Quality and Safety in Health Care最新文献

{"title":"212 Evaluation of physical restraints in rehabilitation and long term care in the CHU of Angers","authors":"Noublanche Sophie, M. Cécile, Tremblay N'guyen Lucie, Mouzet Jean Baptiste, Sultan Anne Marie, Ghali Alaa","doi":"10.1136/QSHC.2010.041624.69","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.69","url":null,"abstract":"Background and objectives The evaluation of passive physical restraint practices in the Department of Follow-up Care and Long-Term Care at the Hospital of Angers performed in 2004 led to training and education sessions for the medical and paramedical staff who were present at that time. In order to measure their impact, two targeted clinical audits (ACC) have been proposed in 2006 and 2008. The principal objectives of this study are as follows: Attempt to mirror the best practices set by ANAES (HAS) ‘Limit the risks attached to physical restraints for seniors’ (October 2000) Enable the medical staff to better understand this tool and its consequences Limit the use of physical restraints by seeking alternative solutions Phase out the non-relevant or excessive uses of physical restraints The main purpose of these audits are to (i) enhance the quality of medical prescription for physical restraints, (ii) improve information to patients and their family and (iii) develop monitoring of physical restraints and prevent its related risks. Procedure The clinical audits have tracked each restrained patient during one day (excluding patients constrained with bed barriers). We used the grids and tracking sheets as guided by ANAES. Subsequent to the results of the first audit, the following initiatives have been implemented: Information sessions and continuous education for all the medical and paramedical staff (new personnel) Specialised theoretical classes for interns and students Training for the use of equipment and installation of the patient (senior units) Display of the prescription and the monitoring sheets on the computer desk Appointment of a doctor responsible for claims and conflicts The second audit performed in 2008 confirmed the need for the first initiatives and notably fostered the following actions: Continue regular informal and formal information sessions for the medical and paramedical staff Continue to reduce the use of restraints to limit negative effects that are the most difficult to foresee Point out the risks created by the increasing use of the ‘adaptable’ chair Increase the use of the prescription sheet in order to improve its information quality (education of prescribing doctors) Simplify the monitoring sheet to foster its use. Attempt to merge the prescription and monitoring sheets Further improve the traceability of the information for the patients and their family The current objectives are now: Regularly continue the evaluations (ACC) (approximately every two years) Prepare the same type of audit for the other units of the department Prepare the same type of audit in the CRRRF long-term care unit (les Capucins) Propose an evaluation of professional practices of physical restraints in EHPAD Results in terms of clinical impact Previously, the average complication rate was 30%, 70% of patients in long-term care (SLD) and 14% of patients in follow-up care (SSR). The education initiatives enabled to decrease the rate to 16.5% (36% ","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"75 1","pages":"A116 - A117"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90386770","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}

{"title":"255 Impact of the systematic cardiology consultation for patients with HIV under triple therapy","authors":"P. Jourdain, F. Funck, O. Boirau, A. Boireau, J. Dagorn, P. Hervio, L. Blum","doi":"10.1136/qshc.2010.041632.38","DOIUrl":"https://doi.org/10.1136/qshc.2010.041632.38","url":null,"abstract":"Patients with HIV have seen their life expectancy significantly improve with the emergence of poly antiviral therapies. However, it was recently shown that these therapies had an impact on lipid metabolism. We therefore wanted to determine what could be the impact of cardiological care systematically in this population. Methodology We have systematically proposed to all patients with HIV under triple therapy followed Pontoise Hospital to receive a consultation followed by a cardiological assessment involving biological, echocardiography, Doppler with cervical measurement of intima media. Depending on the clinical and biological data it was then proposed diagnostic tests as arterial Doppler of lower limbs and stress test. We then compared these data with those of literature studies on comparable populations in terms of age and sex. Results Of 97 patients regularly followed 77 were seen either in consultation or out patient hospital. The 20 missing patients did not wish to go to the cardiology consultation for personal reasons. The average age of our cohort was 49.05±5 years making it a young population. HIV is on average 6 years (1–10). After the clinical examination 74% are active smoking on average at 15 PY, 54% are overweight (77.7 kg to 1.71 cm on average). The hip turn is 97.3 cm for a tour of shoulders to 110.48 cm. 15% have clinical lipodystrophy. 