Littérature scientifique sur le sujet « Hôpital royal des forçats »

En Belgique, l’Arrêté royal d’exécution concernant l’infirmière en pratique avancée (IPA) n’a pas encore été publié. Pourtant, cette fonction existe. Nous nous intéresserons à l’infirmière ressource douleur (IRD) qui, dans une fonction transversale, fait un travail d’IPA bien avant sa reconnaissance légale. Depuis 2007, le ministère de la Santé finance des projets de prise en charge de la douleur. En 2013, une équipe algologique multidisciplinaire composée d’un médecin, un/une infirmière et un psychologue a été mise en place dans chaque hôpital aigu en Belgique. Sa mission est de sensibiliser les soignants à la nécessité d’une prise en charge correcte de la douleur dans le but de prévenir l’apparition d’une chronicisation. L’IRD a dû, au fil des années, développer des compétences propres de l’IPA : le jugement clinique, l’information, l’éducation, l’accompagnement, la mobilisation des ressources du patient et de l’équipe infirmière ainsi que la recherche.

Background: Medication errors can cause severe injuries and may lead to death. Electronic health records (EHRs) that are well designed and implemented could help to reduce medication errors. The medication management process needs close study to understand how medication safety metrics evolve as hospitals mature in terms of their EHR implementation. Objective: To examine the effect of adopting EHRs on medication errors at the Royal Commission Hospital in Jubail, Saudi Arabia, a Health Information Management System Society (HIMSS) stage 6 hospital. Methods: This study had a quasi-experimental time-series design. Retrospective data were collected for 1.5-year periods before and after implementation of EHRs. The variables analyzed were obtained from various units in the study setting. Data on medication errors were collected from the risk management section of the quality department. The medication management process was studied qualitatively. The quantitative data were analyzed using descriptive and inferential statistics. Results: The median number of medication orders per patient showed a significant decrease, from 22.76 before EHR implementation to 18.76 after implementation (p < 0.001). The median number of incidents per patient showed a significant increase, from 0.029 before to 0.040 after implementation (p = 0.004). The qualitative analysis of processes involved in the medication management process helped to explain these changes. Conclusion: Contrary to expectations, this study showed that an HIMSS stage 6 hospital could experience an increase in medication errors following implementation of EHRs. Qualitative analysis showed that the increase in medication error reporting rate could be attributed to an increase in detection following improvement in the medication management process. This has implications for interpreting quality metrics as hospitals mature in terms of their EHR implementation. RÉSUMÉ Contexte : Les erreurs de médication peuvent causer des blessures graves et entraîner la mort. La bonne conception et la mise en place de dossiers de santé électroniques (DSE) pourraient aider à les réduire. Le processus de gestion des médicaments doit faire l’objet d’un examen attentif pour comprendre comment les paramètres de sécurité relatifs aux médicaments évoluent à mesure que les hôpitaux se modernisent grâce à la mise en place de DSE. Objectifs : Examiner l’effet de l’adoption des DSE sur les erreurs de médication au Royal Commission Hospital de Jubail, en Arabie saoudite, un hôpital de stade 6 de la Health Information Management System Society (HIMSS). Méthodes : Cette étude utilisait une méthodologie de série chronologique quasi expérimentale. Des données rétrospectives ont été recueillies pendant des périodes de 1,5 an avant et 1,5 an après la mise en place des DSE. Les variables analysées ont été obtenues à partir de diverses unités dans le cadre de l’étude. Les données sur les erreurs de médication ont été recueillies auprès de la section de gestion des risques du service qualité. Le processus de gestion des médicaments, quant à lui, a été étudié de manière qualitative. Les données quantitatives ont été analysées à l’aide de statistiques descriptives et inférentielles. Résultats : Le nombre médian d’ordonnances médicales par patient a fortement diminué, passant de 22,76 avant à 18,76 après la mise en place des DSE (p < 0,001). Le nombre médian d’incidents par patient a quant à lui augmenté de manière importante et est passé de 0,029 avant à 0,040 après la mise en place des DES (p = 0,004). Les résultats de l’analyse qualitative des étapes du processus de gestion des médicaments expliquent en partie ces changements. Conclusion : Contrairement aux attentes, cette étude a montré qu’un hôpital de stade 6 de la HIMSS pourrait connaître une augmentation des erreurs de médication à la suite de la mise en place de DSE. L’analyse qualitative a montré que l’augmentation du taux de déclaration des erreurs de médication pouvait être attribuée à une augmentation de la détection suivant l’amélioration du processus de gestion des médicaments. Ce constat a des implications pour l’interprétation des indicateurs de la qualité à mesure que les hôpitaux se modernisent en mettant en place des DSE.

