In order to implement individual instrument traceability, the evolution of laser and micropercussion markings was evaluated over 250 sterilisation cycles. A datamatrix associated with its alphanumeric code was applied on three types of instruments by laser or micropercussion. All instruments had a unique identifier affixed by the manufacturer. The sterilisation cycles corresponded to the usual cycles performed in our sterilisation unit. The laser markings had very good visibility but were quickly affected by corrosion: 12% of the markings were corroded after the 5th sterilisation cycle. Similar results were observed for unique identifiers applied by the manufacturer but with visibility attenuated by sterilisation cycles: 33% of identifiers were poorly visible after the 125th sterilisation cycle. Finally, micropercussion markings were less susceptible to corrosion but initially showed poorer contrast.

An innovative partnership between advanced practice nurses (APN) in psychiatry and mental health, the pharmacy department of a public health institution and the various health care professionals in the city. It allows the APN to establish itself in a secure manner and to take ownership of drug prescription. It is at the service of users in order to improve the safety and quality of care and to optimise their quality of life with a care proposal adapted to their needs.

UNASSIGNED: Past research on disciplinary action by pharmacist regulatory bodies has shown that most cases concern community pharmacists, with few occurring in a hospital setting.
UNASSIGNED: To investigate how discipline-related issues involving pharmacists are dealt with by hospital pharmacy departments in Canada.
UNASSIGNED: Hospital pharmacy directors and managers from small, medium, and large hospitals across Canada were invited to participate in semi-structured telephone interviews. The interview questions focused on the discipline process in participants\' organizations, the situations when reporting to the regulatory body is deemed to be warranted, possible penalties, and recommendations for improving the regulatory body or organizational discipline process.
UNASSIGNED: Ten participants, from British Columbia, Saskatchewan, Ontario, New Brunswick, Prince Edward Island, and Newfoundland and Labrador, agreed to be interviewed. Five key themes emerged as contributing to lower rates of hospital pharmacist discipline cases being escalated to the regulatory college level: robust organizational discipline processes independent from the regulatory college, a practice environment promoting competence, union representation, preference for a remedial approach to discipline, and lack of clarity about when to report to the regulatory authority.
UNASSIGNED: This study identified a number of reasons why discipline of hospital pharmacists by a regulatory body may be less prevalent than discipline relating to community pharmacists. The main reasons may be lack of clarity about when to report a case to the regulator and a lack of transparency, given that many cases are handled internally within hospitals. Environmental supports for competence and employee protections (e.g., through a union) may also reduce discipline cases.
UNASSIGNED: Des recherches antérieures sur les mesures disciplinaires prises par les organismes de réglementation des pharmaciens ont montré que la plupart des cas concernaient des pharmaciens communautaires, et que peu se produisaient en milieu hospitalier.
UNASSIGNED: Examiner comment les questions disciplinaires impliquant des pharmaciens sont traitées par les départements de pharmacie hospitalière au Canada.
UNASSIGNED: Les directeurs et gestionnaires de pharmacies de petits, moyens et grands hôpitaux au Canada ont été invités à participer à des entrevues téléphoniques semi-structurées. Les questions portaient sur le processus disciplinaire en place dans les organismes des participants; les situations où le signalement à l’organisme de réglementation était jugé justifié; les sanctions possibles; et les recommandations pour améliorer le processus disciplinaire de l’organisme de réglementation ou de l’organisme.
UNASSIGNED: Dix participants de la Colombie-Britannique, de la Saskatchewan, de l’Ontario, du Nouveau-Brunswick, de l’Île-du-Prince-Édouard et de Terre-Neuve-et-Labrador ont accepté d’être interrogés. Cinq thèmes clés ont été identifiés comme contribuant au taux plus faible de cas de discipline des pharmaciens hospitaliers remontés au niveau de l’organisme de réglementation: des processus disciplinaires organisationnels solides indépendants de l’organisme de réglementation; un environnement de pratique favorisant la compétence; la représentation syndicale; la préférence pour une approche corrective de la discipline; et le manque de clarté quant au moment où il faut signaler à l’autorité de réglementation.
UNASSIGNED: Cette étude a identifié un certain nombre de raisons pour lesquelles les mesures disciplinaires relatives des pharmaciens hospitaliers par un organisme de réglementation peuvent être moins répandues que celles liées aux pharmaciens communautaires. Les principales raisons pourraient être le manque de clarté quant au moment de signaler un cas à l’autorité réglementaire et un manque de transparence, étant donné que de nombreux cas sont traités en interne dans les hôpitaux. Les soutiens environnementaux pour la compétence et la protection des employés (par exemple, par l’entremise d’un syndicat) peuvent également réduire les cas de discipline.