32% have hypertension (defined as PA>140/95 on two occasions). 67% had dyslipidaemia with 75% of mixed dyslipidemia. None of this has diabetes. The intima media thickness is on average 0.81 (left) and right 0.82 mm for a standard 0.73 mm in our test cohort (p<0.05) and 0.75 mm as the threshold cut off in Canadian studies (p<0.05). The echocardiography proved normal in 80% of patients and in 100% of patients with BNP levels <30 pg/ml. After 1 year follow-up we found a arteriopathy obliterans of lower limbs in 13% and ischaemic heart disease documented in 11% of patients which is significantly higher than expected given the class d age. Conclusion It seems appropriate to be able to propose to patients with HIV a cardiovascular consultation in view of their specific risk profile, nonroutinely detection of almost 24% of patients with atherosclerosis and of the increase intima media size highlighted in our study. However, echocardiography should not be systematic. Le patient VIH + a vu son espérance de vie nettement s'améliorer avec l'émergence des poly thérapies antivirales. Pour autant, il a été récemment démontré que ces trithérapies avaient un impact sur le métabolisme des lipides sur le plan clinique (lipodystrophies) et biologiques (modification du bilan lipidique). Nous avons donc voulu déterminer quel pouvait être l'impact d'une prise en charge cardiologique systématique dans cette population. Méthodologie Nous avons systématiquement proposé à tous les patients VIH + sous trithérapie suivis au centre hospitalier de Pontoise de bénéficier d'une consultation cardiologique sui","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"99 1","pages":"A183 - A183"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90395597","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}

{"title":"213 How to improve the quality of medication management from prescription to administration: Experience in a medical ICU","authors":"P. Michel, Veinstein Anne, Chatellier Delphine, Frat Jean Pierre, Bescond Véronique, Grassin Joelle, Voultoury Julien, R. René","doi":"10.1136/QSHC.2010.041624.27","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.27","url":null,"abstract":"Background The lack of quality observed on the prescriptions and the errors of administration of treatments are often explained in ICU by their multiplicity and the frequency of their modifications. The frequency of theses errors in ICU justifies the implementation of programs of improvement of the quality in this domain1 2 Methods After an audit of the practices, we targeted the most frequent errors and workbench of the strict rules of prescription, retranscription and administration of medicines. Follow-up The complexity of the analysis of a file and the wish to set up a long-lasting procedure made choose the method of sampling. Every month, 10 files were randomly selected and analysed by a student in pharmacy during two consecutive days. A grid of analysis was pre-established by the pharmacist and one ICU MD. Each files was double-checked for validation by the pharmacist and the ICU doctor. A first step analysis was conducted during 9 months identifying several types of error an then allowing the establishment of the rules of practice and their communication to all the medical medical team (Period 1). The results of the period 1 were compared to those of the next 45 months (period 2). Résults Among 2374 patients admitted during period 2 (20586 days), 420 files (18%) were analysed corresponding to 4% of days of ICU hospitalisation. Types of errors Period 1192 D/patients Period 2 Absence of written prescription 32.3% 7% Incomplète prescription 49.5% 12.5% Errors of posology or medication type 9.4% 0% Association or galenic not corresponding 1.5% 1.2% Incidence of the errors of prescriptions (per day per patient) 0.92/D. Patient 0.13/D. Patient Errors of retranscription 20.8% 3.3% Errors of administration 33.3% 9.2% Incidence of the “nurse” errors (per day per patient) 0.54/D. Patient 0.08/D. Patient Conclusion The establishment of strict rules, the choice of documents of care adapted to the prescriptions and to the plans of care as well as a regular follow-up of the obtained results Their communication within the team allows a very sensitive improvement of the quality of treatments administered to the patients. Contexte Les défauts de qualité observés sur les prescriptions médicales et les erreurs d'administration des traitements sont souvent expliqués en Réanimation par leur multiplicité et la fréquence de leurs modifications. La fréquence de telles erreurs en Réanimation justifie la mise en place de programmes d'amélioration de la qualité dans ce domaine.1 2 Programme mis en œuvre Après un audit des pratiques, nous avons ciblé les erreurs les plus fréquentes et établi des règles strictes de prescription, de retranscription et d'administration des médicaments . Eléments de suivi La complexité de l'analyse d'un dossier et le souhait de mettre en place une procédure pérenne a fait choisir la méthode d'échantillonnage. Chaque mois, 2 journées de 10 dossiers tirés au sort sont analysées par un étudiant en pharmacie à ","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"11 1","pages":"A74 - A75"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74632146","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}

