Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041608.2
Y. Ejot, F. Raffe, V. Osseby-Guy, D. Touze, A. Peyron, F. Pelisser, P. Routhier, M. Giroud
Context and Aims Secondary prevention of stroke is a major medical challenge because recurrence is a cause of motor handicap and dementia. The prevention strategy lies on two effective and validated measures: identification of the risk factors of recurrence and the specific treatment of these risk factors. Nevertheless, there is a mismatch between the data of positive clinical trials conducted in highly selected populations and the results observed in real life from nonselected populations. On the basis of this observation, the neurologists of Burgundy have set up a care network, called Réseau Bourgogne–AVC, whose aims were to decrease the incidence of stroke recurrence, using national and international recommendations. Program and Methods The Réseau Bourgogne—AVC was set up with the label of Unions Régionales des Caisses d'Assurance Maladie (URCAM) and Appalachian Regional Healthcare (ARH) in 2003 to coordinate and standardize the secondary prevention of stroke in the region. The evaluation was based on the population of the city of Dijon (150 000 inhabitants) thanks to the Dijon Stroke Registry which collects close to 220 strokes every year. Data have been gathered continuously since 1985. Data on recurrent strokes from 1985 to 2002 allowed us to calculate a model of the trends using a Poisson Logistic regression, considering the age, sex and year as continuous variables. The curve of the recurrent strokes observed from 2003 to 2007 was compared to the curve of expected recurrent stroke. Results During the period 2003–2007, we collected 162 recurrent strokes (14.8% of the cases) compared to 196 expected recurrent strokes (18.0% of the cases), with a significant decrease (0.82 (0.70-0.96)) (p=0.013). Discussion The significant decrease in the number of strokes collected since 2003 compared to the expected number, is a new and encouraging trend with regard to the actions conducted by the network. The first explanation for the decrease in the number of recurrent strokes could be the decrease in the incidence rates of stroke in Dijon. However, in Dijon, the incidence rate has been stable since 1985. Another explanation could be the decrease in the mortality rates observed in Dijon. However, an increase in the number of patients surviving strokes would increase the number of recurrent strokes because of the increased number of the population at risk of recurrence. The use of new therapies could also explain this trend. But between 2003 and 2007, there were no new therapies, apart from statins, which were validated at the end of our study. The probable explanation is the effect of the stroke network. The network could act by spreading awareness of good practices, appropriate treatments and the relevant indications, encouraging better compliance of patients, better coordination in secondary prevention, decompartmentalisation of medical services, and the development of follow-up at home to provide patients with therapeutic education and thus allow t
{"title":"008 Evaluation of the efficacy of a care network for secondary prevention stroke","authors":"Y. Ejot, F. Raffe, V. Osseby-Guy, D. Touze, A. Peyron, F. Pelisser, P. Routhier, M. Giroud","doi":"10.1136/QSHC.2010.041608.2","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041608.2","url":null,"abstract":"Context and Aims Secondary prevention of stroke is a major medical challenge because recurrence is a cause of motor handicap and dementia. The prevention strategy lies on two effective and validated measures: identification of the risk factors of recurrence and the specific treatment of these risk factors. Nevertheless, there is a mismatch between the data of positive clinical trials conducted in highly selected populations and the results observed in real life from nonselected populations. On the basis of this observation, the neurologists of Burgundy have set up a care network, called Réseau Bourgogne–AVC, whose aims were to decrease the incidence of stroke recurrence, using national and international recommendations. Program and Methods The Réseau Bourgogne—AVC was set up with the label of Unions Régionales des Caisses d'Assurance Maladie (URCAM) and Appalachian Regional Healthcare (ARH) in 2003 to coordinate and standardize the secondary prevention of stroke in the region. The evaluation was based on the population of the city of Dijon (150 000 inhabitants) thanks to the Dijon Stroke Registry which collects close to 220 strokes every year. Data have been gathered continuously since 1985. Data on recurrent strokes from 1985 to 2002 allowed us to calculate a model of the trends using a Poisson Logistic regression, considering the age, sex and year as continuous variables. The curve of the recurrent strokes observed from 2003 to 2007 was compared to the curve of expected recurrent stroke. Results During the period 2003–2007, we collected 162 recurrent strokes (14.8% of the cases) compared to 196 expected recurrent strokes (18.0% of the cases), with a significant decrease (0.82 (0.70-0.96)) (p=0.013). Discussion The significant decrease in the number of strokes collected since 2003 compared to the expected number, is a new and encouraging trend with regard to the actions conducted by the network. The first explanation for the decrease in the number of recurrent strokes could be the decrease in the incidence rates of stroke in Dijon. However, in Dijon, the incidence rate has been stable since 1985. Another explanation could be the decrease in the mortality rates observed in Dijon. However, an increase in the number of patients surviving strokes would increase the number of recurrent strokes because of the increased number of the population at risk of recurrence. The use of new therapies could also explain this trend. But between 2003 and 2007, there were no new therapies, apart from statins, which were validated at the end of our study. The probable explanation is the effect of the stroke network. The network could act by spreading awareness of good practices, appropriate treatments and the relevant indications, encouraging better compliance of patients, better coordination in secondary prevention, decompartmentalisation of medical services, and the development of follow-up at home to provide patients with therapeutic education and thus allow t","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"107 1","pages":"A3 - A4"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81334536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041616.10
G. Osseby, Y. Béjot, A. Chantegret, J. Durier, D. Honnart, H. Roy, F. Ricolfi, J. Gerbet, A. Bernard, T. Moreau, M. Giroud, M. Freysz
Context The management of acute stroke has become a structuring model in hospital organisation with the aim to improve the acute care of stroke. Stroke has become a medical emergency since the arrival of new active treatments in cerebral infarction. Fibrinolysis, for example, needs to be administered within the first 3 hours following admission to a stroke unit. The fact that stroke is a race against time is a new reality for carers. In contrast, the consequences of a poorly organised network may be severe. If fibrinolysis were used in all of the eligible cases of cerebral infarction, we could avoid 7500 deaths or severe handicap in France every year. Objectives What triggered our interest in setting up the Professional Practice Evaluation (PPE) was the realisation in 2006 that in Dijon University Hospital only a small number of interventions involved fibrinolysis (a mean of 12 per year). The principal aim of the PPE was to identify the intrahospital factors that led to delay in admission to the Stroke Unit at Dijon CHU, while the secondary objective was to increase the use of fibrinolysis every year. Methods All of those involved in the stroke network were trained according to a standardised protocol from 01 January 2006 to 30 September 2006: Staff working in the emergency room, imaging services, biology laboratory, ambulance and transportation services and stroke unit. The indicators, which were compared before and after the PPE, were the following: the delay to imaging, to biological results, to arrival at the stroke unit and the number of fibrinolysis. This prospective work was performed from 01 January 2006 to 30 September 2006, and was evaluated in 2007, and the data were compared to prior data collected since 1985 by the Dijon Stroke Registry. Results We observed the following results: the proportion of imaging performed within the first 3 hours rose from 46% to 83 %; the mean delay to imaging decreased from156 min to 115 min, the time from arrival to imaging dropped from 87 to 37 min; the time between arrival and biological results decreased from 70 to 32 min; the mean annual number of fibrinolyses performed, around 12 per year between 2003 to 2006, tripled in 2007 and by 6 in 2008. Discussion The training of the different professionals dramatically improved all the parameters evaluated, leading to a huge increase in the number of fibrinolyses, and inestimable benefits for stroke patients. Moreover, all the services that were considered unsatisfactory, such as imaging, biological analyses and ambulance, reacted positively, which made it possible to improve the parameters. We found that carers were willing to revise their usual practices without a feeling of guilt, and thus generated a huge improvement in the whole care process. Perspectives We are evaluating the benefits in terms of the decrease in mortality and handicap since the implementation of PPE. Conclusion We have demonstrated that at no extra cost it is possible to improve a stro
{"title":"010 An example of evaluation of the professional practice leading to the improvement of care: the hospital stroke network","authors":"G. Osseby, Y. Béjot, A. Chantegret, J. Durier, D. Honnart, H. Roy, F. Ricolfi, J. Gerbet, A. Bernard, T. Moreau, M. Giroud, M. Freysz","doi":"10.1136/QSHC.2010.041616.10","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041616.10","url":null,"abstract":"Context The management of acute stroke has become a structuring model in hospital organisation with the aim to improve the acute care of stroke. Stroke has become a medical emergency since the arrival of new active treatments in cerebral infarction. Fibrinolysis, for example, needs to be administered within the first 3 hours following admission to a stroke unit. The fact that stroke is a race against time is a new reality for carers. In contrast, the consequences of a poorly organised network may be severe. If fibrinolysis were used in all of the eligible cases of cerebral infarction, we could avoid 7500 deaths or severe handicap in France every year. Objectives What triggered our interest in setting up the Professional Practice Evaluation (PPE) was the realisation in 2006 that in Dijon University Hospital only a small number of interventions involved fibrinolysis (a mean of 12 per year). The principal aim of the PPE was to identify the intrahospital factors that led to delay in admission to the Stroke Unit at Dijon CHU, while the secondary objective was to increase the use of fibrinolysis every year. Methods All of those involved in the stroke network were trained according to a standardised protocol from 01 January 2006 to 30 September 2006: Staff working in the emergency room, imaging services, biology laboratory, ambulance and transportation services and stroke unit. The indicators, which were compared before and after the PPE, were the following: the delay to imaging, to biological results, to arrival at the stroke unit and the number of fibrinolysis. This prospective work was performed from 01 January 2006 to 30 September 2006, and was evaluated in 2007, and the data were compared to prior data collected since 1985 by the Dijon Stroke Registry. Results We observed the following results: the proportion of imaging performed within the first 3 hours rose from 46% to 83 %; the mean delay to imaging decreased from156 min to 115 min, the time from arrival to imaging dropped from 87 to 37 min; the time between arrival and biological results decreased from 70 to 32 min; the mean annual number of fibrinolyses performed, around 12 per year between 2003 to 2006, tripled in 2007 and by 6 in 2008. Discussion The training of the different professionals dramatically improved all the parameters evaluated, leading to a huge increase in the number of fibrinolyses, and inestimable benefits for stroke patients. Moreover, all the services that were considered unsatisfactory, such as imaging, biological analyses and ambulance, reacted positively, which made it possible to improve the parameters. We found that carers were willing to revise their usual practices without a feeling of guilt, and thus generated a huge improvement in the whole care process. Perspectives We are evaluating the benefits in terms of the decrease in mortality and handicap since the implementation of PPE. Conclusion We have demonstrated that at no extra cost it is possible to improve a stro","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"20 1","pages":"A33 - A34"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81390677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041616.11
D. Pouchain, D Huas, J. Lebeau, V. Renard, P. Druais
Program ESCAPE is a cluster randomised controlled trial designed to show that a multifaceted intervention, aimed at general practitioners (GPs), can improve high-risk hypertensive patients' health outcomes, without affecting their quality of life. 12 regional colleges of GP, including 128 investigators, were randomised as clusters in the intervention group (IG), and 11 colleges, including 131 GP, in the control group (CG). 1832 hypertensive patients with at least two other cardiovascular risk factors, including 1047 patients suffering from type 2 diabetes (T2D), all in primary prevention, were included between November 2006 and July 2007, and then followed-up for 2 years. The intervention consisted of: One day of medical education, aiming on the therapeutic targets and strategies for achievement, featured in the HAS and AFSSAPS guidelines on hypertensive and T2D patients' care, An electronic blood pressure (BP) measurement device, and a leaflet summarising the guidelines provided to the GP, five prevention-dedicated consultations, of 30 min each, twice a year, performed by the GP. During these, the GP was to negotiate drug changes if guidelines targets were not achieved, and systematically assessed patient's compliance, dietetics, exercise and smoking issue if needed, A feedback on IG patients' results at baseline and at 1-year follow-up. Primary end point is the number of patients achieving all the targets featured in the guidelines, namely: BP≤140/90 mm Hg, LDL-C≤1.30 g/l, and no smoking, for the hypertensive patients without T2D. BP≤130/80 mm Hg, LDL-C≤1.0 g/l, HbA1c≤7%, a low-dose of aspirin, and no smoking, for the hypertensive patients with T2D. Secondary end points are: the number of patients achieving each goal, the variation of the value of each goal, clinical cardiovascular events (angina pectoris, acute coronary syndrome, myocardial infarction, stroke, heart failure, arteritis, cardiovascular death, and death from any other cause) and the quality of life (SF-8). Results From 1832 patients included (905 in the IG and 927 in the CG), 1 741 (95%) completed the study. The database will be closed in December 2009. The final results will be available in January 2010, and the comparison between the IG and the CG, in terms of clinical outcomes, will be presented at the HAS and BMJ symposium. The baseline characteristics of the 1832 patients were: Male 63.5%, mean age 61 year, mean body weight=85.9 kg, BMI=30.9 kg/m2, BP=142/82 mm Hg, LDL-C=1.2 g/l, fasting blood glucose=1.2 g/l, mean HbA1c=7.0%. BP targets was achieved for 25.2% of the patients, LDL-C targets for 40.5%, HbA1c target for 54.7% of the T2D patients, 30.2% of them received aspirin, and 78.2% were non smokers. On the primary end point: 7.2% of the 1832 patients achieved their 3 or 5 targets. 11.0% of the 785 hypertensive without T2D patients achieved their three targets. 1.7 % of 1 047 T2D patients achieved their five targets. Conclusion ESCAPE population's baseline characteristics
ESCAPE项目是一项集群随机对照试验，旨在表明针对全科医生(gp)的多方面干预可以改善高危高血压患者的健康结果，而不影响他们的生活质量。12所地区全科学校(128名调查人员)随机分为干预组(IG)和对照组(CG)，分别为11所学校(131名全科学校)。本研究于2006年11月至2007年7月纳入1832例伴有至少两种其他心血管危险因素的高血压患者，其中1047例患有2型糖尿病(T2D)，均为一级预防，随访2年。干预措施包括:一天的医学教育，目的是治疗目标和实现策略，这是HAS和AFSSAPS高血压和T2D患者护理指南的特点，一个电子血压测量装置，以及向全科医生提供指南总结的传单，全科医生每年进行两次，每次30分钟的五次预防专门咨询。在此期间，如果指南目标未达到，全科医生将协商药物变更，并在需要时系统评估患者的依从性，饮食，运动和吸烟问题，并对IG患者的基线和1年随访结果进行反馈。主要终点为无T2D的高血压患者达到指南中所有指标(BP≤140/90 mm Hg, LDL-C≤1.30 g/l，不吸烟)的人数。高血压合并T2D患者，血压≤130/80 mm Hg, LDL-C≤1.0 g/l, HbA1c≤7%，小剂量阿司匹林，不吸烟。次要终点是:达到每个目标的患者人数、每个目标值的变化、临床心血管事件(心绞痛、急性冠状动脉综合征、心肌梗死、中风、心力衰竭、动脉炎、心血管死亡和任何其他原因的死亡)和生活质量(SF-8)。结果1832例患者(IG组905例，CG组927例)中，1741例(95%)完成了研究。该数据库将于2009年12月关闭。最终结果将于2010年1月公布，IG和CG在临床结果方面的比较将在HAS和BMJ研讨会上发表。1832例患者的基线特征为:男性63.5%，平均年龄61岁，平均体重85.9 kg, BMI=30.9 kg/m2，血压=142/82 mm Hg, LDL-C=1.2 g/l，空腹血糖=1.2 g/l，平均HbA1c=7.0%。25.2%的患者血压达标，40.5%的患者LDL-C达标，54.7%的T2D患者HbA1c达标，30.2%的患者服用阿司匹林，78.2%的患者不吸烟。在主要终点:1832例患者中有7.2%达到了3或5个目标。785例无T2D的高血压患者中有11.0%达到了3个指标。1047例T2D患者中有1.7%达到了5个指标。结论ESCAPE人群的基线特征反映了全科医生对高危高血压患者一级预防的做法。患者实现一个(更不用说两个或更多)推荐目标的低比率导致质疑，不仅是实践，而且是日常全科实践中指南目标的“可及性”。ESCAPE的最终结果将量化多方面干预对患者健康结果的临床影响。ESCAPE方案的试验结果是:随机取样，随机取样，随机取样，随机取样，随机取样，随机取样，随机取样，随机取样，随机取样，随机取样，随机取样，随机取样，随机取样12所大学的128名调查人员接受了随机干预(GI)， 11所大学的131名调查人员接受了随机干预(GT)。1 832例高血压患者有2个主要的危险因素，1 047例为2型糖尿病型(DT2)， 3例为2型(包括2006年11月和2007年6月)，2例为急性期。形成一个journee de苏尔目的therapeutiques et les策略倒atteindre indiques在recommandations已经等法国亲戚拉撬en电荷des病人hypertendus用或者无DT2, la fourniture用品tensiometre electronique et d一个传单resumant les recommandations 5磋商specifiques de预防一个duree en 2答。杜兰特celles-ci de 30分钟,将患者的身体状况与目标进行比较，将患者的身体状况与目标进行比较，将患者的身体状况与目标进行比较，将患者的身体状况与目标进行比较，将患者的身体状况与目标进行比较，将患者的身体状况与目标进行比较，将患者的身体状况与目标进行比较，将患者的身体状况与目标进行比较，将患者的身体状况与目标进行比较。
