Validation d'un outil automatisé et ciblé d'analyse pharmaceutique au CHU de Liège

Contexte Le couplage de la prescription informatisée à un advanced Clinical Decision Support System (CDSS) est un élément-clé de la sécurisation du circuit du médicament. L’objectif de cette étude est de valider un outil automatisé d’analyse pharmaceutique selon les critères institutionnels de qualité et d’accréditation JCI. Méthode L’outil regroupe quatre algorithmes d’analyse pharmaceutique approuvés institutionnellement. Il repère et qualifie les lignes de prescriptions comme appropriées ou inappropriées selon les règles intégrées dans les algorithmes. L’analyse est réalisée sur l’ensemble des prescriptions informatisées du CHU de Liège. Sur une période de 21 jours, une étude comparative prospective a été réalisée entre l’analyse pharmaceutique d’un pharmacien référent, sans les qualifications fournies par les algorithmes, et l’outil automatisé. La validation de ce dernier se base sur une analyse statistique mesurant des indicateurs de qualité et d’efficience. Une sensibilité au-dessus de 95,0 % et un taux de faux négatifs inférieur à 5,0 % permettent l’utilisation de cet outil ainsi que des algorithmes en analyse pharmaceutique journalière. Les temps d’analyse journalier des pharmaciens référent et contrôle ont été mesurés ainsi que le taux d’acceptation des intervenions pharmaceutiques par le corps médical. Résultats L’étude a porté sur un échantillon de 857 lignes de prescriptions, dont 634 qualifiées « appropriées » et 223 « inappropriées » par le pharmacien. La validation statistique de l’outil a révélé en moyenne une sensibilité de 97,5 % et un taux de faux négatifs de 2,5 %. L’analyse pharmaceutique a généré 74 interventions du pharmacien auprès du corps médical avec un taux d’acceptation de 81,1 %. La validation journalière utilisant l’outil informatisé permet un gain de temps de 48,3 % par rapport à l’analyse pharmaceutique manuelle. Conclusions La validation d’un outil automatisé d’analyse pharmaceutique par une méthode statistique permet d’objectiver la qualité des résultats fournis par cet advanced CDSS. Il met en évidence des prescriptions potentiellement inappropriées. Le taux élevé d’acceptation des interventions pharmaceutiques démontre l’efficience de la synergie outil – pharmacien dans l’analyse pharmaceutique centralisée

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Oprichting en financiering van antibiotherapiebeleidsgroepen in de belgische ziekenhuizen

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Implementation of antibiotic management teams in Belgian hospitals

SCOPUS: re.jinfo:eu-repo/semantics/publishe

Prospective multicentre feasibility study of a quality of care indicator for intravenous to oral switch therapy with highly bioavailable antibiotics

Background: Enhanced oral (po) bioavailability of antimicrobial drugs allows conversion to po therapy once a patient meets defined clinical criteria. This can reduce length of hospital stay, healthcare costs and risk of complications related to intravenous (iv) access. We developed a quality indicator for assessing the appropriate iv-to-po switch of bioavailable antibiotics and evaluated its feasibility and clinical relevance across acute healthcare systems. Methods: The study was designed as a multicentre, multinational observational audit. The indicator was the proportion of inappropriate iv treatments at any point in time in adult patients treated with fluoroquinolones, clindamycin, linezolid or metronidazole. Treatments were prospectively evaluated by a trained physician or clinical pharmacist using predefined clinical criteria. The feasibility of the indicator was evaluated by measuring data availability, data collection workload and sensitivity to improvement. Results: Data were collected over a 3 month period in five university hospitals in Austria, Belgium and Germany and iv treatment was assessed in 211 patients. The indicator was measurable in 99.1% of cases. By intention-to-treat analysis, 37.0% (95% CI 30.5-43.9) of treatments were inappropriate, ranging from 17.5% to 53.8% across hospitals. The median time needed for case assessment and documentation was 29 min. Conclusions: This quality indicator was found to be generally feasible in hospitals across three European countries, and informative about the local need for clinical quality improvement. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe