Quality and Safety in Health Care最新文献

{"title":"119 Impact of a patient education network (Vichy Diabetes network) on practices in diabetology","authors":"A. Didier, Davis Eric, C. Richard, M. Franck","doi":"10.1136/qshc.2010.041624.81","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.81","url":null,"abstract":"Background and objectives Education is a key component of the care of diabetic patients. Back in 1999 we set up a network for the management of diabetics which is centred on an out-of-hospital structured therapeutic patient education (TPE) programme Its main objective is to help improve the patient's state of health. Programme The TPE programme comprises three parts (a total of 27 h) and is implemented by trained professionals (doctors, dieticians, chiropodists, nurses) in an out-of-hospital setting. An external assessment using standards established by the French National Authority for Health (HAS) was performed from 2005 to 2007. Analysis focused on items in the patient's file (blood pressure (BP), glycated haemoglobin (HbA1c), LDL cholesterol), health professional and patient satisfaction surveys, a quality of life questionnaire (DHP 81), and reimbursements by French national health insurance. The data were compared to the results of the 2001 ENTRED study. Results The analysis concerned 268 patients with type 2 diabetes (mean age, 65.2 years; 55.2% male). The disease had been diagnosed on average 12.1 years earlier and 31.4% of patients were on insulin. There was no difference beween our population and the ENTRED population. The satisfaction score was 8.9/10 and 6.9/10 for network patients and professionals, respectively, versus 8.4/10 and 6.4/10, respectively, for ENTRED patients and professionals. The quality of life score was 6.7/81 versus 16.3/81 for ENTRED. Annual eye examinations were performed in 83.3% of network patients versus 66.9% of ENTRED patients. At least three HbA1c measurements were made in 71% of network patients versus 51.5% of ENTRED patients. Over the three parts, an HbA1c of <6.5% was found in an increasing proportion of network patients: 30.1% (part 1), 36.3% (part 2) and 42.6% (part 3), as was an LDL value of <1 g: 44.7% (part 1), 50.9% (part 2) and 62.4% (part 3). However, only 34.6% of network patients had a BP <130/80 that remained unchanged over time. The mean length of hospital stay was 12.1 days/patient in 15.6% of network patients versus 18.4 days/patient in 25.2% of ENTRED patients. The savings made by national health insurance (constant €) were 1088 €/patient/year, of which 252 € related to ambulatory pharmacy costs and 837 € to hospital expenditure. Network costs were 1107 €/patient/part. The cost of one satisfaction point per medical expense was 473.8 € in the network versus 499.8 € for ENTRED. The cost of one quality of life point per expense was 57.5 € in the network versus 64.9 € for ENTRED. Discussion and conclusion The impact of the network was highly positive with regard to patient satisfaction and quality of life but less so with regard to health professional satisfaction. Working within a network helps improve professional practices. The network provides educational value for patients independently of any care they receive and this can be translated into better clinical and biological test results. Th","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":"84373169","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":"158 The development and implementation of a checklist in dialysis units","authors":"Bourgeois Maryline, C. B. Agnès, Pachot Monique, Galland Roula, Isabelle Shoenfelfer","doi":"10.1136/qshc.2010.041624.99","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.99","url":null,"abstract":"Background and objectives Haemodialysis centres in France are being converted into “medicalised dialysis units” where the full-time presence of a physician is no longer required. This has prompted managers to ask questions about safety. Dialysis sessions require many nursing skills, in particular at the start of the session which is a critical phase because of the age of the patients (mean age, 73 years) and the number of comorbidities, and because of renal insufficiency symptoms such as hyperkalemia, salt and water overload, and fatigue. The use of a haemodialysis generator and extracorporeal circulation requires technical skills, and decoagulation and care of vascular access add to the risks. Our objective was to introduce a checklist for nurses that would help the nurse decide whether to start the dialysis session or not. Programme The checklist was built from the clinical processes and protocols currently used in the unit, such as those dealing with clinical situations where a physician should be called, patient monitoring during a dialysis session, and patient welcome. The checklist had to be short, simple, easy to use, and unambiguous. It was