{"title":"246 Effects of a multifaceted intervention on the cardiovascular risk factors of high-risk hypertensive patients in primary prevention (ESCAPE trial)","authors":"D. Pouchain, D Huas, J. Lebeau, V. Renard, P. Druais","doi":"10.1136/QSHC.2010.041616.11","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041616.11","url":null,"abstract":"Program ESCAPE is a cluster randomised controlled trial designed to show that a multifaceted intervention, aimed at general practitioners (GPs), can improve high-risk hypertensive patients' health outcomes, without affecting their quality of life. 12 regional colleges of GP, including 128 investigators, were randomised as clusters in the intervention group (IG), and 11 colleges, including 131 GP, in the control group (CG). 1832 hypertensive patients with at least two other cardiovascular risk factors, including 1047 patients suffering from type 2 diabetes (T2D), all in primary prevention, were included between November 2006 and July 2007, and then followed-up for 2 years. The intervention consisted of: One day of medical education, aiming on the therapeutic targets and strategies for achievement, featured in the HAS and AFSSAPS guidelines on hypertensive and T2D patients' care, An electronic blood pressure (BP) measurement device, and a leaflet summarising the guidelines provided to the GP, five prevention-dedicated consultations, of 30 min each, twice a year, performed by the GP. During these, the GP was to negotiate drug changes if guidelines targets were not achieved, and systematically assessed patient's compliance, dietetics, exercise and smoking issue if needed, A feedback on IG patients' results at baseline and at 1-year follow-up. Primary end point is the number of patients achieving all the targets featured in the guidelines, namely: BP≤140/90 mm Hg, LDL-C≤1.30 g/l, and no smoking, for the hypertensive patients without T2D. BP≤130/80 mm Hg, LDL-C≤1.0 g/l, HbA1c≤7%, a low-dose of aspirin, and no smoking, for the hypertensive patients with T2D. Secondary end points are: the number of patients achieving each goal, the variation of the value of each goal, clinical cardiovascular events (angina pectoris, acute coronary syndrome, myocardial infarction, stroke, heart failure, arteritis, cardiovascular death, and death from any other cause) and the quality of life (SF-8). Results From 1832 patients included (905 in the IG and 927 in the CG), 1 741 (95%) completed the study. The database will be closed in December 2009. The final results will be available in January 2010, and the comparison between the IG and the CG, in terms of clinical outcomes, will be presented at the HAS and BMJ symposium. The baseline characteristics of the 1832 patients were: Male 63.5%, mean age 61 year, mean body weight=85.9 kg, BMI=30.9 kg/m2, BP=142/82 mm Hg, LDL-C=1.2 g/l, fasting blood glucose=1.2 g/l, mean HbA1c=7.0%. BP targets was achieved for 25.2% of the patients, LDL-C targets for 40.5%, HbA1c target for 54.7% of the T2D patients, 30.2% of them received aspirin, and 78.2% were non smokers. On the primary end point: 7.2% of the 1832 patients achieved their 3 or 5 targets. 11.0% of the 785 hypertensive without T2D patients achieved their three targets. 1.7 % of 1 047 T2D patients achieved their five targets. Conclusion ESCAPE population's baseline characteristics","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"6 1","pages":"A34 - A35"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82119056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/qshc.2010.041632.13
P. Coriat, Y. Le Manach, A. Foucrier, J. Goarin, M. Fléron
Background and Objectives Postoperative acute cardiac events are one of the most common causes of mortality following vascular surgery. The repercussions of myocardial infarction (MI) exacerbate immediate postoperative mortality and seriously impact on life expectancy. Postoperative surveillance to detect elevated troponin I (cTnI) levels (the most accurate cardiac biomarker for postoperative MI) is not only crucial to early diagnosis of postoperative MI but can also help limit long-term mortality by prompting appropriate treatment. However, the impact of such treatment on short- and long-term postoperative morbidity and mortality has not been studied. Management might be suboptimal. Our objective was to analyse the immediate and longer term (1 year) impact of following recommendations based on evidence-based data by intensifying treatment of coronary artery disease in patients presenting elevated postoperative cardiac cTnI levels following major vascular surgery. Programme We undertook a retrospective case-controlled study on a population of 665 consecutive patients who had undergone vascular surgery. The case subjects were the 66 patients (9.9%) with elevated postoperative cTnI. For each case, we selected 2 controls from the remaining patients using logistic regression and nearest neighbour matching methods applied to preoperative and intra-operative sets of variables Results According to an independent expert committee, 44 (67%) of the 66 patients had received treatment intensification. Mean follow-up was 14 months (range, 6–31). Intensified postoperative cardiovascular treatment was associated with significant benefit in terms of 1-year mortality (p=0.027) on comparing patients who had or had not received intensified treatment. There was no difference in mortality between patients receiving intensified postoperative therapy and those who did not experience a postoperative elevation in cTn1, suggesting that treatment might normalise life expectancy in patients with elevated cTnI. In over 70% of patients, the treatment taken at 1 year on a regular basis was no different from the treatment they had been given on discharge from hospital. Discussion and Conclusion In patients with elevated postoperative cTnI, short- and long-term outcomes can be improved by following evidence-based recommendations for the management of acute coronary syndromes. In addition, appropriate secondary prevention of coronary artery disease following hospital discharge contributes towards a positive impact on life expectancy in these patients. Contexte et objectifs L'insuffisance coronaire aiguë reste l'une des principales causes de morbidité et de mortalité chez les opérés de chirurgie vasculaire. Cette complication aggrave le risque postopératoire immédiat et altère de façon importante l'espérance de vie à moyen terme des opérés. La mise en évidence d'une élévation de troponine (TnI) post opératoire qui détecte avec fiabilité une insuffisance coronair
背景和目的术后急性心脏事件是血管手术后最常见的死亡原因之一。心肌梗死(MI)的影响加剧了术后立即死亡率并严重影响预期寿命。术后监测检测肌钙蛋白I (cTnI)水平升高(术后心肌梗死最准确的心脏生物标志物)不仅对术后心肌梗死的早期诊断至关重要，而且可以通过促进适当的治疗来帮助限制长期死亡率。然而，这种治疗对术后短期和长期发病率和死亡率的影响尚未研究。管理可能不是最理想的。我们的目的是分析基于循证数据的建议对大血管手术后出现心脏cTnI水平升高的患者强化冠状动脉疾病治疗的近期和长期(1年)影响。我们对665例连续接受血管手术的患者进行了回顾性病例对照研究。病例对象为66例(9.9%)术后cTnI升高的患者。对于每个病例，我们使用术前和术中变量集的逻辑回归和最近邻匹配方法从剩余患者中选择2例对照。结果根据独立专家委员会的数据，66例患者中有44例(67%)接受了强化治疗。平均随访14个月(范围6-31)。与接受或未接受强化治疗的患者相比，术后强化心血管治疗与1年死亡率的显著获益相关(p=0.027)。术后接受强化治疗的患者与术后cTn1水平未升高的患者之间的死亡率没有差异，这表明治疗可能使cTnI水平升高的患者的预期寿命正常化。在超过70%的患者中，1年定期接受的治疗与出院时接受的治疗没有什么不同。对于术后cTnI升高的患者，遵循循证建议处理急性冠状动脉综合征可改善短期和长期预后。此外，出院后适当的冠状动脉疾病二级预防有助于对这些患者的预期寿命产生积极影响。背景与目的:冠状动脉病变aiguë发病原因与死亡原因与血管外科手术相关。其他并发症加重了其他风险，即停止后的变性和变性后的变性，并使变性后的变性和变性后的变性更为重要。在过去的一段时间里，我一直在为我的个人生活做准备，我一直在为我的个人生活做准备，我一直在为我的个人生活做准备。Cette hypothise est est samtayacei par le fait que que preprise en charge de l' suffisance coronaire aiguë停止后的samuresire para<e:1>不适应的samurese, car l'impact de preprise en charge现代的samuresisance coronaire aiguë sur la mortalit<e:1>法院期限et l' espacriance de vie de opsamrimes in ' jamais的samures<e:1>。在长期治疗过程中，对患者进行治疗后，对患者进行治疗后，对患者进行治疗后，对患者进行治疗后，对患者进行治疗后的治疗。方案1:1 . <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> - - - - - - - - - - - - - - - - - - - - -莱斯66年中科院(10%)标识correspondaient辅助病人ayant呈现一个海拔postoperatoire de TnI杜兰特拉里面有d 'etude。Pour chque cas 2 .将所有的可变因素(年龄、性别、是否患有糖尿病、是否患有糖尿病等)与所有的可变因素(体积、是否患有糖尿病等)结合起来，将所有的可变因素(体积、是否患有糖尿病等)结合起来。我分析统计数据，重新调整后的薪金，重新调整后的薪金，后勤保障，以及设备和附加程序。有一个显著的差异，即:观察到的死亡时间和死亡时间(1)与患者的死亡时间和死亡时间(1)相比有显著的差异(p=0.027)。另外，在观察过程中，患者的生存过程有差异，患者的生存过程有差别，患者的生存过程有差别，患者的生存过程有差别，患者的生存过程有差别，患者的生存过程有差别，患者的生存过程有差别，患者的生存过程有差别，患者的生存过程有差别，患者的生存过程有差别，患者的生存过程有差别。
{"title":"092 Long-term impact of cardiovascular therapy intensification after postoperative myocardial necrosis following major vascular surgery: a case control study","authors":"P. Coriat, Y. Le Manach, A. Foucrier, J. Goarin, M. Fléron","doi":"10.1136/qshc.2010.041632.13","DOIUrl":"https://doi.org/10.1136/qshc.2010.041632.13","url":null,"abstract":"Background and Objectives Postoperative acute cardiac events are one of the most common causes of mortality following vascular surgery. The repercussions of myocardial infarction (MI) exacerbate immediate postoperative mortality and seriously impact on life expectancy. Postoperative surveillance to detect elevated troponin I (cTnI) levels (the most accurate cardiac biomarker for postoperative MI) is not only crucial to early diagnosis of postoperative MI but can also help limit long-term mortality by prompting appropriate treatment. However, the impact of such treatment on short- and long-term postoperative morbidity and mortality has not been studied. Management might be suboptimal. Our objective was to analyse the immediate and longer term (1 year) impact of following recommendations based on evidence-based data by intensifying treatment of coronary artery disease in patients presenting elevated postoperative cardiac cTnI levels following major vascular surgery. Programme We undertook a retrospective case-controlled study on a population of 665 consecutive patients who had undergone vascular surgery. The case subjects were the 66 patients (9.9%) with elevated