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| Name | Class |
|---|---|
| Sainte-Anne Military Teaching Hospital | UNKNOWN |
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Environmental awareness leads medical field to question its responsibility and possibilities for action.
Drug residues can have a major environmental impact as per their bioaccumulation, toxicity and persistence characteristics, depending on where they are discarded. In France, drug residues should be disposed of by incineration, but in practice, this is not systematic. Moreover, data on drug wastage in Intensive Care Units (ICU) are rare.
GAME-OVER observational study aims to evaluate drug wastage in ICU in France and to suggest ways to improve health care practices.
Observational study with data collection during a 24-hour business day. Data collected refer to healthcare team's practices and patients.
Collection starts when day shift starts (at 7:00 am) and ends when night shift leaves (at 7:00 am the following day).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intravenous (IV) drugs | Patient and prepared/administrated/discarded IV drugs data will be collected during 24 hours. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Quantification of IV drugs wastage | Other | Drugs are prescribed depending on physician discretion. Specific collection bins are provided to ICU. Healthcare teams discard syringes labelled with name and dilution which have been used to prepare drugs into these bins. After 24 hours of collection, bins are analyzed by investigators. |
| Measure | Description | Time Frame |
|---|---|---|
| Ratio of overall wastage in milliliter (mL) of prepared and discarded IV drugs to overall volume in milliliter (mL) of prepared IV drugs. | Wastage is defined as any prepared and unused drug that remains in syringe or IV bag. | 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Reason for discarding drug residues | A questionnaire will be fulfilled by healthcare teams with the following possible categories: 1/ prepared in advance and not used ; 2/ systematic change at fixed times ; 3/ prescription change ; 4/ change by anticipation of care ; 5/ drug no longer needed ; 6/ preparation error ; 7/ other reason. | 24 hours |
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Inclusion Criteria:
Exclusion Criteria:
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Adult patients hospitalized in intensive care units during the 24 hours of data collection.
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| Name | Affiliation | Role |
|---|---|---|
| Erwan D'ARANDA, MD | Sainte-Anne Military Teaching Hospital | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Centre Hospitalier de Charleville-Mezieres | Charleville-Mézières | Ardennes | 08000 | France | ||
| CHRU de Strasbourg |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41345913 | Result | Atchade E, Cungi PJ, Pons S, Dahyot-Fizelier C, Cesana M, Lukaszewicz AC, Bouhemad B, Trouiller P, Chelly J, Montravers P, Vardon F, D'Aranda E; SFAR Critical Care Committee; SFAR Sustainability Committee; SFAR Research Network; GAME-OVER Study group; GAME-OVER investigators group. Characteristics of French intensive care units and patients: an ancillary analysis of the GAME-OVER study. BMC Anesthesiol. 2025 Dec 5;26(1):27. doi: 10.1186/s12871-025-03473-5. | |
| 41493367 |
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| Drug residues discarding process | A questionnaire will be used to determine which discarding process are applied by nurses in their usual pratices. | 24 hours |
| Use of enteral administration route | Use of enteral administration route versus per os and IV routes will be analyzed for paracetamol and proton pump inhibitor according to the accessibility of enteral route and the reason and the date of patient entry in ICU. | 24 hours |
| Cost of overall IV drug wastage | Estimated cost of drug residues will be evaluated for each drug, according to the reason for discarding, by the following formula : volume of discarded IV drugs x theoretical price | 24 hours |
| Strasbourg |
| Bas-Rhin |
| 67098 |
| France |
| Hôpital Nord | Marseille | Bouches Du Rhône | 13015 | France |
| Centre Hospitalier d'Aurillac | Aurillac | Cantal | 15000 | France |
| Groupe Hospitalier Littoral Atlantique | La Rochelle | Charente-Maritime | 17019 | France |
| CHU de Besançon | Besançon | Doubs | 25000 | France |
| Centre Hospitalier de Montélimar | Montélimar | Drôme | 26216 | France |
| Hôpital privé Claude Galien | Quincy-sous-Sénart | Essonne | 91480 | France |
| HIA Clermont Tonnerre | Brest | Finistère | 29240 | France |
| CHRU de Brest | Brest | Finistère | 29609 | France |
| CHU de Nîmes | Nîmes | Gard | 30900 | France |
| Clinique Saint Augustin | Bordeaux | Gironde | 33000 | France |
| CHU de Bordeaux - Hôpital Pellegrin | Bordeaux | Gironde | 33076 | France |
| HIA Robert Picqué | Bordeaux | Gironde | 33140 | France |
