Viviane Lievin

Aspects spécifiques de la nutrition artificielle à domicile

Le but premier ďune nutrition artificielle a domicile est de poursuivre ľadministration ďun apport nutritionnel adequat tout en permettant au patient de quitter ľhopital et, dans la mesure du possible, de retrouver une activite familiale, sociale et professionnelle normale.

Implementation of a new health information technology for the management of cancer chemotherapies

Background Cancer chemotherapy drugs are classified as high-risk molecules. Safety of the cancer chemotherapy process is often achieved with the implementation of a health information technology to each step or to the entire process. However, computerisation could lead to the emergence of new unintended medication errors. The aim of the study was to evaluate the impact of new software designed for the management of anticancer chemotherapies. Method The cartography of the process and the failure modes, effects and criticality analysis were performed by a multidisciplinary team. Criticality indexes were calculated considering or not the implementation of the commercial software (CytoWeb). Quality and satisfactory indicators were measured before the implementation and during the use of the software. Results Our results demonstrated the complexity of the cancer chemotherapy process in the hospital. Risk analysis highlighted the positive impact of CytoWeb on the process safety but pointed out some steps that were not positively influenced by the software. Although a decrease of 38.6% of error rate was observed with the electronic system, new unintended medication errors emerged. These errors were due to inadequate use of the software (encoding of the wrong drug, the wrong dose, the wrong patient parameters or lab results and lack of prescriber adherence). Our satisfaction survey showed that the hospital pharmacists and doctors were less satisfied by the software than the nurses, mostly in terms of task achievement and time saving. Survey’s results highlighted some weaknesses in the user training and in the collaboration between the medical staff. Conclusions Our work showed the emergence of unintended medication errors linked to computerisation that were due to an inadequate use of the software. Other issues were highlighted such as the lack of collaboration between the medical staff, the lack of prescriber implication and weaknesses in the user training or in the information related to CytoWeb.

P056 Nutrition parentérale à domicile (NPAD) : une expérience de 20 ans dans un centre belge de référence

Introduction et but de l’etude La NPAD qui fut initialement utilisee chez des patients presentant une insuffisance intestinale chronique associee a une pathologie benigne (B) a ete progressivement etendue aux patients souffrant d’un cancer a un stade avance (C) et incapables d’etre alimentes par voie orale. Nous rapportons l’experience de 20 ans de NPAD representant plus de 90 000 jours de traitement. Materiel et methodes Les dossiers de tous les patients sous NPAD entre 1987 et 2007 ont ete revus retrospectivement en soulignant l’incidence, la prevalence, maladies sous-jacentes, indications, evolution et complications septiques et hepatiques. Resultats En 20 ans, 125 patients ont ete inclus en NPAD, 65 (B) et 60 (C). L’incidence et la prevalence annuelles etaient respectivement de 3 et 3 en 1987, 15 et 32 en 2007. Les pathologies (B) etaient : maladie de Crohn (24 %), vascu-laire mesenterique (32 %), post-chirurgicale (16 %), enterite radi-que (4 %) et diverses (25 %). L’indication etait un grele court dans 85 %. La duree moyenne de NPAD etait de 52 mois. Parmi ces 65 patients (B) 26 sont decedes, 23 ont ete sevres et 16 sont en cours. Le deces fut lie a la NPAD dans 3/26 patients (13 %). On a observe 2 suicides. Seulement 2 patients sont candidats potentiels a une transplantation intestinale. Une alteration des enzymes hepatiques est frequente (65 %) mais 1 seul cas de faillite hepatique a ete observe. Un episode septique du catheter central survient tous les 23 mois en moyenne. Pour les patients (C) L’indication etait l’obstruction sur carcinose peritoneale (100 %). La survie mediane est de 63 jours (12-240 jours) pour C gastrique mais 35 jours (4-424 jours) pour les autres cancers. 19 des 60 (C) sont decedes endeans le 1 er mois et 5 ont survecu plus d’un an. Conclusions Le nombre de cas continue a augmenter. 35 % des patients (B) ont pu etre sevres. Le deces est attribuable a la NPAD dans 13 % des cas. Peu de cas sont candidats a une transplantation intestinale. La survie mediane des patients cancereux sous NPAD est tres courte.