Clinical decision support systems (CDSS) are tools that have been used for several years by clinical pharmacy teams to support pharmaceutical analysis, with a perspective of contributing to the quality of care in collaboration with the other health care team members. These tools require both technical, logistical and human resources. The growing use of these systems in different establishments in France and in Europe gave birth to the idea of meeting to share our experiences. The days organized in Lille in September 2021 aimed at proposing a time of exchange and reflection on the use of these CDSS in clinical pharmacy. A first session was devoted to feedback from each establishment. These tools are essentially used to optimize pharmaceutical analysis and to secure patient medication management. This session outlined the clear advantages and common limitations of these CDSS. Two research projects were also presented to put the use of these tools into perspective. The second session of these days, in the form of workshops, addressed 4 themes that surround the implementation of CDSS: their usability, the legal aspect, the creation of rules and their possible valorization. Common problems were raised, the resolution of which requires close collaboration. This is a first step proposing a beginning of harmonization and sharing that should be deepened in order not to lose the dynamics created between the different centers. This event ended with the proposal to set up two working groups around these systems: the creation and structuring of rules for the detection of risk situations and the common valorization of the work.

A wide variety of medical devices (MDs) used in hospitals are made of flexible plasticized polyvinylchloride (PVC). Different plasticizers are present in variable amounts in the PVC matrix of the devices and can leach out into the infused solutions and may enter into contact with the patients. The ARMED1 project aims to assess the migration of these plasticizers from medical devices and therefore the level of exposure in patients. For the first task of the project, eight methods were developed to directly detect and quantify the plasticizers in the PVC matrix of the MDs. We compared the overall performances of the analytical methods using standardized and validated criteria in order to provide the scientific community with the guidance and the technical specifications of each method for the intended application. We have shown that routine rapid screening could be performed directly on the MDs using the FTIR technique, with cost-effective analyses. LC techniques may also be used, but with limits and only with individual quantification of the main plasticizers expected in the PVC matrix. GC techniques, especially GC-MS, are both more specific and more sensitive than other techniques. NMR is a robust and specific technique to precisely discriminate all plasticizers in a MD but is limited by its cost and its low ability to detect and quantify plasticizer contamination, e.g. by DEHP. All these results have been confirmed by a real test, called the " blind test " carried out on 10 MD samples.

Background Polyvinyl chloride (PVC) infusion tubes are too widely used in our hospital. Even in intensive care units (ICU), PVC is commonly used although polyethylene (PE) is specifically recommended to limit container-content interactions. For example, insulin is used to achieve tight glucose control in ICU patients. Its adsorption on PVC is well known, but rarely considered in the choice of infusion device when nurses compose their infusion assemblies. Purpose This model of interaction was used as a tool, to educate nurses in the issue of choosing the right equipment and to illustrate the clinical impact of an unsuitable medical device in the administration of a drug. For this, we showed healthcare workers how the insulin concentration changed by comparing the infusion between two devices available in our hospital. Materials and methods ICU nurses prepared 40 mL insulin syringes (1 IU/mL) according to the ICU preparation protocol. The concentration was determined by UV-spectrophotometry at 4 points in the syringes to assess their homogeneity and dose accuracy. Then, PVC and PE syringe extension lines (SEL, L:150 cm, ID:1 mm) used in our hospital were evaluated. Firstly, each SEL was filled with 1 IU/mL insulin solution and closed with Luer-lock plugs. Measurements were achieved after 15 and 60 min of contact. Secondly, the insulin levels were measured at the egress of both SEL every 5 min over a 24 h time period at a flow rate of 2 mL/h. Results were expressed as a percentage of the theoretical value. All experiments were repeated 5 times. Statistical comparisons were performed with a Mann-Whitney test (p = 0.05). Results Eleven nurses prepared 48 insulin syringes with an average proportion of 100.6 ± 3.9% of the theoretical value in all points of the syringes. After 15 min of contact, the insulin levels dropped significantly in PVC SEL compared to PE SEL (46.2 ± 2.4% vs 98.4 ± 1.7%, p = 0.01, respectively). The level continued to drop at 60 min (30.1 ± 4.0% vs 96.0 ± 0.6%, p = 0.01, respectively). During infusion tests, the insulin concentration after a 24 h infusion was only 64.6 ± 2.0% using PVC SEL whereas it was maintained at 101.7 ± 0.8% with PE SEL (p = 0.01). Conclusions A paradoxical situation exists in the insulin infusion context. Although this interaction with PVC is well documented and confirmed by this study, ICUs still use it. This study allowed us to demonstrate that even if the preparation process is performed correctly and the concentration is homogeneous, PE SEL are really more suitable for insulin administration and must replace PVC SEL. The use of such a tool may help pharmacists in the ongoing education of nurses. Other drugs are being considered to enhance the study and to support our infusion training group. An evaluation of the impact of our training course on daily practice is planned. No conflict of interest.

Background Polyvinyl chloride (PVC) infusion tubes are too widely used in our hospital. Even in intensive care units (ICU), PVC is commonly used although polyethylene (PE) is specifically recommended to limit container-content interactions. For example, insulin is used to achieve tight glucose control in ICU patients. Its adsorption on PVC is well known, but rarely considered in the choice of infusion device when nurses compose their infusion assemblies. Purpose This model of interaction was used as a tool, to educate nurses in the issue of choosing the right equipment and to illustrate the clinical impact of an unsuitable medical device in the administration of a drug. For this, we showed healthcare workers how the insulin concentration changed by comparing the infusion between two devices available in our hospital. Materials and methods ICU nurses prepared 40 mL insulin syringes (1 IU/mL) according to the ICU preparation protocol. The concentration was determined by UV-spectrophotometry at 4 points in the syringes to assess their homogeneity and dose accuracy. Then, PVC and PE syringe extension lines (SEL, L:150 cm, ID:1 mm) used in our hospital were evaluated. Firstly, each SEL was filled with 1 IU/mL insulin solution and closed with Luer-lock plugs. Measurements were achieved after 15 and 60 min of contact. Secondly, the insulin levels were measured at the egress of both SEL every 5 min over a 24 h time period at a flow rate of 2 mL/h. Results were expressed as a percentage of the theoretical value. All experiments were repeated 5 times. Statistical comparisons were performed with a Mann-Whitney test (p = 0.05). Results Eleven nurses prepared 48 insulin syringes with an average proportion of 100.6 ± 3.9% of the theoretical value in all points of the syringes. After 15 min of contact, the insulin levels dropped significantly in PVC SEL compared to PE SEL (46.2 ± 2.4% vs 98.4 ± 1.7%, p = 0.01, respectively). The level continued to drop at 60 min (30.1 ± 4.0% vs 96.0 ± 0.6%, p = 0.01, respectively). During infusion tests, the insulin concentration after a 24 h infusion was only 64.6 ± 2.0% using PVC SEL whereas it was maintained at 101.7 ± 0.8% with PE SEL (p = 0.01). Conclusions A paradoxical situation exists in the insulin infusion context. Although this interaction with PVC is well documented and confirmed by this study, ICUs still use it. This study allowed us to demonstrate that even if the preparation process is performed correctly and the concentration is homogeneous, PE SEL are really more suitable for insulin administration and must replace PVC SEL. The use of such a tool may help pharmacists in the ongoing education of nurses. Other drugs are being considered to enhance the study and to support our infusion training group. An evaluation of the impact of our training course on daily practice is planned. No conflict of interest.