The second joint congress of l’Association des Médicins Biochimistes du Québec (AMBQ) and the Canadian Association of Medical Biochemists (CAMB) was held this year from October 7 to 9 in Montreal. The setting was the picturesque Hôtel Place d’Armes, which is situated in the historic Old Montreal district. There were over 60 attendees comprising both Specialists and Medical residents-in-training and representing the breadth of Canada from the Atlantic to the Pacific. The scientific committee composed of Dr. Jean. Dubé (Centre Hospitalier U. de Sherbrooke), Dr. Bernard Fruteau-de-Laclos (Centre Hospitalier AUQ), Dr. Élaine Letendre (Centre Hospitalier U. de Montreal), Dr. Bassam A. Nassar (Capital Health) and Dr. Claude Petitclerc (CHUM) arranged a series of informative and interesting scientific sessions. Day 1 saw a training session for the medical residents conducted by Dr. Yves Giguère (Centre Hospitalier de l’U. Laval) on Prenatal Screening. A meeting of the specialty committee of the Royal College for Medical Biochemistry followed this. A major topic of this meeting was the re-alignment of the training requirements. Day 2 began with the business meeting of the AMBQ. The scientific sessions began later that day with a session on “Pharmacotoxicology and the Role of the Laboratory” chaired by Drs. Andre Mattman (B.C. Children & Women’s Health Centre) and Bassam A. Nassar. The first speaker, Dr. Margaret Thompson (Hospital for Sick Children), in her talk “Clinical Toxicology – for the Laboratory” reviewed the role of the Ontario Poison Centre, which may serve as a model for the rest of the country. This was followed by Dr. Zulfikarali Verjee (HSC), who is clearly a master of the subject, with his talk, “Challenges in Urine Drug Screens: Ongoing Issues”. The morning session ended with Dr. Andre Mattman’s presentation “Heavy Metal Toxins – How and Why to Test in the Clinical Laboratory”. Day 3 moderated by Dr. Élaine Letendre (CHUM) focused on risk factors for cardiovascular disease. The first speaker in the morning was Dr. Jacques Genest Jr. (McGill University Health Centre) who reviewed the new Canadian guidelines for the diagnosis and treatment of dyslipidemias. He described in detail the thinking behind the new guidelines. This was followed by a presentation by Dr. Allan Jaffe (Mayo Clinic) who gave the audience a most authoritative description of the soon to be introduced fourth generation high sensitivity assays for troponins. These assays will have a marked impact on the assessment of cardiac damage perhaps even more so than the original introduction of the troponins. The afternoon featured three speakers discussing the pro and cons of high-sensitivity C-reactive protein for the assessment of cardiovascular disease. Dr. Jean Grégoire (Institut de cardiologie de Montréal) presented the pro side of the debate reviewing in particular the recent Jupiter trial. Dr. James Brophy (MUHC) presented the con side of the debate in a most entertaining manner. He even had the audience performing stretching exercises! It was left to Dr. Jean Bergeron (CHUL) to provide a balanced view of the two preceding speakers. The last day, Day 4, was primarily dedicated to oral and poster presentations by the residents. A jury consisting of Drs. Jean Dubé (CHUS), Yves Guigère (CHUL), and Joël Girouard (CHUL) had the “difficult” task of awarding prizes to the best oral and to the best poster presentations. The winners this year were Dr. Alexis Blaass (U. de Montréal) for the oral presentation entitled “Characterization of a new LCAT mutation causing familial LCAT deficiency (FLD) and the role of APOE as a modifier gene of the FLD phenotype” and Dr. Adell Elsharif (McMaster U.) for the poster presentation entitled “Method Validation Study to Evaluate the Analytical Performance of the STAT–SITE Meter for the Measurement of Serum Beta-Hydroxybutyrate”. The scientific portion of the conference ended with a most comprehensive presentation on smoking cessation, both clinical approaches and therapeutics by Dr. Joanne Provencher (Hôpital Laval). Dr. Provencher reminded us that smoking cessation by an individual could be achieved with the correct support. The day and the congress ended with a business meeting of the CAMB chaired by the out going president, Dr. Bassam A. Nassar. A new executive was elected: Dr. Elizabeth MacNamara (SMBD-Jewish General Hospital, president), Dr. Yves Guigère (CHUL, vice-president), Dr. Andrew Don-Wauchope (McMaster U. Health Sciences Centre, secretary-treasurer), Dr. Andre Mattman (BCCWHC, councilor), Dr. Brian M. Gilfix (MUHC, councilor), Dr. John Heathcote (Vancouver, councilor), and Dr. Datlily Ooi (Children’s Hospital of Eastern Ontario, councilor), We all look forward to next year’s combined meeting which is again slated to take place in Montreal in October.