formatted in order to answer the question: “what must be checked before starting dialysis in order to ensure the safety of a dialysis session?” and included the following sections: reading the medical file and consulting data on earlier dialysis sessions, checking the generator setting and the physician's dialysis order, and clinical assessment of the patient. Each item of each section had to be ticked Yes or No. The presence of certain symptoms (ticked Yes) meant that the session could not start and a physician had to be called. The checklist was validated by all nephrologists and pilot tested for self-care dialysis in a small dialysis unit by experienced nurses. In September 2009, its use was extended to a new set of dialysis centres converted into medicalised dialysis units. The checklist is attached to the patient's monitoring record and signed by the nurse. Results The checklist was rapidly accepted by all the nurses and pleased physicians and patients. The clinical assessment of the patient reassured nurses, physicians and patients with regard to safety. Nurses completely changed their way of managing dialysis sessions, and transformed technical care of the dialysis patient into global care. After 2 months of checklist use, 137 checklists were reviewed. In 7% of cases a physician was called and in 22% of these cases some adaptation was required before the start of dialysis. In the absence of the physician, the nurse became the patient's main contact, thus completely changing the nurse's role throughout the dialysis session. The nurses even asked for checklist use to be extended to dialysis centres (where a nephrologist is on permanent duty). Conclusion The use of a checklist can enhance safety at the start of a dialysis session. Its use can better delineate the roles of physicians with regard to ","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":"84724047","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":"240 Lifestyle modification by therapeutic education improves the prognosis of acute coronary syndrome and the distribution of fatty acids in erythrocyte membranes","authors":"M. Baudet, C. Daugareil, M. Bucau, S. Caspar-Bauguil, P. Hericotte","doi":"10.1136/QSHC.2010.041624.65","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.65","url":null,"abstract":"Background Cardiovascular disease resulting from atherosclerosis is influenced by lifestyle choices including smoking, lack of physical activity, unhealthy diet and obesity. Objectives The global treatment of patients with acute coronary syndrome (ACS) requires modification of their lifestyle. Methods Eight hundred and eighty-six patients exhibiting this syndrome received consultations with a therapeutic education (TE) nurse, aiming to decrease their risk factors and to modify their dietary habits. The initial consultation gathers information on six principal risk factors and 15 dietary habits. Our unit has developed a software program which gives each answer either a positive digital score if those factors lead to increased atherosclerosis or a negative score if those factors protect against the disease. In order to evaluate the biological impact of the TE dietary advises which reproduce the recommendations currently accepted, fatty acid composition in erythrocyte membrane phospholipids was determined in another group of 71 patients with ACS, upon arrival in intensive coronary care and again 1 year after TE. Results Patient outcome was compared for those who were followed regularly in voluntary Therapeutic Education consultations (Group 1, n=285) and those who were not (Group 2, n=593), with a median follow-up of 40 months. Eight patients left the program. The 285 patients of Group I were seen every 6 months in consultation; progress was observed, not only for the control of risk factors (the score decreased from 6.3 to 4.5, p<0.001) but also for their dietary habits (the score decreased from 1.5 to−7.1, p<0.001). Compared to Group 2, Group 1 patients had less cardiovascular events including death (43 patients with event vs 172, p<0.001), or other events linked to atherosclerosis (34 vs 121, p<0.01) with fewer hospitalisations for cardiovascular events (41 vs 161, p<0.001). In reference to total fatty acids, EPE+DHA increased from 6.24%+/-6.51 to 7.67%+/−1.67 (p<0.05), oleic acid increased from 14.45%+/−1.08 to 15.26%+/−1.06 (p<0.05), total saturated acids decreased from 40.68%+/−1.53 to 39.97%+/−1.63 (p<0.05) and pro-inflammation ratios n−6/n−3 and Arachidonic Acid/EPA+DHA decreased respectively from 4.14+/−1 to 3.27+/−0.70 (p<0.05) and from 3.02+/−0.93 to 2.41+/−0.84 (p<0.05). Conclusion In ‘real life’ and in addition to randomised studies: (1) lifestyle, including cardiovascular risk factors and risky dietary habits which participated in the onset of ACS, may be improved by TE (2) prognosis is simultaneously improved (3) the TE dietary