Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041624.69
Noublanche Sophie, M. Cécile, Tremblay N'guyen Lucie, Mouzet Jean Baptiste, Sultan Anne Marie, Ghali Alaa
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%
背景和目的2004年对昂热医院后续护理和长期护理部的被动身体约束做法进行了评估,为当时在场的医务人员和辅助医务人员举办了培训和教育课程。为了衡量其影响,2006年和2008年提出了两次针对性临床审计(ACC)。本研究的主要目的如下:试图反映美国国家安全与环境研究所(HAS)制定的最佳做法"限制老年人身体约束附带的风险"(2000年10月)使医务人员更好地了解这一工具及其后果通过寻求替代解决办法限制身体约束的使用逐步淘汰不相关或过度使用身体约束这些审计的主要目的是:(i)提高身体约束医疗处方的质量;(ii)改善对患者及其家属的信息;(iii)发展对身体约束的监测并预防其相关风险。临床审核对每一位受约束的患者进行了一天的跟踪(不包括受床障限制的患者)。我们使用的网格和跟踪表的指导下,美国国家航空航天局。根据第一次审计的结果,实施了下列措施:为所有医务和辅助医务人员(新入职人员)举办信息介绍会和继续教育为实习生和学生开设专门的理论课对病人进行设备使用和安装方面的培训(老年病房)在电脑桌上显示处方和监测表任命负责索赔和冲突的医生2008年进行的第二次审计确认了第一次倡议的必要性,并特别促进了以下倡议行动:继续定期为医务人员和辅助医务人员举办非正式和正式的情况介绍会继续减少使用束缚物,以限制最难以预见的负面影响指出越来越多地使用"适应性"椅子所造成的风险增加处方单的使用,以提高其信息质量(对开处方的医生进行教育)简化监测单,促进其使用。尝试合并处方和监护单进一步提高患者及其家属信息的可追溯性目前的目标是:定期继续评估(ACC)(大约每两年一次)为科室其他单位准备相同类型的审计为CRRRF长期护理单位(les Capucins)准备相同类型的审计建议对EHPAD中物理约束的专业实践进行评估结果的临床影响之前,平均并发症发生率为30%,长期护理(SLD)患者占70%,随访护理(SSR)患者占14%。教育举措使这一比例在2006年降至16.5%(特殊教育群体36%,特殊教育群体11.4%),在2008年降至12%(特殊教育群体13%,特殊教育群体11.8%),使用腰带的人数大幅减少,取而代之的是坐在扶手椅上的桌子。2004年和2008年对与使用物理约束有关的并发症的评估特别强调了褥疮数量的减少和严重跌倒的消失,这表明了风险预防政策的真正好处。讨论和结论虽然2004年发现了使用人身限制的不当行为,但对医务人员的教育使减少使用人身限制的政策得以实施。身体约束的话题现在很容易被提出,并被认为是病人护理的一部分。医务人员特别注意通过再适应预防相关风险。医务人员仍然没有准备好通知病人,特别是那些精神错乱或情绪激动的病人。皮带的配方在数量上似乎可以接受,但质量却不足。我们离HAS的建议还有很长的路要走,但正在朝着尊重老年人尊严和正直的身体约束做法迈进。背景,目标,评价,使用和实践,争论,物理被动,和,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换,交换。在2006年和2008年期间,对两个审计系统(ACC)和<s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> <s:1> (cima))的影响。Les principaux目的ce阵痛是:Tendre年代'approcher盟mieux des有实际du referentiel de l导演(已经)“限幅器Les个de la争用体格de la人阿吉”(octobre 2000) Permettre辅助soignants de mieux逮捕cet(中央东部东京)outil et de好en认识Les的后果。 限制使用替代品的束缚,寻求见去掉无关的用途,甚至滥用这些审计的主要方向是提高处方质量的束缚,加强信息给患者及其亲属和发展监测预防风险和束缚。有针对性的临床审计记录了某一天包含的所有患者(不包括仅通过床屏障包含的患者)。使用了收集网格和分析的数据载体。根据第一次审核的结果,我们采取了以下改进措施:信息理论和认识规律的全体人员和医务辅助人员(新)具体的理论培训为主体的内部和外部实践研讨会上提供装备的使用和安装的老年病患者(单位)提供关于监督厅的电脑监控表的时效和任命一位护理员référent-contention二次审核,导致2008年只会加强第一项行动,特别是将鼓励我们:进行定期的培训和宣传医学和药物学(还原)奉行以限制使用有害影响最难防范风险教鞭漂移的无牌照l’adaptable +椅子使用,提高使用单张处方要提高信息质量(这段+宣传+治疗师)简化监测表来促进它的使用。+/-为处方和监测建立单一记录进一步改善对患者和/或亲属的信息可追溯性现在的项目是继续定期评估(ACC)(大约每两年一次)准备对其他中心单位进行类似类型的审计。准备一个同样类型的审计中CRRRF的长期护理服务(猴)提出一项评估专业做法的束缚EHPAD现状而言影响临床结果显示平均患病率为30%,70%为我们的病人在长期护理(SLD)和14%的患者后护理和康复(SSR)。人员的认识将有助于减轻这种流行16.5% (36%)SSR SLD和11.4%,2006年和2008年的12%,SSR年SLD和11.8%(13%)与安全带的使用大幅度下降,而输给l’adaptable困在轮椅的轮子后面。2004年和2008年对与使用约束装置相关的并发症进行的评估显示,除其他外,形成的褥疮数量大大减少,严重摔倒的情况也消失了,这证明了一项真正的风险预防政策。讨论和结论虽然2004年的清单显示了遏制良好做法的缺陷,但护理人员的意识使减少使用成为可能。“遏制”的主题现在很容易处理,它本身就被视为一种关怀。护理人员特别注意通过康复预防风险。他们手无寸铁地通知病人,特别是精神错乱或不安的病人。皮带的处方似乎是定量的,但质量很差。我们离HAS的建议还有很长的路要走,但我们正在朝着尊重老年人尊严和完整性的有益遏制迈进。
{"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}
Pub Date : 2010-04-01DOI: 10.1136/qshc.2010.041632.38
P. Jourdain, F. Funck, O. Boirau, A. Boireau, J. Dagorn, P. Hervio, L. Blum
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
随着多重抗病毒治疗的出现,HIV患者的预期寿命显著提高。然而,最近的研究表明,这些疗法对脂质代谢有影响。因此,我们想要确定在这一人群中系统的心脏病护理可能会产生什么影响。我们系统地建议所有接受三联治疗的HIV患者在Pontoise医院接受会诊,然后进行心脏学评估,包括生物、超声心动图、多普勒和宫颈中内膜测量。根据临床和生物学资料,提出了下肢动脉多普勒和应激试验的诊断方法。然后,我们将这些数据与文献研究在年龄和性别方面的可比人群的数据进行比较。结果97例患者定期随访,其中77例在门诊或门诊就诊。20名失踪的病人因个人原因不愿去心脏病科会诊。我们的队列平均年龄为49.05±5岁,属于年轻人群。艾滋病毒感染平均为6年(1-10年)。经临床检查,74%的人平均为15 PY的主动吸烟,54%的人超重(平均77.7 kg ~ 1.71 cm)。臀转为97.3厘米,肩部转至110.48厘米。15%有临床脂肪营养不良。32%患有高血压(定义为两次PA>140/95)。67%的患者有血脂异常,75%的患者有混合性血脂异常。这些人都没有糖尿病。在我们的测试队列中,标准0.73 mm的内膜中膜厚度平均为0.81 mm(左),右0.82 mm (p 140/95)。67%的人是单一脂质异常的人,75%的人是混合脂质异常的人。奥库尼·卡森特·德·糖尿病。L' samisisseur intima mcametdia est en moyenne de 0,81, Gauche et de 0,82 mm, comdroite pour one normale de 0,73 mm, not队列检验(p< 0.05)和de 0,75 mm comme seil de cut off dans les cametines, canadienes (p< 0.05)。患者的心率正常,80%的患者与100%的患者的心率正常,而患者的心率正常值< 30 pg/ml。Au terme du bilan et d'un和de suivous avons retrotrovous,分别为:one artsamriopathie, ente ente, ente ente, ente ente, ente ente, ente ente, ente, ente, ente, ente, ente, ente, ente, ente, ente, ente, ente, ente, ente, ente, ente。综上所示,在患者VIH +的情况下,所有的患者都有相同的情况,例如,所有的患者都有相同的情况,所有的患者都有相同的情况,所有的患者都有相同的情况,所有的患者都有相同的情况,所有的患者都有相同的情况,所有的患者都有相同的情况,所有的患者都有相同的情况。Par contre l' samchographie cardiaque ne doit pas être system sammatique。
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Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041632.12
K. Kuteifan, C. Berg, J. Mootien, A. M. Gutbub, J. Navellou, J. Quenot
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
