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Background: Health care organization and management have changed over the last decades. Heading a pharmacy department in Canada in 2015 is quite challenging. It appears crucial to ensure that new pharmacists are made aware of such issues. Objective: To describe the teaching of hospital pharmacy management to post-graduate pharmacy students. Methods: Observational retrospective study. Data were extracted from the course syllabus and presentations by pharmacy residents on management controversies between 2005 and 2014. The aim was to profile the teaching and explore topics discussed over the last 10 years in Quebec universities. Results: The mandatory course is made up of two segments (theoretical and practical); during the practical segment, pharmacy residents gather information on their management experience and resolve a management controversy presented as an oral/ written communication. Over the last 10 years a clinical professor trained a total of 572 pharmacy residents who reviewed 213 topics overall. Eighty percent of management controversies concerned procedures (n = 170) and 17% (n = 36) technologies (n = 7 missing data). The key topics covered were in decreasing order: pharmacy management (19%), pharmaceutical care (18%), human resource management (10%), drug prescribing (9%) and drug compounding (8%). Fifty percent (n = 106) of were considered innovative. Conclusion: The study provides a 10-year outlook on the teaching of pharmacy management to hospital pharmacy residents in Québec. We feel that sharing this teaching experience is key with respect to the training of hospital pharmacy residents. [ABSTRACT FROM AUTHOR]

Objective: To compare the role and perception of hospital pharmacists in the dispensing of oral cancer drugs (MAVO) in Europe and North America. Method: Descriptive, exploratory and cross-sectional study. Identification of a hospital pharmacist by targeted legal entity. 44 variables were identified and grouped into three themes: demographics (n = 3), perceptions of current practice (n = 31), perceptions of the assignment of nine pharmaceutical tasks (n = 10) and an optimal scenario of care. Questionnaire in English and French on SurveyMonkey®, Palo Alto (CA, USA), tested by five hospital pharmacists and sent by email. Results: Fourteen respondents (14/21, 67 %) provided usable answers (e.g., 7 in Europe: Germany, Austria, Belgium, Spain, France, Netherlands and Switzerland, and 7 in North America: Quebec, Alberta, New Brunswick, Ontario, Manitoba, Prince Edward Island and the United States). Validation of MAVO prescription compliance involves the hospital pharmacist in 12 cases out of 14. A majority of respondents (11/14) do not have enough resources to ensure quality supervision of all patients treated by MAVO. Conclusion: Regardless of the legal entity, a majority of respondents consider that the workload is on the rise and that the resources are insufficient to ensure quality pharmaceutical services and care (i.e., safety and proper use). This exploratory study shows the interest of reflecting on the current model of pharmaceutical practice (hospital against pharmacy) in order to ensure adequate and efficient treatment of cancer patients. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the management of emergency drugs in a mother-child teaching hospital. Methods: A physical inventory of all the resuscitation carts, emergency carts, and emergency boxes was taken. Fifteen compliance criteria were established to evaluate partial trays of emergency medications. The contents of full and partial emergency medication trays and boxes were revised, and an improved process was implemented based on a review of the literature. The research team included 2 pharmacists, 1 anesthetist, 1 intensivist, 1 emergency doctor, 1 nurse, and 1 research assistant. Results: Before the harmonization process, there were 11 full resuscitation carts with 48 items and 30 partial emergency carts with an average item count of 15.4 ± standard deviation 4.4, as well as 16 pediatric boxes and 3 emergency boxes in pediatrics and obstetrics, respectively. During the evaluation process, 1,911 distribution units were checked, 2.5% of which had expired. Following the process there were 14 identical resuscitation carts with 43 items and 25 emergency carts with 21 items. Conclusion: There are few examples of steps that can be taken to evaluate and update the management of emergency medications in health care facilities. This evaluative study outlines an approach that entailed taking a physical inventory, evaluating the process, and improving the management model within a tertiary care university hospital center. A review of the new process will be performed in 12 months' time. [ABSTRACT FROM AUTHOR]

Objective. To describe environmental contamination with hazardous drugs in a hospital pharmacy setting before and after reorganizing a hematology-oncology satellite pharmacy. Methods. This is a descriptive study of surface contamination with cyclophosphamide, ifosfamide, and methotrexate in two hematology-oncology satellite pharmacies. In order to measure surface contamination with hazardous drugs, samples from four distinct measurement sites within the pharmacy were taken in each of the two phases (pre- and postphases) using a sampling procedure and an analytical method modified from Larson et al. Results. A total of 133 samples from four measurement sites were taken and analyzed over the course of the study (specifically 60 prephase samples and 73 postphase samples). The study showed a significant increase in the number of positive samples (from 66.7% to 90.4%, p<0.001) from the pre- to the postphase. The increase, however, is only significant in terms of the location where completed preparations were placed after they had come out from under the hood (from 0/15 to 21/28, p<0.001) and the work surface (from 8/15 to 15/15, p = 0.006) and only in terms of ifosfamide. Furthermore, for the other sites studied, the number of positive samples remained unchanged between the pre- and postphase. A statistically significant difference between the pre- and postphase was observed in terms of ifosfamide for three of the four measurement sites studied and methotrexate for one of the four sites. Average concentrations were higher in the post phase in three of the four cases. Conclusion. This study describes environmental contamination with hazardous drugs in a hospital pharmacy setting before and after reorganizing a hematology-oncology satellite pharmacy. The study showed that a refitting of the hemato-oncology pharmacy is not a sufficient strategy to reduce the environmental contamination by ifosfamide because a significant increase in the number of positive samples from the pre- to the postphase have been observed. Many factors can contribute to influence the contamination of hazardous drugs such as the workflow and the training of the personal. Continuous environmental surveillance of hazardous drugs is required to document traces and help reduce risks. [ABSTRACT FROM AUTHOR]

Purpose. The results of contamination monitoring during a one-year pilot period are described. Summary. A hematology-oncology satellite pharmacy conducted contamination monitoring for one year, using methotrexate as the index marker. From January 12, 2005, to December 21, 2005, 40 sampling sessions occurred during which 238 wipe samples (excluding positive controls) were collected. Each week, seven wipe samples were prepared by pharmacy technicians. Samples were obtained from the blank reference (site 0), the external metallic window frame of the main biological safety cabinet (BSC) (site 1), the back of the phone receiver (site 2), the external surface of an i.v. solution bag that was inside the BSC the previous hour (site 3), a working surface used for the final packaging and labeling (site 4), and the floor of the preparation room (site 5). The sixth sample was a positive methotrexate control. The methotrexate was detected by a high-performance liquid chromatograph with a fluorometric detector. Five samples tested positive for methotrexate—two from site 1, one from site 2, one from site 4, and one from site 0 (the blank); the last finding was thought to have most likely been the result of an error or sample mix-up during the wipe-sampling procedures. Despite differences in the sampling methods used, the type of wetting solution used, and the volume of desorption solution, the results were consistent with the literature in terms of few positive results. Conclusion. A program was developed to monitor surface contamination by methotrexate in a hematology-oncology satellite pharmacy. [ABSTRACT FROM AUTHOR]

Investigates the availability of antidotes in Quebec hospitals before and after dissemination of guidelines. Reasons for deficient stocking of antidotes; Outcomes of a written survey mailed to the pharmacy directors of hospitals that were members of the Quebec Hospital Association; Recommendations for minimum stocking of antidotes in hospitals; Factors that could contribute to an increase in antidote stocking.

Presents letters to the editor on a number of medical topics as of November 27, 2001. Cost of maintaining adequate antidote supplies; Personalized medications; Thoughts on clear clinical practice guidelines; Use of probiotics as medical therapies.

