{"id":15706,"date":"2014-09-01T00:00:00","date_gmt":"2014-08-31T22:00:00","guid":{"rendered":"http:\/\/ricom-web.com\/gestions-hospitalieres\/medicaments-a-risque\/"},"modified":"2018-03-07T15:56:36","modified_gmt":"2018-03-07T14:56:36","slug":"medicaments-a-risque","status":"publish","type":"post","link":"https:\/\/www.ricom-web8.com\/gestions\/medicaments-a-risque\/","title":{"rendered":"M\u00e9dicaments \u00e0 risque"},"content":{"rendered":"<span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Temps de lecture\u00a0: <\/span> <span class=\"rt-time\"> 4<\/span> <span class=\"rt-label rt-postfix\">minutes<\/span><\/span><p>Un groupe de r\u00e9flexion pluridisciplinaire compos\u00e9 de pharmaciens, m\u00e9decins et cadres de sant\u00e9 a \u00e9t\u00e9 constitu\u00e9 par la commission du m\u00e9dicament et des dispositifs m\u00e9dicaux st\u00e9riles (CMDMS) du CHRU de Montpellier. Dans un premier temps, ce groupe a proc\u00e9d\u00e9 \u00e0 une revue de la litt\u00e9rature\u2009:<\/p>\n<ul>\n<li>arr\u00eat\u00e9 du 6 avril 2011 relatif au management de la qualit\u00e9 de la prise en charge m\u00e9dicamenteuse et aux m\u00e9dicaments dans les \u00e9tablissements de sant\u00e9\u2009<sup class=\"appel\" data-toggle=\"modal\" data-target=\"#notes\">(1)<\/sup>,<\/li>\n<li>la liste de l\u2019Institute for Safe Medication Practices\u2009<sup class=\"appel\" data-toggle=\"modal\" data-target=\"#notes\">(2)<\/sup>,<\/li>\n<li>la liste des Never Events de l\u2019Agence nationale de s\u00e9curit\u00e9 du m\u00e9dicament et des produits de sant\u00e9 (ANSM)\u2009<sup class=\"appel\" data-toggle=\"modal\" data-target=\"#notes\">(3)<\/sup>,<\/li>\n<li>les recommandations de la Haute Autorit\u00e9 de sant\u00e9\u2009<sup class=\"appel\" data-toggle=\"modal\" data-target=\"#notes\">(4)<\/sup>,<\/li>\n<li>publications scientifiques\u2009<sup class=\"appel\" data-toggle=\"modal\" data-target=\"#notes\">(5)<\/sup>.<\/li>\n<\/ul>\n<h1>Mat\u00e9riels et m\u00e9thodes<\/h1>\n<p>Afin d\u2019\u00e9laborer une liste en rapport avec nos pratiques quotidiennes, les acteurs de terrain ont \u00e9t\u00e9 sollicit\u00e9s. Un questionnaire a ainsi \u00e9t\u00e9 envoy\u00e9 aux r\u00e9f\u00e9rents m\u00e9dicaux, pharmaceutiques et infirmiers des groupes de travail de la CMDMS pour identifier les m\u00e9dicaments \u00e0 risque.<\/p>\n<button data-toggle=\"collapse\" data-target=\"#5399\">figure 1<\/button><div id=\"5399\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">figure 1<\/span><\/p>\n<h2>Questionnaire envoy\u00e9 aux r\u00e9f\u00e9rents des groupes de travail de la CMDMS<\/h2>\n<p><img decoding=\"async\" class=\"alignnone wp-image-22669 size-full\" src=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2016\/09\/2014_411_1.png\" alt=\"2014_411_1\" width=\"600\" height=\"354\" srcset=\"https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2016\/09\/2014_411_1.png 600w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2016\/09\/2014_411_1-300x177.png 300w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/p>\n<\/div>\n<div class=\"38b5809c-7621-4375-a58d-9d375493f009\" style=\"display: none;\"><\/div>\n<p>Ils devaient sp\u00e9cifier les m\u00e9dicaments de leur sp\u00e9cialit\u00e9 m\u00e9dicale qu\u2019ils consid\u00e8rent comme \u00ab\u2009\u00e0 risque\u2009\u00bb et justifier ce risque\u2009:<\/p>\n<ul>\n<li>risque li\u00e9 \u00e0 la prescription ou la dispensation\u2009;<\/li>\n<li>risque li\u00e9 \u00e0 l\u2019administration\u2009: probl\u00e8mes d\u2019unit\u00e9, dosage, voie d\u2019administration\u00a0;<\/li>\n<li>risque pharmacologique li\u00e9 \u00e0 la mol\u00e9cule, marge th\u00e9rapeutique \u00e9troite, suivi clinique n\u00e9cessaire\u2009;<\/li>\n<li>interactions m\u00e9dicamenteuses ou alimentaires\u2009;<\/li>\n<li>risque li\u00e9 \u00e0 la d\u00e9tention, au stockage.