{"title":"105 Effects of a specifically-designed intensive care information system length of stay and mortality","authors":"Brisson Hélène, Arbelot Charlotte, Lu Qin, B. Bélaid, Vezinet Corinne, Bodin Liliane, Movschin Marie, Rouby Jean-Jacques","doi":"10.1136/QSHC.2010.041624.25","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.25","url":null,"abstract":"Introduction An intensive care information system (ICIS) has numerous advantages. It enables all the patients' data to be collected in a “computer file”. The automatic acquisition of data reduces human error, and computerised physician order entry limit errors in administering medication. Thanks to computerised data, the creation of a “clinical decision support system” enables diagnosis optimisation and follow-up of treatments. The goal of this study was to evaluate the impact of a personalised ICIS on critically ill patients' mortality and length of stay in the intensive care unit (ICU). Materials and methods The system chosen for Multidisciplinary ICU (12 beds) of Pitie-Salpetriere hospital in Paris was the program Metavision (IMDsoft, Tel Aviv, Israel). It is an adjustable system, offering the possibility of being completely reformatted and adapted according to specific needs. A team consisting of doctors, nurses, auxiliary nurses, and monitors was trained for 2 weeks to use the program. Then, for 1 month, the ICIS was personalised for the unit before being implemented. After defining the various clinical, biological, and radiological parameters indispensable for diagnosis and follow-up of acute respiratory disease, haemodynamic, renal, and hepatic failures, screens were created, integrating pertinent parameters in the form of tables and graphics. These screens enable all the relevant elements to be grouped together, but also allow the visualisation of their evolution along time. We compared the Simplified Acute Physiology Score (SAPS II) and the Sequential Organ Failure Assessment (SOFA) at patient's admission, length of patients' stay in the ICU, and mortality over two 6-month periods: before the implementation of Metavision from June to November 2008, and after implementation, from March to August 2009. Data were compared between groups by a Mann–Whitney test (median and IQR 25–75%), and a χ2 test. The first 3 months following the implementation of Metavision were not taken into account, in order to exclude the difficulties inherent to the implementation of a new computerised system. Results One hundred twelve patients were hospitalised between June and November 2008, and 160 between March and November 2009. SAPS II and SOFA scores showed no difference between the two groups: (SAPS II: 39 (26–54) vs 44 (28–59), p=0.7, SOFA: 6 (3–10) vs 6 (4–10), p=0.49). The length of stay in intensive care was shortened by 2 days after implementation of Metavision: 9 (5–20) versus 7 (3.5–14), p=0.02. A trend was observer towards a decrease in mortality: 17% to 14.5%, p=0.6. Discussion The interest of the system we have chosen is its adjustability, its ability to combine on the same screen (“clinical decision support screen”), a high number of clinical, biological, or radiological data. These screens enable the assessment of therapies on patients' organ failures. ICIS enables optimisation of patient's care, which may explain the reduction in duration of pat","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"5 1","pages":"A72 - A73"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74922139","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}

{"title":"196 Care network promoting the education of type 2 diabetic patients: short term efficacy and comparison with a hospital service specialised in diabetic care","authors":"B. Philip, Durain-Sieffert Danielle, Contal Irène, Cheryl Benjamin, D. Kevin, F. Renaud, Ziegler Olivier","doi":"10.1136/QSHC.2010.041632.29","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041632.29","url":null,"abstract":"Background, objectives The diabetes care network ‘Maison du diabète et de la nutrition de Nancy et 54’ (MDN54) is a territorial structure which organises formalised and structured therapeutic patient education (TPE) by a multidisciplinary team for type 2 diabetic patients (T2DM) or obese people, usually not treated by an endocrinologist. The goal of this study was to (1) compare baseline characteristics of the T2DM patients from MDN54 with patients followed in a diabetes university hospital department (CHU), (2) to describe the follow