[Thesaurus of pharmacist interventions associated with inappropriate proton pump inhibitors prescriptions]. / Thésaurus d'interventions pharmaceutiques associées aux prescriptions injustifiées d'inhibiteurs de la pompe à protons.

OBJECTIVES: Proton pump inhibitors (PPI) are the most effective drugs in the treatment of acid-related gastrointestinal disorders. Yet, many studies reported potential adverse drug reactions associated with long-term use. In order to reduce the rates of inappropriate PPI prescriptions and to improve patient safety, a tool aimed at guiding pharmacists to analyze PPI prescriptions was designed. It results in a thesaurus of clinical situations designed to argue about the inappropriateness of some PPI prescriptions and to highlight the risk associated with them. METHODS: Clinical situations in which PPIs are inappropriate were identified by four pharmacists in one gastroenterological, one surgery/liver transplantation, one internal medicine and one oncology units. A scientific literature search was performed for each clinical situation in order to corroborate the pharmacist interventions. RESULTS: The thesaurus comprises two parts, the first one is dedicated to 12 clinical situations in which a PPI is not required (acute pancreatitis, cholecystectomy etc.), while the second one focus on 22 situations in which PPIs are associated with specific adverse drug reactions (Clostridium difficile infection, vitamin deficiency etc.). Eighty-one articles were used to support the pharmacist interventions. CONCLUSION: This thesaurus is an analysis tool aimed at guiding pharmacists identify and argue about the inappropriateness of some PPI prescriptions in order to convince doctors to discontinue or not to initiate PPI prescriptions.

[The Use of Checklists in Medicine]. / Checklisten in der Medizin.

The Use of Checklists in Medicine Abstract. This mini-review highlights the success story of checklists in perioperative medicine. It provides a background to the introduction of medical checklists, the WHO Guidelines for Safe Surgery, and the most important checklist studies. We outline the advantages of checklists and possible difficulties in their implementation and provide examples of various checklists. We come to the conclusion that checklists are helpful and that their best potential benefit depends on their correct implementation.

[Polypharmacy and Neuroleptics in Swiss Nursing Homes in the Years 2019 and 2020]. / Polymedikation und Neuroleptika in Schweizer Pflegeheimen in den Jahren 2019 und 2020.

Polypharmacy and Neuroleptics in Swiss Nursing Homes in the Years 2019 and 2020 Abstract. We present data from 92404 clinical assessments from 619 Swiss nursing homes . The data were collected in 2019 and 2020 from over 65-year-old residents. Two-thirds of those studied had severe cognitive limitations, one quarter had significant behavioral disorders and just over half of the assessed patients showed signs of emotional instability or depression. 46% were treated with nine or more different drugs, 37% received a neuroleptic in 85% for more than 90 days. There is a positive correlation between the number of drugs taken, age, cognitive impairment and susceptibility to falls. Since neuroleptics are administered in 30% under uncertain indication and the susceptibility to falls is increased by 40% under neuroleptics, their use should be reduced in the course of structured interprofessional processes.

Impact of computerized physician order entry system on parenteral nutrition medication errors in a teaching neonatal intensive care unit.

OBJECTIVES: Parenteral nutrition (PN) offers a quality therapeutic option when enteral feeding is non-tolerated or impossible. However, it can be associated with an increased risk of medical errors, especially in sensitive populations such as newborns. This study aimed at determining the impact of the implementation of a computerized physician order entry (CPOE) system on PN medication errors in the neonatology department in the largest teaching hospital in Tunisia. MATERIEL AND METHODS: The frequency of medication errors in PN, in a teaching neonatal intensive care unit, was prospectively reviewed by a pharmacist between December 2018 and March 2019 in a two-phase interventional study (pre and post locally developed CPOE System implementation). RESULTS: Implementation of CPOE system decreased PN order errors from 379 to 147 representing a 61.1% reduction. The decreases on PN order errors per stage, i.e. prescribing and preparation, were form 207 to 22 (89.4%), and from 117 to 66 (43.6%), respectively. Mean nutrients intakes were in conformity to the recommended daily intakes during the CPOE phase of the study. CPOE is a protective tool against prescription and preparation errors. It significantly impacted all items of the ordering process. CONCLUSIONS: In addition to the rigorous application of the recommendations, the CPOE system allows to reduce the risk of PN medication errors. This improves the safety and quality of medicines in newborns.

