The major DEHP leaching caused by olive oil-based emulsions raises cause for concern because DEHP presents distinctive toxic effects, including an increased risk of cholestasis.

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Background Intravenous (IV) iron preparations bypass the difficulties (malabsorption and side effects) associated with oral iron for the treatment of iron deficiency anaemia (IDA). Ferric carboxymaltose (FCM) can be administered as a single infusion over short periods of time but is more expensive than iron sucrose (IS) when the patients are hospitalized. Objectives To evaluate the appropriateness of FCM prescriptions and to establish the economic impact of this management (including disease coding) compared to the use of IV IS. Setting This study was conducted for inpatients in all departments (orthopaedic department, gastroenterology department and two units of the internal medicine department) where FCM was widely prescribed. Method We retrospectively identified 224 patients, diagnosed with IDA using laboratory parameters and/or disease coding, who received FCM between January and December 2014. Main outcome measure The primary outcome was the rate of appropriateness of FCM prescriptions and the financial impact compared to IV IS. Results 89 Patients were included. The total additional cost for an inappropriate prescription of IV FCM (68% of cases) was of 6053 €. The total incremental cost of unsuitable disease coding was estimated at 31,688 €. Indications for IV FCM were categorized: intestinal bleeding (31%), malabsorption (17%), intolerance (9%) and refractory to oral iron (7%). The majority of patients (62%) received 1000 mg of FCM per week. The average length of hospital stay was of 10 days. Conclusion The prescription of IV iron was appropriate in most cases but did not necessarily require FCM. The use of IV IS, in many cases, could present a cost-saving option for inpatients with IDA. The lack of an IDA coding generated incremental costs.

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BackgroundDrug supply shortages are not uncommon and their frequency and duration are increasing essentially because of production issues. The absence of advanced warning from drug manufacturers may affect the delivery of patient care. Drug supply shortages have several consequences on pharmacy departments and by the way on care services.PurposeTo quantify these shortages and their impact in our hospital.Material and methodsThe drug supply shortages are regularly monitored in the pharmacy department using data collection with the following items: the drug, the manufacturer, information about the source of disruption, dates of beginning and end, the substitute treatment. The data collected between September 1st, 2013 and August 30th, 2014 was analysed.ResultsOne hundred and seventeen drug shortages were recorded: 48% were injectable drugs, 43% oral drugs and 9% external medicines. On average, five drugs per week (range, 1–13) were in short supply and the shortage lasted 65 days (range, 3–329). The pharmacy service was alerted by: the group purchasing organisations (42%), the French drug agency (20%) or the supplier (18%). Substitute treatments were proposed in 68% of shortages by the group purchasing organisations but only in 8% by the supplier. In 13% of the cases, there was no therapeutic alternative. The main impact of drug shortages on pharmacy services was the amount of time spent by staff repeatedly managing this problem: choice and creation of substitute treatment, order processing, purchases for account, information to the physicians. In addition, in the wards, changing treatment or the use of less familiar alternative drugs may raise patient safety issues.ConclusionThe drug supply shortages are a public health problem. It would be interesting to estimate the financial impact at the origin of the staff workload.References and/or acknowledgementsNo conflict of interest.