recommendations produce erythrocyte membrane modifications which protect against cardiovascular disease. Contexte Les maladies cardiovasculaires secondaires à l'athérosclérose sont influencées par une mauvaise hygiène de vie incluant tabagisme, sédentarité, mauvaises habitudes alimentaires et obésité. Objectifs La prise en charge globale des patients ayant eu un syndrome coronaire aigu (SCA) nécessite","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":"81714884","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":"233 Diabetic care in a network of health professionals in the beaune area","authors":"Noubel Julien, Mercier Patricia, Dumont François","doi":"10.1136/QSHC.2010.041624.89","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.89","url":null,"abstract":"Objectives The GPSPB a Network of Health Professionals in the Beaune Area is a primary care network created February 2002. It covers a population of over 77,000 people and gathers together 123 health professionals. One of the health priorities of the network concerns diabetes. The aim of the study was to evaluate the overall satisfaction of patients with the diabetes care they receive and to measure the medico-economic impact of coordinated care (GPs, dieticians and podiatrists). Program To follow-up satisfaction questionnaires sent to patients with diabetes who applied to the GPSPB from April 2006 to the end of December 2007 (48 people). To study the evolution of relevant biomedical data (HbA1c, LDL, BMI) to assess the efficacy of care in 52 patients with type 2 diabetes from April 2006 to May 2008. To compare diabetic patients managed by the GPSPB with other diabetic patients in Côte d'Or in terms of quantitative data supplied by the national health insurance system for services provided between June 2008 to May 2009. This comparison includes all costs incurred by these patients. Résults Sixty-two percent of patients responded to the questionnaire, and overall the level of satisfaction was high, particularly regarding the combined dietetics and podiatry consultation. Most diabetic patients were stabilised or had seen improvements in their results over this period of time. There was a significant decrease in LDL (−0.16 g/l), p<0.01. The decreases in BMI (−3.73 kg/m2) and HbA1c (−0.43%), however, were not significant. In the study period, the average cost for a GPSPB diabetic patient was 9,812 Euros while the average cost for a Côte-d'Or diabetic patient was 13,592. The savings of 3780 Euros per patient was mainly due to reduced costs for hospitalisation, transport and income replacement. GPSPB diabetics, however, incur higher costs for paramedical services. Conclusion This study shows that in chronic diseases such as type 2 diabetes, it is possible to improve management of patients thanks to the creation of more efficient patient-centered care networks, with the coordinated intervention of different health professionals; the GPSPB is such a network. Patients seem satisfied with the additional support offered by the network. Even though there were few patients in the study, we observed an improvement in their biomedical data over two years with non-significant decreases in HbA1c and BMI, and a significant decrease in LDL. It has also shown the impact of the network in the reduction of health care costs. More research is necessary to determine whether this type of care organisation modifies the incidence of morbidity and mortality in this population, and whether these results persist in the long term. Prise en charge des patients diabétiques dans un groupement interprofessionnel de santé territorial. Evaluation de 52 patients du Groupement des Professionnels de Santé du Pays Beaunois. Objectif(s), Contexte Le Groupement des Professionnels 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":"80554538","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":"041 Impact of perinatal care network improvement program on post-partum hemorrhage–related morbidity","authors":"S. Jerome, Ducloy Jean-Claude, Bailleux Bernard, E. Anne, S. Philippe, D. Anne-sophie","doi":"10.1136/QSHC.2010.041624.40","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.40","url":null,"abstract":"Introduction Post-partum haemorrhage (PPH) remains the leading cause of maternal morbidity and mortality in France and worldwide. PPH can occur in any parturient. Perinatal care network is defined as a practioners’ and women's hospitals’ association organising mother and child management around the birth period. The aim of our medical practice improvement program (MPIP) was to standardise the management of PPH in every women hospital of the network according to the French guidelines.1 The aim of the study was to measure the impact of the MPIP on PPH-related morbidity.2 Program The MPIP created a common management guideline and critical care chart resulting from the chart of each