postoperative cTnI. For each case, we selected 2 controls from the remaining patients using logistic regression and nearest neighbour matching methods applied to preoperative and intra-operative sets of variables Results According to an independent expert committee, 44 (67%) of the 66 patients had received treatment intensification. Mean follow-up was 14 months (range, 6–31). Intensified postoperative cardiovascular treatment was associated with significant benefit in terms of 1-year mortality (p=0.027) on comparing patients who had or had not received intensified treatment. There was no difference in mortality between patients receiving intensified postoperative therapy and those who did not experience a postoperative elevation in cTn1, suggesting that treatment might normalise life expectancy in patients with elevated cTnI. In over 70% of patients, the treatment taken at 1 year on a regular basis was no different from the treatment they had been given on discharge from hospital. Discussion and Conclusion In patients with elevated postoperative cTnI, short- and long-term outcomes can be improved by following evidence-based recommendations for the management of acute coronary syndromes. In addition, appropriate secondary prevention of coronary artery disease following hospital discharge contributes towards a positive impact on life expectancy in these patients. Contexte et objectifs L'insuffisance coronaire aiguë reste l'une des principales causes de morbidité et de mortalité chez les opérés de chirurgie vasculaire. Cette complication aggrave le risque postopératoire immédiat et altère de façon importante l'espérance de vie à moyen terme des opérés. La mise en évidence d'une élévation de troponine (TnI) post opératoire qui détecte avec fiabilité une insuffisance coronair","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"39 1","pages":"A160 - A160"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78970536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041624.74
Reckmans Caroline
Background and objectives Between 1998 and 2006, the St Vincent residential home for elderly dependent people (EHPAD) welcomed both residents without cognitive impairment and residents with Alzheimer's disease. We identified four main types of problem: quarrels, runaways, falls, and depressive syndrome. These incited us to set up a ‘Lifestyle project’ within a sheltered area welcoming Alzheimer patients. Its main objective was to offer patients a material and human space that was reassuring and friendly and that would help them maintain their residual abilities and enjoyment of life. The focus was on daily living activities, different types of pastime, entertainment, and encouraging self-expression. Program In October 2007, we created the ‘CANTOU’, a homely house within the St Vincent residential home, with accommodation suitable for 16 Alzheimer patients. Patients in this sheltered area have a Mini-Mental score (MMS) of 3-10/30 and suffer from excessive wandering. The team care includes three house matrons during the day and one at night. Management is tailored to each patient. The main objective of our program is to fight depression by early detection of: Eating disorders: We fight lack of appetite by a culinary project linked to ‘work’ in a vegetable garden. We monitor weight loss weekly and use high-protein food supplements when needed. Anxiety and agitation: We propose a pastime based on social life in order to widen links with the ‘outside world’ and enhance relationships with the family. We help prevent falls by using ‘Alzheimer's beds’ that can be lowered right down to the ground. Loss of self-esteem: We offer a pastime based on daily living which aims to raise the patient's self-esteem and maintain functional abilities, without inducing any frustration. There is great flexibility in all our activities and relationships. Their aim is to maintain the patient's self-esteem, encourage use of residual abilities, support procedural memory, and in particular help patients enjoy life. Results After 2 years, we have observed an improvement in several aspects of the residents' quality of life: (i) We have not observed any weight loss, rather the contrary, (ii) We have never had any need to use neuroleptics or anxiolytic drugs, unlike in retirement homes where they are in routine use, (iii) Residual functions have been maintained. The MMS is stable in three CANTOU residents whereas three residents in the main establishment are now bedridden. Project limitations Once the patient no longer reacts to stimuli, he or she is transferred to the main establishment. Looking ahead To apply the same lifestyle project in a daycare setting for a greater number of patients. Conclusion High-quality nursing care for Alzheimer's patients helps maintain their residual capacities. Objectif(s), contexte Entre 1998 et 2006, l'EHPAD St Vincent accueillait des résidents sans trouble cognitif ainsi que des résidents Alzheimer. Nous avions pu identifier 4 types de diffic
背景和目的在1998年至2006年期间，圣文森特养老院(EHPAD)接待了没有认知障碍的居民和患有阿尔茨海默病的居民。我们确定了四种主要类型的问题:争吵、离家出走、跌倒和抑郁综合症。这促使我们在一个欢迎老年痴呆症患者的庇护区内建立了一个“生活方式项目”。它的主要目标是为患者提供一个令人放心和友好的物质和人类空间，帮助他们保持剩余的能力和享受生活。重点是日常生活活动，不同类型的消遣，娱乐和鼓励自我表达。2007年10月，我们在圣文森特住宅区内建造了“CANTOU”，这是一座适合16名阿尔茨海默病患者居住的家庭住宅。该庇护区患者的迷你精神评分(MMS)为3-10/30，并且患有过度流浪。团队护理包括白天三名女管家和晚上一名女管家。管理是为每个病人量身定制的。我们项目的主要目标是通过早期发现来对抗抑郁症:饮食失调:我们通过一个与菜园“工作”相关的烹饪项目来对抗食欲不振。我们每周监测体重下降情况，并在需要时使用高蛋白食物补充剂。焦虑和激动:我们提出了一种基于社交生活的消遣方式，以扩大与“外部世界”的联系，并加强与家人的关系。我们使用“老年痴呆症床”来帮助预防跌倒，这种床可以降低到地面。丧失自尊:我们提供一种基于日常生活的消遣，旨在提高患者的自尊和维持功能能力，而不会引起任何挫折。我们所有的活动和关系都有很大的灵活性。他们的目的是维护病人的自尊，鼓励使用剩余的能力，支持程序记忆，特别是帮助病人享受生活。结果2年后，我们观察到居民的生活质量在几个方面有所改善:(i)我们没有观察到任何体重下降，相反;(ii)我们从未需要使用任何神经抑制剂或抗焦虑药物，不像在养老院那样常规使用;(iii)残余功能得到维持。三名CANTOU居民的MMS稳定，而主要机构的三名居民现在卧床不起。一旦病人对刺激不再有反应，他或她就被转移到主要设施。展望未来将同样的生活方式项目应用到日托环境中，为更多的病人服务。结论对阿尔茨海默病患者进行高质量的护理有助于维持其残障能力。从1998年到2006年，圣文森大学的一项研究表明，在老年痴呆症患者中，变性人的认知障碍与变性人的认知障碍是相同的。世界上有四种不同类型的障碍型和障碍型的障碍型和障碍型的障碍型和障碍型。D'où l' id哀伤哀伤哀伤哀伤哀伤哀伤哀伤哀伤哀伤哀伤哀伤哀伤哀伤哀伤哀伤哀伤哀伤哀伤哀伤。目标:主要的<s:2> <s:2>和/或其他的<s:2> <s:2>和/或所有的<s:2>和/或所有的<s:2> <s:2>和/或所有的/或所有的/或所有的/或所有的/或所有的/或所有的/或所有的/或所有的。塞西，你的日常生活，你的生活，你的动画，你的表情。方案2007年10月，在CANTOU的圣文森特，"小公司"，"小型公司"，在阿尔茨海默病中心，16人参加了"老年痴呆症"项目。6例患者的病情在MMS中心3月10日至30日期间发生，3例患者的病情在MMS中心3月10日至30日期间发生，3例患者的病情在MMS中心发生。“变变”是指“变变”，而不是“变变”。计划的目标是确定控制障碍的原则，即在可能的情况下，将所有的障碍都加以解决;计划的目标是确定所有的障碍都加以解决;计划的目标是确定所有的障碍都加以解决;计划的目标是确定所有的障碍。La perte de poids est surveillance(监视)是一种非常简单的方法。Nous avons恢复了所有的补品，包括超蛋白和超蛋白。在“社会生活”的基础上，提出了“社会生活”与“社会生活”的结合，并提出了“社会生活”与“社会生活”的结合。我说的是，我的前任，我的前任，我的前任，我的前任，我的前任，我的前任，我的前任，我的前任，我的前任，我的前任，我的前任，我的前任，我的前任，我的前任，我的前任，我的前任。活动变少了，人际关系变少了，人际关系变少了，人际关系变好了，人际关系变好了。 它们的目的是保持自尊，重视每个人的剩余能力，支持程序性记忆，最重要的是生活的乐趣。结果经过两年的手术，我们可以观察到居民生活质量在几个方面的改善:饮食:我们没有观察到体重减轻，相反。焦虑:我们从不在“必要时”使用神经安定药或抗焦虑药处方。不像养老院，他们几乎是系统地管理的。自尊:我们注意到剩余功能的维持。在两年内，我们发现三名Cantou居民的MMS稳定，而三名MDR居民现在卧床不起。该项目的局限性是，一旦患者对刺激不再有反应，就会考虑转移到MDR一侧。以同样的生活项目发展更重要的日间接待。结论到目前为止，我们可以看到阿尔茨海默氏症患者的护理质量有利于其剩余能力的维持。
{"title":"069 Lifestyle project for patients with Alzheimer's disease in highly sheltered accommodation within a residential home","authors":"Reckmans Caroline","doi":"10.1136/QSHC.2010.041624.74","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.74","url":null,"abstract":"Background and objectives Between 1998 and 2006, the St Vincent residential home for elderly dependent people (EHPAD) welcomed both residents without cognitive impairment and residents with Alzheimer's disease. We identified four main types of problem: quarrels, runaways, falls, and depressive syndrome. These incited us to set up a ‘Lifestyle project’ within a sheltered area welcoming Alzheimer patients. Its main objective was to offer patients a material and human space that was reassuring and friendly and that would help them maintain their residual abilities and enjoyment of life. The focus was on daily living activities, different types of pastime, entertainment, and encouraging self-expression. Program In October 2007, we created the ‘CANTOU’, a homely house within the St Vincent residential home, with accommodation suitable for 16 Alzheimer patients. Patients in this sheltered area have a Mini-Mental score (MMS) of 3-10/30 and suffer from excessive wandering. The team care includes three house matrons during the day and one at night. Management is tailored to each patient. The main objective of our program is to fight depression by early detection of: Eating disorders: We fight lack of appetite by a culinary project linked to ‘work’ in a vegetable garden. We monitor weight loss weekly and use high-protein food supplements when needed. Anxiety and agitation: We propose a pastime based on social life in order to widen links with the ‘outside world’ and enhance relationships with the family. We help prevent falls by using ‘Alzheimer's beds’ that can be lowered right down to the ground. Loss of self-esteem: We offer a pastime based on daily living which aims to raise the patient's self-esteem and maintain functional abilities, without inducing any frustration. There is great flexibility in all our activities and relationships. Their aim is to maintain the patient's self-esteem, encourage use of residual abilities, support procedural memory, and in particular help patients enjoy life. Results After 2 years, we have observed an improvement in several aspects of the residents' quality of life: (i) We have not observed any weight loss, rather the contrary, (ii) We have never had any need to use neuroleptics or anxiolytic drugs, unlike in retirement homes where they are in routine use, (iii) Residual functions have been maintained. The MMS is stable in three CANTOU residents whereas three residents in the main establishment are now bedridden. Project limitations Once the patient no longer reacts to stimuli, he or she is transferred to the main establishment. Looking ahead To apply the same lifestyle project in a daycare setting for a greater number of patients. Conclusion High-quality nursing care for Alzheimer's patients helps maintain their residual capacities. Objectif(s), contexte Entre 1998 et 2006, l'EHPAD St Vincent accueillait des résidents sans trouble cognitif ainsi que des résidents Alzheimer. Nous avions pu identifier 4 types de diffic","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"38 1","pages":"A121 - A122"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88273584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041624.72