| Hôpital Robert Boulin | Libourne | Gironde | 33500 | France |
| CHU de Toulouse - Hôpital Purpan | Toulouse | Haute Garonne | 31059 | France |
| Clinique la Croix du Sud | Quint-Fonsegrives | Haute-Garonne | 31130 | France |
| CHU de Toulouse - Hôpital Rangueil | Toulouse | Haute-Garonne | 31059 | France |
| Clinique Pasteur | Toulouse | Haute-Garonne | 31300 | France |
| Centre Hospitalier Emile Roux | Le Puy-en-Velay | Haute-Loire | 43000 | France |
| Hôpital privé d'Antony | Antony | Hauts-de-Seine | 92160 | France |
| HIA Percy-Clamart | Clamart | Hauts-de-Seine | 92141 | France |
| Hôpital Américain de Paris | Neuilly-sur-Seine | Hauts-de-Seine | 92200 | France |
| CHU de Rennes | Rennes | Ille-et-Vilaine | 35033 | France |
| CHRU de Tours | Chambray-lès-Tours | Indre-et-Loire | 37170 | France |
| CHU de Grenoble | La Tronche | Isère | 38700 | France |
| Centre Hospitalier de Dax | Dax | Landes | 40100 | France |
| Centre Hospitalier de Mont-de-Marsan | Mont-de-Marsan | Landes | 40024 | France |
| Centre Hospitalier Simone Veil | Blois | Loir-et-Cher | 41000 | France |
| Centre Hospitalier de Saint Nazaire | Saint-Nazaire | Loire-Atlantique | 44600 | France |
| Centre Hospitalier d'Orléans | Orléans | Loiret | 45100 | France |
| Centre Hospitalier de Cahors | Cahors | Lot | 46005 | France |
| CHU d'Angers | Angers | Maine-et-Loire | 49100 | France |
| Centre Hospitalier Mémorial de Saint-Lô | Saint-Lô | Manche | 50000 | France |
| CHU de Reims | Reims | Marne | 51100 | France |
| Centre Hospitalier Bretagne Atlantique de Vannes | Vannes | Morbihan | 56017 | France |
| CHU de Lille - Hôpital Huriez | Lille | Nord | 59037 | France |
| CHU de Lille - Hôpital Roger Salengro | Lille | Nord | 59037 | France |
| Centre Hospitalier du Forez | Montbrison | Pays de la Loire Region | 42600 | France |
| CHU de Saint-Etienne | Saint-Priest-en-Jarez | Pays de la Loire Region | 42270 | France |
| CHU de Clermont-Ferrand | Clermont-Ferrand | Puy-de-Dôme | 63003 | France |
| Hôpital Pierre Wertheimer | Bron | Rhône | 69677 | France |
| Hôpital Edouard Herriot | Lyon | Rhône | 69003 | France |
| Clinique de la Sauvegarde | Lyon | Rhône | 69009 | France |
| CHU Félix-Guyon | Saint-Denis | Réunion | 97400 | France |
| CHU de la Réunion | Saint-Pierre | Réunion | 97410 | France |
| Grand Hôpital de l'Est Francilien | Meaux | Seine-et-Marne | 77100 | France |
| CHU d'Amiens | Amiens | Somme | 80054 | France |
| Hôpital Nord Franche-Comté | Trévenans | Territoire De Belfort | 90400 | France |
| Centre Hospitalier Victor Dupouy | Argenteuil | Val d'Oise | 95100 | France |
| Hôpital Henri Mondor | Créteil | Val-de-Marne | 94000 | France |
| HIA Sainte Anne | Toulon | Var | 83000 | France |
| Hôpital Sainte Musse | Toulon | Var | 83056 | France |
| CHU de Poitiers | Poitiers | Vienne | 86021 | France |
| Centre Hospitalier de Versailles | Le Chesnay | Yvelines | 78150 | France |
| CHU Dupuytren | Limoges | 87042 | France |
| Hôpital Lariboisière | Paris | 75010 | France |
| Hôpital La Pitié-Salpétrière | Paris | 75013 | France |
| Hôpital Bichat | Paris | 75018 | France |
| Centre Hospitalier de Mayotte | Mamoudzou | 97600 | Mayotte |
| Centre Hospitalier Princesse Grace | Monaco | 98000 | Monaco |
| Result |
| d'Aranda E, Cungi PJ, Chelly J, Pons S; GAME-OVER Study Group, GAME-OVER Study Investigators, French Society of Anesthesia & Intensive Care Medicine (SFAR) Sustainability; Committee, SFAR Critical Care Committee, and SFAR Research Network; GAME-OVER Study Group, GAME-OVER Study Investigators, French Society of Anesthesia & Intensive Care Medicine (SFAR) Sustainability and Committee, SFAR Critical Care Committee, and SFAR Research Network. Sustainable Intensive Care: Do Not Forget IV to Oral Switch! Crit Care Med. 2026 Jan 1;54(1):218-223. doi: 10.1097/CCM.0000000000006944. Epub 2026 Jan 6. No abstract available. |
| 41566365 | Result | d'Aranda E; GAME-OVER investigators group; Pons S, Chelly J, Atchade E, Bonnet L; SFAR Sustainable Development Committee; Dahyot-Fizelier C; SFAR Critical Care Committee; Kamel T, Giannoni F, Collange O, Besnier E, Schoeffler M, Mayeur N, Quere PL, Marecal L, Pernod C, Geay C, Esnault P, Cinotti R; SFAR Research Network; Cesana M, Cungi PJ. Correction: Discarded intravenous medication in the ICU: the GAME-OVER multicenter prospective observational study. Crit Care. 2026 Jan 21;30(1):32. doi: 10.1186/s13054-025-05822-9. No abstract available. |
| 39985053 | Derived | d'Aranda E; GAME-OVER investigators group; Pons S, Chelly J, Atchade E, Bonnet L; SFAR Sustainable Development Committee; Dahyot-Fizelier C; SFAR Critical Care Committee; Kamel T, Giannoni F, Collange O, Besnier E, Schoeffler M, Mayeur N, Quere PL, Marecal L, Pernod C, Geay C, Esnault P, Cinotti R; SFAR Research Network; Cesana M, Cungi PJ. Discarded intravenous medication in the ICU: the GAME-OVER multicenter prospective observational study. Crit Care. 2025 Feb 21;29(1):84. doi: 10.1186/s13054-025-05299-6. |