of the 11 low risk women's hospitals. These guidelines included initial aggressive and timed management of the uterine tone, vascular and coagulation resuscitation. The critical care chart included three sections: the first one was the graduated timed common chart (poster and verso of the data collection paper support); the second is the intensive care data collection paper support; the third one is the prevention chart poster for high risk patients. Five training teams performed educational program for midwives, paramedics and medical doctors. Impact of the MPIP was measured by the haemorrhage-related morbidity of the transferred patients in 2006 after MPIP versus 2004 before MPIP. Collected data was the adequacy of the management to the protocol and PPH-related morbidity indicators. Results The results are described in Abstract 041 table 1. Despite the limited number of cases, it can be observed a trend for better detection of PPH (0.88% to 1.25%) and for better and more rapid management of PPH in the primary care units. When PPH became so severe that ICU transfer is indicated, no more hemorrhagic shock had been noted after MPIP. Red blood cells transfusion, procoagulant treatment and embolisation are less required in the tertiary care unit leading to quicker discharge from obstetrics ICU. Abstract 041 Table 1 Comparison of the severe PPH management and related morbidity before and afer MPIP 2004 before MPIP 2006 after MPIP p Deliveries (Low risk) 21373 20 619 NA PPH 189 259 0.26 Transfer to obstetrics ICU 16 13 0.004 Transfer delay (min) 205 (90–300) 158 (60–270) 0.001 Haemorrhagic shock 5 0 0.001 Transfusion 5 2 0.05 Procoagulant complement 9 4 0.10 Uterine A embolisation 7 2 0.26 Discharge after 12 h from the obstetrics ICU 11/16 12/13 NS Improving the obstetrics care at the nearest of the patient could be the new challenge for maternal risk management as suspected in ICM and FIGO joint guidelines3 and in the French perinatal networks study.4 Intractable obstetrics haemorrhage mortality can be reduced by a tertiary care safety programimproving management of patients at high risk of HPP.5 Any delay or indecision in PPH primary care management contributes to the severity of the disease and to maternal morbidity, despite adequate secondary obstetrics ICU. Perinatal netw","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":"77830243","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":"257 Impact of intervention program on vitamin K antagonist prescription practices in elderly patients","authors":"C. Mouchoux, S. Touzet, C. Colin, M. Lépine, C. Goubier-Vial, S. Wesolowski","doi":"10.1136/qshc.2010.041624.76","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.76","url":null,"abstract":"Background Venous thromboembolism and the prevention of thromboembolic risk during atrial fibrillation are two main indications for vitamin K antagonist (VKA) therapy in elderly patients. Due to the high risk of haemorrhages, prescribing a VKA treatment requires complying with practice guidelines. Furthermore, medical treatment of excess dosage must be adapted in order to minimise the risk of haemorrhage and thrombosis. This study aimed to assess the impact of intervention program on prescription of VKAs and medical treatment of excess dosage at a healthcare facility fir the elderly. Method A ‘before/after’ study was conducted at a 632-bed geriatric. All patients treated with VKAs were included and followed-up for a period of 2 months. The program assessed composed of two interventions. The first intervention, aiming to improve prescription practices, was based on the distribution of a guideline for VKAs treatment adapted to geriatric care and the local context. The three steps in conception these practices guidelines were: 1/in-depth bibliographical research by all physicians at the facility, followed by selection of pertinent references; 2/writing by a pharmacist and a physician; and 3/proofreading, correction and approval by all of the prescribing staff at the facility. After it was approved, the prescribing guidelines for VKA treatment was presented at an institutional meeting and then distributed at each physician and pharmacist and each care unit. The second intervention, aiming to improve treatment of excess dosage, was based on an oral presentation of recommendations for treatment of excess dosage by pharmacist. Results One hundred and ten and 115 patients were enrolled respectively before and after implementation of the intervention program. Implementation of the practices guidelines resulted in a significant increase in the prescription rate of warfarin (8% vs 40%, p<0.001) and a significant decrease rate of acenocoumarol (21% vs 6%, p<0.01). The incidence of excess dosage (6.4% vs 2.6%, p>0.05) decreased between the two phases of the study. Medical treatment of the excess dosage was wrong with recommendations