OBJECTIVE: The new European regulation (MDR) on medical devices (MD) is expected to have major impacts on the industrial sector, but also consequences on healthcare professionals. Our objective was to evaluate the impact of the MDR on the supply of MDs in hospital pharmacies at the level of a French university hospital.
METHODS: We conducted a prospective follow-up of marketing cessations and supply disruptions directly related to the MDR between November 2019 and September 2020. The data were analyzed accounting for the nature of the suppliers (status/size), the nature of the MDs (route/class), and the proposed alternatives. The economic impact on hospital pharmacies was also estimated.
RESULTS: Over this period, 96 MD product designations were declared out of stock or in cessation (total of 402 references), of which half corresponded to class IIa MDs, mainly used for surgical procedures. Of the 14 companies concerned (36% French), the majority were manufacturers, of small/medium-size or intermediate size. Substitutions were proposed for only 15 products (15.6%). The cost of pharmaceutical management of these disruptions/marketing cessations was estimated at 3052€.
CONCLUSIONS: Even before the official date of its application, the impacts of the MDR on the supply function of hospital pharmacies are already visible. In the short, medium and long term, prospective monitoring of the impacts, positive or negative, would seem to be justified at the level of manufacturers, healthcare professionals and end users of MDs.

OBJECTIVE: The objective was to describe the trends in the consumption of narcotic drugs, substances related to narcotic drugs (SAS) and psychotropic drugs between a French hospital and a Quebec hospital between 2013 and 2017.
METHODS: This is a retrospective descriptive study. The consumption data was obtained from the pharmacy management software and was extracted by financial year (January 1st, 2013 to December 31st, 2017 for the French hospital and April 1st, 2013 to March 31st, 2018 for the Quebec hospital). For each drug considered to be narcotics, SAS and psychotropic drugs in France or subject to the legislation on designated substances in Quebec, we identified the quantities consumed from 2013 to 2017. The data werepresented according to the following therapeutic classes: opioids (N02A), other analgesics (N02B), anxiolytics (N05B), hypnotics and sedatives (N05C), general anesthetics (N01A), psychostimulants (N06B), androgens (G03B) and antagonists peripheral opioid receptors (A06A). The data were expressed as a defined daily dose (DDJ) for 1000 patient-days (PDs).
RESULTS: In the French hospital, the consumption of narcotics, SAS and psychotropic drugs varied from 676 to 560 DDJ per 1000 PDs between 2013 and 2017. While it varied from 1019 to 756 DDJ per 1000 PDs between 2013 and 2017 in the Quebec hospital. In 2017, the most widely used therapeutic classes in French hospitals were, in decreasing order, anxiolytics (211 DDJ per 1000 PDs) (i.e. alprazolam), opioids (205 DDJ per 1000 PDs) (i.e. tramadol, morphine injectable) and hypnotics and sedatives (64 DDJ per 1000 PDs) (i.e. midazolam injectable). In Quebec hospitals, the three therapeutic classes the most used in 2017 were, in decreasing order, opioids (314 DDJ per 1000 PDs) (i.e. hydromorphone injectable, morphine injectable), anxiolytics (221 DDJ per 1000 PDs) (i.e. clobazam) and hypnotics and sedatives (108 DDJ per 1000 PDs) (i.e. midazolam injectable).
CONCLUSIONS: This study notes a decrease in the consumption of opioids and other substances in both the French and Quebec establishments between 2013-2017. More work is needed to better describe the differences observed between the profile of each establishment. This is why monitoring consumption trends, therapeutic indications and preventive measures are essential.

In order to treat a pediatric patient with ligneous conjunctivitis secondary to congenital plasminogen deficiency, a supply of topically administered replacement human plasminogen has been required. In the absence of market approval, this blood-derived drug is managed by a temporary authorisation for nominative use, allowing monthly hospital dispensations. To ensure regulatory compliance and proper use of the drug, it took two years of interactions between various hospital departments and the laboratory to define the pharmaceutical supply chain in our hospital and allow the patient to receive treatment. The main difficulties lie in respecting the cold chain of this drug stored frozen in the bottles not ready for use. Transportation from the laboratory to the patient\'s home via the hospital pharmacy is carried out in calibrated conditions, ensuring a temperature below -20°C for 72h. Reception and dispensing steps were combined into a single pharmaceutical service in order to optimise transport time while ensuring the safety and traceability of the drug lots. Each month, a date is scheduled between the hospital pharmacy, the laboratory and the family to ensure that delivery and dispensing take place on the same day. Appropriate use and handling are explained to the family. However, two issues remain to be addressed by the manufacturer to facilitate future use of human plasminogen: the thermostability problem, which does not allow stays away from home longer than three days, and self-administration by the child, which is unlikely to be feasible due to handling difficulties.