Policy and Practice Note: Policy, Safety, and Regulation with Regard to Ontario Home Care Clients and Personal Support Workers.

In light of COVID-19 and elevated concerns for the health of older Canadians receiving care, this Policy and Practice Note explores the confluence of the current home care policy landscape and the organisation of personal support worker (PSW) work, and highlights the need to consider governance of PSW work generally, and in-home and community care especially. PSWs are currently not professionally regulated, nor is there a central site documenting location, education, or any form of verification of the PSW workforce. Home care PSWs often provide physical care in isolated settings with no in-person supervision. In home and community health care, complaints about PSWs can be scattered among different service providers or client files not linked to or searchable by PSW name. This policy note explores how these factors and the currently unregulated status of PSWs affect home care safety in general as well as in the context of COVID-19, Ontario's decentralised home care system, and efforts towards professional regulation.

Clima ético y cultura de seguridad del paciente pediátrico en un hospital de especialidad del sureste de México / Ethical climate and culture of pediatric patient safety in a hospital specialty of southeast Mexico / Clima ético e cultura de segurança do doente pediátrico num hospital especial do sudeste do México / Climat éthique et culture de sécurité du patient pédiatrique dans un hôpital spécial du Sud-est du Mexique

Resumen: Objetivo: Determinar la relación entre el clima ético organizacional y la Cultura de Seguridad del Paciente en el personal de enfermería del Hospital Regional de Alta Especialidad del Niño "Dr. Rodolfo Nieto Padrón". Material y Métodos: Estudio cuantitativo, descriptivo, correlacional y transversal, los instrumentos utilizados para medir el clima ético hospitalario, la encuesta de Linda Olsón (1988) y la cultura de seguridad del paciente, el cuestionario el MOSPS (2011). La muestra la constituyeron 168 profesionales de enfermería. Resultados: El índice global de clima ético hospitalario de 56.29, las enfermeras percibieron un clima de seguridad global de 8 (57.1%), en una escala del 0 al 10. Los eventos notificados en un año fueron de 0 incidentes por escrito (88.7%). Se encontró que existe una asociación positiva y significativa (rs=.404; p=.000) entre el clima ético y los eventos adversos, así comodel clima ético con la seguridad (rs=.231; p=.003) y del clima ético hospitalario y la percepción de seguridad del paciente (rs=.636; p=.000). Conclusiones: El clima ético hospitalario percibido, se orienta a un ambiente positivo y de confianza en el trabajo colaborativo entre profesionales y pacientes, en contraste con los hallazgos de desconfianza y subordinación que son desfavorables para el ejercicio profesional en otras disciplinas, la relación con los jefes y con el hospital.

Abstract: Objetive: To determine the relationship between the organizational ethical climate and the Safety Culture of the Patient in the nursing staff of the Regional Hospital of High Specialty of the Child "Dr. Rodolfo Nieto Padrón ". Materials and methods: Quantitative, descriptive, correlational and transversal study, the survey of Linda Olsón (1988) and the culture of patient safety, the questionnaire MOSPS (2011) used as instruments to measure the hospital ethics climate. The sample consisted of 168 nursing professionals. Results: The global index of hospital ethical climate of 56.29, nurses perceived a climate overall security of 8 (57.1%), on a scale of 0 to 10. Events reported in one year were 0 incidents in writing (88.7%). It was found that there is a positive and significant association (rs = .404; p = .000) between the ethical climate and the adverse events, as well as the ethical climate with safety (rs = .231; p = .003) and the hospital's ethical climate and the perception of patient safety (rs = .636; p = .000). Conclusions: The perceived hospital ethical climate is oriented towards a positive and reliable environment in the collaborative work between professionals and patients, in contrast to the findings of distrust and subordination that are unfavorable for professional practice with other disciplines, the relationship with the chiefs and with the hospital.