during the first phase of the study and did not change during the second phase. Discussion—conclusion The intervention program implemented at the facility resulted in a concrete, nearly immediate change in prescription practices, primarily concerning the choice of molecule. However, according to our analysis, the two interventions did have not the same impact on prescription practices and treatment of excess dosage. An ‘active’ intervention, such a conception of local guideline for VKAs treatment, has a greater impact than the oral presentation of guidelines for treating excess dosage. In order to improve the safety of VKA treatment in elderly, the improvement in prescription practices must be continued by means of enhancement: Training and awareness programs and tracking changes in practices: implementation of indicators. Context","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":"90763660","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":"292 Improvement of pain management in emergency medicine: a multicentric audit of 50 emergency services","authors":"A. Ricard-Hibon, T. Ariski, S. Guéant, J. Borel-Kühner, M. Cauterman, M. Raphael","doi":"10.1136/QSHC.2010.041608.23","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041608.23","url":null,"abstract":"Background and Objectives The objective is (1) to assess pain management in emergency services (ES) and (2) to assess the impact of quality improvement measures. Program A quality assurance process was developed and implemented by 50 French emergency services (ES) based in teaching, public, private and military hospitals. An initial retrospective audit of medical charts (T0) allowed development of quality initiatives and prospective evaluation of their impact at three monthly intervals (T1 and T2). For each ES, 50 medical charts were randomly selected. Inclusion criteria were: all patients aged ≥15 years old presenting to the ES. There were no exclusion criteria. Data collected included general demographic data, diagnosis, presence of pain as the primary motif for consultation, assessment of the pain intensity (PI) at admission and after the care management, analgesic treatments and times of pain care management. Outcome measures were: time to PI assessment at admission, time to treatment, proportion of patients assessed, proportion of patients with adequate pain relief. Statistical analysis was performed using ANOVA for quantitative data and chi-square test for qualitative data. Results 7516 patients were included during the 3 periods (T0 n=2679, T1 n=2498, T2 n=2339). 4670 patients complained of pain at admission (62% of the studied population). The rate of patients presenting with severe pain and treated by morphine was: T0 n=22 (11%), T1 n=46 (11%), T2 n=36 (8%). Abstract 292 Table 1 n=4670 T0 (n=1580) T1 (n=1598) T2 (n=1492) p Patients with PI assessment (%) 465 (29%) 992 (62%) 1073 (72%) 0.0001 Treated patients (%) 728 (46%) 782 (49%) 801 (54%) 0.001 Assessed patients last period (%) 144 (9%) 329 (21%) 407 (27%) 0.0001 Patients with pain relief (%) 119 (8%) 249 (16%) 333 (22%) 0.0001 Time to assessment (min±SD) 65±159 66±148 61±148 NS Time to treatment (min±SD) 90±137 92±151 85±135 0.05 Discussion and Conclusion This wide scale quality assurance process has led to an improvement in the proportion of appropriately assessed and treated patients. However, delays in pain care management and the proportion of patients with adequate pain relief should be improved. Contexte et objectifs L'objectif est d’évaluer la prise en charge (PEC) de la douleur en médecine d'urgence et d’évaluer l'efficacité des mesures correctrices mise en place. Programme 50 SU volontaires (CHU, CHG, 1 hôpital des armées, 2 structures privées répartis sur le territoire national) se sont engagés dans une procédure d'assurance qualité comprenant une phase de lancement puis un audit de dossier rétrospectif initial (T0) suivi de mesures correctrices évaluées par 2 audits successif à 3 mois d'intervalle (T1 et T2). Chaque SU devait analyser à chaque audit 50 dossiers tirés au sort. Les patients inclus étaient des adultes > 15 ans se présentant au SU, aucun facteur d'exclusion. Etaient recueillis: Les caractéristiques générales du patient, les pathologies, l","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":"90800537","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":"214 Strategies to reduce the incidence of bedsores in a Geriatric Institution","authors":"Jafarbay Jamileh, Bernardou Colette, D. Martine, Poret Françoise, Lombardin Cécile, M. Christine, Arvieu Jean Jacque","doi":"10.1136/QSHC.2010.041624.70","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.70","url":null,"abstract":"Meah [National Mission of Hospital Consulting and Auditing] Introduction The prevalence and incidence of bedsores in the departments for mid- to long-term geriatric hospital are very