Audits are essential for reviewing and improving the medication-use process. Identifying areas for improvement can limit the risk of errors when preparing and administering drugs. Pediatric centers face specific challenges in ensuring the safety of the medication-use process. The objective of this study was to observe and compare compliance with criteria for the preparation and administration of medications by nurses in a mother-and-child university hospital center over two consecutive years. This observational cross-sectional study was conducted in a Canadian mother-and-child university hospital center. Audits were conducted over a 1-month period in 16 and 18 nursing care sectors in 2021 and 2022, respectively. The standardized audit evaluated compliance with prespecified criteria related to the preparation and administration of medication by nursing staff (77 criteria for 2021 and 82 criteria for 2022). The auditors comprised nurses and a pharmacist trained by the research team. Compliance was compared between years and assessed through a chi-square test. The audit consisted of 522 observations in 2021 and 448 observations in 2022. Overall compliance was 76% in 2021 and 66% in 2022. The compliance rate by criterion ranged from 16% to 100%. In 2021 and 2022, 51 (84%) and 52 (87%) of the criteria, respectively, had compliance rates of more than 75%, and 12 (20%) and eight (13%), respectively, had 100% compliance. There were statistically significant decreases in compliance for nine of the 39 criteria for preparation of medications, notably prior hand hygiene (91%% vs. 84%, p = 0.002), and for six of the 17 criteria for administration of medications, including mentioning possible adverse effects to the patient (41% vs- 30%, p = 0.008). In this study, compliance was over 75% for most of the criteria. However, for a few criteria, we observed a decrease in compliance from 2021 to 2022. Various hypotheses are proposed to explain these decreases, such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Occupational exposure to antineoplastic drugs can lead to long-term adverse effects on workers' health. A reproducible Canadian surface monitoring program was established in 2010. The objective was to describe contamination with 11 antineoplastic drugs measured on 12 surfaces among hospitals participating in this annual monitoring program. Methods: Each hospital sampled six standardized sites in oncology pharmacies and six in outpatient clinics. Ultra-performance liquid chromatography coupled with tandem mass spectrometry was used for cyclophosphamide, docetaxel, doxorubicin, etoposide, 5-fluorouracil, gemcitabine, irinotecan, methotrexate, paclitaxel, and vinorelbine. Platinum-based drugs were analyzed by inductively coupled plasma mass spectrometry; this excludes inorganic platinum from the environment. Hospitals filled out an online questionnaire about their practices; a Kolmogorov–Smirnov test was used for some practices. Results: One hundred and twenty-four Canadian hospitals participated. Cyclophosphamide (405/1445, 28%), gemcitabine (347/1445, 24%), and platinum (71/756, 9%) were the most frequent. The 90th percentile of surface concentration was 0.01 ng/cm² for cyclophosphamide and 0.003 ng/cm² for gemcitabine. Centers that prepared 5000 or more antineoplastic per year had higher concentrations of cyclophosphamide and gemcitabine on their surfaces (p = 0.0001). Almost half maintained a hazardous drugs committee (46/119, 39%), but this did not influence the cyclophosphamide contamination (p = 0.051). Hazardous drugs training was more frequent for oncology pharmacy and nursing staff than for hygiene and sanitation staff. Conclusions: This monitoring program allowed centers to benchmark their contamination with pragmatic contamination thresholds derived from the Canadian 90th percentiles. Regular participation and local hazardous drug committee involvement provide an opportunity to review practices, identify risk areas, and refresh training. [ABSTRACT FROM AUTHOR]

A 19-month-old child presented with fever and acute neurological deterioration with hypertonia, tremors, and clonus 1 day after starting metoclopramide. The clinical course of the patient was suggestive of neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS), which can both be triggered by metoclopramide. This first pediatric report of an overlap between NMS and SS associated to metoclopramide highlights the importance of considering this new entity and its consequences on treatment. [ABSTRACT FROM AUTHOR]

Background. Pharmacists have relied on the contribution of assistant pharmacist for several decades. Pharmacist can no longer work without the pharmacy technicians to efficiently and safely practice pharmacy. Aim. The aim of this study was to conduct a comprehensive literature review to examine the roles and the impacts of pharmacy technicians. Methods. Literature search in PubMed (January 1996-March 21th, 2018). Were included articles in French and English presenting pharmacy technician roles (e.g. defined activities supporting pharmacist and the drug use circuit in retail of hospital pharmacy practice) and their impacts. Were excluded articles about interviews, guidelines, practice models, curriculum and continuing education of pharmacy technicians. Each pharmacy technician activity was identified and collected. Each impact associated to a pharmacy technician activity was coded according to nine types of outcomes. Results. Sixty-eight studies were included. Fifty-four percent (37/68) of included studies had an observational design. A total of 62 positive outcomes associated to pharmacy technicians' activities were reported in a total of 33 articles included. Activities associated to a positive impact were, in decreasing order, related to medication errors and discrepancies (n=20), workload management (n=12), costs, adverse drug reactions (n=3), morbidity (n=2), patient compliance and healthcare workers satisfaction (n=1) or others (n=20). No published studies were associated to negative outcomes. A total of 85 descriptive indicators associated to pharmacy technicians' activities were identified in a total of 57 articles included. Conclusion. This literature review highlights the contribution of technical staff in supporting the practice of pharmacy. Pharmacy technicians contribute to a variety of activities and several studies show a favorable impact of their activity. [ABSTRACT FROM AUTHOR]

Résumé: Les pharmaciens sont confrontés à faire des choix. L'objectif principal est d'identifier les caractéristiques du choix dans le domaine de la santé. L'objectif secondaire est de décrire le concept accountability for reasonableness (A4R). Méthode : Les caractéristiques applicables au concept de choix ont été identifiées à partir d'une séance de remue-méninges. Des ouvrages sur le choix ont été recherchés à partir de la banque de données getAbstract©. Des articles relatifs au concept A4R ont été recherchés sur PubMed. Une analyse qualitative commentée est présentée. Résultats : Nous avons identifié 17 caractéristiques applicables au concept de choix (p. ex. choix libre ou non libre, éthique ou non éthique, éclairé ou non éclairé, fixe ou qui peut évoluer). Chacune de ces caractéristiques varie compte tenu du contexte, des valeurs et des conditions propices ou non à ce choix. Les ouvrages sélectionnés sur getAbstract© mettent en évidence que choisir est difficile et qu'il existe de nombreux biais (p. ex. émotions, biais de confirmation, aversion à la perte). Les quatre articles retenus sur PubMed décrivent les conditions du concept A4R : le choix doit reposer sur des preuves, avoir un caractère public, être contestable et être contrôlé ; ainsi que des conditions complémentaires (démocratisation du processus, utilisation uniforme et cohérente des directives, processus appliqué de manière prospective et systématique, autonomie institutionnelle, récompense des hôpitaux qui appliquent les directives). Conclusion : Notre étude met en évidence 17 caractéristiques applicables au concept de choix et que la responsabilité associée au caractère raisonnable d'un choix est un concept important en santé. Chaque département de pharmacie devrait se doter d'une politique entourant la prise de décision pour mener à des choix raisonnables. Pharmacists are faced with making choices every day. The main objective is to identify the characteristics related to the concept of choice in healthcare. The secondary objective is to describe the concept of accountability for reasonableness (A4R). Method : This is a review of literature. Identification of the characteristics applicable to the concept of choice from a brainstorming session. Literature search on the concept of choice from the getAbstract© database and selection of key elements. Search for articles related to the A4R concept on PubMed with a qualitative analysis. Results : Identification of 17 characteristics applicable to the concept of choice. The books selected in getAbstract© highlight that choosing is difficult and that this act is influenced by many factors and biases. The four articles selected from the PubMed research describe the conditions of the A4R concept (choice based on evidence, being public, contestable and controlled) and complementary conditions. Conclusion : Our study highlights 17 characteristics applicable to the concept of choice. The responsibility associated with the reasonableness of a choice is an important concept in health. Choosing is difficult. Each pharmacy department should have a decision-making policy, including values, criteria and principles that should lead to reasonable choices. [ABSTRACT FROM AUTHOR]

Background: Working as a healthcare professional involves abiding by the legal framework and standards of practice as well as being able to make choices. Such choices are based in particular on selecting treatments and modes of intervention. Goals: The main objective is to assess the perception of the comfort level of pharmacy students exposed to a contextualized didactic device that involves validating prescriptions for a new drug. The secondary objective is to assess how students perceive their training as to decision-making. Methods: The descriptive cross-sectional study is the first part of a 10-step contextualized didactic device. The second part is an online questionnaire handed to third-year pharmacy students at Université de Montréal. The study was carried out using an online tool (SurveyMonkey, Palo Alto (CA), USA). Results: A total of 176 students provided complete and usable responses (participation rate: 95%). The contextualized didactic device raises participant awareness to the fact that they must make reasonable decisions (e.g. whether or not to validate a prescription). Conclusion: This study demonstrated the feasibility of using a contextualized didactic device to analyze and dispense a new drug. The data collected emphasizes the ability to adjust the comfort level regarding different actions based on various items of information. Most students state they are adequately trained to evaluate effectiveness, safety and compliance, but not so much on drug costs. It may be useful to consider more training on decision-making including the costs in pharmacy surroundings. [ABSTRACT FROM AUTHOR]

