6 research outputs found
Validation d'un outil automatisé et ciblé d'analyse pharmaceutique au CHU de LiÚge
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.
Lâobjectif de cette Ă©tude est de valider un outil automatisĂ© dâanalyse pharmaceutique selon les critĂšres institutionnels de qualitĂ© et dâaccrĂ©ditation JCI.
MĂ©thode
Lâoutil regroupe quatre algorithmes dâanalyse pharmaceutique approuvĂ©s institutionnellement. Il repĂšre et qualifie les lignes de prescriptions comme appropriĂ©es ou inappropriĂ©es selon les rĂšgles intĂ©grĂ©es dans les algorithmes. Lâanalyse est rĂ©alisĂ©e sur lâensemble des prescriptions informatisĂ©es du CHU de LiĂšge. Sur une pĂ©riode de 21 jours, une Ă©tude comparative prospective a Ă©tĂ© rĂ©alisĂ©e entre lâanalyse pharmaceutique dâun pharmacien rĂ©fĂ©rent, sans les qualifications fournies par les algorithmes,
et lâoutil automatisĂ©. La validation de ce dernier se base sur une analyse statistique mesurant des indicateurs de qualitĂ© et dâefficience. Une sensibilitĂ© au-dessus de 95,0 % et un taux de faux nĂ©gatifs infĂ©rieur Ă 5,0 % permettent lâutilisation de cet outil ainsi que des algorithmes en analyse pharmaceutique journaliĂšre. Les temps dâanalyse journalier des pharmaciens rĂ©fĂ©rent et contrĂŽle ont Ă©tĂ© mesurĂ©s ainsi que le taux dâacceptation des intervenions pharmaceutiques par le corps mĂ©dical.
RĂ©sultats
LâĂ©tude a portĂ© sur un Ă©chantillon de 857 lignes de prescriptions, dont 634 qualifiĂ©es « appropriĂ©es » et 223 « inappropriĂ©es » par le pharmacien. La validation statistique de lâoutil a rĂ©vĂ©lĂ© en moyenne une sensibilitĂ© de 97,5 % et un taux de faux nĂ©gatifs de 2,5 %. Lâanalyse pharmaceutique a gĂ©nĂ©rĂ© 74 interventions du pharmacien auprĂšs du corps mĂ©dical avec un taux dâacceptation de 81,1 %. La validation journaliĂšre utilisant lâoutil informatisĂ© permet un gain de temps de 48,3 % par rapport Ă lâanalyse pharmaceutique manuelle.
Conclusions
La validation dâun outil automatisĂ© dâanalyse pharmaceutique par une mĂ©thode statistique permet dâobjectiver la qualitĂ© des rĂ©sultats fournis par cet advanced CDSS. Il met en Ă©vidence des prescriptions potentiellement inappropriĂ©es. Le taux Ă©levĂ© dâacceptation des interventions pharmaceutiques dĂ©montre lâefficience de la synergie outil â pharmacien dans lâanalyse pharmaceutique centralisĂ©e
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 lowâmiddle-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 âsingle-useâ 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 lowâmiddle-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 highâ and lowâmiddleâincome 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