Resumo: Objetivo: Determinar a relaçâo entre o clima ético organizacional e a cultura de segurança do doente na equipe de enfermagem do Hospital Regional de Alta Especialidade da Criança "Dr. Rodolfo NietoPadrón ". Materiais e métodos: Estudo quantitativo, descritivo, correlacional e transversal, os instrumentos utilizados para medir o clima ético hospitalar foram a pesquisa de Linda Olsón (1988) e a cultura de segurança do doente, o questionário MOSPS (2011). A amostra foi composta por 168 profissionais de enfermagem Resultados: O índice global do clima ético hospitalar é de 56,29, os enfermeiros perceberam um clima de segurança global de 8 (57,1%), numa escala de 0 a 10. Os eventos notificados por escrito num ano sao de 0 incidentes (88,7% ). Verificou-se a existência de uma associaçâo positiva e significativa (rs = 0,404, p = 0,000) entre o clima ético e os eventos adversos, bem como o clima ético com a segurança (rs = 0,231; p = 0,003) e o clima ético hospitalar e a percepçao da segurança do doente (rs = 0,636; p = 0,000). Conclusao: O clima ético hospitalar percebido orienta-se num ambiente positivo e de confiança no trabalho colaborativo entre profissionais e doentes, em opsiçao aos dados de desconfiança e subordinaçao que sao desfavoráveis para a prática profissional com outras disciplinas, as relaçoes com os chefes e com o hospital.

Résumé: Objectif: Déterminer la relation entre le climat éthique organisationnel et la culture de sécurité du patient parmi le personnel infirmier de l'Hôpital régional de haute spécialité de l'enfant "Dr. Rodolfo Nieto Padrón ". Matériel et méthodes: Étude quantitative, descriptive, corrélationnelle et transversale, instruments utilisés pour mesurer le climat éthique en milieu hospitalier, enquête Linda Olsón (1988) et culture sur la sécurité des patients, questionnaire MOSPS (2011). L'échantillon comprenait 168 professionnels infirmiers. Résultats: Indice global du climat hospitalier éthique de 56,29, les infirmières ont perçu un climat de sécurité global de 8 (57,1%) sur une échelle de 0 à 10. Les événements rapportés au cours d'une année sont de 0 incidents écrits (88,7%). Il a été constaté qu'il existe une association positive et significative (rs=0,404, p=0,000) entre le climat éthique et les événements indésirables, ainsi que le climat éthique avec sécurité (rs= 0,231; p = 0,003) et le climat éthique hospitalier et perception de la sécurité des patients (rs = 0,636; p=0,000). Conclusions: Le climat éthique hospitalier perçu est orienté vers un environnement positif et digne de confiance dans le travail collaboratif entre professionnels et patients, contrairement aux conclusions de méfiance et de subordination défavorables à la pratique professionnelle avec d'autres disciplines, la relation avec les chefs. et avec l'hôpital.

De la sécurité des patients à la résilience des systèmes de soins: un état de l'art / From patient safety to the resilience of healthcare systems: the state of the art

Résumé La sécurité des patients est devenue une priorité des politiques de santé publique. En 30 ans, les systèmes de santé se sont approprié les outils de gestion des risques conçus pour les industries. L'objectif de cette revue de littérature est de décrire les modèles et les démarches de sécurité actuellement déployés dans les systèmes de santé et d'explorer les nouvelles perspectives. La recherche bibliographique a été réalisée à partir de trois bases de données, en français et en anglais. L'analyse thématique du matériel retenu (48 références) a guidé la construction de l'article et l'identification d'une typologie de démarches de prévention. Après une présentation des démarches « classiques ¼, nous exposons les limites de ces démarches dans le contexte spécifique des soins. Puis nous présenterons les perspectives scientifiques actuellement envisagées pour construire de nouvelles approches de prévention en santé. Ces perspectives interrogent, en conclusion, la nécessité d'un changement de paradigme, comme le propose le courant de l'« ingénierie de la résilience ¼.

Abstract Patient security has become a priority in public health policies. In 30 years, health systems have adopted the risk management tools designed for industries. The purpose of this review of the literature is to describe the current security models and approaches deployed in health systems and to explore new perspectives. The bibliographic search was conducted from three databases, in French and in English. The thematic analysis of the selected material (48 references) guided the construction of the article and the identification of a typology of prevention approaches. After a presentation of the «classical¼ approaches, the limits of these approaches in the specific context of care are exposed. The scientific perspectives currently envisaged to build new approaches to prevention in health are then presented. By way of conclusion, these perspectives question the need for a paradigm shift, as proposed by the current of «resilience engineering¼.