Pharmacists play a key role to ensure a safe and optimal use of biosimilars. The objective was to assess the impact of a training session on pharmacists' knowledge and views on regulatory and clinical considerations regarding biosimilars. Methods: A prospective study pre-post intervention. Hospital pharmacists were invited to participate to a training session about characteristics, clinical considerations and substitution rules for biosimilars in Quebec. The evolution of participants' knowledge and views was measured by comparing responses to two anonymous online surveys: pre and post training. A descriptive statistical analysis of the results was performed. Results: The overall response rate to the pre-training survey, the training session and the post-training survey were respectively: 52% (n=30/58), 52% (n=30/58) and 41% (n=24/58). Pharmacists knew the main differences between a biosimilar and a generic drug. They reported significant knowlegde improvement on biosimilar regulatory considerations (64% vs. 85%, p<0,001) and on biosmilars clinical considerations (73% vs. 87%, p=0,011). After the training session, they were more comfortable to explain what is a biosimilar to a healthcare worker or a patient (43% vs. 100%, p<0.001) and to explain the substitution rules for biosimilars in Quebec to a physician (20% vs. 71% p = 0.001). Conclusion: The training session was well received by pharmacists and allowed them to improve knowledge of biosimilars. [ABSTRACT FROM AUTHOR]

Purpose Training represents a considerable portion of research activities and is vastly different for each clinical trial. This variation is partially explained by the lack of detailed regulations surrounding training procedures, which hinders the ability of investigational drug service (IDS) staff to plan their workload. The aim of this study was to quantify the workload associated with trial-specific training of IDS staff. The secondary aim was to identify the factors associated with training complexity. Methods A retrospective study was carried out in the IDS of a mother and child university hospital. Trial-specific documents on which the pharmacy staff was trained were analyzed. Workload was calculated by measuring reading time. The readability of each document was determined by the Flesch Reading Ease score. The complexity of the trials was established using the scoring method of Calvin-Lamas et al. The influence of the following factors on training was assessed by analysis of variance: sponsor type, research phase, and research focus by medical specialty. Results A total of 93 clinical trials and 433 documents were included. Investigator's brochures were the longest (a mean [SD] of 107 [46] pages; P < 0.0001) and most difficult documents to read (mean [SD] readability score, 25.5 [4.4]; P < 0.0001). Trials with industry sponsors required a significantly longer overall reading time (mean [SD], 12.26 [6.72] hours; P < 0.0001). On average, a mean (SD) of 9.42 (7.16) hours of reading were necessary to train one employee for a clinical trial. Conclusion This study is the first to document reading time necessary for training of IDS staff. The training workload varied by sponsor type, while the research phase and medical specialty had little impact. IDS units would benefit from a tool that could identify complex trials. [ABSTRACT FROM AUTHOR]

Introduction: Occupational exposure to antineoplastic drugs can lead to long-term adverse effects on workers' health. Environmental monitoring is conducted once a year, as part of a Canadian monitoring program. The objective was to describe contamination with 11 antineoplastic drugs measured on surfaces. Methods: Six standardized sites in oncology pharmacy and six in outpatient clinic were sampled in each hospital. Samples were analyzed by ultra-performance liquid chromatography coupled with tandem mass spectrometry (non-platinum drugs) and by inductively coupled plasma mass spectrometry (platinum-based drugs). The limits of detection (in ng/cm2) were: 0.0006 for cyclophosphamide; 0.001 for docetaxel; 0.04 for 5-fluorouracil; 0.0004 for gemcitabine; 0.0007 for irinotecan; 0.0009 for methotrexate; 0.004 for paclitaxel, 0.009 for vinorelbine, 0.02 for doxorubicine, 0.0037 for etoposide and 0.004 for the platinum. Sub-analyses were done with a Kolmogorov-Smirnov test Results: 122 Canadian hospitals participated. Cyclophosphamide (451/1412, 32% of positive samples, 90th percentile of concentration 0.0160 ng/cm2) and gemcitabine (320/1412, 23%, 0.0036 ng/cm2) were most frequently measured on surfaces. The surfaces most frequently contaminated with at least one drug were the front grille inside the biological safety cabinet (97/121, 80%) and the armrest of patient treatment chair (92/118, 78%).The distribution of cyclophosphamide concentration was higher for centers that prepared ≥ 5000 antineoplastic drug preparations/year (p < 0.0001). Conclusions: This monitoring program allowed centers to benchmark their contamination with pragmatic contamination thresholds derived from the Canadian 90th percentiles. Problematic areas need corrective measures such as decontamination. The program helps to increase the workers' awareness. [ABSTRACT FROM AUTHOR]

Although pharmacists have been involved in oncology for decades, there is no recent literature review highlighting the pharmacist roles and impacts in this area. The objective of this article is to present a literature review of the roles and benefits of oncology pharmacist. Method: Literature review. A search strategy on PubMed was conducted from January 1990 to July 7, 2016. The search strategy used the following keywords: pharmacist, pharmacy, clinical pharmacy, pharmaceutical services, pharmaceutical care, neoplasms. The studies addressing the roles and benefits of oncology pharmacist were considered. Results: 22 articles were included (e.g. 15 observational/descriptive studies, 2 cohort studies, 2 randomized controlled trials, 2 before and after studies, 1 comparative study). Regarding the descriptive indicators and impact of pharmaceutical interventions in oncology, our literature review revealed 77% (72/94) descriptive indicators and 23% (22/94) outcome indicators. Of the 22 outcome indicators identified, they were either positive (82%, 18/22) or neutral (18%, 4/22) and they were related to following impacts: morbidity (9%, 2/22), adverse events (4.5%, 1/22), medication errors (14%, 3/22), patient adherence (9%, 2/22), satisfaction (4.5%, 1/22), costs (9%, 2/22) and other benefits (50%, 11/22). Conclusion: Relatively little data on the roles and benefits of pharmacists has been published. Many scientific societies consider the pharmacist as an important member in the multidisciplinary team whose goal is to provide care to cancer patients. [ABSTRACT FROM AUTHOR]

Context: The practice of pharmacy and the role of the pharmacists are evolving both in France and in Quebec. Educational strategies in pharmacy need to be adapted to better prepare the future pharmacists. Objectives: The main objective was to assess and compare how French interns and Quebec residents read, perceive and use scientific data on the roles of pharmacists and how it impacts their activities. The secondary objective was to measure their assessment of the Impact Pharmacie website. Material and methods: A 32- question survey was developed for the cross-sectional descriptive study. The sampling included Ile-de-France interns and Quebec residents. Results: A total of 46 interns (19.5%) and 34 residents (51.5%) responded. A statistically significant difference was demonstrated regarding 7/16 items that assessed the reading of scientific data and 3/12 items that assessed the perception of usefulness and practicality. Interns and residents thought that they would benefit from reading additional related articles. They sensed the data had potential and was underused. Some 25% of interns versus 71.0% of residents were familiar with the Impact Pharmacie website prior to the survey. Conclusion: This study confirms that future pharmacists demonstrate that the data on the role of pharmacists and the impact of their activities are not really looked at despite an overall positive perception. Pharmacists agreed that practical data was important and that a systematic integration of data in the pharmacy curriculum would be valuable. The Impact Pharmacie website is an example of an educational tool that can potentially improve the reading rate of scientific literature. [ABSTRACT FROM AUTHOR]

Background: In our view, there is too little emphasis on the results stemming from evaluative research on professional practice in pharmacist training. Methods: We developed a structured approach that included a literature review of evidence, combined with a strategy of knowledge transfer including the creation of the French-language Impact Pharmacie website. On the website, fact sheet pages present an overview of the roles of pharmacists on a given topic, including a description of activities and its impact on multiple outcomes, including morbidity and costs. Results: During an information conference that included the presentation of relevant articles on the role and impact of pharmacists and the presentation of the Impact Pharmacie website, we evaluated Quebec pharmacists' exposure to and perception of pharmacy practice evidence. The participants supported the use of the literature and stated that they were not sufficiently exposed to the evidence. Respondents thought the Impact Pharmacie website was clear and relevant, felt that it should be incorporated in the academic curriculum and found it useful in their professional practice. Conclusion: We believe that the Impact Pharmacie website is an innovative educational tool that can provide food for thought to pharmacists, which is why the results and the awareness-raising approach are being shared. [ABSTRACT FROM AUTHOR]