背景和目的处方是药物循环组织的起跑线,决定了所有参与给药过程的人员的工作。我们研究的目的是评估在法国东北部的重症监护病房(icu)学院的药物处方。方案对4个icu进行了两轮临床审核。所有24小时内开出的处方都由每个ICU的医生和药剂师审查。建立了良好的处方规范标准,并将其分发给所有团队成员。3个月后发出了提醒。第二轮临床审核在第一轮审核后6个月进行。结果第一轮处方数为180张,第二轮处方数为193张。不合格率分别为33.9%和12.4%。两轮的主要错误是:添加未签名和未盖章(没有日期或时间)的处方(70%对58%),未签名的剂量变化(16%对9%),未签名的停药命令(18%对9%),未开处方的药物,未提及剂量,口服处方,以及不符合剂型。讨论与结论药物的调配和给药取决于处方。开药时的主要风险是处方不适合患者的临床状况,可能的药物相互作用以及缺乏可能导致错误的细节。制定和分发指南是减少icu中处方错误和管理药物相关风险的重要步骤。综上所述,标准的制定和分发有助于降低icu的处方不符合率。目前,我们正准备在医院内发布最常用的输注或注射给药标准以及可通过胃管给药的药物清单。导语:处方是一种简单的治疗方法,它可以使患者在治疗过程中恢复正常。“组织结构”是指“组织结构”,而“组织结构”是指“组织结构”。根据东北大学的规定,我们的目标是:在东北大学的规定下,我们的目标是:在东北大学的规定下,我们的目标是:在东北大学的规定下,我们的目标是:3 .联合国审计机构,est . sys . sys .和4种服务。Toutes处方d'une psamuest de 24 heures ont samuest revues par un msamuest et pharmacien dans chque service。1 .在所有的成员中,所有的成员都是由)组成的。Un deuxi相关 - - - 6 mois。rs - 3有180个处方,其中有180个是与mr - 3相关的,193个是与mr - 3相关的。不符合标准的人分别占33.9%和12.4%。原则上的错误(Les erreurs principales qui not samices):关于处方无标志的samices (70% vs 58%)、修改无标志的samices (16% vs 9%)、arrêt无标志的samices (18% vs 9%)、给药无规定的samicha (18% vs 9%)、无标志的samicha(18%)、无规定的samicha(18%)、无规定的samicha(18%)、无规定的samicha(18%)、无规定的samicha(18%)和无规定的samicha(18%)。讨论La qualit d'une prescription du m.m.acdiment ment,条件细胞des m.m.acdiment:分配和管理。危险的原则鼓励你把你的前程前程看成是你的前程,把你的前程看成是你的前程,把你的前程看成是你的前程,把你的前程看成你的前程,把你的前程看成是你的前程。建议的扩散是指对所有的薪金薪金和薪金薪金的限制,以及对薪金薪金薪金和薪金薪金的限制。结果拉认识et de referentiel de La扩散处方medicamenteuse有的08 taux de非公司des处方en复活。列出了扩散«内部网»,列出了传播«内部网»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»,列出了传播»。
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Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041632.28
B. Clémence
Background and objectives One of the quality improvement programmes implemented by the emergency department of Rennes university hospital concerns the clinical impact and appropriateness of orders for imaging tests in urologic emergencies. Our objective was to evaluate compliance with a recommended low-dose protocol in cases of acute renal colic and complicated pyelonephritis and the clinical impact of this protocol on the quality of care. Programme Acute renal colic and pyelonephritis are common reasons for arrivals in the emergency department. A multidisciplinary team within the emergency department developed a radiology protocol for management of these cases. For all cases of suspected acute renal colic but for complicated cases of pyelonephritis only, a low-dose CT scan was recommended. No radiology exam was recommended by the emergency department for simple acute pyelonephritis. Emergency physicians and radiologists were to apply the low-dose protocol to all cases tagged ‘CT-scan for pyelonephritis’ and ‘CT-scan for renal colic’. Results This was a before-after comparison based on the review of 315 files. The clinical impact of the protocol was threefold: (i) Positive impact on existing practices: There was a significant increase in orders for CT-scans in complicated forms of acute renal colic and pyelonephritis, in line with earlier recommendations; (ii) Changes in practice: There was a decrease in orders for plain abdominal X-rays which are very often used for diagnosis in cases of acute flank pain; CT-scanning was used in preference to abdominal x-ray plus abdominal ultrasound for both acute renal colic and pyelonephritis; the radiation dose was reduced but nevertheless remained higher than the low-dose recommended in the literature; (iii) Implementation of the protocol did not affect the time taken to perform the exams nor to manage patients in the emergency department. Discussion and conclusion Certain questions remain unanswered such as the issue of radiation exposure in young patients in whom these afflictions may recur. Moreover, not all physicians agree on all points, such as the management of simple acute pyelonephritis. In addition, the latest consensus conference guidelines recommend first-line abdominal X-ray and ultrasound for the management of acute renal colic. The next step is therefore to use our findings as a basis for a review of the protocol by the whole team in order to make any necessary adjustments. Contexte, objectif (s) Dans le cadre des démarches d'amélioration de la qualité, le CHU de Rennes a développé des programmes d'évaluation des pratiques professionnelles dont un axe retenu était celui de l'impact et de la pertinence de la prescription et du délai des examens d'imagerie. Cette étude a été appliquée à l'imagerie des urgences urologiques médicales. Programme La colique néphrétique et la pyélonéphrite sont deux motifs fréquents de consultation dans un service d'urgence. Dans le service des ur
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Pub Date : 2010-04-01DOI: 10.1136/qshc.2010.041624.60
E. Carlos, E. Nicolas, Peiretti Alexandra, Douheret Florian, Roussel Eric, Mann Yvan, Echahed Khalid, Capel Olivier, J. Xavier, Serre Patrice, Bonnefoy Eric
