments en établissement de santé de 2006 à 2010 
RÉSUMÉ
Contexte:
Si les ruptures d’approvisionnement de médicaments font partie de la réalité de la pratique pharmaceutique depuis plusieurs décennies, elles deviennent une préoccupation quotidienne pour les pharmaciens dans les années 2000 et dépassent les frontières de la littérature pharmaceutique.
Objectif:
L’objectif principal de cette étude était de quantifier le nombre de médicaments en rupture de stock par année et la durée de ces interruptions. L’objectif secondaire visait à décrire le nombre de médicaments en rupture de stock par fabricant et par classe thérapeutique.
Méthode:
Cette étude descriptive et rétrospective des ruptures d’approvisionnement en médicaments a porté sur l’ensemble des médicaments à contrat pour les hôpitaux des régions administratives de Montréal, de Laval et de l’Estrie, au Québec. Le nombre de ruptures de stocks, le nombre de jours de rupture de stock et leur durée moyenne par année ont été calculés par fabricant et par classe thérapeutique. De plus, la proportion de produits en rupture de stock et la proportion de jours de rupture de stocks ont été déterminées par classe thérapeutique. Les données ont été analysées à l’aide de statistiques descriptives (c.-à-d. somme, moyenne, écart-type, médiane, intervalle).
Résultats:
Entre le 1er janvier 2006 et le 31 août 2010 (une période de 56 mois), 2400 ruptures de stocks ont été dénombrées pour un total de 258 105 jours de rupture de stocks (durée moyenne de 108 jours, écart-type de 130 jours et intervalle de 5 à 1623 jours). Un total de 70 fabricants étaient impliqués dans la survenue de toutes les ruptures d’approvisionnement de médicaments relevées durant cette période. Cinquante pour cent (50 %) des ruptures de stocks et des jours de rupture de stocks provenaient de quatre fabricants. Les interruptions étudiées touchaient la majorité des classes thérapeutiques de médicaments disponibles sur le marché. Toutefois, 50 % des ruptures de stocks provenaient de trois classes thérapeutiques (médicaments du système nerveux central, agents anti-infectieux et médicaments cardiovasculaires).
Conclusion:
Il s’agit des premières données canadiennes publiées sur l’étendue des ruptures d’approvisionnement sur le marché hospitalier. L’étude a démontré que les ruptures de stocks touchent la plupart des fabricants et la majorité des classes thérapeutiques. D’autres études sont nécessaires afin d’explorer les causes et les conséquences des ruptures d’approvisionnement en établissements de santé.
PMCID: PMC3242576  PMID: 22479098
ruptures d’approvisionnement en médicaments; rupture de stock; fabricant; établissement de santé; drug shortages; inventory shortage; manufacturer; hospital
11.  A Pilot Study of Bar Codes in a Canadian Hospital 
Background:
In 2004, the US Food and Drug Administration issued a new rule requiring most prescription and some over-the-counter pharmaceutical products to carry bar codes down to the level of individual doses, with the intent of reducing the number of medication errors. Despite these regulatory changes in the United States, Health Canada has not yet adopted any mandatory bar-coding of drugs.
Objective:
To evaluate the feasibility of using commercial bar codes for receipt and preparation of drug products and to evaluate the readability of the bar codes printed on various levels of drug packaging.
Methods:
This cross-sectional observational pilot study was conducted in the Pharmacy Department of a Canadian mother–child university hospital centre in July 2010. For the purposes of the study, research drugs and cytotoxic drugs in various storage areas, as well as locally compounded medications with bar codes generated in house, were excluded. For all other drug products, the presence or absence of bar codes was documented for each level of packaging, along with the trade and generic names, content (i.e., drug product), quantity of doses or level of packaging, therapeutic class (if applicable), type of bar code (1- or 2-dimensional symbology), alphanumeric value contained in the bar code, standard of reference used to generate the alphanumeric value (Universal Product Code [UPC], Global Trade Item Number [GTIN], or unknown), and readability of the bar codes by 2 scanners.
Results:
Only 33 (1.9%) of the 1734 products evaluated had no bar codes on any level of packaging. Of the 2875 levels of packaging evaluated, 2021 (70.3%) had at least one bar code. Of the 2384 bar codes evaluated, 2353 (98.7%) were linear (1-dimensional) and 31 (1.3%) were 2-dimensional. Well over three-quarters (2112 or 88.6%) of the evaluated bar codes were readable by at least 1 of the 2 scanners used in the study.
