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":null,"pages":null},"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":null,"pages":null},"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":"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":null,"pages":null},"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":"185 Assessment of imaging orders for acute renal colic and pyelonephritis in the emergency department","authors":"B. Clémence","doi":"10.1136/QSHC.2010.041632.28","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041632.28","url":null,"abstract":"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","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90662511","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":"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":null,"pages":null},"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}

{"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":null,"pages":null},"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":"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}