Background The purpose of this study was to determine whether implementation of regional guidelines improves the management of acute myocardial infarction with ST-elevation (STEMI), in terms of reperfusion decision and orientation. Program The editing of local guidelines in a hospital or a network of care is recognised as a useful approach, but rarely evaluated. The RESCUe network has defined and implemented a guideline shared by 30 hospitals to improve MI care pathway and transfer of STEMI. To evaluate the guideline's impact, the emergency doctors involved in the network included in a prospective register all suspected MI entering the prehospital care pathway, to analyse their route since the call to the centre 15. Recent data were compared to those collected before the guideline dissemination. The acute phase indicators spotting good practices as defined by French National Authority for Health were evaluated: rate and time to reperfusion, rate of direct referral to transfer to interventional cardiology center (ICC), rate of patients receiving anti-platelet therapy, analgesia and Heparin, in hospital mortality. Results Between February 2008 and May 2009, 568 patients with less than 24 h STEMI at the acute phase were managed by the 18 mobile intensive care units (MICU) and the 8 ICC of the zone covered by RESCUe network. Their data were compared to those of 544 patients managed between January 2004 and December 2005, using the same inclusion criteria and analysis. The exhaustivity not evaluated in 2005, was 95% in 2009. The comparison of the results between 2005 and 2009 shows: a significant improvement (p<0.05): of the reperfusion rate (all techniques) from 86 to 90%, for those receiving primary percutaneous coronary intervention (PPCI) from 23 to 63%, antalgic therapy from 33 to 50% and heparin (unfractionned heparin and low molecular weight heparin) from 69 to 90%. The rate of clopidogrel therapy, recently implemented reached 87% in 2009. a significant reduction (p<0.05) of the: median ‘door to balloon’ time from 240 to 105 min, thrombolytic therapy rate from 66 to 27% and rate of patients not receiving reperfusion therapy from 14 to 10%. an in hospital mortality rate of 6%. Discussion The establishment of regional guideline allowed improving STEMI care pathway since the call to the 15 Center to the reperfusion for patients managed by mobile intensive care units. The access to reperfusion therapy and recommended treatments for the patients managed within this care pathway has significantly improved between 2005 and 2009, according to guidelines, with a privileged referral to the interventional cardiology center. Conclusion The establishment of a regional guideline with measurement of its implementation brings together health professionals and significantly improve the acute care pathway for MI management, for patients benefit. Guideline and clinical practice indicators are efficient tools (i) to implement good practices according to guidelines
本研究的目的是确定区域性指南的实施是否能在再灌注决策和定位方面改善急性st段抬高心肌梗死(STEMI)的治疗。在医院或护理网络中编辑当地指导方针被认为是一种有用的方法,但很少进行评估。急救网络定义并实施了由30家医院共享的指导方针,以改善心肌梗死的护理途径和STEMI的转移。为了评估指南的影响,参与网络的急诊医生将所有进入院前护理途径的疑似心肌梗死患者纳入前瞻性登记,分析他们自呼叫中心以来的路线15。最近的数据与指南发布前收集的数据进行了比较。评估了法国国家卫生管理局定义的确定良好做法的急性期指标:再灌注率和时间、直接转诊到介入性心脏病中心(ICC)的比率、接受抗血小板治疗、镇痛和肝素治疗的患者比率、住院死亡率。结果2008年2月至2009年5月,18个流动重症监护室(MICU)和8个急救网络覆盖区域的ICC对急性期STEMI少于24 h的568例患者进行了管理。他们的数据与2004年1月至2005年12月期间544名患者的数据进行比较,使用相同的纳入标准和分析。2005年未评估的穷竭性在2009年为95%。2005年与2009年的结果比较显示:再灌注率(所有技术)从86%提高到90%,接受首次经皮冠状动脉介入治疗(PPCI)的患者从23%提高到63%,止痛治疗从33%提高到50%,肝素(未分离肝素和低分子量肝素)从69%提高到90%,显著改善(p<0.05)。最近实施的氯吡格雷治疗率在2009年达到87%。门到球囊的中位时间从240分钟减少到105分钟,溶栓治疗率从66%减少到27%,未接受再灌注治疗的患者率从14%减少到10%,显著减少(p<0.05)。医院死亡率为6%区域指南的建立使得STEMI从呼叫15中心到移动重症监护室管理的患者再灌注的护理路径得以改善。根据指南,在2005年至2009年期间,在该护理途径下管理的患者获得再灌注治疗和推荐治疗的机会显著改善,并优先转诊到介入性心脏病学中心。结论区域指南的建立及其实施情况的衡量汇集了卫生专业人员,并显著改善了急性心肌梗死管理的护理途径,使患者受益。指南和临床实践指标是(1)根据指南实施良好做法(2)评估、改进和跟踪专业实践的有效工具。目的:背景:Évaluer影响、应用、调温、调温、调温、调温、调温、调温、调温、调温、调温、调温、调温、调温、调温、调温、调温、调温、调温。方案:"确定和确定"、"确定和确定"、"确定和确定"、"确定和确定"、"确定和确定"、"确定和确定"。Le栅网救援defini et mis在地方联合国referentiel commun ses 30 etablissements进行初步优化器倒拉撬en电荷等les过户des infarctus du myocarde用sus-decalage du段圣倒在安勤科技的,里面的urgentistes信徒救援包括在联合国registre prospectif全部的怀疑d 'infarctus aigus du myocarde (IDM)取了en电荷en pre-hospitalier苏尔拉杜区防疫线网格afin d特定Le parcours从l 'appel盟中心15。不确定的是,不确定的是,不确定的是,不确定的是,不确定的是,不确定的是,不确定的是,不确定的是,不确定的是。三个指标阶段的健康状况,如健康状况阶段的健康状况,如健康状况阶段的健康状况,如健康状况阶段的健康状况,如健康状况阶段的健康状况,如健康状况阶段的健康状况,如健康状况阶段的健康状况,如健康状况阶段的健康状况,如健康状况阶段的健康状况,如健康状况阶段的健康状况。在2008年至2009年5月,有568名患者被诊断为患有<s:1> <s:1> <s:1>医疗器械和其他医疗器械中的<s:1>医疗器械和其他医疗器械中的<s:1>医疗器械和其他医疗器械中的<s:1>医疗器械和医疗器械中的医疗器械。在2004年1月和2005年1月,对544名患者进行了调查,并将其纳入纳入标准和分析标准。从2005年的统计数据看,2009年的统计数据是95%。
{"title":"279 Name of program: evaluation of the strategy of treatment for myocardial infarction by the RESCUe network","authors":"E. Carlos, E. Nicolas, Peiretti Alexandra, Douheret Florian, Roussel Eric, Mann Yvan, Echahed Khalid, Capel Olivier, J. Xavier, Serre Patrice, Bonnefoy Eric","doi":"10.1136/qshc.2010.041624.60","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.60","url":null,"abstract":"Background The purpose of this study was to determine whether implementation of regional guidelines improves the management of acute myocardial infarction with ST-elevation (STEMI), in terms of reperfusion decision and orientation. Program The editing of local guidelines in a hospital or a network of care is recognised as a useful approach, but rarely evaluated. The RESCUe network has defined and implemented a guideline shared by 30 hospitals to