<\/li>\n<\/ul>\n<p>Dans un deuxi\u00e8me temps, une liste a \u00e9t\u00e9 \u00e9labor\u00e9e par la pharmacovigilance \u00e0 partir des donn\u00e9es du centre r\u00e9gional de pharmacovigilance (CRPV-LR)\u2009:<\/p>\n<ul>\n<li>la liste de l\u2019ISMP r\u00e9actualis\u00e9e annuellement en fonction des notifications collect\u00e9es par l\u2019institut\u2009;<\/li>\n<li>le bilan des notifications d\u2019\u00e9v\u00e9nements ind\u00e9sirables (EI) graves parvenues au CRPV-LR en 2012\u2009;<\/li>\n<li>la liste des m\u00e9dicaments soumis \u00e0 des plans de gestion de risque (ANSM) et le bilan des signaux faibles (CRPV-LR).<\/li>\n<\/ul>\n<p>Dans un troisi\u00e8me temps, une extraction des donn\u00e9es \u00e0 partir du logiciel de prescription informatique a \u00e9t\u00e9 r\u00e9alis\u00e9e. Nous avons ainsi analys\u00e9 toutes les lignes ayant fait l\u2019objet d\u2019un refus de validation par un pharmacien pendant les mois de janvier et f\u00e9vrier 2013 et la justification pharmaceutique de ce refus.<\/p>\n<p>Enfin, les donn\u00e9es de l\u2019Observatoire des \u00e9v\u00e9nements iatrog\u00e8nes m\u00e9dicamenteux du service des urgences adultes du CHRU de Montpellier\u2009<sup class=\"appel\" data-toggle=\"modal\" data-target=\"#notes\">(6)<\/sup> ont \u00e9t\u00e9 utilis\u00e9es. Ces diff\u00e9rentes sources ont \u00e9t\u00e9 exploit\u00e9es pour \u00e9tablir une premi\u00e8re liste de m\u00e9dicaments et\/ou familles th\u00e9rapeutiques (M\/FT) \u00e0 risque, en pr\u00e9cisant le domaine de risque et les actions de pr\u00e9ventions d\u00e9j\u00e0 r\u00e9alis\u00e9es.<\/p>\n<h1>R\u00e9sultats<\/h1>\n<h2>Questionnaires<\/h2>\n<p>Sur les 13 r\u00e9ponses aux questionnaires envoy\u00e9s aux r\u00e9f\u00e9rents m\u00e9dicaux, pharmaceutiques et infirmiers des groupes de travail de la CMDMS, 35 M\/FT ont \u00e9t\u00e9 cit\u00e9s.<\/p>\n<button data-toggle=\"collapse\" data-target=\"#5400\">figure 2<\/button><div id=\"5400\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">figure 2<\/span><\/p>\n<h2>R\u00e9partition des domaines de risque des m\u00e9dicaments consid\u00e9r\u00e9s \u00ab\u00e0 risque\u00bb<\/h2>\n<p><img decoding=\"async\" class=\"alignnone wp-image-22670 size-full\" src=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2016\/09\/2014_411_2.png\" alt=\"2014_411_2\" width=\"600\" height=\"276\" srcset=\"https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2016\/09\/2014_411_2.png 600w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2016\/09\/2014_411_2-300x138.png 300w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/p>\n<\/div>\n<div class=\"1559bee2-9dce-40c7-8406-60d0627829d3\" style=\"display: none;\"><\/div>\n<h2>Donn\u00e9es du CRPV-LR<\/h2>\n<p>Un bilan des notifications d\u2019EI graves parvenues au CRPV-LR en 2012 a \u00e9t\u00e9 effectu\u00e9. Sur les 1\u2009170 effets d\u00e9clar\u00e9s, seuls les 669 qualifi\u00e9s de graves (57\u2009%) ont \u00e9t\u00e9 retenus. Les trois classes principalement mises en cause sont les opio\u00efdes, les antibiotiques et les anti-inflammatoires non st\u00e9ro\u00efdiens (AINS).<\/p>\n<h2>Analyse des refus de validation pharmaceutique<\/h2>\n<p>L\u2019extraction via le logiciel de prescription DXCare a permis d\u2019analyser 6\u2009108 lignes de prescription refus\u00e9es\u2009:<\/p>\n<ul>\n<li>55\u2009% de m\u00e9dicaments par voie orale,<\/li>\n<li>44\u2009% de m\u00e9dicaments injectables,<\/li>\n<li>1\u2009% de m\u00e9dicaments par autres voies (patchs, a\u00e9rosols).