Conclusions:
On the basis of these results, bar-coding could be used for receipt of 80.9% of the drug products at this Canadian hospital and for the preparation and dispensing of 70.1% of the products.
PMCID: PMC3161800  PMID: 22479068
bar-coding; pharmaceutical products; packaging; code-barres; produits pharmaceutiques; conditionnement
13.  Utilisation de lignes directrices dans le cadre de l’implantation de cabinets automatisés décentralisés en établissement de santé 
RÉSUMÉ
Contexte :
Il existe peu de données sur les conséquences de l’utilisation des cabinets automatisés décentralisés (CAD) en établissements de santé.
Méthode :
Il s’agit d’une étude descriptive de la conformité des pratiques par rapport à des lignes directrices publiées dans le cadre de l’implantation de CAD. L’objectif principal de l’étude est d’évaluer la conformité globale et celle de chaque processus du circuit du médicament. L’étude se déroule au sein du Centre hospitalier universitaire (CHU) Sainte-Justine, un établissement mère–enfant de 500 lits. À partir des lignes directrices portant sur l’utilisation sécuritaire des CAD de l’Institute for Safe Medication Practice (aux États-Unis) (2008) et de son outil d’autoévaluation (2009), nous avons évalué la conformité de la pratique à 30 jours et à 120 jours après l’implantation.
Résultats :
Nous avons procédé de novembre 2009 à avril 2010 à l’implantation de sept stations de CAD au sein du CHU Sainte-Justine. Le profil de conformité est passé de 66 % à 74 % de janvier à avril 2010. Pour chaque processus relatif à l’utilisation sécuritaire des CAD, nous présentons une brève description des critères ainsi que les éléments de non-conformité liés à la technologie ou aux aspects organisationnels. Pour chaque élément de non-conformité, nous avons déterminé les actions requises auprès du fabricant afin de modifier l’équipement (c. à .d. aspects technologiques) et auprès de l’établissement afin de modifier les modalités d’utilisation (aspects organisationnels) en précisant le ou les processus impliqués.
Conclusion :
Cette étude décrit la conformité des pratiques au CHU Sainte-Justine par rapport à des lignes directrices publiées par l’Institute for Safe Medication Practices. L’utilisation de lignes directrices dans le cadre de l’implantation de cabinets automatisés décentralisés en établissement peut aider à guider les actions tant sur le plan technologique qu’organisationnel.
PMCID: PMC3093417  PMID: 22479039
automatisation; gestion des risques; gestion de la qualité; automation; risk management; quality management
14.  A Pilot Comparative Study of the Clarity and Assessability of the Drug Management Standards of Accreditation Canada and the US Joint Commission 
Background:
There are few data comparing the drug management standards of the US and Canadian agencies that accredit health care institutions.
Objective:
To evaluate the clarity and assessability of criteria in the drug management standards adopted by Accreditation Canada and the Joint Commission (United States).
Methods:
A pilot study was conducted to compare the clarity and assessability of the criteria listed in the 2 standards. Criteria that were common to the 2008 versions of the Canadian and US drug management standards were identified. A panel of 12 health care professionals was assembled to independently rate the clarity (i.e., clear or unclear) and the assessability (i.e., assessable or not assessable) of each statement, using a validated comparative grid.
Results:
In total, there were 143 Canadian standards and 103 US standards. Sixty-two (43%) of the 143 Canadian criteria could be directly paired with a US criterion, whereas 70 (68%) of the 103 US criteria could be paired with one or more Canadian criteria. Six of the US criteria were paired with more than one Canadian criterion, and 12 of the Canadian criteria could be paired with more than one US criterion. Four of the 22 themes in the Canadian standards had no equivalent criteria in the US standards. Panel members from the pharmaceutical practice group evaluated the clarity and assessability of the Canadian criteria more severely than panel members from the nursing practice group: 86% versus 95% of individual ratings were deemed “clear” by these two groups, respectively (p < 0.001) and 64% versus 88% of individual ratings were deemed “assessable” (p < 0.001). There were no criteria that were considered unclear or unassessable by all of the panel members.
Conclusions:
Few data are available on drug management standards and their impact on health care. A better understanding of these standards, as well as comparisons of Canadian standards with those of other countries, might help in determining their clarity and assessability. A larger-scale study is required to validate the observations reported here.