Résumé: La diffusion de données et d'indicateurs à l'équipe de la pharmacie comporte plusieurs bénéfices théoriques, mais ceux-ci sont peu diffusés et doivent être adaptés aux besoins de l'équipe. Méthodes. Étude descriptive transversale. L'objectif est de décrire l'utilisation actuelle et projetée d'indicateurs de gestion en pharmacie hospitalière au sein d'un centre hospitalier universitaire. La situation actuelle de la diffusion et de l'utilisation de données et d'indicateurs a été décrite. Des indicateurs et données d'intérêt ont été identifiés par revue de la littérature et en consultant les chefs d'équipe des secteurs visés. Un sondage a été envoyé à l'équipe. Chaque répondant devait coter les indicateurs d'intérêt de leur(s) secteur(s) de pratique selon un score de priorité d'affichage, permettant de calculer un score pondéré pour chaque donnée et indicateur. Résultats. Cinquante-sept réponses ont été obtenues (taux de participation de 63,3 % ; 57/90 personnes disponibles, soit 31 pharmaciens, 23 préparateurs, 2 membres non identifiés et 1 membre autre). Des 93 données et indicateurs proposés, le score pondéré de priorité d'affichage varie de 1,44 à 4,05 par item (moyenne de 2,69 ± 0,52). En utilisant arbitrairement un seuil de 2,5 ou moins, 37 de ces données et indicateurs ont été priorisés. Conclusion. Cette étude décrit une démarche structurée pour évaluer et sélectionner des données et indicateurs en vue de les diffuser aux membres d'un département de pharmacie via un tableau de bord. Un total de 93 données et indicateurs ont été identifiés par les membres de l'équipe afin de soutenir les pratiques en pharmacie hospitalière. Several theoretical benefits of disseminating data and indicators to the pharmacy team exist, but they are not usually distributed, and they must be adapted to the pharmacy team's needs. Methods: This is a descriptive cross-sectional study. The objective is to describe the current and projected use of hospital pharmacy management indicators within a university hospital center. The current state of dissemination and use of data and indicators was described. Indicators and data of interest were identified from a literature review and by consulting targeted sectors' team leaders. A survey was sent to the team where each respondent rated the indicators of interest for their area(s) of practice according to a display priority score, allowing for a weighted score to be calculated for each data and indicator. Results: Fifty-seven responses were obtained (participation rate of 63.3%; 57/90 people available, i.e., 31 pharmacists, 23 preparers, 2 unidentified members and 1 other member). Of the 93 data and indicators available, the weighted display priority score ranges from 1.44 to 4.05 per item (average of 2.69 ± 0.52). Using an arbitrary threshold of 2.5 or less, 37 of these data and indicators were prioritized. Conclusion: This study describes a structured process for evaluating and selecting data and indicators with the objective to share them to members of a pharmacy department via a dashboard. A total of 93 data and indicators were identified by team members to support hospital pharmacy practices. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare workers exposure to antineoplastic drugs can lead to adverse health effects. Guidelines promote the safe handling of antineoplastic drugs, but no safe exposure limit was determined. Regular surface sampling contributes to ensuring workers safety. Methods: A cross-sectional monitoring is conducted once a year with voluntary Canadian centers, since 2010. Twelve standardized sampling sites were sampled. Samples were analyzed by high performance mass coupled liquid chromatography. The limits of detection (in ng/cm2) were: 0.001 for cyclophosphamide and gemcitabine; 0.3 for docetaxel and ifosfamide; 0.04 for 5-fluorouracil and paclitaxel; 0.003 for irinotecan; 0.002 for methotrexate; 0.01 for vinorelbine. Results: The surfaces from 109 centers were sampled between 01/01/2020–18/06/2020. Twenty-six centers delayed their participation because of the COVID-19 pandemic. 1217 samples were analyzed. Surfaces were frequently contaminated with cyclophosphamide (34% positive, 75th percentile 0.00165 ng/cm2) and gemcitabine (16% and <0.001 ng/cm2). The armrest of patient treatment chairs (84% to at least one drug), the front grille inside the biological safety cabinet (BSC) (73%) and the floor in front of the BSC (55%) were frequently contaminated. Centers that prepared ≥5000 antineoplastic drugs annually had higher concentration of cyclophosphamide on their surfaces (p < 0.0001). Contamination measured on the surfaces was reduced from 2010 to 2020. Conclusions: This large-scale study showed reproducible long term follow up of the contamination of standardized sites of Canadian centers and a reduction in surface contamination from 2010 to 2020. Periodic surface sampling help centers meet their continuous improvements goals to reduce exposure as much as possible. The COVID-19 pandemic had a limited impact on the program. [ABSTRACT FROM AUTHOR]

Objective: Occupational exposure to antineoplastic drugs (ANPs) occurs mainly through dermal contact. Our study was set up to assess the potential exposure of hospital sanitation (HS) personnel, for whom almost no data are available, through contamination of surfaces they regularly touch. Methods: In the oncology departments of two hospitals around Montreal, surface wipe samples of 120–2000 cm2 were taken at 10 sites cleaned by the HS personnel and five other sites frequently touched by nursing and pharmacy personnel. A few hand wipe samples were collected to explore skin contamination. Wipes were analyzed by ultra-performance liquid chromatography tandem–mass spectrometry for 10 ANPs. Results: Overall, 60.9% of 212 surface samples presented at least one ANP above the limits of detection (LOD). Cyclophosphamide and gemcitabine were most often detected (52% and 31% of samples respectively), followed by 5–fluorouracil and irinotecan (15% each). Highest concentrations of five ANPs were found in outpatient clinics on toilet floors (5–fluorouracil, 49 ng/cm2; irinotecan, 3.6 ng/cm2), a perfusion pump (cyclophosphamide, 19.6 ng/cm2) and on a cytotoxic waste bin cover (gemcitabine, 4.97 ng/cm2). Floors in patient rooms had highest levels of cytarabine (0.12 ng/cm2) and methotrexate (6.38 ng/cm2). Hand wipes were positive for two of 12 samples taken on HS personnel, seven of 18 samples on nurses, and two of 14 samples on pharmacy personnel. Conclusions: A notable proportion of surfaces showed measurable levels of ANPs, with highest concentrations found on surfaces cleaned by HS personnel, who would benefit from appropriate preventive training. As potential sources of worker exposure, several hospital surfaces need to be regularly monitored to evaluate environmental contamination and efficacy of cleaning. [ABSTRACT FROM AUTHOR]

Abstract: Background: Hepatorenal tyrosinemia (HT1, fumarylacetoacetate hydrolase deficiency, MIM 276700) can cause severe hepatic, renal and peripheral nerve damage. In Québec, HT1 is frequent and neonatal HT1 screening is practiced. Nitisinone (NTBC, Orfadin ®) inhibits tyrosine degradation prior to the formation of toxic metabolites like succinylacetone and has been offered to HT1 patients in Québec since 1994. Methods: We recorded the clinical course of 78 Québec HT1 patients born between 1984 and 2004. There were three groups: those who never received nitisinone (28 patients), those who were first treated after 1month of age (26 patients) and those treated before 1month (24 patients). Retrospective chart review was performed for events before 1994, when nitisinone treatment began, and prospective data collection thereafter. Findings: No hospitalizations for acute complications of HT1 occurred during 5731months of nitisinone treatment, versus 184 during 1312months without treatment (p<0.001). Liver transplantation was performed in 20 non-nitisinone-treated patients (71%) at a median age of 26months, versus 7 late-treated patients (26%, p<0.001), and no early-treated patient (p<0.001). No early-treated patient has developed detectable liver disease after more than 5years. Ten deaths occurred in non-nitisinone treated patients versus two in treated patients (p<0.01). Both of the latter deaths were from complications of transplantation unrelated to HT1. One probable nitisinone-related event occurred, transient corneal crystals with photophobia. Interpretation: Nitisinone treatment abolishes the acute complications of HT1. Some patients with established liver disease before nitisinone treatment eventually require hepatic transplantation. Patients who receive nitisinone treatment before 1month had no detectable liver disease after more than 5years. [Copyright &y& Elsevier]

Rationale, aims and objectives Ensuring the safety of the medication process is a major world health concern. Within this framework, a field study of compliance at various stages of the medication process in health care units was conducted. The objective of our study was to compare compliance at the moment of drug administration at the patient's bedside before and after implementing certain measures (self-study activities for the nursing staff, publication of the findings of the preliminary study and identification of priorities for action, among others). Methods This is an observational study aimed at comparing compliance at various stages of the medication process in terms of dose verification, preparation and administration, on ward, before and after the implementation of corrective measures. Compliance was evaluated using an observational checklist that included 36 criteria. The evaluation was conducted on inpatients in nine health care units and the Emergency Care Unit of a university hospital centre. Compliance rates were calculated for each evaluated criterion separately and by category. The degree of significance and corresponding changes between 2007 and 2008 were also measured. Results The compliance rate for all the applicable criteria used on the checklist showed a significant increase from 16% in 2007 to 28% in 2008. A significant increase was also observed in the compliance rates for drug verification (91% vs. 76%) and drug preparation on wards (50% vs. 23%), particularly with regard to entering drug names and a second identifier on the label. Conclusions Compliance rates at various separately evaluated stages in 2008 were relatively satisfactory. There is, however, room for improvement in total compliance. The introduction of simple tools and adapted communication strategies led to a sizeable improvement in the medication process at our facility. [ABSTRACT FROM AUTHOR]