Passadori Yves, Leveque Michel, Meyer Martin
Background and objectives The creation of the Regional Observatory for Quality in Alsace arose from the synergy between continuous medical education initiatives for general practitioners (GPs) (FMC 68) and initiatives led by the college of French geriatricians (CPGF) and the Regional Hospitalization Agency (ARH) of Alsace. Our programme is a result of this synergy. Its objectives are to improve medication management in the elderly, in or out of hospital, by enrolling general practitioners (GPs), hospital pharmacists, and hospital practitioners in a regional quality management programme. Programme Our quality improvement initiative concerns the pharmacological care of an elderly population (aged over 65 years) with multiple diseases and of a geriatric population aged over 80. Its method is the clinical audit. 2006: Test in a long-term care unit (CM Saales) within the framework of the HAS accreditation scheme for health care organizations (version V2) 2007–2009: Clinical audits by 60 GPs with the support of an HAS certified body 2008: Creation by CPGF of 5 ‘targeted clinical audits’ kits (HAS methodology) relative to drug prescriptions in the elderly December 2008–October 2009: Adaptation of the kits by hospital pharmacy quality group, test of audit criteria, training of hospital pharmacists in kit use, first round of audit, improvement plan. Kit presentation to the coordinating doctors of residential homes for the elderly. January 2010: Second round of audit by hospital pharmacists 2010: Raising the awareness of community pharmacists. Results Sixty GPs (1080 medical records) participated in the three rounds of the clinical audit held in 2007 to 2009. Compliance was poor in the first round for the following audit criteria but improved in subsequent rounds: 2007: Three criteria relating to screening for renal failure (aetiology, exploration, and renal failure stage) 2008: Two criteria relating to risk factors (detecting falls, naming the carer in charge) 2009: Three out of 6 criteria for the prescription of benzodiazepines in the elderly showed poor compliance. Three showed subsequent improvement (treatment duration, short intervention followed by discontinuation, and prescription re-evaluation). Fourteen hospitals (500 prescriptions; medical records) are participating in the audit. Compliance was poor for 4 out of 12 criteria in the first round: (i) no more than two psychotropic drugs (including benzodiazepines) should be prescribed, (ii) creatinine clearance should be given, (iii) the prescription should specify patient weight, (iv) the pharmaceutical form should be appropriate for the patient. Results for the second round are awaited. Discussion and conclusion The impact of this quality initiative on pharmacological care in the elderly is difficult to determine in terms of morbidity and mortality. Appropriate clinical impact indicators need to be developed. However, thanks to the programme, health professionals involved in different types of care
背景和目标阿尔萨斯区域质量观察站的建立源于全科医生(gp)继续医学教育倡议(FMC 68)与法国老年医学会(CPGF)和阿尔萨斯地区住院管理局(ARH)领导的倡议之间的协同作用。我们的课程就是这种协同作用的结果。其目标是通过将全科医生(gp)、医院药剂师和医院从业人员纳入区域质量管理方案，改善医院内外老年人的药物管理。方案:我们的质量改进倡议涉及患有多种疾病的老年人口(65岁以上)和80岁以上老年人口的药理学护理。其方法是临床审核。2007-2009年:在卫生保健组织(第2版)卫生保健系统认证计划框架内在长期护理单位(CM Saales)进行测试;在卫生保健系统认证机构的支持下，由60名全科医生进行临床审计;2008年:CPGF创建了5个针对老年人药物处方的“针对性临床审计”工具包(卫生保健系统方法)- 2008年12月- 2009年10月;医院药学质量小组对试剂盒的适应，审核标准的测试，医院药师对试剂盒使用的培训，第一轮审核，改进计划。向安老院舍的协调医生赠送资料袋。2010年1月:第二轮医院药师审核2010:提高社区药师的认识。结果共60名全科医生(1080份病历)参加了2007 - 2009年三轮临床审核。2007年:与肾衰竭筛查有关的三项标准(病因学、探查和肾衰竭分期)2008年:与风险因素有关的两项标准(检测跌倒，指定负责护理人员)2009年:老年人苯二氮卓类药物处方的6项标准中有3项的依从性较差。其中3例出现后续改善(治疗时间、短期干预后停药、处方重新评估)。14家医院(500张处方);医疗记录)正在参与审核。在第一轮的12项标准中，有4项的依从性较差:(i)不应开超过两种精神药物(包括苯二氮卓类药物)，(ii)应给予肌酐清除率，(iii)处方应注明患者体重，(iv)药物形式应适合患者。第二轮投票的结果正在等待中。从发病率和死亡率的角度来看，这一质量倡议对老年人药理学护理的影响很难确定。需要制定适当的临床影响指标。然而，由于该方案，参与不同类型护理(医院和全科医生)的保健专业人员已经能够对利害攸关的问题获得同样的认识。该方案现已扩展到阿尔萨斯各地的住宅和社区药剂师。这是阿尔萨斯打击毒品相关错误的共同文化的开始。目标(5):背景:<s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1>·······最优的办法是，将规定的<s:1>医疗器械和<s:1>医疗器械和<s:1>医疗器械和<s:1>医疗器械和<s:1>医疗器械和<s:1>医疗器械和<s:1>医疗器械和<s:1>医疗器械和<s:1>医疗器械和<s:1>医疗器械和<s:1>医疗器械和<s:1>医疗器械和<s:1>医疗器械和医疗器械。《区域质量管理条例》和《双动力协同作用条例》。关于人的<s:1> <s:1> <s:1>交换交换器和<s:1> <s:1>交换交换器和其他交换交换器的专业实务方案评价。60个交换交换器和其他交换交换器，1080个交换交换器，14个交换交换器，500个交换交换器和交换交换器，历史:测试服务中参与de舌头duree CM萨尔en 2006中干部de la认证V2 2007 - 2009 EPP menee在sud de l想欧珀莱de 60 (medecins多面手用l 'appui de l 'OA融合创造68 2008 de工具d 'audit从计划PMSA de la par勒大学来完成des geriatres法语Decembre 2008,《关于药物和薪金薪金的适应办法》，《关于薪金薪金的办法》，《关于薪金薪金的办法》，《关于薪金薪金的办法》，《关于薪金薪金的办法》，《阿尔萨斯薪金薪金的办法》。
{"title":"270 Improving pharmacological care of the elderly in Alsace","authors":"Passadori Yves, Leveque Michel, Meyer Martin","doi":"10.1136/QSHC.2010.041624.72","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.72","url":null,"abstract":"Background and objectives The creation of the Regional Observatory for Quality in Alsace arose from the synergy between continuous medical education initiatives for general practitioners (GPs) (FMC 68) and initiatives led by the college of French geriatricians (CPGF) and the Regional Hospitalization Agency (ARH) of Alsace. Our programme is a result of this synergy. Its objectives are to improve medication management in the elderly, in or out of hospital, by enrolling general practitioners (GPs), hospital pharmacists, and hospital practitioners in a regional quality management programme. Programme Our quality improvement initiative concerns the pharmacological care of an elderly population (aged over 65 years) with multiple diseases and of a geriatric population aged over 80. Its method is the clinical audit. 2006: Test in a long-term care unit (CM Saales) within the framework of the HAS accreditation scheme for health care organizations (version V2) 2007–2009: Clinical audits by 60 GPs with the support of an HAS certified body 2008: Creation by CPGF of 5 ‘targeted clinical audits’ kits (HAS methodology) relative to drug prescriptions in the elderly December 2008–October 2009: Adaptation of the kits by hospital pharmacy quality group, test of audit criteria, training of hospital pharmacists in kit use, first round of audit, improvement plan. Kit presentation to the coordinating doctors of residential homes for the elderly. January 2010: Second round of audit by hospital pharmacists 2010: Raising the awareness of community pharmacists. Results Sixty GPs (1080 medical records) participated in the three rounds of the clinical audit held in 2007 to 2009. Compliance was poor in the first round for the following audit criteria but improved in subsequent rounds: 2007: Three criteria relating to screening for renal failure (aetiology, exploration, and renal failure stage) 2008: Two criteria relating to risk factors (detecting falls, naming the carer in charge) 2009: Three out of 6 criteria for the prescription of benzodiazepines in the elderly showed poor compliance. Three showed subsequent improvement (treatment duration, short intervention followed by discontinuation, and prescription re-evaluation). Fourteen hospitals (500 prescriptions; medical records) are participating in the audit. Compliance was poor for 4 out of 12 criteria in the first round: (i) no more than two psychotropic drugs (including benzodiazepines) should be prescribed, (ii) creatinine clearance should be given, (iii) the prescription should specify patient weight, (iv) the pharmaceutical form should be appropriate for the patient. Results for the second round are awaited. Discussion and conclusion The impact of this quality initiative on pharmacological care in the elderly is difficult to determine in terms of morbidity and mortality. Appropriate clinical impact indicators need to be developed. However, thanks to the programme, health professionals involved in different types of care","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"1 1","pages":"A120 - A121"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83735000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/qshc.2010.041632.9
P. Schilliger, J. Juillard, H. Merlin