Unusual occurrence reporting system: Sharing a ten years experience from a tertiary care JCIA accredited university hospital.

PURPOSE: Identifying a true measure of safety is challenging in radiation oncology. A culture of unusual reporting may however be used as an indirect measure for it. The purpose of this study is to share our experience of unusual occurrence reporting system, established in the Radiation Oncology section since 2006, the first of this nature in Pakistan. MATERIALS AND METHODS: Data is collected over the last ten years. An in-house online reporting system has been developed for reporting unusual events. All the reported events are evaluated retrospectively. The stage of unusual occurrence along the radiation therapy process, possible causes, severity and preventive measures taken are discussed. RESULTS: Analysis of the 501 unusual occurrences reported over the last ten years has shown a substantial decrease in the number of significant mistakes observed. Of the total, 57 % unusual occurrences have been reported by radiation therapy technologists, including treatment preparation processes. Oversight is supposed to be the most common cause for unusual occurrences. CONCLUSIONS: The ten years experience with reporting and documenting of unusual occurrences resulted in a safety culture where every individual is willing to share any type of incident with a free well. Our experience at the Aga Khan University Hospital (AKUH) shows that the major reason for the occurrence of incidents was oversight. The majority of unusual occurrences were reported by radiation therapy technologists, as expected, since they handle the bulk of the treatment planning process.

A retrospective study of complaint letters sent to a Swiss Emergency Department between 2009 and 2014.

OBJECTIVE: Patient complaints are a valuable resource for monitoring and improving patient safety and quality of care. The purpose of this study was to analyze the complaint letters received at a Swiss academic emergency department (ED) over six years. METHODS: A retrospective study of all complaint letters sent to a Swiss academic ED between 2009 and 2014 was conducted. The following data were extracted: epidemiology items, reasons for complaints, hospital responses, follow-up, and severity of the events mentioned in the complaints. All complaint letters related to adult patients evaluated in the ED between 2009 and 2014 were included and a qualitative evaluation was performed based on a systematic taxonomy. Context, patient characteristics, mode of resolution and clinical severity of the related adverse event were evaluated. RESULTS: A total number of 156 complaints were recorded, corresponding to an annual complaint rate of 5.5 to 8.8 per 10,000 visits. The complaints concerned mostly three domains (clinical care, management and patient or caregiver relationship) with a slight predominance for organisation and logistics (39%) compared with 31.4% for standard of care and 29.6% for communication/relational complaints. The majority of complaints were sent within one month of the ED visit. Most complaints were resolved with written apologies or explanations. The consequences of 73.5% of the events in question were considered minor or negligible, 19% moderate, and 6.5% major. Only 1% (two cases) was related to situations with catastrophic consequences. CONCLUSION: Complaint incidence in our ED was low and remained stable over the six-year observation period. Most of the complaints pertained to incidents that entailed negligible or minor consequences. As most complaints were due to inadequate communication, interventions targeting improvement of the doctor/patient communication are required.

[Pharmaceutical record's use in drugs sales service: Analysis of five months of experimentation]. / Utilisation du dossier pharmaceutique en rétrocession : analyse de 5 mois d'expérimentation.

OBJECTIVE: The pharmaceutical record integrated in the health insurance card is now exploitable by hospital pharmacists. The aim of this study is to assess the impact of pharmaceutical record's use in hospital drugs sales service and the relevance of this tool to secure the ambulatory dispensing of drugs. METHOD: All patients admitted in hospital drugs sales service between June and October 2016 were included. With the patient's consent, pharmaceutical record was created and/or consulted and implemented. When it included the city pharmacy's treatment, a pharmaceutical analysis was carried out to research drug interaction with hospital drugs sales service's treatment. If a contraindicated or not recommended association was detected, a pharmaceutical intervention was sent to the general practitioner, by secured mail. Each stage was timed. RESULTS: For the 183 included patients, 40 pharmaceutical records have been created and 74 completed. For the 69 remaining patients, pharmaceutical record could not be used. At the end of these 5 months, 86 pharmaceutical records included city pharmacy's and hospital treatments. The pharmaceutical analysis performed have shown 24 drugs interactions related to hospital treatment; seven inappropriate associations were transmitted to the general practitioner. Five minutes were required for both the use and the analysis of pharmaceutical record. CONCLUSION: Now, the pharmaceutical record is systematically used in the hospital drugs sales service, and its content is systematically analyzed. It represents one of the tool improving communication between town-hospital networks, and helps secure the ambulatory drugs dispensation.