Résumé: La pandémie du coronavirus SRAS-CoV-2 (Covid-19) a nécessité la mise en place de mesures sanitaires sérieuses. L'objectif principal est de décrire l'expérience vécue par un département de pharmacie en comparant le recours au travail à distance et au télétravail avant et depuis la pandémie. Méthode. Cette étude descriptive et rétrospective se déroule dans un centre hospitalier de 500 lits. Les éléments suivants ont été recensés : identification des politiques, des procédures et des tâches admissibles au travail à distance ou au télétravail en ce qui concerne la gestion pharmaceutique, les soins, les services, la recherche et l'enseignement. L'état de situation prépandémie a été établi. Résultats. Depuis la pandémie, des changements de pratique ont été apportés : la relocalisation de postes de travail, l'activation d'un accès à distance pour tous, l'identification des opportunités de télétravail, la mise en place d'un environnement de travail fonctionnel à domicile et la réévaluation des outils de communication. Conclusion. Cette étude met en évidence l'expérience d'un centre hospitalier universitaire canadien durant la pandémie. The coronavirus SARS-CoV-2 (COVID-19) pandemic caused a worldwide crisis. Serious sanitary measures were recommended by public health organizations to limit the risks of contamination and distancing measures have been implemented. The main objective is to describe the experience of a center with distancing measures and telework and to compare it before and during the COVID-19 pandemic. Methods. This descriptive and retrospective study takes place at a 500-bed hospital. This study consisted of a review of the pharmacy department's politics and procedures and of the pharmaceutical tasks that were eligible to telework (management, pharmaceutical care, services, research and teaching). The situation before the pandemic was established. Results. During the COVID-19 pandemic, changes were reported including: distancing measures with relocation of workstations, remote access activations, identification of telework opportunities, development of a functional telework environment and revaluation of the communication tools. Conclusion. There is limited data available on physical distancing and telework in pharmacy. This descriptive study highlights the experience of a Canadian hospital during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The main objective was to determine the decontamination efficacy of quaternary ammonium, 0.1% sodium hypochlorite, and water after deliberate contamination with four antineoplastics (ifosfamide, 5-fluorouracil, irinotecan, methotrexate). A stainless-steel surface was deliberately contaminated with ifosfamide (15 µg), 5-fluorouracil (10 µg), irinotecan (1 µg), and methotrexate (1 µg). First, a single decontamination step with either water, quaternary ammonium, or 0.1% sodium hypochlorite was tested. Then, the effect of up to four successive decontamination steps with either quaternary ammonium or 0.1% sodium hypochlorite was tested. Commercial wipes consisting of two layers of non-woven microfibers with an inner layer of highly absorbent viscose fibers were used. Triplicate surface samples were obtained and tested by ultra-performance liquid chromatography tandem mass spectrometry. The limits of detection were 0.004 ng/cm2 for ifosfamide, 0.040 ng/cm2 for 5-fluorouracil, 0.003 ng/cm2 for irinotecan, and 0.002 ng/cm2 for methotrexate. After a single decontamination step, the 0.1% sodium hypochlorite eliminated 100% of contamination with 5-fluorouracil, irinotecan, and methotrexate and 99.6 ± 0.5% of ifosfamide contamination. Quaternary ammonium and water also removed 100% of the 5-fluorouracil, and 99.5% to 99.9% of the other three antineoplastics. For ifosfamide, irinotecan, and methotrexate, the decontamination efficacy increased with successive decontamination steps with quaternary ammonium. 5-fluorouracil was undetectable after a single decontamination step. Methotrexate was the only drug for which decontamination efficacy was less than 100% after four decontamination steps. 100% decontamination efficacy was achieved from the decontamination step with 0.1% sodium hypochlorite for 5-fluorouracil, irinotecan, and methotrexate. For ifosfamide, 100% efficacy was achieved only after the third decontamination step. It was possible to make all traces of antineoplastic undetectable after deliberate contamination with 5-fluorouracil, irinotecan, and methotrexate with a 0.1% chlorine solution; up to three decontamination steps were needed to make ifosfamide undetectable. Water or quaternary ammonium removed more than 99.5% of deliberate contamination. In several scenarios, it was necessary to repeat the decontamination to eliminate residual traces. More work is needed to identify the optimal decontamination approach for all of the antineoplastic drugs used. [ABSTRACT FROM AUTHOR]

Workers can reduce their risk of exposure to hazardous drugs by following safe handling guidelines. Healthcare centers need to dedicate time and resources in order to implement new safety recommendations. The objective was to present the results of a national survey about the safe handling of hazardous drugs in healthcare centers.Quebec healthcare centers performed an auto-evaluation to the newly updated safe handling guidelines in 2021. Centers rated each criterion as compliant or non-compliant. The guidelines tailored recommendations according to three categories of hazards: G1, consisting mostly of carcinogenic drugs; G2, other hazardous drugs; and G3, those with reproductive toxicity. The questionnaire prompted participants to document their planned corrective measures for non-compliant criteria.Most centers participated (28/29, 97%). The overall compliance was 58% (8761/15,216 criteria). The conformity per theme was hygiene and sanitation (1290/1,878, 69%), laundry (221/367, 60%), pharmacy (2658/4,474, 59%), nursing (3436/6,017, 57%), spills and accidental exposure (353/649, 54%), and general measures (803/1,831, 44%). It was higher for recommendations regarding G1s (4226/6,115, 69%) than for G2s (1626/3557, 46%) and G3s (372/916, 41%).This project successfully used an innovative approach that combined a national auto-evaluation survey, an actionable report, and the involvement of a community of practice. Centers were able to benchmark their implementation of safe handling guidelines, and community of practices may help in sharing the best practices. The design of the questionnaire helped in targeting corrective measures. More work is needed for safe handling practices that relate to G2 and G3 drugs. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this pilot study was to determine the frequency of urination and the concentration of four hazardous drugs (cyclophosphamide, ifosfamide, methotrexate, and fluorouracil) in workers' 24-h urine samples in relation to exposure to traces with hazardous drugs. Methods: The study was conducted in three healthcare centers in the region of Montréal, Quebec, Canada. We recruited healthcare workers (nurses and pharmacy technicians) assigned to the hematology-oncology department. Each participant was asked to collect all urine voided during a 24-h period, to fill out an activity journal documenting tasks performed and to document the use of personal protective equipment. Samples were analyzed for cyclophosphamide, ifosfamide, methotrexate, and alpha-fluoro-beta-alanine (FBAL, the main urinary metabolite of 5-fluorouracil). Drugs were quantified by ultra-performance liquid chromatography-tandem mass spectrometry (positive electrospray MRM mode). Results: Eighteen healthcare workers (10 nurses and 8 technicians) were recruited and provided consent to participate. Urine samples were obtained between 1 September and 30 September 2019. The number of urinations over the 24-h collection period ranged from 3 to 11 per participant. A total of 128 urine samples were analyzed for the 18 workers. All urine samples were negative for the four antineoplastics tested. Conclusion: No traces of cyclophosphamide, ifosfamide, methotrexate, or FBAL were found in the 24-h urine samples of 18 healthcare workers practicing in three healthcare facilities in Quebec. Although it was feasible to collect 24-h urine samples in this research project, it appears unrealistic to do so recurrently as part of a large-scale surveillance program. [ABSTRACT FROM AUTHOR]