improve MI care pathway and transfer of STEMI. To evaluate the guideline's impact, the emergency doctors involved in the network included in a prospective register all suspected MI entering the prehospital care pathway, to analyse their route since the call to the centre 15. Recent data were compared to those collected before the guideline dissemination. The acute phase indicators spotting good practices as defined by French National Authority for Health were evaluated: rate and time to reperfusion, rate of direct referral to transfer to interventional cardiology center (ICC), rate of patients receiving anti-platelet therapy, analgesia and Heparin, in hospital mortality. Results Between February 2008 and May 2009, 568 patients with less than 24 h STEMI at the acute phase were managed by the 18 mobile intensive care units (MICU) and the 8 ICC of the zone covered by RESCUe network. Their data were compared to those of 544 patients managed between January 2004 and December 2005, using the same inclusion criteria and analysis. The exhaustivity not evaluated in 2005, was 95% in 2009. The comparison of the results between 2005 and 2009 shows: a significant improvement (p<0.05): of the reperfusion rate (all techniques) from 86 to 90%, for those receiving primary percutaneous coronary intervention (PPCI) from 23 to 63%, antalgic therapy from 33 to 50% and heparin (unfractionned heparin and low molecular weight heparin) from 69 to 90%. The rate of clopidogrel therapy, recently implemented reached 87% in 2009. a significant reduction (p<0.05) of the: median ‘door to balloon’ time from 240 to 105 min, thrombolytic therapy rate from 66 to 27% and rate of patients not receiving reperfusion therapy from 14 to 10%. an in hospital mortality rate of 6%. Discussion The establishment of regional guideline allowed improving STEMI care pathway since the call to the 15 Center to the reperfusion for patients managed by mobile intensive care units. The access to reperfusion therapy and recommended treatments for the patients managed within this care pathway has significantly improved between 2005 and 2009, according to guidelines, with a privileged referral to the interventional cardiology center. Conclusion The establishment of a regional guideline with measurement of its implementation brings together health professionals and significantly improve the acute care pathway for MI management, for patients benefit. Guideline and clinical practice indicators are efficient tools (i) to implement good practices according to guidelines","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"141 1","pages":"A107 - A108"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88290768","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.2010.041624.2
Bonneil Paul, V. A. Claire, Tachet Anne, Hoedt Brigitte, Huc Benoit, D. Noel, Picar Walter, Descamp Franck, B. Philippe
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
{"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}
Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041608.7
P. Parneix, D. Zaro-Gon, B. Jarrige, E. Galy, C. Léger, M. Fanon, C. Gautier, S. Marie, A. Mahamat
Background In 1998, under the pressure of consumer associations, the so-called health safety law erected transparency and prevention of nosocomial infections as a major priority public health declined in national guidelines beginning in 1999. The Southwestern France healthcare associated infection control centre (CCLIN So) was created in 1992 with the mission of implementing the national policy in the 473 healthcare facilities located in 7 administrative regions including 3 overseas one. Program Reduce cross contamination by improving hand hygiene's observance was the main objective of the program. Hand disinfection promotion with handrub products (HP), erected as a national strategy in 2001, was achieved throughout infection control professionals networks animated by the CCLIN in each region. Implementation of hand hygiene day with a common tools kit, including video clips promoting HP use, started in 2005. Three multi-centres hand hygiene compliance audits were performed between 1999 and 2008. An annual prevalence study and follow-up of the resistance of the Staphylococcus aureus (S. aureus) via a microbiology laboratories’ network, implemented in 1993, have accompanied the program. Public reporting in the field of healthcare associated infection (HAI) including an indicator of the HP consumption has been a strong support of the strategy enhanced in our region by a software creation to monitor monthly consumption at a ward level. The observance of the hand hygiene, the frequency of methicillin-resistant S. aureus (MRSA) and the prevalence of MRSA HAI were followed as indicators. Results In 1999 the audit showed that 39.7% of care situations were associated with no hand hygiene and proportion of disinfection among hand hygiene was 10.4%. By 2005 these two percentages