Improvement of information gained from the pre-anaesthetic visit through a quality-assurance programme.

BACKGROUND: Pre-anaesthetic evaluation is a fundamental component of anaesthetic practice. The aims of the present study were to assess the quality of the preoperative anaesthetic information gathered and to observe the quality profile after the introduction of a standardized form. This occurred through a four-step quality assurance programme over a 4-yr period. METHODS: The proportion of cases in which a complete recording of data was collected at the preoperative assessment was evaluated by searching in each patient's medical record for what was considered to be the minimum information required to provide satisfactory perioperative care. Fifteen criteria were selected. The recovery profile for each indicator and a global quality index (GQI expressed in %) for each patient's record were collected. In phase 1, the existing situation was assessed. Next, a standardized pre-anaesthetic form (PAF 1) was designed and its implementation evaluated (Phase 2). Phase 3 was performed 16 months after implementation of PAF 1 to assess the long-term value. The form was revised (PAF 2) and its use evaluated again 6 months later (Phase 4). For each evaluation, the records of a 1-month period were examined. Overall 1129 medical records were audited. RESULTS: The GQI increased significantly from 62 to 88% with similar changes for both elective and emergency cases. The recovery profile was improved for most indicators. CONCLUSIONS: We conclude that the quality of information recorded from the pre-anaesthetic visit is improved by using a standardized form. This will hopefully help to improve patient outcome and facilitate computerization of the anaesthetic record.

[Transfusion of fresh frozen plasma (FFP): audit of prescriptions]. / Transfusion de plasma frais congelé (PFC): audit des prescriptions.

OBJECTIVE: To review fresh frozen plasma (FFP) prescriptions and compare their validity to the legal french guidelines (law of the 12/03/91). STUDY DESIGN: Assessment of all prescriptions has been carried out by a multidisciplinary committee. PATIENTS: All the adults transfused with FFP over one year in a teaching hospital. METHODS: Following each head of department's agreement and following a written notice to all prescribers within the hospital to inform them of the undergoing study and its methodological validation by the board of quality experts, each delivery of FFP was followed by a questionnaire addressed to the prescriber. A board of experts then assessed the significance of the prescription in accordance with the legal requirements after reviewing each medical file. RESULTS: 144 prescriptions to 89 patients were assessed: 23% were judged inappropriate by the experts and 6% did not respect the law. The inappropriate transfusions distribute as follows: intensive care patients (73% of which 80% in multiple organ failure (MOF) and 20% in haemorrhagic shock), cirrhotic patients (12%), patients treated with vitamin K antagonists (12%), obstetric patients (3%). Nine percent of the appropriate transfusions were judged in insufficient volume. The hospital mortality rate was 48%. Among prescribers, 59% were not aware of the law. CONCLUSION: A significant proportion of FFP transfusions is inappropriate. This study, which is the first step of a quality assurance program, will be followed by local recommendations for clinical practice. The current standards of prescribing FFP are more restrictive than those defined in the legal french guidelines.

[Blood transfusion in adults: description of a quality assurance program]. / Transfusion sanguine chez l'adulte: description d'un programme d'assurance-qualité.

OBJECTIVES: In 1995, a fatal transfusion complication led to the development of a quality-assurance programme (QAP). Initial analysis showed important deficiencies in practice patterns for both nurses and physicians. No written guidelines had been previously produced. STUDY DESIGN: Evaluation of practice patterns and quality-assurance programme. METHODS: A QAP was prepared and implemented, a booklet describing completely the transfusion process and institutional policies and providing practical information was edited and the medical and non-medical personnel was informed and trained on a regular basis. Implementation was evaluated during a three-year period by measuring previously defined surrogate endpoints of the quality of the transfusion process. RESULTS: Implementation became rapidly close to 100% either for well-accepted requirements (i.e. patient's identity reporting on transfusion forms) or when physicians were highly motivated (i.e. autologous blood transfusion). For other indicators, implementation progressed more slowly (i.e. traceability of labile blood products) although significant efforts were made to improve the computerised system of data collection and although hospital administration showed a very positive behaviour. Finally, other indicators showed only partial implementation. Several practical barriers (perceived lack of time, excessive increase in writing requirements) were described for transfusion checklist or transfusion prescription form but more in-depth insufficiencies (patients'information) were also observed. CONCLUSION: The success of a change of practice patterns relies on hospital administration positive role, education and feedback, written and immediately available guidelines, employment of specially trained personnel, long-standing actions. Future accreditation of hospitals based on well-defined and well-implemented procedures will also be a major help to increase the quality of the transfusion process.

Administration of 3-methylcholanthrene to rats increases the specific hybridizable mRNA coding for cytochrome P-450c.

Poly(A)+-RNA obtained from the livers of 3-methylcholanthrene (3MC)-treated rats was translated into cytochrome P-450c in a cell-free reticulocyte system. In this translational system, no precursor cytochrome P-450c was observed. The mRNA responsible for the synthesis of this cytochrome was isolated by immunoprecipitation of liver polyribosomes obtained at 15 hr after 3MC treatment, and a cDNA was constructed by the reverse transcriptase reaction. The cDNA was further purified by hybridizing at a high R0t (product of RNA concentration and incubation time) to poly(A)+-RNA isolated from control rat liver, and the nonhybridized, single-stranded cDNA was isolated by hydroxylapatite chromatography. This cDNAp-450c was employed in hybridization reactions with poly(A)+-RNA isolated from the livers of rats treated with 3MC for various times. These studies indicated a maximal induction of mRNAp-450c at about 15 hr after 3MC injection, although levels of this mRNA were significantly increased by 7 hr. The mRNAp-450c concentration had diminished by 24 hr but remained higher than control levels for at least 48 hr. These studies establish an effect of 3MC upon the accumulation of mRNAp-450c in rat liver.