289 Improving safety of patient treated by vitamin K antagonists in geriatrics

Autor: S Chauvelier, S Pariel, M Sohane, Joël Belmin, C Oasi, C Bussy, P Ghiassi
Rok vydání: 2010
Předmět:
Zdroj: BMJ Quality & Safety. 19:A121-A121
ISSN: 2044-5423
2044-5415
DOI: 10.1136/qshc.2010.041624.73
Popis: Background Vitamin K antagonists (VKA) are widely used in old patients with atrial fibrillation or venous thromboembolism. Safety is a major concern, especially in old patients. International normalised ratio (INR)>5 is associated with an increased risk of bleeding and is considered as a near miss error. Aim To reduce the incidence of episodes of INR>5 which occurred during the hospital stay of patients of a geriatric hospital ward exposed to VKA. Design: Intervention study, non randomised. Methods The study was done in five geriatric wards comprising acute, intermediate and long-term care beds of a French hospital. The intervention was conducted in one ward of the hospital. A structured teamwork among the medical staff of the geriatric ward was implemented from July to December, 2005. Twice monthly, the medical staff examined during a short meeting the cases of all the patients with INR>5 which occurred during the preceding weeks. The group discussed cases using a tool designed to identify prescribing errors in dose adjustment and/or INR monitoring. The approach was proactive in order to learn from errors and not punitive. The number of patients exposed to VKA and the number of episodes of INR>5 were recorded during a 12-month period before the intervention (2004–2005) and during the year following it in the intervention ward and in control wards (2006). Results In control wards, 60 episodes of INR>5 were recorded in the 267 patients (22.5%) receiving VKA in 2004–2005 and 56 episodes among the 263 (22.1%) in 2006. In the intervention ward, 22 episodes were recorded in the 72 patients (30.6%) in 2004-2005, and 16 episodes of INR>5 were recorded among the 92 patients (17.4%), corresponding to a significant decrease (−43.1%) as compared to control wards (–1.8%, p Conclusion A structured teamwork focused on cases of INR>5 lessen the risk of VKA overdosage and might improve safety of anticoagulation. Learning from errors seems an efficient way to improve quality of care. Contexte Les antivitamines K (AVK) sont largement utilisees chez les patients âges ayant une fibrillation auriculaire ou une maladie veineuse thromboembolique. La securite est une preoccupation majeure, en particulier chez les patients âges. L9international normalised ratio (INR)>5 est associe a une majoration du risque de saignement et est considere comme un evenement critique. But Reduire l9incidence des episodes d9INR>5 survenant pendant le sejour hospitalier chez les patient d9un service de geriatrie recevant des AVK. Type d9etude Interventionnelle non randomisee. Methodes L9etude a ete conduite dans 5 services hospitaliers de geriatrie comprenant des lits de court sejour, de soins de suite-readaptation et soins de longue duree. L9intervention a ete conduite dans un service de l9hopital. Un travail structure au sein de l9equipe medicale a ete conduit de juillet a decembre 2005. Deux fois par mois, l9equipe medicale a examine durant une courte reunion tous les episodes d9INR>5 au cours des semaines precedentes. Le groupe a discute les cas en utilisant un outil concu pour identifier les erreurs de prescription concernant l9ajustement des doses et/ou la surveillance de l9INR. L9approche etait proactive dans le but d9apprendre a partir des erreurs, et non punitive. Le nombre de patients exposes aux AVK et le nombre d9episodes d9INR>5 ont ete collectes durant les 12 mois precedant l9intervention (2004-2005) et pendant l9annee suivante (2006) dans le service intervention et dans les services controles. Resultats Dans les services controles, 60 episodes d9INR>5 ont ete enregistres chez les 267 patients exposes aux AVK en 2004–2005 (22.5%) et 56 episodes chez les 263 patients exposes en 2006 (22.1%). Dans le service intervention, 22 episodes ont ete enregistres chez les 72 patients (30.6%) en 2004–2005, et 16 episodes chez les 92 patients exposes en 2006 (17.4%), ce qui correspondant a une diminution significative (−43.1%) par comparaison aux services controles (−1,8%, p Conclusion Un travail structure au sein de l9equipe medicale centre sur les episodes d9INR>5 a diminue le risque de surdosage par les antivitamines K et pourrait ameliorer la securite de l9anticoagulation. Apprendre a partir des erreurs semble un moyen efficace pour ameliorer la qualite des soins. Dans notre service, des sessions de travail similaires sont encore organisees 3 a 4 fois par an.
Databáze: OpenAIRE
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