title: [Mapping of risks related to medication care in nursing homes: An overview in Alsace - France].
abstract: BACKGROUND
  Medication care of patients in nursing homes involves a complex circuit whose related risks need to be identified. The aim of this study was first to map risks related to medication care in a representative panel of nursing homes under contract with community pharmacies in Alsace, then to propose improvement action plans to remedy the weaknesses identified.
  
  
  METHODS
  This study was conducted on a representative sample of 23 nursing homes in Alsace in 2014. A self-assessment questionnaire (Interdiag EHPAD), divided into 7 fields and made up of 198 questions, was completed by each of the 23 nursing homes during multidisciplinary meetings that were organized by the OMEDIT (observatoire du médicament, des dispositifs médicaux et de l'innovation thérapeutique of Alsace). The percentages of controlled risks were calculated for each of the 7 fields of the medication circuit, both at nursing home and regional levels. Similarly, the percentages of non-controlled risks were calculated for each of the 198 items.
  
  
  RESULTS
  Considering the 7 fields, regional percentages of controlled risks varied from 63% to 85%. The field relative to drug supply was the best controlled, while that relative to prevention was the least controlled. Considering the 198 items, 30 important vulnerability points were identified, among which stand out: failure to report and to analyze adverse drug events, lack of involvement of general practitioner in nursing homes through collaborative approaches and transcription by nurse staff of oral or handwritten prescriptions in medical software. The analysis of those items led to the proposal of 13 improvement actions.
  
  
  CONCLUSIONS
  The study pointed out mainly difficulties linked to the absence of suitable risk management policies and the lack of adjustment between nursing home staffs and general practitioners. In contrast, it revealed that the collaboration between nursing homes and community pharmacies was successful overall. Finally, we hope that this multi-center study, that led to identify concrete proposals, will help nursing homes to improve the quality of medication care for their residents.
authors.affiliation: OMEDIT Alsace, agence régionale de santé d'Alsace, 14, rue du Maréchal-Juin, 67084 Strasbourg cedex, France.
authors.forename: K
authors.initials: K
authors.lastname: Weber
authors.affiliation: OMEDIT Alsace, agence régionale de santé d'Alsace, 14, rue du Maréchal-Juin, 67084 Strasbourg cedex, France. Electronic address: morgane.beck@ars.sante.fr.
authors.forename: M
authors.initials: M
authors.lastname: Beck
authors.affiliation: OMEDIT Alsace, agence régionale de santé d'Alsace, 14, rue du Maréchal-Juin, 67084 Strasbourg cedex, France.
authors.forename: M C
authors.initials: MC
authors.lastname: Rybarczyk-Vigouret
authors.affiliation: OMEDIT Alsace, agence régionale de santé d'Alsace, 14, rue du Maréchal-Juin, 67084 Strasbourg cedex, France; EA 7308, laboratoire HuManiS, école de management de Strasbourg, université de Strasbourg, 67085 Strasbourg cedex, France; Service de pharmacie-stérilisation, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France.
authors.forename: B
authors.initials: B
authors.lastname: Michel
mesh_terms: D000368:Aged; D004358:Drug Therapy / Q000706:statistics & numerical data*; D005602:France; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes; D018570:Risk Assessment; D012308:Risk Management; D011795:Surveys and Questionnaires
keywords: A priori analysis; Analyse a priori; Cartographie des risques; Circuit du médicament; Drug iatrogenesis; Elderly; Gestion du risque; Iatrogénie médicamenteuse; Medication circuit; Nursing homes; Personnes âgées; Risk management; Risk mapping; Établissement médico-social