reached 23.6% and 38.7% respectively to achieve in 2008 10.0% and 71.0%. HP consumption rose from 91 036 litres in 2005 to 187 011 in 2007 associated with an increase percentage of achieved national objective from 22.7% to 44.7%. In parallel 64% of health facilities have organised the 2005 day with 28 632 participating healthcare professionals (HCPs) and 61% in 2007 with 24 299 HCPs trained and 6 099 consumers now associated at this yearly event. The SARM proportion among S. aureus strains was 41.4% in 1999 and it decreased steadily through 37.8% in 2005 to 31.5% in 2008. The prevalence of HAI with SARM decreased from 0.63% of hospitalised patients in 1999 to 0.30% in 2008 with a drop of the HAI prevalence from 5.5% to 3.8% in the same period. Discussion Implementing a policy of active promotion of hand hygiene with prioritising disinfection, faster and more efficient; allowed a significant increase of its observance in southwestern France healthcare facilities. This was made possible by an organisation and a national programme implemented by the CCLIN. The clinical impact of this action can be evaluated throughout the decrease of HAI and MRSA frequencies. The new French hospital hy
{"title":"138 Improving hand hygiene to decrease healthcare associated infections: impact of a ten year strategy in southwestern France","authors":"P. Parneix, D. Zaro-Gon, B. Jarrige, E. Galy, C. Léger, M. Fanon, C. Gautier, S. Marie, A. Mahamat","doi":"10.1136/QSHC.2010.041608.7","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041608.7","url":null,"abstract":"Background In 1998, under the pressure of consumer associations, the so-called health safety law erected transparency and prevention of nosocomial infections as a major priority public health declined in national guidelines beginning in 1999. The Southwestern France healthcare associated infection control centre (CCLIN So) was created in 1992 with the mission of implementing the national policy in the 473 healthcare facilities located in 7 administrative regions including 3 overseas one. Program Reduce cross contamination by improving hand hygiene's observance was the main objective of the program. Hand disinfection promotion with handrub products (HP), erected as a national strategy in 2001, was achieved throughout infection control professionals networks animated by the CCLIN in each region. Implementation of hand hygiene day with a common tools kit, including video clips promoting HP use, started in 2005. Three multi-centres hand hygiene compliance audits were performed between 1999 and 2008. An annual prevalence study and follow-up of the resistance of the Staphylococcus aureus (S. aureus) via a microbiology laboratories’ network, implemented in 1993, have accompanied the program. Public reporting in the field of healthcare associated infection (HAI) including an indicator of the HP consumption has been a strong support of the strategy enhanced in our region by a software creation to monitor monthly consumption at a ward level. The observance of the hand hygiene, the frequency of methicillin-resistant S. aureus (MRSA) and the prevalence of MRSA HAI were followed as indicators. Results In 1999 the audit showed that 39.7% of care situations were associated with no hand hygiene and proportion of disinfection among hand hygiene was 10.4%. By 2005 these two percentages reached 23.6% and 38.7% respectively to achieve in 2008 10.0% and 71.0%. HP consumption rose from 91 036 litres in 2005 to 187 011 in 2007 associated with an increase percentage of achieved national objective from 22.7% to 44.7%. In parallel 64% of health facilities have organised the 2005 day with 28 632 participating healthcare professionals (HCPs) and 61% in 2007 with 24 299 HCPs trained and 6 099 consumers now associated at this yearly event. The SARM proportion among S. aureus strains was 41.4% in 1999 and it decreased steadily through 37.8% in 2005 to 31.5% in 2008. The prevalence of HAI with SARM decreased from 0.63% of hospitalised patients in 1999 to 0.30% in 2008 with a drop of the HAI prevalence from 5.5% to 3.8% in the same period. Discussion Implementing a policy of active promotion of hand hygiene with prioritising disinfection, faster and more efficient; allowed a significant increase of its observance in southwestern France healthcare facilities. This was made possible by an organisation and a national programme implemented by the CCLIN. The clinical impact of this action can be evaluated throughout the decrease of HAI and MRSA frequencies. The new French hospital hy","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"21 1","pages":"A8 - A9"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85607290","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.2010.041616.14
F. Puisieux, V. Pardessus, V Beghin, C. Gaxatte, P. Lagardere, E. Boulanger
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
{"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}