up of those patients during 1 year and (3) to compare the changes of some relevant parameters between the territorial and the hospital structure. Programme: description, implementation, monitoring elements T2DM patients are registered at MDN54 by their general practitioner. The patients take part to TPE programs according to a formalised programme as recommended by the HAS: educational diagnosis, group sessions and/or individual face-to-face meeting with an educator, assessment of self-management, and more educational sessions if needed. The sessions are conducted by a multidisciplinary team including private nurses, dieticians, physiotherapists, psychologists and chiropodist. All the sessions take place outside the hospital, at the head office of the MDN54 or in other quarters or cities (rooms offered by local authorities). The family physician is responsible for the annual diabetes check up according to the french national guidelines. TPE programmes have been adapted to primary care during training courses for general practitioners organised by the CHU team. This annual monitoring includes relevant clinical characteristics (body mass index, blood pressure, diabetes complications: retinopathy, neuropathy, wound risk level for diabetic feet, …) and biological results (HbA1c, LDL-cholesterol, HDL-cholesterol, triglycerides, creatinine's clearance by MDRD, microproteinuria, etc). The MDN54’s cohort included 486 T2DM patients registered between 2005 and 2008; 243 patients had had a complete initial annual assessment and 100 patients 2 successive annual assessments. CHU's cohort included 1997 patients and among them 848 T2DP with 2 successive annual assessments on the same period. Seventy-five patients of both populations were matched (CHUap and MDN54ap) using the propensity score on the initial values of several parameters (age, sex, duration of diabetes, BMI, total cholesterol, creatinine's clearance, retinopathy, renal failure, neuropathy, wound risk, hypertension, peripheral vascular disease, treatment with insulin). Results in terms of clinical impact Initial age (62.8 vs 63.0 years), BMI (31.7 vs 31.3 kg/m2) and HbA1c (7.53 vs 7.49%) of the two cohorts (MDN54 vs CHU) were similar (p=NS). Diabetes' duration (14.3 vs 9.0 years), rate of retinopathy (28.3 vs 10.4%) and nephropathy (44.9 vs 22.2%) were higher in the CHUs cohort (p<0.001). There was an improvement in HbA1c level for MDN54 patients at 1 year (7.53 vs 7","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"147 1","pages":"A174 - A175"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77857728","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}

{"title":"216 Use of good practice indicators by the College of General Practitioners of East Paris","authors":"Atlan Pierre, Dupagne Dominique, W. Philippe, G. Jean-Louis, Pigneur Jacques","doi":"10.1136/QSHC.2010.041624.84","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.84","url":null,"abstract":"Background and objectives The CGEP (French acronym for the College of General Practitioners of East Paris) is an independent association with no funding from industry which has been certified by HAS (French National Authority for Health) and CNFMC (National Councils for Continuous Medical Education). Its members are private and salaried general practitioners. The objective of CGEP is to improve health by improving care through the use of good practice indicators (GPI). The focus is on practice improvement (the aim) rather than on practice assessment per se (the tool). Programme This was a 3-year programme initiated in 2007, run by the association's committee, and with 29 participating GPs. The programme involves an analysis of practice and sharing of experience by GPs on chosen GPIs for common diseases (in particular iatrogenic disease, sleep disturbances, orders for tests, diabetes, and hypertension). The GPI criteria were reliability of the recommendations (ie, no conflict of interest with the health care industry), their relevance to professional practice, and feasibility within the scope of general practice. These criteria are potential guarantors of health improvements through guideline implementation. Practice analysis and sharing of experience occurred twice at a 6 to 12 months interval. Participants received guides on each indicator for practice analysis. They were able to make qualitative and quantitative comparisons of their own practice over time and also compare their practice with that of their peers at different times. The indicators were also used to measure trends in practice for the whole group. Results No participant dropped out suggesting that the initiative was relevant and feasible. There was a positive trend towards compliance with guideline recommendations by almost all participants and especially by the group as a whole (eg, for orders for tests, diabetes, child obesity). For example, group compliance showed increases: from 37% to 86% of patient files for the GPI ‘no a non steroidal anti-inflammatory drug during pregnancy’ (iatrogenic disease during pregnancy); from 33% to 79% for the GPI ‘advice on the correct use of condoms’ (sexually transmitted infections); from 37% to 56% for the GPI ‘prescription of alternatives to benzodiazepines’ (sleep disturbances). Although compliance is a surrogate endpoint for determining clinical impact, it is nevertheless essential. Discussion and conclusion Relevant and reliable GPIs are essential. Without them, there is no practice improvement plan and consequently no managed clinical improvement. However, GPIs are few and far between despite work done by HAS and the first-rate journal Prescrire. CGEP plans to turn the present initiative into a permanent project but its scope of action is seriously hampered by administrative ‘beating about the bush’ and by mandatory participation of GPs in various schemes (CME/PPA/CDP). The participation of specialists and allied health professionals, besi","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"54 1","pages":"A130 - A131"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76666690","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}

{"title":"143 Utilisation review of antibiotic use in intensive care in the CH of PAU","authors":"Bonneil Paul, V. A. Claire, Tachet Anne, Hoedt Brigitte, Huc Benoit, D. Noel, Picar Walter, Descamp Franck, B. Philippe","doi":"10.1136/QSHC.2010.041624.2","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.2","url":null,"abstract":"Introduction In 2004, the intensive care unit (ICU) of the general hospital in Pau noted practices with inadequate antibiotic therapy recommendations. The prescriptions were inhomogeneous and non protocolised among intensivists. The incidence of multi-resistant bacteria (MRB) was not followed. The aim of this program was medico-economic: reduce the selective pressure of antibiotic therapy at a lower cost while meeting the recommendations of learnt societies. It was necessary to prescribe better, less, without adverse clinical impact. Program Protocolisation antibiotic prescriptions (choice of molecules, time limitation, mono or dual therapy, duration of dual therapy) adapted to the ecology of ICU Formation of two physician service (university degree in infectious diseases) Designated referrers Choice of antibiotics during the daily meeting after discussion with all medical team's members (except emergency infectious diseases) When possible, decrease patient exposure rate to invasive devices resuscitation (endotracheal tube, urinary catheter or central venous catheter). Annual review in collaboration with the departments of hygiene and bacteriology to update the protocols of antibiotherapy Monitoring the use of antibiotics with the pharmacy service Clinical monitoring: average length of stay, attack rate of nosocomial infections, mortality, incidence of multi-resistant bacteria Results 2005 2006 2007 2008 Average cost of antibiotics per patient (euro) 572 466 305 343 Rate of exposure to invasive intubation (%) – 75 81 62 Rate of exposure to urinary catheter (%) – 91 91 84 Rate of exposure to central catheter (%) – 86 76 59 Incidence of pneumonia acquired under mechanical ventilation (PAVM) (%) – 33 22 15 Incidence of infections of central venous catheters (%) – 0 1 0 Incidence of urinary tract infections (%) – 8 2 3 Mortality rate (%) 23 22 19 17 Average length of stay (day) 9.5 9.1 8.5 8.0 Between 2005 and 2008, we followed the prevalence of multi-resistant bacteria at our ICU (Pseudomonas aeruginosa, MRSA, Stenotrophomonas maltophilia, ESBL, Acinetobacter baumannii). There were no significant change. There were always between 4 and 6% of patients with MRB. Conclusion The objectives were achieved: reduction of overall consumption of antibiotics in the ICU without significant change in the ecology of the service. Since the establishment of the program, the attack rate of nosocomial infections, the average length of stay and mortality were reduced. This program enables annually to take stock of antibiotic prescriptions. they are adapted to the impact of nosocomial infections and type of MRB isolated. The protocols can be adapted every year to the ecology of the service in collaboration with the departments of hygiene and bacteriology. This kind of program allows to carry out a policy medico-economic of the antibiotics in intensive care unit. It raises awareness and to promote cooperation between both the clinicians (intensivists) and external partn","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"19 1","pages":"A48 - A49"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88042453","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}