<\/li>\n<\/ul>\n<p>Les m\u00e9dicaments concern\u00e9s s\u2019av\u00e8rent \u00eatre des m\u00e9dicaments du \u00ab\u2009quotidien\u2009\u00bb, le risque \u00e9tant major\u00e9 par leur fr\u00e9quence de prescription. Les trois premiers M\/FT sont le parac\u00e9tamol (13\u2009%), les antibiotiques (7\u2009%) et les inhibiteurs de la pompe \u00e0 protons (IPP &#8211; 5\u2009%). Les motifs de refus \u00e9tant le plus souvent des doublons de prescription lors des relais IV\/per os, la non-adaptation des posologies aux r\u00e9sultats biologiques du patient\u2026\u2009:<\/p>\n<ul>\n<li>parac\u00e9tamol\u2009: posologie maximale d\u00e9pass\u00e9e, pas d\u2019adaptation des posologies chez le sujet \u00e2g\u00e9 ou insuffisant r\u00e9nal, doublon IV\/per os, non-respect des intervalles entre les prises, redondance\u2026\u2009;<\/li>\n<li>antibiotiques\u2009: absence d\u2019adaptation posologique (sur\/sous-dosage, pas d\u2019adaptation \u00e0 la fonction r\u00e9nale), absence d\u2019adaptation \u00e0 l\u2019antibiogramme, relais IV\/per os, rythme d\u2019administration, redondance, dur\u00e9e du traitement, non-conformit\u00e9 aux r\u00e9f\u00e9rentiels\u2026\u2009;<\/li>\n<li>IPP\u2009: surdosage, doublon IV\/per os, redondance, substitution formes adultes et p\u00e9diatriques, rythme d\u2019administration\u2026<\/li>\n<\/ul>\n<h2>Observatoire des \u00e9v\u00e9nements iatrog\u00e8nes m\u00e9dicamenteux, urgences adultes<\/h2>\n<p>D\u2019apr\u00e8s l\u2019observatoire, les m\u00e9dicaments le plus souvent responsables d\u2019\u00e9v\u00e9nements iatrog\u00e8nes sont les AVK, les antiagr\u00e9gants plaquettaires et les diur\u00e9tiques. Une premi\u00e8re liste de m\u00e9dicaments \u00e0 risque a \u00e9t\u00e9 \u00e9tablie sur la base des crit\u00e8res suivants\u2009:<\/p>\n<ul>\n<li>fr\u00e9quence de prescription,<\/li>\n<li>criticit\u00e9 en termes de risque pour le patient,<\/li>\n<li>possibilit\u00e9 de mise en \u0153uvre simple et pragmatique d\u2019actions correctives et pr\u00e9ventives<\/li>\n<\/ul>\n<p>Vingt-trois m\u00e9dicaments ou familles th\u00e9rapeutiques ont ainsi \u00e9t\u00e9 list\u00e9s, avec r\u00e9pertoire du domaine de risque associ\u00e9 et des actions r\u00e9alis\u00e9es.<\/p>\n<button data-toggle=\"collapse\" data-target=\"#5401\">tableau 1<\/button><div id=\"5401\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">tableau 1<\/span><\/p>\n<h2>Liste de m\u00e9dicaments\/familles th\u00e9rapeutiques \u00e0 risque ayant servi de base de travail (extrait)<\/h2>\n<p><img decoding=\"async\" class=\"alignnone wp-image-22671 size-full\" src=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2016\/09\/2014_411_3.png\" alt=\"2014_411_3\" width=\"600\" height=\"418\" srcset=\"https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2016\/09\/2014_411_3.png 600w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2016\/09\/2014_411_3-300x209.png 300w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/p>\n<\/div>\n<div class=\"32e06280-635e-4b4d-a52a-be8e6ad8a110\" style=\"display: none;\"><\/div>\n<p>Dans cette premi\u00e8re liste, 60\u2009% des M\/FT b\u00e9n\u00e9ficient d\u00e9j\u00e0 d\u2019actions de s\u00e9curisation (dispensation sur ordonnance nominative, recommandations de bon usage, audits de stockage ou param\u00e9trages sp\u00e9cifiques du logiciel de prescription\u2026). Cette premi\u00e8re liste a \u00e9t\u00e9 discut\u00e9e par le groupe de r\u00e9flexion pluridisciplinaire afin de prioriser les