La cellule de retour d’expérience (CREx) en radiothérapie : un outil indispensable au management de la sécurité. Une évaluation après deux ans d’activité au centre Oscar-Lambret

Lartigau, Éric; Coche‐Dequeant, B.; Dumortier, V; Giscard, S.; Lacornerie, T.; Lasue, A.; Cheval, V.; Martel, V.; Malfait, Benjamin; Fuchs, Anna; Pestel, M; Damman, Marleen; Forrest, M.

doi:10.1016/j.canrad.2008.07.007

Cited by 24 publications

(1 citation statement)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The implementation of such strategies is highly related to hospital resources (ie, human and financial resources) 13. Multidisciplinary “experience feedback committees” are devoted to registration, analysis, and correction of precursor events 14,15. This concept is followed by high-risk industries, such as aeronautics or nuclear energy, for “near misses” and accidents.…”

Section: Introductionmentioning

confidence: 99%

<p>Interprofessional safety reporting and review of adverse events and medication errors in critical care</p>

Chapuis

Chanoine

Colombet

et al. 2019

TCRM

View full text Add to dashboard Cite

Background The intensive care unit (ICU) environment is prone to the risk of adverse events (AEs) and medication errors (MEs). The objective of this work was to describe a multidisciplinary safety program focused on AE and ME reporting and review in an ICU over a 7-year period. Methods The program was implemented in an 18-bed medical ICU of a 2,200-bed university hospital. A multidisciplinary steering committee (intensivist, clinical pharmacist, nurses, and research assistants) met monthly. The first part of the meeting was dedicated to the review of events targeted through an internal voluntary reporting system, and the second part concerned the analysis of the previous month’s events, according to a standardized method called Orion, inspired by the aeronautic industry. Results A total of 808 AEs were reported, mostly related to medication processes (30.3% and 33.4% for prescription and administration, respectively). Among these, 526 AEs were related to medications (65.1%), of which 464 were MEs (88.2%). These MEs concerned mostly anti-infective drugs (23.5%) and related to wrong doses (35.8%). Among all AEs reported, 58 (43 MEs [74.1%]) were analyzed further and found to be associated with anti-infective (16.1%) and vasoactive drugs (16.1%). According to National Coordinating Council for Medication Error Reporting and Prevention classification, most AEs caused no harm to patients (category A–D: 38 events, 65.5%). Nurses were most often involved in the analysis (50.7%), along with pharmacists (37.5%). Training was identified as the most frequent corrective action (45.1%). Conclusion This program dedicated to AE and ME reporting, review, and analysis in ICU showed long-term engagement of the health care team in AE surveillance and helped in targeting measures for education, organization, and promoting teamwork and safety.

show abstract

Section: Introductionmentioning

confidence: 99%