Introduction: The primary objective was to describe environmental contamination with National Institute for Occupational Safety and Health Group 1 hazardous drugs in oncology pharmacies and outpatient clinics in Canada in 2019, as part of an annual surveillance project. Methods: In each participating center, 12 standardized sites (6 in the oncology pharmacy and 6 in outpatient clinic) were sampled. Each sample was prepared to allow quantification of six antineoplastic drugs (cyclophosphamide, ifosfamide, methotrexate, gemcitabine, 5-fluorouracil, and irinotecan) by ultra-performance liquid chromatography-tandem mass spectrometry. Samples were also tested for three additional antineoplastic drugs (docetaxel, paclitaxel, and vinorelbine) without quantification. The impact of certain characteristics of the sampling sites was evaluated with a Kolmogorov–Smirnov test for independent samples. Results: Ninety-three Canadian centers participated in 2019, with a total of 1045 surfaces sampled. Cyclophosphamide was the drug most often found in the surface samples (32.4% of samples with positive result), followed by gemcitabine (20.3%). The front grille inside the biological safety cabinet (81.5% of samples positive for at least one antineoplastic drug) and the armrest of a treatment chair (75.8%) were the most frequently contaminated surfaces. Centers with more oncology inpatient and outpatient beds, those that prepared more antineoplastic drugs each year, and those that used more cyclophosphamide each year had higher concentrations of cyclophosphamide contamination on the surfaces tested (p < 0.0001). Conclusion: Traces of dangerous drugs were found in oncology pharmacies and oncology outpatient clinics in 93 Canadian hospitals in 2019. However, the quantities measured were very small. Every healthcare worker should consider these work areas to be contaminated and should wear appropriate protective equipment. [ABSTRACT FROM AUTHOR]

Résumé: Le circuit du médicament est un élément central de l'organisation d'un établissement de santé. L'objectif principal est de décrire le circuit du médicament dans deux centres hospitaliers universitaires (un français et un canadien), identifier et discuter les similitudes et différences. Méthode : Il s'agit d'une étude descriptive transversale de type qualitative menée d'août à septembre 2019. Deux établissements pédiatriques de santé ont été identifiés, soit l'hôpital universitaire Necker-Enfants Malades (HUNEM) à Paris, France et le centre hospitalier universitaire Sainte-Justine (CHUSJ) à Montréal, Québec, Canada. À partir d'une séance de réflexion collective, nous avons développé une grille d'analyse incluant 22 items qui caractérisent le profil de chaque établissement, 23 liés au profil de la pharmacie à usage intérieur et 20 autres décrivant les étapes du circuit du médicament. Les membres de l'équipe de recherche de chaque établissement de santé ont complété le contenu de la grille, revu et commenté les réponses de l'autre établissement. Nous avons indiqué pour l'ensemble des items les similitudes ou différences entre les deux établissements. Résultats : Parmi les différences, on note un nombre de pharmaciens (36,4 vs 15 en équivalent temps plein) et de préparateurs en pharmacie (50 vs 23,3 en équivalent temps plein) deux fois plus élevé, une dispensation nominative et la préparation d'un plus grand nombre de doses dans un format prêt à l'emploi pour le personnel infirmier et un droit de prescription des pharmaciens au CHUSJ. À HUNEM, on observe un périmètre d'activité plus important, des dépenses plus importantes (95 vs 17 millions d'euros) et une robotisation davantage déployée. L'étude met en évidence 11 similitudes et 9 différences sur les 20 étapes du circuit du médicament. Conclusion : Il s'agit d'une étude décrivant le circuit du médicament dans deux centres hospitaliers universitaires : un canadien et un français. Il existe autant de similitudes que de différences entre les deux centres en ce qui concerne les services et soins pharmaceutiques. Il est difficile de comparer la pratique pharmaceutique au sein de deux établissements de santé provenant de deux pays, compte tenu du grand nombre d'éléments et de termes qui diffèrent. Ce type de comparaison nous paraît utile pour favoriser une meilleure compréhension des pratiques entre la France et le Canada. Elle peut également contribuer à favoriser l'évolution des services et soins dans chaque pays en profitant des données recueillies. D'autres échanges sont toutefois nécessaires afin d'évaluer les retombées des approches mises en place dans chaque pays. The drug circuit is central to the organization of a health facility. Objective : The main objective is to describe the drug circuit in a French and Canadian university hospital center, identify and discuss similarities and differences. Method : This is a qualitative cross-sectional descriptive study conducted from August to September 2019. Two pediatric health establishments have been identified, namely Necker-Enfants Malades University Hospital (HUNEM) in Paris, France and the University Hospital Center Sainte-Justine (CHUSJ) in Montreal, Quebec, Canada. From a brainstorming session, we developed an analysis grid including 22 items that characterize the profile of each institution, 23 items related to the profile of the indoor pharmacy and 20 others items describing the steps of the drug circuit. Research team members from each health facility completed the grid content, reviewed and commented on the other institution's responses. For all items, we indicated the similarities or differences between the two hospitals. Results : Among the differences were a number of pharmacists (36.4 vs 15) and pharmacy technicians (50 vs 23.3) twice as high, a nominal dispensing and the preparation of the largest number of doses in a ready-to-use format for nurses and a prescription right for pharmacists at the CHUSJ. In HUNEM, there was a greater scope of activity, larger expenses (95 vs 17 million euros) and more extensive robotization. The study highlighted 11 similarities and 9 differences over the 20 steps of the drug circuit. Discussion-conclusion : This is a study describing the drug circuit in two university hospitals: a Canadian and a French. There are as many similarities as differences between the two centers in terms of pharmaceutical services and care. It is difficult to compare pharmaceutical practice in two healthcare facilities from two countries, given the large number of elements and terms that differ. This type of comparison seems useful to us for promoting a better understanding of the practices between France and Canada. It can also help foster the development of services and care in each country by taking advantage of the data collected. However, other exchanges are necessary in order to assess the impact of the approaches implemented in each country. [ABSTRACT FROM AUTHOR]

Résumé: Objectif : L'objectif principal est de décrire les classifications de codification du séjour hospitalier pour les diagnostics et les interventions effectuées en cours d'hospitalisation au Canada. L'objectif secondaire est d'illustrer avec des exemples leurs rôles et possibles applications à la pharmacie hospitalière. Méthode : Il s'agit d'une revue de littérature. Les termes suivants : « international classification of diseases », « Canadian classification of health intervention », « clinical coding » et « pharmacy » ont été utilisés. Nous avons également consulté deux archivistes. Résultats : Deux classifications types ont été identifiées et décrites soit la Classification internationale des maladies (CIM) et la Classification canadienne des interventions (CCI). Un profil comparé de la CIM et de la CCI en 2018 a été effectué. Nous présentons trois applications pratiques de ces deux classifications utiles à la pratique pharmaceutique : lors d'une revue d'utilisation de médicaments, lors d'activités pour assurer le bon usage des médicaments et lors d'activités de pharmacovigilance. Conclusion : Ce travail décrit la classification internationale des maladies (CIM) et la classification canadienne des interventions (CCI). Il permet également d'illustrer des travaux impliquant la collaboration pharmacien-archiviste médical. Les pharmaciens hospitaliers devraient s'intéresser davantage à ces classifications et à leurs applications en pratique hospitalière. Objective : The main objective is to describe two coding classifications of hospital stay for diagnosis and procedures performed during hospitalization in Canada. The secondary objective is to illustrate practical applications of these two classifications to hospital pharmaceutical practice. Methods : This is a literature review. The following terms: «international classification of diseases», «Canadian classification of health intervention», «clinical coding» and «pharmacy» were used. We also consulted two medical records technicians. Results : Two standard classifications have been identified and described: the International classification of diseases (ICD) and the Canadian classification of health intervention (CCI). A comparative profile of the CIM and the CCI in 2018 has been carried out. We present three useful applications of these two classifications in pharmaceutical practice: for a drug utilization review, for proper drug use, and for pharmacovigilance activity. Conclusion : This work describes the International classification of diseases (ICD) and the Canadian classification of interventions (CCI). Hospital pharmacists should be more interested in these classifications and their applications in hospital practice. This study also illustrates work involving the pharmacist-medical records technicians collaboration. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs. Résumer la littérature relative aux rôles du pharmacien en dermatologie-allergologie, présenter un profil succinct de ces deux secteurs et développer une offre de soins pharmaceutiques cohérente en dermatologie-allergologie au Centre hospitalier universitaire (CHU) Sainte-Justine. Méthodes. Il s'agit d'une étude descriptive constituée d'une revue de littérature des articles portant sur le rôle du pharmacien en dermatologie-allergologie, d'une description sommaire des secteurs de la dermatologie et de l'allergologie, ainsi que de la mise à jour de l'offre de soins pharmaceutiques dans ces secteurs. Résultats. Un total de 35 articles (16 en dermatologie et 19 en allergologie) ont été inclus dans la revue de littérature. La majorité de ces articles était de faible qualité et décrivait les activités pharmaceutiques sans en mesurer l'impact. Les activités pharmaceutiques principalement rapportées par la littérature étaient la réalisation de conseils aux patients (articles de dermatologie) et la documentation des interventions effectuées (articles d'allergologie). En 2017-2018, les secteurs de la dermatologie et de l'allergologie ont effectué environ 14 000 et 5 000 consultations médicales de façon respective. L'offre de soins pharmaceutiques a été mise à jour en fonction de 21 activités pharmaceutiques, permettant d'identifier la pertinence d'un pharmacien répondant en dermatologie-allergologie. Conclusion. Il existe peu de données sur les rôles et les retombées de l'activité pharmaceutique en dermatologie-allergologie. Cet article présente une démarche originale incluant une revue de littérature (35 articles), un profil succinct des secteurs et une réflexion entourant les activités pharmaceutiques d'un pharmacien répondant en dermatologie-allergologie au sein d'un centre hospitalier universitaire mère-enfant. Objectives. Summarize the literature on the pharmacist's role in dermatology-allergology, present a brief description of these two sectors and develop a pharmaceutical care offer in dermatology-allergology in a mother-child teaching hospital center. Methods. This article is a descriptive study consisting of a literature review on the pharmacist's role in dermatology-allergology, a brief description of the dermatology and allergology sectors and an optimization of the pharmaceutical care in these sectors. Results. A total of 35 articles (16 in dermatology and 19 in allergology) were included in the literature review. The majority of these articles were of poor quality and described the pharmaceutical activities without measuring their impact. The pharmaceutical activities mainly reported in the literature were the advices to patients (dermatology articles) and the documentation of the pharmaceutical interventions (allergy articles). In 2017-2018, the dermatology and allergology sectors performed approximately 14,000 and 5,000 medical consultations respectively. The pharmaceutical care offer has been updated, allowing us to identify the relevance of a responding pharmacist in dermatology-allergology. Conclusion. There is few data on the roles and outcomes of the dermatology-allergology pharmaceutical activities. This article presents an original approach including a literature review (35 articles), a brief profile of the sectors and a reflection on the pharmaceutical activities of a dermatology-allergology pharmacist in a mother-child teaching hospital center. [ABSTRACT FROM AUTHOR]