{"title":"199 How to follow the assessment of renal transplantation patients?","authors":"G. Mourad, R. Geneviève, Deshormière Nadine","doi":"10.1136/qshc.2010.041624.100","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.100","url":null,"abstract":"Objective (s), context A problem of Length of Stay was identified in 2006, on renal transplanted patients. In deed the average Length of stay (23 days) of the CHRU was superior of 3 days to the national one (19 days). The objective of the assessment realised by all the medical and paramedical teams was to identify all the reasons of the increase of stay to try to eliminate them. Program: description, implementation elements of follow-up To reach the defined objective, the professionals, realised a first analysis of their practices by identifying all the step of the care of patients (HAS method: clinical pathway) and the dysfunctions. This study was completed par a file review of the renal transplanted patients on the total clinical pathway. All the professionals participated to the first evaluation over twelve months. Regular assessments on main criteria were realised for two years (Length of the stay, ischaemia time…), as well as punctual assessment (audit of protocol—files review…) Results All these studies allowed: The definition of the target clinical path of the renal transplanted from the immediate post operating to the exit of the establishment validated by all the professionals. The identification and quantification of critical points of each step of the care of patient The definition of principal reasons of deviance of the length of stay such as: the professional variability of practice on the care process of patients the delays of exit due to the not knowledge of the immuno-depressant treatment (often by ignorance, in particular because of the language) or in the detection of histories of not - compliance therapeutics. the main complications arising at 82% of the population. Different types of improvement were identified. The patient's education formalisation of therapeutic education on immuno-depressant treatment training of the nurses to these education doing a systematic traceability of the information connected to this education in the patient file evaluation of this education for each patient The medical and nurses protocols harmonisation and updating of care protocols The first elements allowed making decrease average of length of stay of 23 days in 2006 in 16 days in 2007. Since 2007, average of Length of Stay from immediate post operating to exit of the patient (clinical pathway target) is the tracer indicator. This indicator evolved positively thanks to actions plan. A new evaluation of the clinical pathway was realised in 2009. The therapeutic education and his traceability are in accordance with the protocols what allows us to eliminate one cause of deviance of length of stay. The turn over of paramedical teams requires a systematic training of newcomers and an evaluation of knowledge. The main protocols of care were audited on files and their application is largely respected. The main study of 2009 concerns essentially the complications, and in particularly the urinary infection. The analysis specifies their characteristics,","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"37 1","pages":"A146 - A147"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90102804","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}

{"title":"089 Assessing the impact of recommendations on drug prescriptions in intensive care units","authors":"K. Kuteifan, C. Berg, J. Mootien, A. M. Gutbub, J. Navellou, J. Quenot","doi":"10.1136/QSHC.2010.041632.12","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041632.12","url":null,"abstract":"Background and Objectives The prescription is the starting line in the organisation of the drug circuit and determines the work of all those involved in the drug delivery process. The aim of our study was to assess drug prescription in the intensive care units (ICUs) of the College of intensivists of North-East France. Programme A two-round clinical audit was conducted in four ICUs. All prescriptions written out over a 24-h period were reviewed by a doctor and a pharmacist in each ICU. Criteria for good prescribing practices were established and distributed to all team members. A reminder was issued 3 months later. The second round of the clinical audit was carried out 6 months after the first. Results The number of prescriptions was 180 in the first round and 193 in the second. The non-conformity rate was 33.9% and 12.4%, respectively. The main errors in the two rounds were: adding an unsigned and unstamped (no date or time) prescription (70% vs 58%), unsigned change in dose (16% vs 9%), unsigned order to discontinue drug administration (18% vs 9%), administration of a drug that was not prescribed, no mention of dose, oral prescription, and noncompliance with dosage form. Discussion and Conclusion The dispensation and administration of a drug depends on the prescription. The main risks when prescribing drugs are the prescription of a treatment unsuited to the patient's clinical condition, possible drug interactions and a lack of detail that may induce errors. Establishing and distributing guidelines is an essential step in reducing prescribing errors and managing drug-related risks in ICUs. In conclusion, the production and distribution of