OBJECTIVE: The Sterilization Unit of the Narbonne Hospital Center (France) has decided to embark on a process of NF EN ISO 9001: 2015 certification. The objective is to describe how the working group has appropriated the provisions relating to staff training in order to build a skills development plan for its Sterilization agents.
METHODS: A multi-professional working group has been set up. After a preliminary inventory, an inventory of skills needs, expectations of the agents, available means, and a bibliographical research, the group drew up a training plan with the support of a quality engineer from the Hospital Centre. The training plan was validated by a review of the management of the establishment.
RESULTS: Several teaching aids were chosen: a serious game developed by the working group, the planning of instrumentation sessions, quality meetings and feedback committees. The principle of transdisciplinarity and recourse to multi-professional exchanges is the common thread in the elaboration of the training plan.
CONCLUSIONS: The use of the selected materials is formalised in the form of a skills development plan indexed in the institution\'s quality management system. The application of the requirements of the ISO 9001 standard in terms of training in our Sterilization quality management system enables risk control and continuous improvement of the training plan to comply with technical and regulatory changes in the profession.

Pharmacotherapeutic care is now expanding in public mental health institutions. Annual grants are funding the public psychiatric field, hindering access to therapeutic innovation and expensive medications due to long length of stay. On the threshold of the French Healthcare & Social Services Ministry \"Ma Santé 2022\" plan (\"My Health 2022\"), there is a risk of altering the continuum of care because of the complexity of the financing of certain high added value therapies. Despite a desire to adapt the system to meet constantly changing health needs, no actions have been taken to this date in psychiatry, with no funds being allocated for valuable medication, in contrary to follow-up care and rehabilitation structures, to our knowledge. This reinforces the discrepancy with the evolution of research, and further widens the gap in inequalities between health sectors. Optimising the funding of expensive medicines in psychiatry would make it possible to reduce the stranglehold of current allocations. Following the example of recent reforms in the follow-up care and rehabilitation structures, extra funds for high value-added therapies would make it possible to reduce complex medical decisions: from prevention to reintegration, patient care continuity would be vastly guaranteed.

OBJECTIVE: The objective was to identify the main texts applicable to the practice of pharmacy in Quebec, then count the specific number of recommendations and criteria and describe the evolution of the legal and normative framework.
METHODS: This is a descriptive and retrospective study of the main texts applicable to the legal and normative framework for the practice of pharmacy on January 1st, 2019.
RESULTS: A total of 107 texts relating to the practice of pharmacy in Quebec were identified. They come from the legislator (53.1 %), the Order of pharmacists (26.1 %) or other organizations (20.8 %). These were laws/regulations (n=59), contributing to the optimal use of drugs (n=18), relating to hospital pharmacy management (n=18), the provision of pharmaceutical care (n=11), drug preparation (n=3), oncology practice (n=2) or health and safety at work (n=1). Thirty-three texts were considered for enumeration of recommendations and explicit criteria, for a total of 235 recommendations and 3703 explicit criteria applicable to the practice of hospital pharmacy in Quebec.
CONCLUSIONS: There is a significant increase in the number of texts, recommendations and criteria applicable to the practice of hospital pharmacy in Quebec. Compliance with this legal and normative framework appears to be a considerable challenge for hospital pharmacists. It seems worthwhile to further promote discussion with text-issuing agencies in order to keep the search for compliance realistic.

OBJECTIVE: The development of information systems in French hospitals is mandatory. The aim of this work was to analyze the content of exchanges carried out within social networks, dealing with problems encountered with hospital pharmacies information systems.
METHODS: Messages exchanged via the mailing list of the Association pour le Digital et l\'Information en Pharmacie and abstracts of communications presented at hospital pharmacists trade union congresses were analyzed. Those referring to information systems used in hospital pharmacies were selected.
RESULTS: From March 2015 to June 2016, 122 e-mails sent by 80 pharmacists concerned information systems. From 2002 to 2016, 45 abstracts dealt with this topic. Problems most often addressed in these 167 documents were \"parameterization and/or functionalities\" (n=116), interfaces and complexity of the hospital information systems (n=52), relationship with health information technologies vendors and poor reactivity (n=32), additional workload (n=32), ergonomics (n=30), insufficient user training (n=22). These problems are interdependent, lead to errors and in order to mitigate their consequences, they compel pharmacy professionals to divert a significant amount of working hours to the detriment of pharmaceutical care and dispensing and preparing drugs.
CONCLUSIONS: Hospital pharmacists are faced with many problems of insecurity and inefficiency generated by information systems. Researches are warranted to determine their cost, specify their deleterious effects on care and identify the safest information systems.