Purpose: The main objective was to determine the efficacy of various types of cleaning equipment and products after deliberate contamination with cyclophosphamide. The secondary objective was to test various cleaning scenarios using these equipment and products. Methods: The study had two phases: testing of cleaning equipment (wipe : woven microfibers – Hygen®, two layers of non-woven microfibres and an inner layer of highly absorbent viscose fibres – MicronSolo®, two layers of non-woven microfibres and an inner layer of highly absorbent viscose fibres – MicroMix®, simili-tissu (low filament production) – Tork® and, mop : woven microfibers – Hygen®, microfibre and viscose – MicroOne®) and products (disinfectant : quaternary ammonium – DR100®, chlorine 0.1% – Zochlor® – Brutab® – PCS® NPH, sodium hypochlorite 2%, cleaner : detergent – Nu- Action 3®, cleaner and disinfectant: sodium hypochlorite 0.6% + detergent – Aliflex® and water) in phase 1 and testing of various cleaning procedures in phase 2. Specific areas of a room with a laminar flow hood (class II/type B2) were contaminated with 10 mcg of cyclophosphamide. Different types of surfaces were cleaned with various scenarios and the remaining cyclophosphamide was measured by the Institut national de santé publique du Québec. All tests were performed in triplicate. Results: A total of 189 samples were obtained: 42 negative controls and positive controls, 54 during phase 1 and 93 during phase 2. All products were more than 96.5% effective. The 0.1% chlorines were the most effective products. Cleaning procedures with two or three products had average cleaning efficacies of 99.94–99.99%. Efficacy increased with the number of successive cleanings. When two products were used, the average cleaning efficacy varied between 99.78% and 99.98%, depending on the surface. Conclusion: All cleaning products tested reduced cyclophosphamide contamination by more than 96.58%. Cleaning efficacy increased with successive cleaning. No scenario was effective in removing 100% of traces. Additional studies with larger samples should be conducted to confirm these results. [ABSTRACT FROM AUTHOR]

We report a case of an 17-year-old male with a drug reaction in the spectrum of Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), triggered by carbamazepine, who was succesfully treated with the combination of dexamethasone, cyclosporine, and etanercept. This triple therapy halted and prevented skin epidermolysis without immediate or late onset complications. [ABSTRACT FROM AUTHOR]

Objective To describe the problems faced by young patients and their parents when obtaining and using compounded drugs. Methods This prospective observational descriptive study included patients 0 to 21 years of age who were discharged from a mother–child tertiary hospital with a prescription containing at least one compounded drug between February 2016 and July 2016. Families were called 7 to 10 business days after discharge to complete a telephone follow-up questionnaire. Retail pharmacies were contacted to obtain additional information in order to compare the dispensed compounded drug with the prescription and published master formulas. Results The parents of 71 patients with a median age of 6.9 months were surveyed regarding 99 compounded drugs corresponding to 34 different oral formulations. Out of 314 issues identified, 252 were considered as problems: 9 involved major and 243 minor problems with real or potential consequences. Conclusion This study identified a significant number of compounding-related problems. It suggests that current practice standards are insufficient and action should be taken to improve the use and the dispensation of compounded drugs to ensure patients' safety. [ABSTRACT FROM AUTHOR]

Background: Pharmacy practice in health facility requires hospital management skills and is based on good knowledge acquired at the university and in practice. Purpose: Compare theoretical training and exposure to hospital pharmaceutical management (HPM) during hospital pharmacy residency in Quebec and in France. Methods: This is a descriptive and comparative study. From the academic programs in Quebec (Université de Laval and Université de Montreal) and in France (Universités de Paris Descartes, Lille, Montpellier, Lyon), educational tools as well as normative texts, seven themes were identified to define the hospital management and they were used as comparison variables. The results are presented in three separate tables (comparative profile of the theoretical training, comparative profile of HPM exposures and comparative profile of the seven topics of theoretical training and exposure to HPM) and were collected from a panel composed of four French hospital interns with a discussion involving Quebec hospital pharmacy residents. No statistical analysis was used. Results: Academically, a mandatory HPM program exists in Quebec led by one professor and hospital pharmacist. In France, the HPM program is divided into different concepts addressed in several mandatory or optional courses conducted by various professors. In health care institutions, French residents have more opportunities for exposure to HPM than Quebecers because of the residency duration, the diversity of residency (versatility) and the expected autonomy. Conclusion: Teaching and exposure to HPM differ between Quebec and France and the approaches are complementary. [ABSTRACT FROM AUTHOR]

Context Oncology workers are occupationally exposed to antineoplastic drugs. This exposure can induce adverse health effects. In order to reduce their exposure, contamination on surfaces should be kept as low as possible. Objectives To monitor environmental contamination with cyclophosphamide, ifosfamide, and methotrexate in oncology pharmacy and patient care areas in Canadian hospitals. To describe the impact of some factors that may limit contamination. Methods This is a descriptive study. Twelve standardized sites were sampled in each participating center (six in the pharmacy and six in patient care areas). Samples were analyzed for the presence of cyclophosphamide, ifosfamide, and methotrexate by ultra-performance liquid chromatography tandem mass spectrometry technology. Descriptive statistical analyses were done and results were compared with a Kolmogorov–Smirnov test for independent samples. Results In 2015, 48 hospitals participated in this study (48/202, 24%). Overall, 34% (181/525) of the samples were positive for cyclophosphamide, 8% (41/525) for ifosfamide, and 6% (31/525) for methotrexate. The 75th percentile value of cyclophosphamide surface concentration was 6.9 pg/cm2. For ifosfamide and methotrexate, they were lower than the limit of detection. Centers who prepared more antineoplastic drugs per year and centers who used more cyclophosphamide per year showed significantly higher surface contamination (p < 0.0001). Over the years, we observed a reduction in surface contamination. Conclusion In comparison with other multicenter studies that were conducted in Canada, the concentration of antineoplastic drugs measured on surfaces is decreasing. Regular environmental monitoring is a good practice in order to maintain contamination as low as reasonably achievable. [ABSTRACT FROM AUTHOR]