Conocimiento e Implementación de la seguridad del paciente quirúrgico en una institución pediátrica del sureste de México / Knowledge and Implementation of safety in Surgical patients' in a pediatric institution in southeastern Mexico / Conhecimento e Implementaçâo de segurança dos pacientes cirúrgicos numa instituiçâo pediátrica no sudeste do México / Connaissance et mise en œuvre de la sécurité des patients chirurgicaux dans un établissement pédiatrique du sud-est du Mexique

Resumen: Objetivo: Evaluar el nivel de conocimiento e implementación de la seguridad del paciente quirúrgico en una institución pediátrica. Materials and methods: Estudio observacional, descriptivo y de corte transversal, en el periodo comprendido de abril 2014-diciembre 2015. La muestra de 78 profesionales de salud del equipo quirúrgico del Hospital Regional de Alta Especialidad del Niño "Dr. Rodolfo Nieto Padrón" de los diversos turnos laborales, los instrumentos de recolección de datos fueron 1) Cuestionario de conocimiento de seguridad del paciente quirúrgico y 2) Cuestionario de cumplimiento de seguridad quirúrgica. Resultados: El nivel de conocimiento del equipo quirúrgico acerca de la seguridad quirurgica fue bueno en 77% de los participantes. En la evaluación del cumplimiento se sumaron las puntuaciones del total de ítems del instrumento y se dividieron entre el total de las medidas para estimar las medias. Se encontró un promedio de 85.6 % en la fase 1 antes de la anestesia que corresponde a un cumplimiento bueno, en la fase 2 antes de la incisión de la piel 79.86% o cumplimiento regular y en los factores del entorno interno y externo del área quirúrgica que influyen en la seguridad del paciente quirúrgico de la fase 3, antes que el paciente abandone el quirófano 85.2% o cumplimiento bueno. Conclusión: Las evaluaciones de las tres etapas de la verificación de la seguridad quirúrgica en el paciente pediátrico permitieron identificar las áreas de oportunidades para mejorar su implementación, disminuir el número de complicaciones, muertes evitables y avanzar sobre una cultura de seguridad del paciente quirúrgico.

Abstract: Objective: To evaluate the level of knowledge and implementation of the safety of surgical patients in a pediatric institution. Materials and methods: Observational, descriptive and cross-sectional study in the period April 2014- December 2015. The sample of 78 health professionals who are members of the surgical team Regional High Specialty Hospital del Niño "Dr. Rodolfo Nieto Padrón "of various work shifts, using 2 assessment instruments. 1) Knowledge Questionnaire safety of surgical patients and 2) Compliance Questionnaire surgical safety. Results: The level of knowledge of the surgical team regarding surgical safety was good with 77% in study participants. In compliance assessment scores of all instrument items were added and divided by the total of measures to estimate the means. an average of 85.6 was found in phase 1 before anesthesia corresponding to a good compliance in phase 2 before the skin incision 79.86 or regular compliance and factors internal and external environment of the surgical area that influence in the safety of the surgical patient phase 3 before the patient leaves the operating room or 85.2 good compliance. Conclusions: Evaluations of the three stages of verification of surgical safety in pediatric patients helped identify areas of opportunities to improve their implementation, reduce the number of complications, avoidable and advance a culture of safety of the surgical patient deaths.