widespread. The occurrence of bedsores during hospitalisations has major human and financial consequences. The Abondances Gerontology Center is a 310-bed unit and receives poly-pathologic patients. In 2005, a one-day audit concluded that 28 patients had bedsores, of which 22 were acquired in the hospital. Objective Part of the 2007 MeaH* pilot program ‘improve the prevention and the treatment of bedsore’, a quantitative objective for this project was reduce the incidence of bedsore by 50%. Methods The institution set up an organisational project spread out over 18 months, in four phases. From April to July 2007, the first phase was devoted to diagnosis, set up a group project, appointment of a project officer and tracking indicators, such as the incidence and prevalence through monthly reports and quarterly reviews of files. From August to November 2007, the second phase was dedicated to determining the action plan. From December 2007 to September 2008, the third phase was concerned the implementation of the action plan. The last phase, from October to December 2008, was assessment of the actions undertaken and leverage of the pilot program. Results The diagnostic phase enabled identifying strong and weak points. The audit made the teams aware of bedsore prevention upon patient in-take. A decision tree specifying the role of everyone on the staff was developed. The personnel were regularly informed about the project's advancement. At the end of phase four, we achieved our objective. We realised decrease the incidence by 50%. Conclusion Setting an outcome objective, formation, and the best coordination, made possible to decrease the incidence of bedsores by 50%, especially stage 3 and 4(NPUAP Classification). Contexte En juillet 2007, la prévalence des escarres a pu être évaluée à près de 16% des patients au centre de gérontologie Les Abondances. Parmi celles-ci, jusqu'à 69% sont acquises en cours d'hospitalisation. Leurs conséquences notamment pour les patients âgés sont importantes en termes de qualité des soins (souffrance, mise en jeu du pronostic fonctionnel et détérioration du niveau d'autonomie, augmentation du risque relatif de décès, …) et de surcoûts (allongement de la durée de séjour, accroissement de la charge en soins, coût des traitements, …). Objectif l'objectif quantitatif de ce projet, est de diminuer de 50% le taux d'incidence des escarres acquises. Méthode, programme Afin d'améliorer la prévention, le dépistage et le traitement des escarres, l'établissement a conduit, sur l'ensemble des unités, un projet d'organisation institutionnelle, étalé sur 18 mois découpés en 4 phases. La première phase, d'avril à juillet 2007, a été consacrée au diagnostic. La gestion du projet repose notamment sur la création d'un comité","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":"90460946","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":"208 Assessment of teamwork by self-employed health professionals in the management of type 2 diabetes patients: the ASALEE project","authors":"M. Julien, Bourgueil Yann, Leboulch Philippe, Yilmaz Engin","doi":"10.1136/QSHC.2010.041624.83","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.83","url":null,"abstract":"Background and objectives The French healthcare system for ambulatory care is a fragmented system rather than an integrated system with formally organized primary care. Most health care professionals in the primary care sector are self-employed, work in solo practice, are paid on a fee-for-service (FFS) basis and, historically, are not subject to constraints due to mandatory and strict quality regulation. As a result, several signs of inefficiency in healthcare delivery have come to light. This has been especially true with regard to the chronically ill who have not benefited from any marked improvement in the delivery of care despite the fact that chronic diseases represent a growing burden and consume an increasing share of the resources within the French healthcare system. At the same time, we are expecting a future shortage of medical doctors and an increase in the supply of nurses. A growing number of stakeholders (sickness funds, health authorities, local representatives…) and professionals' representatives are therefore supporting multidisciplinary group practice and teamwork in the primary care sector in order to improve access to primary care and the quality of the care and services delivered. The objective of our study was to assess the efficacy and cost of teamwork between nurses and general practitioners (GPs) within a project called ASALEE (French acronym for Health Action by Teams of Self-employed Health Professionals). The study concerned the management of patients with type 2 diabetes. Programme ASALEE was launched in 2004 in the Deux-Sèvres department (France). In 2007, 41 GPs and eight nurses were taking part in the project and, at