Purpose There are health risks to workers occupationally exposed to antineoplastic drugs. We hypothesized that implementing a biological monitoring program would be feasible. The goal was to present the results of our pilot cross-sectional study of biological monitoring of four antineoplastic drugs. Methods We recruited workers from the hematology–oncology department and control workers in a mother–child university health center. This study was preceded by an information period during which we aimed at enhancing the workers’ awareness and knowledge of the risks of occupational exposure. Participants filled out a journal containing activities performed and personal protective equipment worn. One urine sample was collected at the end of their shift. Samples were analyzed by UPLC/MS-MS for the presence of cyclophosphamide, ifosfamide, methotrexate, and alpha-fluoro-beta-alanine (5-fluorouracile’s main urinary metabolite). Results The participation rate was 85.7% (102/119). No urine sample had detectable concentrations of any of the four drugs evaluated (0/101; 0/74 nurses, 0/11 pharmacists, 0/9 pharmacy technicians, and 0/7 doctors). In the 5 days before sampling, 67/92 (72.8%) hematology–oncology participants performed at least one activity with antineoplastic drugs. Nurses wore all of the recommended protection for technical activities (86.2%), but rarely for non-technical activities (14.9%). Pharmacists and pharmacy technicians wore all of the recommended protection for all activities (100.0%). Conclusions This pilot study had a good participation rate. The absence of positive samples was a good indication that the measures in place ensured workers’ safety, even though we found areas where the worker protection can be enhanced. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to describe women's satisfaction and perceptions on the postpartum self-administered medication (SAM) program at our institution and on pain relief. Also, we aimed at describing maternal and breastfed infants' adverse events with the use of the postpartum SAM program. Method This prospective 1-group mixed methods survey conducted in a mother-and-child tertiary center included women enrolled in the postpartum SAM program who had a live newborn, understood French or English, and were at least 18 years old. Newborns included cohabited with their mother during their hospitalization and had received breast milk at least once. Data were collected through direct interviews using a questionnaire and through medical charts. Results We included 314 mothers and 263 breastfed newborns in the study. Ninety-seven percent of all users appreciated the SAM. The self-reported median overall improvement of pain was 80% (interquartile range, 70%-90%). However, 18% of users who delivered vaginally and 32% who delivered through caesarean would have preferred traditional drug dispensing by the nurse ( P = .009). Drugs used in the SAM program were generally well tolerated. There were no worrisome adverse drug events reported in newborns' medical charts. Conclusion Results show a 97% rate of satisfaction of the SAM program and a high self-reported pain improvement in a cohort of 314 women using our SAM program. The results suggest that the SAM program should remain a standard practice in our institution. Some recommendations will be drawn to better tailor the SAM program to the needs expressed by the users. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: The medication‐use system in hospitals is very complex. To improve the health professionals' awareness of the risks of errors related to the medication‐use system, a simulation of medication errors was created. The main objective was to assess the medical, nursing and pharmacy staffs' ability to identify errors related to the medication‐use system using a simulation. The secondary objective was to assess their level of satisfaction. Method: This descriptive cross‐sectional study was conducted in a 500‐bed mother‐and‐child university hospital. A multidisciplinary group set up 30 situations and replicated a patient room and a care unit pharmacy. All hospital staff, including nurses, physicians, pharmacists and pharmacy technicians, was invited. Participants had to detect if a situation contained an error and fill out a response grid. They also answered a satisfaction survey. Results: The simulation was held during 100 hours. A total of 230 professionals visited the simulation, 207 handed in a response grid and 136 answered the satisfaction survey. The participants' overall rate of correct answers was 67.5% ± 13.3% (4073/6036). Among the least detected errors were situations involving a Y‐site infusion incompatibility, an oral syringe preparation and the patient's identification. Participants mainly considered the simulation as effective in identifying incorrect practices (132/136, 97.8%) and relevant to their practice (129/136, 95.6%). Most of them (114/136; 84.4%) intended to change their practices in view of their exposure to the simulation. Conclusions: We implemented a realistic medication‐use system errors simulation in a mother–child hospital, with a wide audience. This simulation was an effective, relevant and innovative tool to raise the health care professionals' awareness of critical processes. [ABSTRACT FROM AUTHOR]

Objectives: To review published data on the pharmacist’s implication in obstetrics and gynecology, to evaluate current activities and to suggest adjustments for pharmaceutical practice optimization. Methods: Descriptive study in three steps: scientific literature review on the role of the obstetrics and gynecology pharmacist, description of current activities in our center, recommendations for optimization of the pharmaceutical practice based on published data and suggestions from the pharmacists working on the obstetrics and gynecology wards. Results: Fifteen articles showed that pharmacists reduce medication errors, improve patient knowledge on their medication and were positively evaluated by patients. The quality of evidence was often of poor quality. The pharmacists in our center already perform the majority of activities described in the scientific literature: medication reconciliation, pharmacotherapy optimization, pharmacokinetics follow-ups, patient counseling, healthcare providers education and creation of protocols. The following changes are suggested to optimize current practice: reorganization of information ressources, evaluation of the patients’ satisfaction, increased access to self-medication, implementation of a structured pharmaceutical care program for outpatients including those consulting the medically assisted reproduction centre and enhanced participation to research projects. Conclusion: Pharmaceutical care in obstetrics and gynecology is poorly documented. Pharmacists in our centre accomplish many of the activities described in the scientific literature. Nevertheless, this exercise generated recommendations to optimize the role of the pharmacist in obstetrics and gynecology in our centre. [ABSTRACT FROM AUTHOR]

Methylphenidate- and amphetamine-based psychostimulants are the most common medications used to treat the symptoms of attention-deficit/hyperactivity disorder in children. Ocular side effects including dry eyes, mydriasis, accommodation disturbance, and blurry vision are listed in the product monograph but interestingly, are rarely reported in the paediatric literature. Our patient, a 9-year-old boy, presented a significant decrease in visual acuity secondary to accommodation disorder after being treated with methylphenidate hydrochloride controlled release (Biphentin) and lisdexamfetamine (Vyvanse). The unusual acute adverse effect, altered accommodation leading to a decline in visual acuity, emphasizes the importance of considering any change in vision following the introduction of psychostimulant medication as a potential adverse effect. This case highlights the importance of pharmacovigilance especially in paediatrics where data are lacking. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess unlicensed and off-label drug use in a tertiary care paediatric hospital in Canada on a single day. METHODS: A cross-sectional study in a tertiary care paediatric hospital was conducted on one randomly selected day. Active prescriptions for children <18 years of age were analyzed. Unlicensed drug use was defined as the use of nonmarketed drugs in Canada or marketed drugs with pharmacy compounding. Off-label drug use was defined as the use of marketed drugs in Canada for an unapproved age group, indication, dosing, frequency and/or route of administration. Off-label drug uses associated with strong scientific support were analyzed using the Pediatric Dosage Handbook, 14th edition and Micromedex® Solutions. Number and proportion of unlicensed and off-label drug uses, and off-label drug uses associated with strong scientific support were measured. RESULTS: A total of 2145 drug prescriptions were extracted on March 5, 2014, for inclusion in the present study. The unlicensed drug use rate was 8.3% (57 unlicensed drug products; 75 nonmarketed drug prescriptions and 103 pharmacy compounding prescriptions) and the off-label drug use rate was 38.2% (161 substances; 819 prescriptions). Reasons for off-label drug use included unapproved age group (n=436 [53.2%]), dosing (n=226 [27.6%]), frequency (n=206 [25.2%]), indication (n=45 [5.5%]) and administration route (n=46 [5.6%]). Of the off-label drug prescriptions, 39.3% (n=322) were associated with strong scientific support. CONCLUSIONS: On a randomly selected day, 8.3% of prescriptions were unlicensed and 38.2% were off-label for children hospitalized at the authors' institution. Of off-label prescriptions, only 39.3% were associated with strong scientific support. [ABSTRACT FROM AUTHOR]

Introduction: Smart pumps are expected to prevent and reduce medication errors. The implementation of smart pumps requires a significant effort and collaboration of physicians, nurses, pharmacists, and other stakeholders.Objectives: The main objective of this study was to evaluate the impact of new smart pumps on reported drug-related accidents and incidents (AIs).Method: This is a descriptive retrospective pre-post study conducted at a women's and pediatric hospital with 500 beds. A strong multidisciplinary team (nurse, pharmacist, pharmacy resident, physician, biomedical technician, information technology technician, patient safety officer, manager) was involved in the planning, implementation, and monitoring technology implementation. A total of 1045 smart pumps were implemented in 2011 in our hospital. The reported number of AIs related to intravenous drug administration (AIIV) before and after the implementation of 1045 smart pumps were collected.Results: A total of 2911 AI events related to medications, devices, and equipment were self-reported by clinical staff in the pre-phase (Y0), 3523 in the post-phase (Y1), and 2788 in the post-phase (Y2). The total AIIV increased from 1432 in Y0 to 1834 in Y1 and decreased to 1389 in Y2.Conclusions: We observed no risk reduction associated with the implementation of smart pumps in a 500 bed mother-child hospital. Further studies are required to explore the details of the potential risk reduction associated with the use of smart pumps. [ABSTRACT FROM AUTHOR]