actions \u00e0 conduire et d\u00e9finir une liste plus restreinte de m\u00e9dicaments ou classes de m\u00e9dicaments \u00e0 cibler prioritairement. Ainsi, treize m\u00e9dicaments ou familles th\u00e9rapeutiques de m\u00e9dicaments dits \u00ab \u00e0 risque\u2009\u00bb ont \u00e9t\u00e9 list\u00e9s et constituent la liste du CHRU\u2009:<\/p>\n<ul>\n<li>agonistes adr\u00e9nergiques IV,<\/li>\n<li>antiarythmiques,<\/li>\n<li>anticoagulants injectables,<\/li>\n<li>antivitamines K,<\/li>\n<li>benzodiaz\u00e9pines,<\/li>\n<li>cytotoxiques (dont le m\u00e9thotrexate),<\/li>\n<li>digitaliques IV,<\/li>\n<li>\u00e9lectrolytes (dont le KCl inj),<\/li>\n<li>insuline,<\/li>\n<li>nouveaux anticoagulants oraux (Naco),<\/li>\n<li>parac\u00e9tamol,<\/li>\n<li>sp\u00e9cialit\u00e9s injectables avec calcul de dose et\/ou dilution et\/ou param\u00e9trage de seringue \u00e9lectrique,<\/li>\n<li>sp\u00e9cialit\u00e9s utilis\u00e9es en anesth\u00e9sie-r\u00e9animation au bloc op\u00e9ratoire.<\/li>\n<\/ul>\n<h1>Conclusion<\/h1>\n<p>La liste des m\u00e9dicaments \u00e0 risque sera valid\u00e9e par la commission m\u00e9dicale d\u2019\u00e9tablissement et diffus\u00e9e dans notre \u00e9tablissement. Le tableau reprenant la liste des M\/FT a \u00e9t\u00e9 compl\u00e9t\u00e9 avec une colonne suppl\u00e9mentaire pour pr\u00e9ciser l\u2019antidote de chacun quand il existe. Un plan d\u2019action est en cours de r\u00e9alisation pour diminuer les risques li\u00e9s \u00e0 l\u2019utilisation des M\/FT de cette liste. Ces actions viendront compl\u00e9ter celles d\u00e9j\u00e0 r\u00e9alis\u00e9es\u2009; elles ont pour objectifs\u2009:<\/p>\n<ul>\n<li>\u2009de mettre des \u00ab\u2009barri\u00e8res\u2009\u00bb pour \u00e9viter le risque (par exemple le r\u00e9f\u00e9rencement d\u2019un seul dosage pour \u00e9viter les confusions)\u2009;<\/li>\n<li>\u2009de mettre \u00e0 disposition des prescripteurs les derni\u00e8res recommandations en lien avec le logiciel de prescription\u2009;<\/li>\n<li>\u2009de pr\u00e9voir au niveau de la CMDMS la r\u00e9daction de protocoles partag\u00e9s par l\u2019ensemble des prescripteurs\u2009;<\/li>\n<li>\u2009de r\u00e9aliser des audits de pratiques\u2009;<\/li>\n<li>\u2009d\u2019\u00e9laborer un tableau de standardisation des dilutions pour l\u2019administration des injectables\u2009;<\/li>\n<li>\u2009de sensibiliser les prescripteurs sur le bon usage de ces m\u00e9dicaments.<\/li>\n<\/ul>\n<p>De plus, la validation pharmaceutique des prescriptions int\u00e9grera prioritairement les M\/FT de cette liste.<\/p>\n<script>function PlayerjsAsync(){} if(window[\"Playerjs\"]){PlayerjsAsync();}<\/script>","protected":false},"excerpt":{"rendered":"<p>Afin de r\u00e9pondre aux exigences de l\u2019arr\u00eat\u00e9 du 6 avril 2011 en termes de gestion des risques li\u00e9s \u00e0 la prise en charge m\u00e9dicamenteuse, la commission du m\u00e9dicament et des dispositifs m\u00e9dicaux st\u00e9riles (CMDMS) du CHRU de Montpellier a \u00e9t\u00e9 charg\u00e9e d\u2019\u00e9tablir une liste de \u00ab\u2009m\u00e9dicaments \u00e0 risque\u2009\u00bb propre \u00e0 l\u2019\u00e9tablissement.  Une premi\u00e8re liste de treize m\u00e9dicaments\/familles th\u00e9rapeutiques (M\/FT) a ainsi \u00e9t\u00e9 \u00e9tablie d\u2019apr\u00e8s la criticit\u00e9 du risque, la fr\u00e9quence de prescription et la possibilit\u00e9 de mise en \u0153uvre pratique d\u2019actions correctives et pr\u00e9ventives. Un plan d\u2019action est en cours de r\u00e9daction pour diminuer les risques li\u00e9s \u00e0 l\u2019utilisation des M\/FT de cette liste et prioriser leur validation pharmaceutique.