BackgroundSTOPP and START criteria were developed to identify potentially inappropriate prescription (PIP) and potentially prescribing omission (PPO), and to improve the use of medication in older people.PurposeThe aim of this study was to evaluate the medical care for elderly patients in an acute geriatric department with the STOPP and START criteria.Material and methodsThis study included patients admitted to the acute geriatric department in an academic hospital from July to October 2015. Using pre-admission treatment, a pharmacist used STOPP and START criteria version 2 to identify PIPs and PPOs. After the patient’s discharge, a geriatrician and a pharmacist assessed how many STOPP and START criteria were followed according to the discharge prescription. The reason for not following STOPP/START criteria was investigated using clinical records.ResultsAmong 81 patients included, 224 PIPs were identified according to STOPP criteria, of which 168 (75%) were followed by the geriatricians. Among 56 cases of non-adherence to STOPP criteria, 50 cases (90%) presented a justified reason for this decision. Among 262 inappropriate prescriptions identified by geriatricians, 94 (36%) prescriptions were supplementary and not identified by STOPP criteria. Supplementary drugs stopped the most by geriatricians were drugs related to the cardiovascular system (n=28), mostly because the treatment was ineffective (n=7).According to START criteria, 90 PPOs were identified, of which 56 (62%) were followed by the geriatricians. Among 34 cases of non-adherence to START criteria, 27 cases (79%) presented a justified reason for this decision. Among 273 omission prescriptions identified by geriatricians, 217 prescriptions were supplementary and not identified by START criteria. The drugs started most by geriatricians were drugs related to the central nervous system (n=79), mostly because patients presented moderate pain (n=36).ConclusionIn this study, PIP and PPO STOPP and START criteria were usually followed by geriatricians. The reasons for not following the criteria were usually justified. However, cases of non-adherence to START criteria were more important than cases of non-adherence to STOPP criteria. In these cases, geriatricians added more drugs than the START criteria. More studies about following these criteria should be performed in older patients admitted to hospital, especially in others wards, without geriatricians.No conflict of interest

Background Thermo-sensitive drugs must be stored overall the circuit, from manufacture to administration for the patient, at 2°C-8°C. The hospital mission is to ensure patient safety and quality of care. Evaluation and improvement of the thermosensitive drug management process are essential in preventing and limiting iatrogenic events. Purpose The present study aimed to assess the risk of the thermo-sensitive drug management process according to a proactive analysis: failure mode and effects analysis method (FMEA). Material and methods A multidisciplinary study group was assembled and a process diagram was drafted, illustrating all steps of the cold chain. Failure modes that could occur were identified and classified according to their risk priority score (RPS) determined on the basis of the likelihood of occurrence, the severity of the potential effect and the probability of detection. The failures' causes were closely examined by establishing Ishikawa diagrams in order to propose corrective and preventive actions. Results The evaluation process detected 42 potential failures. The frequency of failure modes were as follow: 24% in drug storage at the depot step, 21.4% in drug storage in the care units step and 19% in drug storage in the different units of the the pharmacy step. These three steps were considered the most critical. Among the most critical failure modes was the failure of the refrigerator with a RPS equal to 16, the non-compliance of the cold chain during transport with a RPS equal to 60 and the non-control of the temperature at receipt of the thermo-sensitive drug. This last mode of failure seems to be the most critical, with a RPS equal to 80. Preventive measures such as the control of temperature at the drug reception and immediate storage in a freezer box have been proposed to get rid of the most critical failures. Conclusion FMEA was useful to help understand the cold chain process, detecting possible failures and prioritising remedial interventions. The systematic use of proactive risk analysis is needed for continuous safety improvement of the thermosensitive drug management process. REFERENCES AND/OR ACKNOWLEDGEMENTSSpecial thanks to the multidisciplinary group members.No conflict of interest.5PSQ-157 IMPACT OF ANTICHOLINERGIC BURDEN, QUANTIFIED

the combined occurrence of stroke, TIA, cardiovascular death and acute coronary syndrome (ACS). Furthermore, we collected data about clinical parameters (age, sex, ethnicity), comedication during follow-up and vascular risk factors.We tested the association between carrying LOF or GOF alleles and the primary endpoint in a univariate analysis, and multivariate analysis including those clinical parameters previously related to clopidogrel response. OR and HR were calculated and P-values<0.05 were considered statistically significant. Results Sixty-seven patients were recruited, 53 (79.1%) because of stroke, mean age 68.2±9.83 years, 35.8% females and 100% caucasians. Carrying CYP2C19 LOF alleles was significantly associated with the primary endpoint in the single analysis (OR=3.82; 95% CI: 1.1 to 13.2; p=0.028), in the multivariate analysis (OR=5.07; 95% CI: 1.2 to 21.45; p=0.023). This association remains significant if we perform a survival analysis (HR=3.01; 95% CI: 1.01 to 9.0; p=0.048). Carrying CYP2C19 GOF alleles was not related to the primary endpoint in the univariate analysis but, in the multivariate analysis, it was significantly associated with a protection against the primary endpoint. Conclusion CYP2C19 LOF polymorphisms may be used as genetic markers of clopidogrel response in cerebrovascular disease patients. Among these patients, CYP2C19 GOF allele may be considered as a protector against the primary endpoint. REFERENCES AND/OR ACKNOWLEDGEMENTSAgradecimientos: Thanks to all the patients participating.No conflict of interest.

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BackgroundIn order to plan the managemenet a cytotoxic drugs preparation unit (CPDU), pharmacists used a scientific reference source1 it recommended 5 pharmacy technicians for 26,000 preparations per year. 50% of technician effective working time should be spent to preparation and 50% on associated activities (AA).PurposeWhat about in practice? The aim of this study was to assess the technicians’ work load in real life.Material and methods5 technicians were hired in a CPDU in which 60% of the production was for use outside the hospital. Over one week, the times spent on the preparation and on 15 AAs was measured. The staff had to fill in a form giving the exact start and end times of the tasks. The different data collected were analysed and expressed in percentages.Results57% of technician effective working time was allocated to preparation. 9 AAs (36%) were fully done by technicians, the main ones being: preparation of sterilisation trays (17.4%), dressings, hygiene protocols (6%), managing orders (3.4%), schedule organisation (2%). The other AAs such as taking bacterial samples, inventory management, required the help of two additional logistics staff (47% of their working time). Without the help of logistics staff, all the AAs would need 58% of effective working time.ConclusionCompared with our data, the reference source underestimates the time required for preparation and AAs, by 7.4% and 8% respectively. The additional time needed for preparation is explained by the fact that reference data are not accurate for specific preparations. Furthermore, AAs need more time because of the large amount of work outsourced to our department, which isn’t mentioned in the reference source. This study showed that 6 technicians are necessary, instead of the 5 recommended by the guidelines. Moreover, with the new national law concerning hospital organisation, the CDPUs are going to change and the outsourced work they perform will increase; the guidelines need to be reviewed.ReferenceSociété Française de Pharmacie OncologiqueNo conflict of interest.