the time, it was the only project with such a skill mix and a primary care focus. The GPs in the project entrusted the nurses with the computerized management of certain patient data and the holding of therapeutic patient education consultations in accordance with a specific protocol. We used a case-control study design to compare the care of type 2 diabetes patients in the teamwork group (intervention group) and in a group delivered ‘standard’ care by the GPs (control group). We measured process indicators (standard follow-up procedures) and outcomes indicators (glycaemic control) and examined cost over two consecutive periods. Results After 11 months of follow-up, patients in the intervention group were more likely than control group patients to be or become correctly followed-up (OR: 2.1 to 6.8, p<5%) and to achieve glycaemic control (OR: 1.8 to 2.7, p≤5%). However, glycaemic control was achieved only when patients had seen the nurse at least once for therapeutic education and counselling. There was no difference in cost between the intervention and control groups. Conclusion Our teamwork project was both effective and efficient. Its findings may have implications for the design of future teamwork experiments launched by the French health authorities at the end of 2009. Their objective is to test ","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":"88441241","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":"075 Audits of in-hospital management of stroke patients in dedicated and non-dedicated units on a national scale in France","authors":"Bodiguel Eric, Thiery Roselyne, Lairy Gérard, M. Catherine, Woimant France","doi":"10.1136/QSHC.2010.041624.52","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041624.52","url":null,"abstract":"Background and objectives A Cochrane meta-analysis published in 2007 has shown that stroke patients who receive care in a dedicated stroke unit are more likely to survive and become independent than those who are admitted to a non-dedicated unit. The evidence-based practices underlying the better outcomes are given in guidelines such as those produced by the Haute Autorité de Santé (HAS 2002). We used audit criteria derived from these guidelines to assess medical and allied health professional care in different hospital units. Programme Six university hospitals and five general hospitals volunteered to take part in self-auditing of medical and allied health professional care of acute stroke patients. Five hospitals had a dedicated stroke unit and five did not. A stroke unit was opened in one hospital between the two assessments. The study coordinator in each hospital was provided with training in auditing and methodological support by HAS. A first assessment (November 2004) of 290 medical records and 142 allied health professional files led to a tailored quality improvement programme being set up in each hospital. A second assessment (October 2005) of 236 medical records and 102 allied health professional files enabled measurement of the impact of the improvement programmes. A national statitical analysis of the anonymised data was carried out. Results and impact The first audit showed that stroke unit care complied significantly better with guidelines than care in non-dedicated units. The second audit showed an increase in the quality of medical and allied health professional care in both dedicated and non-dedicated units although there was improvement in more items in the non-dedicated units. The main quality improvement actions set up after the first audit concerned staff training, drafting of care protocols, procedures for prompt access to paraclinical exams, check lists, nursing and monitoring documents, and medical order forms. The medical criteria that showed significantly increased compliance between rounds were initial evaluation, blood pressure management, prevention of bronchial obstruction, prescription of speech therapy, and transmission of the hospitalisation report in under 8 days. The allied health professional criteria with significantly increased compliance were admission and initial evaluation, monitoring of swallowing and respiratory frequency, prevention of bronchial obstruction, patient positioning, behavioural monitoring, and preparing for and carrying out hospital discharge. Discussion and conclusion Although we cannot exclude statistical bias, our results indicate that guideline implementation is better in a dedicated setting (stroke units) and that improvement is greater when initial compliance is low (non-dedicated units). We thus advocate that practice improvement strategies be different in dedicated and non-dedicated units. Clinical audits and their simplified versions (mini-audits) are an efficient method of improv","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":"91498089","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}