{"id":1959,"date":"2012-10-01T01:00:00","date_gmt":"2012-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/analyse-prospective-des-evenements-porteurs-de-risques-survenus-dans-le-service-dhepato-gastroenterologie-dun-centre-hospitalier-general\/"},"modified":"2018-10-20T18:40:04","modified_gmt":"2018-10-20T16:40:04","slug":"analyse-prospective-des-evenements-porteurs-de-risques-survenus-dans-le-service-dhepato-gastroenterologie-dun-centre-hospitalier-general","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/analyse-prospective-des-evenements-porteurs-de-risques-survenus-dans-le-service-dhepato-gastroenterologie-dun-centre-hospitalier-general\/","title":{"rendered":"Analyse prospective des \u00e9v\u00e9nements porteurs de risques survenus dans le service d\u2019H\u00e9pato-Gastroent\u00e9rologie d\u2019un Centre Hospitalier G\u00e9n\u00e9ral."},"content":{"rendered":"

2012<\/strong><\/p>\n

Mercedes De Lustrac, Vladimir Andrieux, Emmanuel Driguez, Marie-Pierre Liebaert, J-Pierre Dupuychaffray ; Centre Hospitalier Angoul\u00eame.<\/em><\/p>\n

Vie Professionnelle <\/strong>– \u00a02012-08-11 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Introduction :
\nLes \u00e9v\u00e9nements porteurs de risque (EPR) se d\u00e9finissent comme \u00e9tant des \u00e9v\u00e9nements ind\u00e9sirables associ\u00e9s aux soins, \u00e0 l\u2019exclusion des \u00e9v\u00e9nements ind\u00e9sirables graves (EIG). En \u00e9vitant la dimension dramatique li\u00e9e aux EIG, le travail sur les EPR pourrait permettre de f\u00e9d\u00e9rer une \u00e9quipe autour d\u2019une d\u00e9marche collective d\u2019am\u00e9lioration de la qualit\u00e9 et de la s\u00e9curit\u00e9 des soins.<\/p>\n

Objectifs :
\nEvaluer la faisabilit\u00e9 de l\u2019analyse et obtenir une photographie des \u00e9v\u00e9nements non souhait\u00e9s rapport\u00e9s au nombre de journ\u00e9es d\u2019hospitalisation
\nPr\u00e9ciser les facteurs qui ont permis de r\u00e9cup\u00e9rer la situation et de r\u00e9duire l\u2019impact sur le patient
\nEvaluer le caract\u00e8re \u00e9vitable de l\u2019\u00e9v\u00e9nement et d\u00e9finir d\u2019\u00e9ventuelles barri\u00e8res de pr\u00e9vention
\nEvaluer les r\u00e9sultats de l\u2019\u00e9tude en tant que site pilote, en concertation avec la Commission Risques Inter Sp\u00e9cialit\u00e9s de la HAS
\nR\u00e9pondre aux obligations des \u00e9tablissements de sant\u00e9 et Pr\u00e9sidents de CME d\u2019\u00e9laborer un programme d\u2019am\u00e9lioration de la qualit\u00e9 et de la s\u00e9curit\u00e9 des soins int\u00e9grant les modalit\u00e9s de signalement des \u00e9v\u00e9nements ind\u00e9sirables
\nPermettre de construire une d\u00e9marche de DPC pour tous les professionnels de l\u2019\u00e9quipe participant \u00e0 ce travail<\/p>\n

M\u00e9thodes :
\nEnregistrement prospectif des EPR dans un registre conserv\u00e9 au PC infirmier
\nEtude limit\u00e9e \u00e0 l\u2019unit\u00e9 d\u2019hospitalisation compl\u00e8te du service d\u2019H\u00e9pato-Gastroent\u00e9rologie, pour une dur\u00e9e de N jours cons\u00e9cutifs
\nParticipation volontaire des PH et des param\u00e9dicaux ; d\u00e9claration des EPR accessible \u00e0 l\u2019ensemble de l\u2019\u00e9quipe
\nLa d\u00e9claration : principe de l\u2019anonymat appliqu\u00e9 aux patients et aux professionnels, bref r\u00e9sum\u00e9 de l\u2019\u00e9v\u00e9nement avec un mot sur sa d\u00e9tection, sa r\u00e9cup\u00e9ration, son impact sur le patient, sa pr\u00e9vention, et son caract\u00e8re \u00e9vitable ou non<\/p>\n