Background and objectives A continuous effort is required to improve the quality of individual healthcare practice, through evaluation, exchanges with other professionals, and improvement goals based on robust evidence. Association Mieux Prescrire (AMP), an independent organisation providing continuous education for healthcare professionals, is entirely funded by its subscribers and accepts no subsidies or advertising of any nature. AMP's activities in the fields of continuous education and professional practice evaluation have received accreditation from the French authorities. In 2008, AMP launched a practice improvement programme (PIP), aimed chiefly at healthcare professionals (doctors and pharmacists) working in the primary care sector and who were already enrolled in a Prescrire training programme. The programme is designed to encourage continuous self-evaluation. Programme PIP is an online programme compatible with the constraints of professional practice in the primary care setting. It is based on self-evaluation of individual practices, constructive criticism, and setting goals for improvement. The programme is continuous and lasts 24 months. The first year focuses on implementing goals set by Prescrire, based on reliable clinical data and strong practice recommendations. These goals concern specific actions and patient populations, and are accompanied by solid arguments, referenced data and practical suggestions. Each participant first chooses three sets of three goals, from among a total of 18 proposals, most relevant to their own practice, ie the main types of patient they deal with. During each session the participants analyse their current practices with respect to the different goals, verify after 4 months that they have implemented the proposed improvements, analyse any obstacles encountered, and envisage alternative approaches. Participants can discuss the different goals in specific online forums. Each participant receives an individual assessment report. The second year focuses on the longer term implementation and relevance of the chosen goals, after a 12-month period. The PIP team reviews each participant's six self-evaluations, and their contributions to the forums. These reviews are returned to the participants after anonymisation. They allow the participants to assess the practical relevance of their goals and the feasibility of the programme in the primary care setting. Participants are required to follow the entire programme and to complete the six online questionnaire-based evaluations. Results 799 healthcare professionals entered the programme in January 2008, and 497 of them (62%) continued during the second year. On average, participants reported that they reached their goals in 60%–90% of cases. Taking major public-health objectives by way of an example, the ‘Avoid NSAIDs during pregnancy’ goal was implemented by 77% of participants after 4 months and by 98% at 12 months (among participants remaining in the programm
{"title":"080 Prescrire's practice improvement programme","authors":"P. Schilliger, J. Juillard, H. Merlin","doi":"10.1136/qshc.2010.041632.9","DOIUrl":"https://doi.org/10.1136/qshc.2010.041632.9","url":null,"abstract":"Background and objectives A continuous effort is required to improve the quality of individual healthcare practice, through evaluation, exchanges with other professionals, and improvement goals based on robust evidence. Association Mieux Prescrire (AMP), an independent organisation providing continuous education for healthcare professionals, is entirely funded by its subscribers and accepts no subsidies or advertising of any nature. AMP's activities in the fields of continuous education and professional practice evaluation have received accreditation from the French authorities. In 2008, AMP launched a practice improvement programme (PIP), aimed chiefly at healthcare professionals (doctors and pharmacists) working in the primary care sector and who were already enrolled in a Prescrire training programme. The programme is designed to encourage continuous self-evaluation. Programme PIP is an online programme compatible with the constraints of professional practice in the primary care setting. It is based on self-evaluation of individual practices, constructive criticism, and setting goals for improvement. The programme is continuous and lasts 24 months. The first year focuses on implementing goals set by Prescrire, based on reliable clinical data and strong practice recommendations. These goals concern specific actions and patient populations, and are accompanied by solid arguments, referenced data and practical suggestions. Each participant first chooses three sets of three goals, from among a total of 18 proposals, most relevant to their own practice, ie the main types of patient they deal with. During each session the participants analyse their current practices with respect to the different goals, verify after 4 months that they have implemented the proposed improvements, analyse any obstacles encountered, and envisage alternative approaches. Participants can discuss the different goals in specific online forums. Each participant receives an individual assessment report. The second year focuses on the longer term implementation and relevance of the chosen goals, after a 12-month period. The PIP team reviews each participant's six self-evaluations, and their contributions to the forums. These reviews are returned to the participants after anonymisation. They allow the participants to assess the practical relevance of their goals and the feasibility of the programme in the primary care setting. Participants are required to follow the entire programme and to complete the six online questionnaire-based evaluations. Results 799 healthcare professionals entered the programme in January 2008, and 497 of them (62%) continued during the second year. On average, participants reported that they reached their goals in 60%–90% of cases. Taking major public-health objectives by way of an example, the ‘Avoid NSAIDs during pregnancy’ goal was implemented by 77% of participants after 4 months and by 98% at 12 months (among participants remaining in the programm","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"7 1","pages":"A156 - A157"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89339153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/qshc.2010.041632.21
J. Steinmetz, P. Bilbault, B. Gicquel-Schlemmer, B. Christophe, C. Duja, P. Kauffmann, M. Mihalcea, C. Géronimus, C. Kam, J. Kopferschmitt
Context and Objectives The emergency department is a sector with an important clinical exposure in connection with the required quality of care. This is due to the great number of patients seen every day, the variety of clinical situations met and the multiplicity of colleagues involved. The daily staff meeting with the team coming out of duty is an important moment for the continuation of care (hand over, diagnosis and/or treatments readjusted, organisation of the daily department activity, notified dysfunctional issues), but also for training purpose towards the juniors of the team. The new protocol was put in place in October 2006 after we noticed the lack of structure and the excess of verbal exchanges in the meetings. The objectives were the followings: more formal organisation of the meeting in terms of timing and components, improve the quality of hand over (verbal and written), leave a written trace of the decisions and the benefit-risk discussion made by the staff, track down and handle the dysfunctional issues, survey how the patient's records are kept, discuss the topics which will be developed in priority for the education and training of the junior members of the team. Schedule Internal regulations have been written, summed up in an eight points check-list (daily task distribution, hand over, dysfunctional issues, information about the admitted patients, position of each staff member during the day in the department, patient's records keeping…) used by the moderator. At the beginning of each meeting a moderator and a secretary are designated amongst the seniors of the team. A printed sheet is used, one per day. At the end of the meeting, the secretary transfers the predefined key elements on a data base. The results will be shown from to day to day on graphics automatically updated (number of patients admitted, number and type of dysfunctional issues, missing criteria in keeping patient's records, etc). A special dating stamp is used in the patient's records to underline the decisions made and the benefit-risk discussions. According to the case, the dysfunctional issues are dealt with immediately or discussed later at the debriefing meetings. These meetings, held every 2 months, are formally summarised in a report distributed to the different actors involved. Once these data have been surveyed, an agenda of improvement actions is defined and each theme will be allocated to one of the senior colleagues. An indicator follow up is scheduled and a synthetic assessment is established annually. Results After 3 years, 98% of the structured staff meetings were following the protocol. Most of the meetings didn't last longer than the fixed 45 min. Thanks to the collection of the dysfunctional issues a number of improvement actions are put in place, punctual or general actions, development of clinical pathways, procedures, protocols. Audits were realised as well as practise enquiries or relevance analysis. During these staff meetings about 50 p
