Iatrogenic harm from crushing oral drugs, a common but hazardous practice, can be largely avoided by following recommendations for good practice. The aims of this study were to evaluate the frequency of tablet crushing and opening capsules in hospitals and to compare the nursing practices with national recommendations. From 46 health facilities in Auvergne, 1110 nurses answered an anonymous self-completed questionnaire between September and November 2014 regarding general medication issues, prescription, preparation and administration of crushed medications. Crushing tablets or opening capsules was reported as a daily practice for 28% (increasing to 67% in geriatric units). While most best practice recommendations were followed by most nurses, scope for improvement remained: pharmacists were rarely contacted, rationales for change of medication formulation were seldom recorded in patients' files and medications were often crushed and administered together, risking drug interactions. Study data were used to inform recommendations for practice improvement. As findings bear similarities to those from other countries, this may be a widespread issue and study recommendations may be widely relevant. Practice will be reviewed again once practice improvement has been completed.

Infusion medical devices (MDs) used in hospitals are often made of plasticized polyvinylchloride (PVC). These plasticizers may leach out into infused solutions during clinical practice, especially during risk-situations, e.g multiple infusions in Intensive Care Units and thus may enter into contact with the patients. The migrability of the plasticizers is dependent of several clinical parameters such as temperature, contact time, nature of the simulant, etc… However, no data is available about the influence of the flow rate at which drug solutions are administrated. In this study, we evaluated the impact of different flow rates on the release of the different plasticizers during an infusion procedure in order to assess if they could expose the patients to more toxic amounts of plasticizers. Migration assays with different PVC infusion sets and extension lines were performed with different flow rates that are used in clinical practice during 1h, 2h, 4h, 8h and 24h, using a lipophilic drug simulant. From a clinical point of view, the results showed that, regardless of the plasticizer, the faster the flow rate, the higher the infused volume and the higher the quantities of plasticizers released, both from infusion sets and extension lines, leading to higher patient exposure. However, physically, there was no significant difference of the migration kinetics linked to the flow rate for a same medical device, reflecting complex interactions between the PVC matrix and the simulant. The migration was especially dependent on the nature and the composition of the medical device.