<\/p>\n","protected":false},"author":1202,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[26,2],"tags":[876,1719,1718,525,223,763],"class_list":["post-15706","post","type-post","status-publish","format-standard","hentry","category-dossier","category-gestions-hospitalieres","tag-chu-montpellier","tag-cmdms","tag-famille-therapeutique","tag-gestion-des-risques","tag-medicament","tag-pharmacie"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.8.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>M\u00e9dicaments \u00e0 risque - Gestions hospitali\u00e8res<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ricom-web8.com\/gestions\/medicaments-a-risque\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"M\u00e9dicaments \u00e0 risque - Gestions hospitali\u00e8res\" \/>\n<meta property=\"og:description\" content=\"Afin de r\u00e9pondre aux exigences de l\u2019arr\u00eat\u00e9 du 6 avril 2011 en termes de gestion des risques li\u00e9s \u00e0 la prise en charge m\u00e9dicamenteuse, la commission du m\u00e9dicament et des dispositifs m\u00e9dicaux st\u00e9riles (CMDMS) du CHRU de Montpellier a \u00e9t\u00e9 charg\u00e9e d\u2019\u00e9tablir une liste de \u00ab\u2009m\u00e9dicaments \u00e0 risque\u2009\u00bb propre \u00e0 l\u2019\u00e9tablissement. Une premi\u00e8re liste de treize m\u00e9dicaments\/familles th\u00e9rapeutiques (M\/FT) a ainsi \u00e9t\u00e9 \u00e9tablie d\u2019apr\u00e8s la criticit\u00e9 du risque, la fr\u00e9quence de prescription et la possibilit\u00e9 de mise en \u0153uvre pratique d\u2019actions correctives et pr\u00e9ventives. Un plan d\u2019action est en cours de r\u00e9daction pour diminuer les risques li\u00e9s \u00e0 l\u2019utilisation des M\/FT de cette liste et prioriser leur validation pharmaceutique.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ricom-web8.com\/gestions\/medicaments-a-risque\/\" \/>\n<meta property=\"og:site_name\" content=\"Gestions hospitali\u00e8res\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/gestionshospitalieres\/\" \/>\n<meta property=\"article:published_time\" content=\"2014-08-31T22:00:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2018-03-07T14:56:36+00:00\" \/>\n<meta name=\"author\" content=\"yann Le Sager\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@revue_GH\" \/>\n<meta name=\"twitter:site\" content=\"@revue_GH\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"yann Le Sager\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/www.ricom-web8.com\/gestions\/medicaments-a-risque\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.ricom-web8.com\/gestions\/medicaments-a-risque\/\"},\"author\":{\"name\":\"yann Le Sager\",\"@id\":\"https:\/\/www.ricom-web8.com\/gestions\/#\/schema\/person\/810c9671279c5f5a094f6f0a42237516\"},\"headline\":\"M\u00e9dicaments \u00e0 risque\",\"datePublished\":\"2014-08-31T22:00:00+00:00\",\"dateModified\":\"2018-03-07T14:56:36+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.ricom-web8.com\/gestions\/medicaments-a-risque\/\"},\"wordCount\":1200,\"publisher\":{\"@id\":\"https:\/\/www.ricom-web8.com\/gestions\/#organization\"},\"keywords\":[\"CHRU de Montpellier\",\"CMDMS\",\"famille th\u00e9rapeutique\",\"gestion des risques\",\"m\u00e9dicament\",\"pharmacie\"],\"articleSection\":[\"dossier\",\"Gestions Hospitali\u00e8res\"],\"inLanguage\":\"fr-FR\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.ricom-web8.com\/gestions\/medicaments-a-risque\/\",\"url\":\"https:\/\/www.ricom-web8.com\/gestions\/medicaments-a-risque\/\",\"name\":\"M\u00e9dicaments \u00e0 risque - 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