{"title":"135 Clinical impact of a structured daily staff meeting in an emergency department","authors":"J. Steinmetz, P. Bilbault, B. Gicquel-Schlemmer, B. Christophe, C. Duja, P. Kauffmann, M. Mihalcea, C. Géronimus, C. Kam, J. Kopferschmitt","doi":"10.1136/qshc.2010.041632.21","DOIUrl":"https://doi.org/10.1136/qshc.2010.041632.21","url":null,"abstract":"Context and Objectives The emergency department is a sector with an important clinical exposure in connection with the required quality of care. This is due to the great number of patients seen every day, the variety of clinical situations met and the multiplicity of colleagues involved. The daily staff meeting with the team coming out of duty is an important moment for the continuation of care (hand over, diagnosis and/or treatments readjusted, organisation of the daily department activity, notified dysfunctional issues), but also for training purpose towards the juniors of the team. The new protocol was put in place in October 2006 after we noticed the lack of structure and the excess of verbal exchanges in the meetings. The objectives were the followings: more formal organisation of the meeting in terms of timing and components, improve the quality of hand over (verbal and written), leave a written trace of the decisions and the benefit-risk discussion made by the staff, track down and handle the dysfunctional issues, survey how the patient's records are kept, discuss the topics which will be developed in priority for the education and training of the junior members of the team. Schedule Internal regulations have been written, summed up in an eight points check-list (daily task distribution, hand over, dysfunctional issues, information about the admitted patients, position of each staff member during the day in the department, patient's records keeping…) used by the moderator. At the beginning of each meeting a moderator and a secretary are designated amongst the seniors of the team. A printed sheet is used, one per day. At the end of the meeting, the secretary transfers the predefined key elements on a data base. The results will be shown from to day to day on graphics automatically updated (number of patients admitted, number and type of dysfunctional issues, missing criteria in keeping patient's records, etc). A special dating stamp is used in the patient's records to underline the decisions made and the benefit-risk discussions. According to the case, the dysfunctional issues are dealt with immediately or discussed later at the debriefing meetings. These meetings, held every 2 months, are formally summarised in a report distributed to the different actors involved. Once these data have been surveyed, an agenda of improvement actions is defined and each theme will be allocated to one of the senior colleagues. An indicator follow up is scheduled and a synthetic assessment is established annually. Results After 3 years, 98% of the structured staff meetings were following the protocol. Most of the meetings didn't last longer than the fixed 45 min. Thanks to the collection of the dysfunctional issues a number of improvement actions are put in place, punctual or general actions, development of clinical pathways, procedures, protocols. Audits were realised as well as practise enquiries or relevance analysis. During these staff meetings about 50 p","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"109 1","pages":"A166 - A167"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73534849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041632.2
J. Lehot, C. Lupo, M. Billard, C. Flamens, O. Desebbe, B. Delannoy, O. Bastien, G. Aulagner
Objectives Drug prescription represents a large part of costs in intensive care unit (ICU). However this cost is often ignored by intensivists who choose the product apparently most adapted to a clinical situation. This choice should depend on evidence-based medicine and guidelines but they do not exist for many conditions. Therefore, local guidelines can be decided according to the patients and focused on main costs. Regarding cardiovascular and thoracic surgery, a feasibility study was undertaken in a postoperative acute care unit in order to evaluate whether intensivists would accept this challenge and the consequence on patient's outcome. Programme Meetings started on 8 January 2006 with 2–3 sessions a year to analyse the ordering process. The analysis was performed by consultants (intensivists and pharmacists), registrars and residents. The list of drugs costing more than 10 000 euros a year was examined. The drugs appearing indispensable were not discussed. The others were discussed to find out equivalent but cheaper drugs and/or administration modalities (antibiotics, anaesthetics, dopexamine, L-alanyl-L-glutamine) or to limit rationally their ordering (antithrombin III, human albumine, inhaled nitric oxide). New residents were systematically taught about this programme. Meanwhile monthly morbidity–mortality meetings were pursued. Results Years 2006 2007 2008 Open beds (n) 28.8 27.6 27.3 Number of patients (n) 1728 1754 1813 Mean age (year) 53.3 52.8 59.7 ICU total production 2 643 181 2 544 141 2 733 860 (Relative Complexity Index) Mechanical assistances (n) 37 69 103 Costs (euros, VAT incl.): Antibiotics 190 305 127 678 134 426 Antithrombine III 94 115 65 364 70 310 Anaesthetics 92 706 58 384 49 552 Human albumine 80 913 57 708 44 816 Dopexamine 20 546 8 066 9 452 L-alanyl-L-glutamine 12 407 4 096 7 163 Total 490 992 321 296 315 719 Change vs 2006 (%) −34.5 −35.7 Discussion Despite an increased activity and more senior patients, the order of target drugs decreased by 35.7% in 2008 (175 273 euros per year). Antithrombin III ordering decreased by 46.5% despite the dramatic increase in mechanical circulatory assistances. Meanwhile an increase in morbidity and potentially evitable deaths was not observed. However an increase in four drugs was observed in 2008 suggesting that a profit-sharing with ordering physicians is mandatory to obtain longer effects. This policy should be taught to medical students to increase the performance of ordering. Objectif Les prescriptions médicamenteuses représentent une large part des dépenses en réanimation. Cependant, ce coût est souvent ignoré par les réanimateurs qui choisissent le médicament apparemment le plus adapté à la situation clinique du patient. Ce choix devrait dépendre de données fondées sur les preuves et/ou de recommandations mais ces dernières sont inexistantes dans beaucoup de situations. Ainsi, des recommandations locales peuvent être données en fonction des pathologies renc
{"title":"020 How drug prescriptions in intensive care unit could be optimised?","authors":"J. Lehot, C. Lupo, M. Billard, C. Flamens, O. Desebbe, B. Delannoy, O. Bastien, G. Aulagner","doi":"10.1136/QSHC.2010.041632.2","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041632.2","url":null,"abstract":"Objectives Drug prescription represents a large part of costs in intensive care unit (ICU). However this cost is often ignored by intensivists who choose the product apparently most adapted to a clinical situation. This choice should depend on evidence-based medicine and guidelines but they do not exist for many conditions. Therefore, local guidelines can be decided according to the patients and focused on main costs. Regarding cardiovascular and thoracic surgery, a feasibility study was undertaken in a postoperative acute care unit in order to evaluate whether intensivists would accept this challenge and the consequence on patient's outcome. Programme Meetings started on 8 January 2006 with 2–3 sessions a year to analyse the ordering process. The analysis was performed by consultants (intensivists and pharmacists), registrars and residents. The list of drugs costing more than 10 000 euros a year was examined. The drugs appearing indispensable were not discussed. The others were discussed to find out equivalent but cheaper drugs and/or administration modalities (antibiotics, anaesthetics, dopexamine, L-alanyl-L-glutamine) or to limit rationally their ordering (antithrombin III, human albumine, inhaled nitric oxide). New residents were systematically taught about this programme. Meanwhile monthly morbidity–mortality meetings were pursued. Results Years 2006 2007 2008 Open beds (n) 28.8 27.6 27.3 Number of patients (n) 1728 1754 1813 Mean age (year) 53.3 52.8 59.7 ICU total production 2 643 181 2 544 141 2 733 860 (Relative Complexity Index) Mechanical assistances (n) 37 69 103 Costs (euros, VAT incl.): Antibiotics 190 305 127 678 134 426 Antithrombine III 94 115 65 364 70 310 Anaesthetics 92 706 58 384 49 552 Human albumine 80 913 57 708 44 816 Dopexamine 20 546 8 066 9 452 L-alanyl-L-glutamine 12 407 4 096 7 163 Total 490 992 321 296 315 719 Change vs 2006 (%) −34.5 −35.7 Discussion Despite an increased activity and more senior patients, the order of target drugs decreased by 35.7% in 2008 (175 273 euros per year). Antithrombin III ordering decreased by 46.5% despite the dramatic increase in mechanical circulatory assistances. Meanwhile an increase in morbidity and potentially evitable deaths was not observed. However an increase in four drugs was observed in 2008 suggesting that a profit-sharing with ordering physicians is mandatory to obtain longer effects. This policy should be taught to medical students to increase the performance of ordering. Objectif Les prescriptions médicamenteuses représentent une large part des dépenses en réanimation. Cependant, ce coût est souvent ignoré par les réanimateurs qui choisissent le médicament apparemment le plus adapté à la situation clinique du patient. Ce choix devrait dépendre de données fondées sur les preuves et/ou de recommandations mais ces dernières sont inexistantes dans beaucoup de situations. Ainsi, des recommandations locales peuvent être données en fonction des pathologies renc","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"30 1","pages":"A150 - A150"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74676147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041632.19