Resumo: Objetivo: Avaliar o nível de conhecimento e implementação da segurança dos pacientes cirúrgicos numa instituição pediátrica. Materiais e métodos: Estudo de observação, descritivo e transversal no período de abril 2014 a Dezembro de 2015. A amostra foi constituída por 78 profissionais de saúde que são membros da equipe cirúrgica do Hospital Regional de Alta Especialidade del Niño "Dr. Rodolfo Nieto Padrón" e incluiu vários turnos de trabalho. Foram usados dois instrumentos de avaliação: 1) questionário de conhecimento de segurança do paciente cirúrgico e 2) questionário de cumprimento de segurança cirúrgica. Resultados: O nível de conhecimento da equipe cirúrgica em relação à segurança cirúrgica foi bom, com 77% dos participantes do estudo. Na avaliação do cumprimento de todos os itens do instrumento foram sumadas as pontuações do total de itens e foram divididas pelo total de medidas para estimar as médias. Foi encontrada uma média de 85,6% na fase 1 antes da anestesia, correspondendo a um bom cumprimento. Na fase 2, antes da incisão na pele, 79,86% manifestaram um cumprimento regular e fatores de ambiente interno e externo da área cirúrgica influenciaram na segurança do paciente cirúrgico da fase 3, antes de o paciente sair da sala de operação, com 85,2% de boa adesão. Conclusão: As avaliações das três fases de verificação de segurança cirúrgica em pacientes pediátricos ajudou a identificar áreas de oportunidade para melhorar a sua aplicação, reduzir o número de complicações evitáveis e promover uma cultura de segurança das mortes cirúrgicas de pacientes.

Résumé: Objectif: Évaluer le niveau de connaissances et de mise en œuvre de la sécurité des patients chirurgicaux dans un établissement pédiatrique. Matériel et méthodes: Étude observationnelle, descriptive et transversale, réalisée entre avril 2014 et décembre 2015. L'échantillon est constitué de 78 professionnels de santé, de différents horaires de travail, de l'équipe chirurgicale de l'Hospital Regional de Alta Especialidad del Niño Dr. Rodolfo Nieto Padrón". Les instruments de collecte de données utilisés sont: 1) Questionnaire de connaissance sur la sécurité des patients chirurgicaux et 2) Questionnaire sur le respect de la sécurité chirurgicale. Résultats: Le niveau de connaissance de l'équipe chirurgicale sur la sécurité chirurgicale s'est montré bon pour 77% des participants. Pour l'évaluation du respect de la sécurité, le total des scores de tous les items de l'instrument a été divisé par le nombre de mesures contenues dans le questionnaire. Les moyennes suivantes ont été calculées: 85,6% pour la phase 1 pré-anesthésique (considéré comme une bonne observance); 79,86% pour la phase 2 antérieur à l'incision cutanée (observance régulière) et 85,2% pour les facteurs de l'environnement interne et externe du bloc opératoire qui influent sur la sécurité du patient dans la phase 3, avant qu'il ne quitte la salle d'opération (bonne observance). Conclusion: Les évaluations des trois étapes de vérification de la sécurité chirurgicale envers les patients pédiatriques ont permis d'identifier les domaines susceptibles d'amélioration de leur mise en œuvre pour réduire le nombre de complications, de décès évitables, et progresser dans la culture de la sécurité des patients chirurgicaux.

Review of Hypoglycemia in the Older Adult: Clinical Implications and Management.

The aging of the population is a worldwide phenomenon. The prevalence of diabetes rises with increasing age, so the personal and financial costs of diabetes in the aging population have become significant burdens. In 2012, 104 billion (59%) of the estimated $176 billion in United States healthcare expenditures attributable to diabetes were utilized by patients older than 65 years of age [American Diabetes Association (1)]. With improvement in diabetes management and better glycemic control in the general population, there is an increase in the prevalence of hypoglycemia, which is the complication of the treatment of diabetes. Older adults with diabetes have a higher risk for hypoglycemia due to altered adaptive physiologic responses to low glucose levels. These patients also have comorbidities, such as cognitive and functional loss, that interfere with prompt identification and/or appropriate treatment of hypoglycemia. Older adults who suffer from hypoglycemia also have increased risk for falls, fall-related fractures, seizures and comas and exacerbation of chronic conditions, such as cognitive dysfunction and cardiac events. Thus, hypoglycemia in the older adult must be proactively avoided to decrease significant morbidity and mortality. Education of the patients and caregivers is important in prevention and treatment of hypoglycemia. In this article, we discuss the important aspects and unique challenges pertaining to hypoglycemia in older population. We also highlight the risks, consequences and prevention and management strategies for hypoglycemia that can be used by healthcare providers caring for older populations.