criteria helped lower the rate of non-conformity with prescriptions in ICUs. We are currently preparing Intranet distribution within our hospital of criteria for the most commonly used drugs administered by infusion or injection and a list of drugs that can be administered by gastric tube. Introduction La prescription est le point de départ d'un des processus organisationnels majeurs qu'est le circuit du médicament. Elle conduit à structurer l'organisation du travail de tous les acteurs de la dispensation à l'administration. L'objectif de notre étude est d'évaluer la prescription médicamenteuse dans les services appartenant au Collège des réanimateurs du Nord-Est. Méthode Un audit clinique, est réalisé dans 4 services de réanimation. Toutes les prescriptions d'une période de 24 heures ont été revues par un médecin et un pharmacien dans chaque service. Un référentiel de prescription a été réalisé et distribué à tous les membres des équipes médicales, avec une « piqûre de rappel » à 3 mois. Un deuxième relevé a été réalisé à 6 mois. Résultats 180 prescriptions ont été relevées au premier tour, et 193 au deuxième. Les taux de non conformité étaient de 33,9 % et de 12,4 % respectivement. Les erreurs principales qui ont été notées sont : ajout de prescription non signé","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"53 1","pages":"A159 - A159"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85927492","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}

{"title":"260 The experience of the multidisciplinary falls consultation to reduce the risk of falls and the consumption of psychotropics in old persons at high risk of falls","authors":"F. Puisieux, V. Pardessus, V Beghin, C. Gaxatte, P. Lagardere, E. Boulanger","doi":"10.1136/qshc.2010.041616.14","DOIUrl":"https://doi.org/10.1136/qshc.2010.041616.14","url":null,"abstract":"Background Falling in older persons is a common and serious clinical problem. Most falls are due to multiple associated factors, including disorders of gait, balance, strength and vision…. Polypharmacy and certain medications, especially psycho tropics, are associated with increased risk of falling and can be a remediable factor. Objective To report the experience of the Multidisciplinary Falls Consultation of the University Hospital of Lille (France) in terms of fall prevention and ‘potentially inappropriate medication’ (PIM) and psychotropics consumption reduction. Methods Multidisciplinary Falls Consultation offers to each patient a multidimensional assessment aiming to identify risk factors for falling. According to the assessment findings, recommendations are made and targeted measurements are implemented to reduce the risk of falls and consequences due to falls. A control visit is realised six months later. To determine PIM consumption we used the American list of Beers and the French list of Laroche. Results Among 541 patients (136 men; mean age=80.6±7.6 years) the mean number of drugs taken was 6.1±3.1 per patient. Three hundred sixteen (58.6%) patients took at least one PIM according to the list of Beers and 347 (64.4%) patients according to the list of Laroche. Three hundred (55.5%) took at least one psychotropic drug (mean 1.6±0.9 psychotropics per patient). The most frequent recommendations from the staff were physical therapy, environmental changes, and medication changes. Over the following 6 months, about one out of three patients had experienced new falls. However, the risk of falling was significantly reduced (3.1±7.3 falls/6 months before vs 0.9±2.0 falls/6 months after the intervention). Most of the patients reported having completed more or less totally with the recommendations. In one case out of two, the patient's GP totally complied with our therapeutic recommendations and modified the drug therapy accordingly. Discussion The Multidisciplinary Falls Consultation appears to be effective in reducing psychotropics consumption and falls in older persons at high risk of falling. To increase adherence to the recommendations, we have developed and implemented after the initial multidisciplinary assessment a pilot 12-week program of once-weekly group education (60 min each) and exercise sessions (60 min each). An individual evaluation of capabilities and an education diagnosis are realised initially and a terminal evaluation at the end of the 12-week cycle to assess physical and psychological benefits of this program. Contexte La chute chez les personnes âgées constitue un problème clinique fréquent et grave. La plupart des chutes sont liées à de multiples facteurs associés: troubles de l’équilibre, de la marche, de la force musculaire, de la vision,…. La polymédication et la prise de certains médicaments, en particulier des psychotropes, sont associées à une augmentation du risque de tomber et constituent un facteur de","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"119 1","pages":"A37 - A38"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86276610","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}