F. Fischer, A. Appert-Flory, S. Raynaud, J. Quaranta, J. Levraut, J. Fuzibet
Introduction The preanalytic process is a crucial step for the accuracy of results in a routine medical laboratory. It also has a forensic weight. We report a continuous improvement of the quality process in the management of nonconformities in the preanalytical sector of the Haematology laboratory of the CHU of Nice. Brief Outline of Context Main preanalytical nonconformities (NC) observed in our laboratory in 2007 was collected retrospectively. 169 244 adverse events were recorded, (including lack of date/time of blood collection (n=81269), antithrombotic treatment not specified (n=87753), lack of specimen identification (n=93), inadequate filling (n=100) coagulated blood samples (29)), and analysed using the RCA method. After assessment of the problem and analysis of its cause, we identified and applied some improvement actions. Goal To reduce the two most frequent adverse events observed in our laboratory: Adverse event #1: lack of date/time of blood collection (hour and day) (81 269 over 230 476 received prescription forms (35%)) Adverse event #2: antithrombotic treatment not specified. (87 753 over 166 016 received haemostasis prescription forms (53%)) Our goal was to reduce the global monthly percentages to less than 15% for both items. Strategy for Change We chose two medical departments interested in this approach: the adult emergency department and the department of internal medicine. The corrective actions consisted in meetings with the staff of the two departments (physicians and nurses), to form and inform them on the importance to correctly fulfil the laboratory prescription forms, and the consequences of incomplete data on laboratory results quality. During the successive meetings with the staff of both departments (1 per month from January 2008 to June 2008), follow-up of NC percentages was provided and analysed. Measurement of Improvement and Effects of Changes The monthly follow-up of the NC percentages for the two departments involved in the study is reported below: Adverse event #1 adult emergency department: month 1 (32%), month 12 (27%), month 24 (18%) internal medicine department: month 1 (45%), month 12 (27%), month 24 (6%) Adverse event #2 adult emergency department: month 1 (41%), month 12 (45%), month 24 (40%) internal medicine department: month 1 (75%), month 12 (85%), month 24 (75%) Results Adverse event #1: dramatic improvement in compliance with prescription form fulfilment, sustained in 2009 Adverse event #2: we didn't notice any stable improvement on the NC. We have to develop new corrective actions, maybe based on computerised prescription with the obligation to give information about the treatments. Lessons learned and conclusion: Providing objective data is effective in convincing physicians and nurses of the need for change. Continuous follow-up is essential to ensure that changes are fully implemented. Increased sensitivity of the staff to correct errors was not sufficient to reduce the percentage of adverse
在常规医学实验室中，前分析过程是保证检测结果准确性的关键步骤。它也有法医的重量。我们报告在尼斯的CHU血液学实验室的前分析部门的不合格管理的质量过程的持续改进。回顾收集了2007年在我们实验室观察到的主要分析前不合格(NC)。记录了169 244个不良事件(包括缺少采血日期/时间(n=81269)，未指定抗血栓治疗(n=87753)，缺少标本鉴定(n=93)，不充分填充(n=100)凝固血液样本(29))，并使用RCA方法进行分析。在对问题进行评估并分析其原因后，我们确定并实施了一些改进措施。目的:减少我们实验室观察到的两种最常见的不良事件:不良事件#1:缺乏采血日期/时间(小时和天)(81 269 / 230 476收到处方(35%))不良事件#2:未指定抗血栓治疗。(87,753 / 166 016收到止血处方表格(53%))我们的目标是将这两个项目的全球每月百分比降低到15%以下。我们选择了两个对这种方法感兴趣的医疗部门:成人急诊科和内科。纠正措施包括与两个部门的工作人员(医生和护士)举行会议，形成并告知他们正确填写实验室处方表的重要性，以及数据不完整对实验室结果质量的影响。在与两个部门的工作人员举行的后续会议(2008年1月至2008年6月每月一次)中，提供并分析了NC百分比的后续情况。研究中涉及的两个部门的NC百分比的月度随访报告如下:不良事件#1成人急诊科:第1个月(32%)，第12个月(27%)，第24个月(18%)内科:第1个月(45%)，第12个月(27%)，第24个月(6%)不良事件#2成人急诊科:第1个月(41%)，第12个月(45%)，第24个月(40%)内科:第1个月(75%)，第12个月(85%)，第24个月(75%)结果不良事件#1:对处方表的依从性的显著改善，持续到2009年。不良事件#2:我们没有注意到NC有任何稳定的改善。我们必须制定新的纠正措施，也许是基于计算机化的处方，并有义务提供有关治疗的信息。经验教训和结论:提供客观数据可以有效地说服医生和护士改变的必要性。持续的后续行动对于确保变更得到充分实施至关重要。提高工作人员纠正错误的敏感性并不足以降低不良事件#2的百分比。为了取得成功，RCA方法需要对根本原因进行详尽的分析。引言:在分析过程中，只有一个过程是关键的，只有一个过程是关键的，只有一个过程是关键的，只有一个过程是关键的。Il revêt薪金与薪金的薪金是相同的。现有的报告将继续在尼斯的<s:1>电子烟和电子烟与电子烟和电子烟有关的实验室中使用电子烟和电子烟。2007年，在实验室的研究中，研究了各种类型和类型的数据，分析了各种类型和类型的数据，并对各种类型和类型的数据进行了展望。[n=81269]、[n=87753]、[n=93]、[n=100]、[n=100]、[n= 29]、[n=87753]和[n=81269]。aprs对失调进行了评估，分析了失调的原因，确定了失调的原因，并对失调的行为进行了分析。目的:对NC - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res - res战略:有两种选择的服务，其中包括:有两种选择的服务:有两种选择的服务:有两种选择的服务:有两种选择的服务:有两种选择的服务。 入选的纠正措施主要包括实现这些服务人员的培训和信息会议()的医生和护士,同时强调需要及后果的要求正确填充好,质量和可靠性上发表的结果。会议周期(2008年1月至2008年6月每月一次)还提供了一个机会，向这些服务通报其NC比率的监测情况和观察到的改进情况。结果这两种服务的cn费率监测总结如下。跟踪编号为# 1的标准“采样日期和时间均未提供急诊服务接待”:1个(32%),12月份(27%)、24个(18%)、内科:1个(45%),12月份(27%)、24个(6%),后续的名目为“# 2的标准治疗非急诊”:寄宿处了解到:1个(41%),12月份(45%)、24个(40%)内科:1个(75%),12月份(85%)、24个标准(75%)总结:# 1:标准#2:NC持续高水平:正在考虑另一种纠正行动策略，包括使用相关处方。结论提供客观的结果有助于说服医生和护士改进实践的必要性。随着时间的推移，跟踪这些仪表板有助于随着时间的推移锚定这些改进行动。临床工作人员的意识不足以降低标准2的NC率。通过RCA方法对“根本”原因进行更全面的分析，我们肯定会达到我们的目标。
{"title":"131 Preanalysis nonconformities management in a routine medical laboratory","authors":"F. Fischer, A. Appert-Flory, S. Raynaud, J. Quaranta, J. Levraut, J. Fuzibet","doi":"10.1136/QSHC.2010.041632.19","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041632.19","url":null,"abstract":"Introduction The preanalytic process is a crucial step for the accuracy of results in a routine medical laboratory. It also has a forensic weight. We report a continuous improvement of the quality process in the management of nonconformities in the preanalytical sector of the Haematology laboratory of the CHU of Nice. Brief Outline of Context Main preanalytical nonconformities (NC) observed in our laboratory in 2007 was collected retrospectively. 169 244 adverse events were recorded, (including lack of date/time of blood collection (n=81269), antithrombotic treatment not specified (n=87753), lack of specimen identification (n=93), inadequate filling (n=100) coagulated blood samples (29)), and analysed using the RCA method. After assessment of the problem and analysis of its cause, we identified and applied some improvement actions. Goal To reduce the two most frequent adverse events observed in our laboratory: Adverse event #1: lack of date/time of blood collection (hour and day) (81 269 over 230 476 received prescription forms (35%)) Adverse event #2: antithrombotic treatment not specified. (87 753 over 166 016 received haemostasis prescription forms (53%)) Our goal was to reduce the global monthly percentages to less than 15% for both items. Strategy for Change We chose two medical departments interested in this approach: the adult emergency department and the department of internal medicine. The corrective actions consisted in meetings with the staff of the two departments (physicians and nurses), to form and inform them on the importance to correctly fulfil the laboratory prescription forms, and the consequences of incomplete data on laboratory results quality. During the successive meetings with the staff of both departments (1 per month from January 2008 to June 2008), follow-up of NC percentages was provided and analysed. Measurement of Improvement and Effects of Changes The monthly follow-up of the NC percentages for the two departments involved in the study is reported below: Adverse event #1 adult emergency department: month 1 (32%), month 12 (27%), month 24 (18%) internal medicine department: month 1 (45%), month 12 (27%), month 24 (6%) Adverse event #2 adult emergency department: month 1 (41%), month 12 (45%), month 24 (40%) internal medicine department: month 1 (75%), month 12 (85%), month 24 (75%) Results Adverse event #1: dramatic improvement in compliance with prescription form fulfilment, sustained in 2009 Adverse event #2: we didn't notice any stable improvement on the NC. We have to develop new corrective actions, maybe based on computerised prescription with the obligation to give information about the treatments. Lessons learned and conclusion: Providing objective data is effective in convincing physicians and nurses of the need for change. Continuous follow-up is essential to ensure that changes are fully implemented. Increased sensitivity of the staff to correct errors was not sufficient to reduce the percentage of adverse ","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"99 1","pages":"A164 - A165"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73613481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：