R\u00e9sultats :
\nL\u2019\u00e9tude porte sur les EPR enregistr\u00e9s sur douze semaines cons\u00e9cutives.
\nLa fr\u00e9quence des EPR est sous-\u00e9valu\u00e9e du fait d\u2019une participation h\u00e9t\u00e9rog\u00e8ne des professionnels, et d\u2019un nombre de d\u00e9claration fluctuant selon les phases de motivation de l\u2019\u00e9quipe.
\nLa d\u00e9tection de l\u2019\u00e9v\u00e9nement non souhait\u00e9 a \u00e9t\u00e9 faite par un praticien (50%), ou par un membre de l\u2019\u00e9quipe param\u00e9dicale (50%), et parfois par le patient.
\nLes mesures prises pour r\u00e9cup\u00e9rer le dysfonctionnement et att\u00e9nu\u00e9 l\u2019impact sur le patient ont \u00e9t\u00e9 mises en \u0153uvre par un praticien (57%), ou par une infirmi\u00e8re (43%).
\nL\u2019\u00e9v\u00e9nement ind\u00e9sirable a \u00e9t\u00e9, apr\u00e8s analyse, class\u00e9 \u00e9vitable dans 100% des cas.
\nLes principales classes d\u2019EPR \u00e9taient : d\u00e9faut de transmission d\u2019information sensible, prescription m\u00e9dicamenteuse retard\u00e9e ou inappropri\u00e9e, report d\u2019une proc\u00e9dure endoscopique, risque d\u2019infection nosocomiale.
\nLes principales \u00ab barri\u00e8res \u00bb de pr\u00e9vention issues de l\u2019analyse \u00e9taient : coh\u00e9sion et stabilit\u00e9 de l\u2019\u00e9quipe, communication entre professionnels, planification des t\u00e2ches (programmation bloc), contr\u00f4le crois\u00e9 des prescriptions informatis\u00e9es, sensibilisation r\u00e9p\u00e9t\u00e9e de l\u2019\u00e9quipe \u00e0 la gestion des risques.<\/p>\n

Conclusions :
\nLa gestion des risques en \u00e9quipe d\u00e9clin\u00e9e dans un service de soins est un objectif accessible, capable d\u2019am\u00e9liorer les conditions de prise en charge des patients, et qui a du sens en impliquant l\u2019ensemble des professionnels pour donner \u00e0 leur service un label qualit\u00e9.
\nLe r\u00f4le des param\u00e9dicaux est essentiel dans la d\u00e9tection et dans la r\u00e9cup\u00e9ration des dysfonctionnements, la plupart des EPR sont \u00e9vitables.
\nCe travail en \u00e9quipe sur les EPR devrait \u00eatre prochainement facilit\u00e9 par la HAS par la mise \u00e0 disposition de sa base de retour d\u2019exp\u00e9rience et par la convergence \u00e0 venir avec les programmes d\u2019accr\u00e9ditation des m\u00e9decins.
\nLa HAS souhaite promouvoir ce programme de gestion des risques en \u00e9quipe permettant une extension aux param\u00e9dicaux des mod\u00e8les d\u00e9velopp\u00e9s dans les sp\u00e9cialit\u00e9s m\u00e9dicales, et en faire un programme int\u00e9gr\u00e9 de DPC privil\u00e9gi\u00e9.
\nAinsi, chaque param\u00e9dical pourrait valider son DPC, chaque m\u00e9decin pourrait \u00e0 la fois \u00eatre accr\u00e9dit\u00e9 dans sa sp\u00e9cialit\u00e9 et valider son DPC.<\/p>\n","protected":false},"excerpt":{"rendered":"

2012 Mercedes De Lustrac, Vladimir Andrieux, Emmanuel Driguez, Marie-Pierre Liebaert, J-Pierre Dupuychaffray ; Centre Hospitalier Angoul\u00eame. Vie Professionnelle – \u00a02012-08-11 –\u00a0CO – ________________________________ Introduction : Les \u00e9v\u00e9nements porteurs de risque (EPR) se d\u00e9finissent comme \u00e9tant des \u00e9v\u00e9nements ind\u00e9sirables associ\u00e9s aux soins, \u00e0 l\u2019exclusion des \u00e9v\u00e9nements ind\u00e9sirables graves (EIG). En \u00e9vitant la dimension dramatique li\u00e9e aux […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[5],"tags":[23],"class_list":["post-1959","post","type-post","status-publish","format-standard","hentry","category-professionnel","tag-23"],"yoast_head":"\nAnalyse prospective des \u00e9v\u00e9nements porteurs de risques survenus dans le service d\u2019H\u00e9pato-Gastroent\u00e9rologie d\u2019un Centre Hospitalier G\u00e9n\u00e9ral. - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/analyse-prospective-des-evenements-porteurs-de-risques-survenus-dans-le-service-dhepato-gastroenterologie-dun-centre-hospitalier-general\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Analyse prospective des \u00e9v\u00e9nements porteurs de risques survenus dans le service d\u2019H\u00e9pato-Gastroent\u00e9rologie d\u2019un Centre Hospitalier G\u00e9n\u00e9ral. - 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