Pub Date : 2010-04-01DOI: 10.1136/QSHC.2010.041632.36
M. C. IIliou, T. Badoual, P. Tuppin
Background Cardiac rehabilitation prescriptions are one of the quality criteria for international and french guidelines after an cardiovascular event. However, in France, cardiac rehabilitation rates were lower than 25%. One of the explanations may be a low centre ability, and underused of out patient facilities. Our aim was to evaluate which are the parameters linked with the optimisation of the patient management and improve the centres efficiency. Methods We performed a pilot study during a representative month (June 2009) in the two APHP centres with assessment of different characteristics of patients referred to cardiac rehabilitation. We studied the follows items: length of refer after cardiac event, waiting time to an outpatient appointment, clinical criteria (age, disease, exercise capacity, transfer limitations), residence (transportation mode and travelling time) and social parameters (precariousness, work, disability, loneliness). A multivariate logistic model was used to evaluate independent significant factors predicting the outpatient management. Then, a score was elaborated according to the significant identified variables. Results We included 157 patients, mean age 61.8±14.0 years (from 19 to 88 years old). Pejorative access to outpatient management was linked to remote residence in 27 cases, patient willingness in 25 cases, medical condition in 24 cases, social disability in 13 cases and older age in eight cases. Univariate analysis showed significant differences between patients who can be managed as in or outpatient: ambulatory patients are younger (59.1 vs 63.5 years), male, have a better exercise capacity (83 vs 67 watts), more transport facilities, a short travelling time, without loneliness and lack of psychological or language barriers. In multivariate analysis, the independent parameters were: medical vs surgical origin (OR 1.6), transportation time (OR 1.6, <30 min), loneliness (OR 2.9), exercise capacity(>70 watts, OR 1.97) and patient willingness (OR 5.4). A score >6 is predictive to a major barrier to an outpatient management. Discussion As medical and practical factors can interfere with the ambulatory management of cardiac patients, the patient willingness still the major barrier which require special practitioner accuracy. In order to asses the score validity, we propose,after spread this, a future evaluation of optimal way through the cardiologic channels. Conclusion Outpatient management should in order to optimise access to cardiac rehabilitation care. Objectifs, contexte La prescription de réadaptation cardiaque est un des critères de qualité reconnue par les recommandations internationales et de l'HAS dans le post infarctus du myocarde. Or, les différents registres français montrent que cette prescription est peu fréquente (inférieure à 25 %). Une des hypothèses pouvant expliquer cette situation est le faible nombre de places disponibles dans les centres de réadaptation. De plus, la prise en charge a
{"title":"237 Improved and ambulatory care for patients in cardiac readaptation by a score","authors":"M. C. IIliou, T. Badoual, P. Tuppin","doi":"10.1136/QSHC.2010.041632.36","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041632.36","url":null,"abstract":"Background Cardiac rehabilitation prescriptions are one of the quality criteria for international and french guidelines after an cardiovascular event. However, in France, cardiac rehabilitation rates were lower than 25%. One of the explanations may be a low centre ability, and underused of out patient facilities. Our aim was to evaluate which are the parameters linked with the optimisation of the patient management and improve the centres efficiency. Methods We performed a pilot study during a representative month (June 2009) in the two APHP centres with assessment of different characteristics of patients referred to cardiac rehabilitation. We studied the follows items: length of refer after cardiac event, waiting time to an outpatient appointment, clinical criteria (age, disease, exercise capacity, transfer limitations), residence (transportation mode and travelling time) and social parameters (precariousness, work, disability, loneliness). A multivariate logistic model was used to evaluate independent significant factors predicting the outpatient management. Then, a score was elaborated according to the significant identified variables. Results We included 157 patients, mean age 61.8±14.0 years (from 19 to 88 years old). Pejorative access to outpatient management was linked to remote residence in 27 cases, patient willingness in 25 cases, medical condition in 24 cases, social disability in 13 cases and older age in eight cases. Univariate analysis showed significant differences between patients who can be managed as in or outpatient: ambulatory patients are younger (59.1 vs 63.5 years), male, have a better exercise capacity (83 vs 67 watts), more transport facilities, a short travelling time, without loneliness and lack of psychological or language barriers. In multivariate analysis, the independent parameters were: medical vs surgical origin (OR 1.6), transportation time (OR 1.6, <30 min), loneliness (OR 2.9), exercise capacity(>70 watts, OR 1.97) and patient willingness (OR 5.4). A score >6 is predictive to a major barrier to an outpatient management. Discussion As medical and practical factors can interfere with the ambulatory management of cardiac patients, the patient willingness still the major barrier which require special practitioner accuracy. In order to asses the score validity, we propose,after spread this, a future evaluation of optimal way through the cardiologic channels. Conclusion Outpatient management should in order to optimise access to cardiac rehabilitation care. Objectifs, contexte La prescription de réadaptation cardiaque est un des critères de qualité reconnue par les recommandations internationales et de l'HAS dans le post infarctus du myocarde. Or, les différents registres français montrent que cette prescription est peu fréquente (inférieure à 25 %). Une des hypothèses pouvant expliquer cette situation est le faible nombre de places disponibles dans les centres de réadaptation. De plus, la prise en charge a","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"57 1","pages":"A181 - A182"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85536611","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.2010.041616.6
F. Marianne, Panis Yves, Bretagnol Frédéric
Aim The aim of mortality-morbidity conferences is to increase medical care. In a recent french multicentric trial on colorectal surgery,1 both mortality and morbidity rates were 3.4% and 35%, respectively. The aim of this study was to assess the impact of mortality-morbidity conferences on medical care, especially in terms of operative results, in a colorectal surgical department. Methods All consecutive patients undergoing elective or urgent colorectal and intestinal resections were collected in a prospective database, including patients'characteristics, diagnosis, type of surgery, and postoperative course. All patients were followed 3 months after surgery. A mortality-morbidity conference was systematically performed every 6 months. Seven periods of 6 months were analysed. Results From May 2006 to October 2009, 958 intestinal and/or colorectal resections (urgent procedures in 10% of cases) were performed, including: small bowel resection (n=71), ileocaecal resection (n=140), right (n=93) and left (n=241) colectomy, subtotal colectomy (n=100), rectal resection (n=231) and others (n=82). Comparing the first and the last period, the number of operated patients and laparoscopic procedures increased that is, 115 versus 157 and 59% versus 68%, respectively (p<0.05). The conversion rate into open procedures decreased, 15% versus 3% (p<0.05). The overall mortality rate remained within 5%. The overall morbidity rate and the infectious morbidity decreased, 50% versus 37% (p<0.05) and 25% versus 19% (p<0.05), respectively. The hospital stay was decreased, 14+/−9 days versus 12+/−9 days, (p<0.05). But, the anastomotic leakage and the readmission rates were similar, 10% versus 7.5% and 8% versus 7.6%, respectively. Conclusion The mortality-morbidity conferences lead to improve the medical care in terms of operative results, especially concerning the overall morbidity rate and the hospital stay. Contexte/objectif L'objectif de l’évaluation des pratiques professionnelles est l'amélioration continue de sa propre pratique médicale. En chirurgie colo rectale, la mortalité et la morbidité post-opératoires sont évaluées respectivement à 3,4% et 35% dans l’étude récente de l'Association Française de Chirurgie.1 Le but de notre étude était l'auto-évaluation prospective des résultats opératoires d'un service universitaire de chirurgie colorectale pour mieux connaître et éventuellement améliorer ces valeurs de mortalité et morbidité à l’échelle d'un jeune service. Programme Tous les patients opérés électivement ou en urgence pour une chirurgie de résection intestinale ou colo rectale ont été colligés de manière prospective dans une base de données recueillant les caractéristiques du patient, le diagnostic, le type de chirurgie et la morbi-mortalité post opératoire (126 items) avec un suivi à 3 mois. Tous les 6 mois, une revue de morbi-mortalité (RMM) était faite, lors de la journée de séminaire du service, impliquant tous les p