[The pharmaceutical record in an emergency department: Assessment of its accessibility and its impact on the level of knowledge of the patient's treatment]. / Le dossier pharmaceutique dans un service d'accueil des urgences : évaluation de son accessibilité et de son impact sur le niveau de connaissance du traitement du patient.

Knowledge of the home medication list may impact therapeutic decisions made in the emergency department (ED). In France, the pharmaceutical record (PR) is a shared professional tool arising from the pharmacists lists of all drugs dispensed during the last 4 months. This PR is included in a microchip equipping a "Vitale" card detained by each beneficiary of health insurance benefits. Since 2011, the law authorises experimentally the consultation of the PR by some hospital doctors such as those working in emergency medicine. The purpose of this work is to assess the accessibility to this PR and to verify the hypothesis that its consultation increases the level of information concerning the treatment of patients admitted in an ED. A prospective, single-center, observational study was conducted during a 15-day period on all patients arriving at the Agen hospital emergency department. Of the 1046 patients enrolled in the study, 828 (79 %) presented a "Vitale" card in which a PR furnished with data was found in 45 % of the cases. The only paper source of information available was provided by the PR (25 %), a medical letter (6 %) or a prescription (3 %). A dual reconciliation between 2 of these sources was possible at a rate of about 4 % each whereas only 3 % of patients showed up with the 3 sources of available information. The consultation of PR by the ED staff is significantly possible. It improves quantitatively the level of information and thus optimizes medication assessment, the initial and critical step of the medical management of patients.

An interprofessional qualitative study of barriers and potential solutions for the safe use of insulin in the hospital setting.

OBJECTIVE: Insulin is regularly used in hospitalized patients for glycemic control but is associated with significant risks. The goals of this study were to describe the strengths and weaknesses of a university health centre in the safe use of insulin, to collect improvement proposals from health professionals involved in the management of insulin therapy and to assess inpatient glycemic control. METHODS: This is a qualitative study. Physicians, nurses and pharmacists practising at the Centre Hospitalier Universitaire de Sherbrooke (CHUS) for at least 2 years were invited to join focus groups on safe insulin treatment. Themes up for discussion were roles of professionals in insulin therapy, problems encountered, solutions put forward and strengths of the hospital. The Quality Hyperglycemia Score (QHS) was assessed using an existing cohort of inpatients who were prescribed insulin. RESULTS: A total of 5 focus groups were held in February and March of 2012, involving 31 healthcare professional participants. Several groups pointed out the same problems, namely, lack of access to useful information for optimal management of insulin therapy and lack of communication among personnel on different work shifts. Results of the QHS suggest room for improvement in blood glucose control at our institution. CONCLUSION: These focus groups allowed better identification of the management problems related to the use of insulin in our health institution and possible interventions to solve them. The QHS will be reassessed to measure quality of inpatient glycemic control over time.

Using standardized insulin orders to improve patient safety in a tertiary care centre.

OBJECTIVE: To standardize insulin prescribing practices for inpatients, improve management of hypoglycemia, reduce reliance on sliding scales, increase use of basal-bolus insulin and improve patient safety. METHODS: Patients with diabetes were admitted to 2 pilot inpatient units followed by corporate spread to all insulin-treated patients on noncritical care units in a Canadian tertiary care multicampus teaching hospital. Standardized preprinted insulin and hypoglycemia management orders, decision support tools and multidisciplinary education strategies were developed, tested and implemented by way of the Model for Improvement and The Ottawa Model for Research Process. Clinical and balance measures were evaluated through statistical process control. RESULTS: Patient safety was improved through a reduction in hypoglycemia and decreased dependence on correctional scales. Utilization of the preprinted orders approached the target of 70% at the end of the test period and was sustained at 89% corporately 3 years post-implementation. CONCLUSIONS: The implementation of a standardized, preprinted insulin order set facilitates best practices for insulin therapy, improves patient safety and is highly supported by treating practitioners. The utilization of formal quality-improvement methodology promoted efficiency, enhanced sustainability, increased support among clinicians and senior administrators, and was effective in instituting sustained practice change in a complex care centre.