PMCID: PMC3093418  PMID: 22479040
accreditation; standards; drug management; pharmacy practice; agrément; normes; gestion des médicaments; pratique de la pharmacie
17.  Démarche pour la mise à niveau d’un secteur de soins pharmaceutiques : le cas de l’hémato-oncologie pédiatrique 
Contexte :
Bien que le concept de pharmacie clinique ait été développé dans les années soixante, il existe une grande variété de programmes et une grande disparité entre les programmes en clinique externe et en hospitalisation, bénéficiant de la présence d’un pharmacien dans un secteur de soins.
Objectif:
Éprouver une méthode de mise à niveau des secteurs de soins pharmaceutiques en établissement de santé.
Méthode :
Il s’agit d’une étude descriptive se déroulant au Centre hospitalier universitaire Sainte-Justine, un établissement mère-enfant de 500 lits. Le secteur de soins pharmaceutiques ciblé pour illustrer la méthode de mise à niveau est l’hématologie-oncologie pédiatrique. La méthode comporte trois étapes, soit une revue de la documentation scientifique, un profil du secteur et une mise à jour du niveau de pratique selon un profil des activités pharmaceutiques dans le secteur avant et après la mise à niveau.
Résultats :
Au total, 108 articles ont été recensés et 22 ont été retenus à partir d’une recherche dans PubMed. Après une recherche manuelle complémentaire, 36 articles ont finalement été évalués. Parmi les articles retenus, on compte trois lignes directrices, 11 études de développement, une revue de la littérature scientifique, six études pré- et post-interventions et 15 études quasi expérimentales. Bien que les patients de ce secteur ne comptent que pour 5 % des admissions de l’hôpital, la complexité des cas est élevée tant sur le plan de la codification de l’épisode de soins que du potentiel d’intervention pharmaceutique par admission.
Conclusion :
Il existe peu de données illustrant une démarche de mise à niveau de la pratique dans un secteur de soins pharmaceutiques. Cette étude a éprouvé une méthode de mise à niveau dans un service d’hématologie-oncologie pédiatrique et comporte une revue de la documentation scientifique, un profil du secteur et une description des tâches des pharmaciens de ce secteur avant et après la mise à niveau.
PMCID: PMC2858501  PMID: 22478967
soins pharmaceutiques; hémato-oncologie; modèle de pratique; pharmaceutical care; hematology–oncology; model of pratice
20.  Inventory of Drug Samples in a Health Care Institution 
Background:
Few data exist on the presence of drug samples in health care facilities. Although the use of drug samples has potential benefits, this practice is also controversial, as it can contribute to non-optimal drug use. The objective of this study was to evaluate the inventory of drug samples in a health care institution and to determine compliance with existing policies and procedures.
Methods:
This descriptive observational study was conducted in a university hospital centre from October 18 to November 1, 2007. A standardized data collection form was used for a physical inventory, which was intended to identify all drug samples available in the institution. The following information was recorded: number of locations where drug samples were found, primary patient care activity performed at each location, number of storage areas in the location, type of storage, presence of a lock, location of the key (if a lock was present), medical specialty, number of physicians and nurses likely to use the samples, reasons given for handing out samples, presence of a designated person to manage the samples, physical inventory (i.e., various details for each distribution unit), and declaration of samples to the pharmacy department. The inventory was conducted by 2 research assistants during day shifts.
Results:
A total of 84 locations were included in the inventory, and drug samples were found in 21 locations (with a total of 31 storage areas). All of the locations were intended for ambulatory patients (outpatient clinics and day centres). No drug samples were found in inpatient care units. The drug samples, which came from 62 different pharmaceutical companies, represented a total of 159 generic entities and 266 different brands. Of the distribution units for drug samples that were identified during this inventory, 59% were not on the hospital’s local formulary. Furthermore, only 3.5% of the distribution units had been declared to the pharmacy department, in accordance with established policy. The sample distribution units, including expired units, totalled 78 955 doses, with a total value of Can$48 783 (based on unit prices in effect in October 2007).
Conclusion:
This study presents an inventory of drug samples in an urban health care institution and reports compliance with the institution’s policies and procedures regarding drug samples. Samples were found only in outpatient clinics and represented 2.4 times the hospital’s floor stock of medications. Most of the samples inventoried were not listed on the hospital’s formulary. It appears that the use of drug samples is underestimated in hospital settings. Further studies are needed to evaluate the importance of drug samples and the risks associated with their use.
PMCID: PMC2826967  PMID: 22478908
drugs samples; health care facilities; inventory management; échantillons de médicaments; établissements de santé; gestion des stocks

Results 1-25 (40)