目的召开死亡率-发病率会议的目的是提高医疗保健水平。在法国最近的一项结肠直肠手术多中心试验中,死亡率和发病率分别为3.4%和35%。本研究的目的是评估死亡率-发病率会议对医疗保健的影响,特别是在结直肠外科手术结果方面。方法收集所有连续行择期或紧急结肠和肠道切除术的患者,包括患者的特征、诊断、手术类型和术后病程。所有患者术后随访3个月。每6个月系统地召开一次死亡率-发病率会议。分析了7期6个月。结果2006年5月至2009年10月,共施行958例肠和/或结肠切除术(占10%),包括小肠切除术(71例)、回盲切除术(140例)、右结肠切除术(93例)和左结肠切除术(241例)、结肠次全切除术(100例)、直肠切除术(231例)和其他切除术(82例)。首期与末期比较,手术人数和腹腔镜手术次数分别增加115例和157例,分别增加59%和68% (p<0.05)。开腹转换率下降,15%比3% (p<0.05)。总死亡率保持在5%以内。总发病率50%比37% (p<0.05),感染性发病率25%比19% (p<0.05)。住院时间缩短,14+/ - 9天比12+/ - 9天(p<0.05)。但吻合口瘘和再入院率相似,分别为10%对7.5%和8%对7.6%。结论病死率会议提高了手术效果,特别是降低了总发病率和住院时间。背景/目标将“职业生涯的薪金”定为“职业生涯的薪金”,即“职业生涯的薪金”为“职业生涯的薪金”。3 .在法国医疗保险保险公司,医疗保险保险公司,医疗保险公司,医疗保险公司,医疗保险公司,医疗保险公司,医疗保险公司,医疗保险公司,医疗保险公司,医疗保险公司,医疗保险公司,医疗保险公司,医疗保险公司,医疗保险公司,医疗保险公司,医疗保险公司,医疗保险公司。方案:将患者与其他患者进行比较,将患者与其他携带者进行比较,将患者与其他携带者进行比较,将患者与其他携带者进行比较,将患者与其他携带者进行比较,将患者与其他携带者进行比较,将患者与其他携带者进行比较,将患者与其他携带者进行比较,将患者与其他携带者进行比较,将患者与其他携带者进行比较,将患者与其他携带者进行比较,将患者与其他携带者进行比较。这些指标包括:6个mois、1个mois、1个mois、1个mois、3个mois、3个mois、3个mois、3个mois、3个mois、3个mois、3个mois、3个mois、3个mois、3个mois、3个mois、3个mois、3个mois、3个mois。9 . panalys . (6) mois peuvent danalys . (être companalys .)2006年10月至2009年10月,958例和/或和/或所有的和/或所有的和/或所有的和/或所有的和/或所有的和/或所有的和/或所有的和/或所有的和/或所有的和/或所有的和/或所有的和/或所有的和/或所有的和/或所有的和/或所有的和/或所有的。第一学期,第一学期,第一学期,第一学期,第一学期,第一学期,第一学期,第一学期,第一学期,第一学期,第一学期,第一学期,第三学期,第一学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期,第三学期。Le taux de dsamacires global samacetous toujours infacrieur 6%。患病人数为50 37% (p< 0.05),患病人数为25 19% (p< 0.05),患病人数为14±9±12±9 h (p< 0.05)。与此相反,吻合口瘘管的病例与其他病例相比(10例对7.5%),与其他病例相比(même),与其他病例相比(8例对7.6%)。讨论/展望cete - samet - samet - destination - samet - destination - samet - destination - samet - destination - est - destination - samet - destination, de - même que l ' samet - semestrielle - des - donnsames。结论:医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械与医疗器械相关。
{"title":"117 Assessment of mortality-morbidity conferences in terms of postoperative results in a colorectal surgical department","authors":"F. Marianne, Panis Yves, Bretagnol Frédéric","doi":"10.1136/QSHC.2010.041616.6","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041616.6","url":null,"abstract":"Aim The aim of mortality-morbidity conferences is to increase medical care. In a recent french multicentric trial on colorectal surgery,1 both mortality and morbidity rates were 3.4% and 35%, respectively. The aim of this study was to assess the impact of mortality-morbidity conferences on medical care, especially in terms of operative results, in a colorectal surgical department. Methods All consecutive patients undergoing elective or urgent colorectal and intestinal resections were collected in a prospective database, including patients'characteristics, diagnosis, type of surgery, and postoperative course. All patients were followed 3 months after surgery. A mortality-morbidity conference was systematically performed every 6 months. Seven periods of 6 months were analysed. Results From May 2006 to October 2009, 958 intestinal and/or colorectal resections (urgent procedures in 10% of cases) were performed, including: small bowel resection (n=71), ileocaecal resection (n=140), right (n=93) and left (n=241) colectomy, subtotal colectomy (n=100), rectal resection (n=231) and others (n=82). Comparing the first and the last period, the number of operated patients and laparoscopic procedures increased that is, 115 versus 157 and 59% versus 68%, respectively (p<0.05). The conversion rate into open procedures decreased, 15% versus 3% (p<0.05). The overall mortality rate remained within 5%. The overall morbidity rate and the infectious morbidity decreased, 50% versus 37% (p<0.05) and 25% versus 19% (p<0.05), respectively. The hospital stay was decreased, 14+/−9 days versus 12+/−9 days, (p<0.05). But, the anastomotic leakage and the readmission rates were similar, 10% versus 7.5% and 8% versus 7.6%, respectively. Conclusion The mortality-morbidity conferences lead to improve the medical care in terms of operative results, especially concerning the overall morbidity rate and the hospital stay. Contexte/objectif L'objectif de l’évaluation des pratiques professionnelles est l'amélioration continue de sa propre pratique médicale. En chirurgie colo rectale, la mortalité et la morbidité post-opératoires sont évaluées respectivement à 3,4% et 35% dans l’étude récente de l'Association Française de Chirurgie.1 Le but de notre étude était l'auto-évaluation prospective des résultats opératoires d'un service universitaire de chirurgie colorectale pour mieux connaître et éventuellement améliorer ces valeurs de mortalité et morbidité à l’échelle d'un jeune service. Programme Tous les patients opérés électivement ou en urgence pour une chirurgie de résection intestinale ou colo rectale ont été colligés de manière prospective dans une base de données recueillant les caractéristiques du patient, le diagnostic, le type de chirurgie et la morbi-mortalité post opératoire (126 items) avec un suivi à 3 mois. Tous les 6 mois, une revue de morbi-mortalité (RMM) était faite, lors de la journée de séminaire du service, impliquant tous les p","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":"1961 1","pages":"A29 - A30"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91245799","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}