Impact of a multidisciplinary approach to the control of antibiotic prescription in a general hospital.

We examined the impact of a rational antibiotic prescription programme based on a multidisciplinary consultative approach in a 600-bed hospital. The programme involved four measures: (1). drawing up of a local prescribing consensus with all prescribers; (2). a restricted prescriptions policy for the most expensive antibiotics; (3.assessment of the prescription of these antibiotics by regular audits; and (4). institutional training and information for prescribers. The impact of the programme was assessed by comparing actual prescriptions with the criteria of the local consensus, compliance with the restrictive prescription policy, changes in the average daily cost of antibiotic therapy per inpatient and changes in the local ecology of methicillin-resistant Staphylococcus aureus (MRSA), Enterobacteriaceae producing extended-spectrum beta-lactamases (EPESB) and ceftazidime-resistant Pseudomonas species (CRP). Using a participatory consensual approach, 182 reference recommendations were established (104 for adults, 78 for children), corresponding to 85% of the clinical settings encountered in the hospital. Six audits, conducted since June 1997, show that the rate of unjustified prescriptions first fell significantly (from 6 to 0%, P<0.001), then increased significantly (from 0 to 3%, P<0.05) before stabilizing at 3%. The cost of antimicrobials per inpatient day fell significantly (from US dollars 13.8 in 1997 to US dollars 11 in 2000, P<0.001). The prevalence of MRSA and CRP remained stable, while that of EPESB fell significantly (P<0.001). This multidisciplinary consultative approach thus reduced antibiotic costs, contributed to infection control, and improved the quality of antibiotic prescription.

[Analysis of mode of failure, their effects and criticality: improving of the hospital drug prescribing process]. / Analyse des modes de défaillances, de leurs effets et de leur criticité: amélioration de la prescription des médicaments à l'hôpital.

Failure Mode, Effects, and Criticality Analysis (FMECA) is used in industry to prevent process or product failures. We studied the feasibility of this method in hospital organizations. FMECA was used to improve drug prescription in two medical wards. Failure modes were identified and classified hierarchically. Corrective actions were taken. Involvement of all the professionals concerned in this process was obtained, and has resulted in real acceptance of the proposed changes and in their effective realization.

[Impact of a multidisciplinary approach for monitoring prescribing of antibiotics in a hospital]. / Impact d'une approche pluridisciplinaire pour la maîtrise de la prescription des antibiotiques dans un établissement hospitalier.

OBJECTIVE: The aim of this study was to examine the impact of a rationalized antibiotic prescription program in a 600-bed hospital. PATIENTS AND METHODS: The program was based on a local consensus policy, developed with the prescribers themselves, together with individual nominative dispensing (IDN) of the most costly antibiotics, and training/information programs aimed at institutional prescribers. The impact of the program was assessed in terms of the relevance of prescriptions (6-monthly audits), changes in the overall cost of anti-infectives, the average daily cost per hospital patient, and changes in the pattern of antimicrobial resistance among pathogens isolated in the institution. RESULTS: Reference recommendations were established for most clinical settings encountered in the hospital (104 for adults, 78 for children). The four audits conducted since June 1996 show that the rate of unjustified prescriptions has remained below 6%. The cost of antimicrobials has fallen regularly, both in absolute terms and as a proportion of total drug costs. Finally, resistance rates among the different pathogens studied have fallen or remained stable. CONCLUSION: Rationalization of antimicrobial chemotherapy in a short-stay hospital necessitates an institution-based policy with long-term objectives, a large initial investment and, above all, a participative approach among all prescribers.

[Evaluation of low molecular weight heparin prescription at the Centre Hospitalier Intercommunal de Créteil]. / Evaluation de la prescription des héparines de bas poids moléculaire au Centre Hospitalier Intercommunal de Créteil.

Low-molecular-weight heparin (LMWH) represents a great expense in general hospitals. At the Centre Hospitalier Intercommunal de Créteil (CHIC), the Quality Assessment Council had set up a study on the prescription of LMWH in order to assess concordance between prescriptions and local guidelines on the preventive uses of LMWH. Adherence to the consensus was found in 73 per cent of cases, overprescription in 10 per cent of cases and underprescription in 26 per cent of cases. It is planned to modify the local consensus, taking into account some clinical situations highlighted by this study, and to perform another evaluation in the near future.

The representation of auditory source characteristics: simple geometric form.

Two experiments examined listeners' ability to discriminate the geometric shape of simple resonating bodies on the basis of their corresponding auditory attributes. In cross-modal matching tasks, subjects listened to recordings of pairs of metal bars (Experiment 1) or wooden bars (Experiment 2) struck in sequence and then selected a visual depiction of the bar cross sections that correctly represented their relative widths and heights from two opposing pairs presented on a computer screen. Multidimensional scaling solutions derived from matching scores for metal and wooden bars indicated that subjects' performance varied directly with increasing differences in the width/height (W/H) ratios of both sets of bars. Subsequent acoustic analyses revealed that the frequency components from torsional vibrational modes and the ratios of frequencies of transverse bending modes in the bars correlated strongly with both the bars' W/H ratios and bar coordinates in the multidimensional configurations. The results suggest that listeners can encode the auditory properties of sound sources by extracting certain invariant physical characteristics of their gross geometric properties from their acoustic behavior.