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Thursday 6 April 2017

How to improve your practice

By Dr IM  |  22:28 No comments

How to improve your practice

Groups analysis practices peer ( Peer Review ) : Several doctors meet 6-8 times a year to analyze the issues raised in their records compared with data referenced .

Self-assessment tools and secure administration of drugs in health care settings : an analysis of the process of administration of the drug ( drug delivery to the patient regardless of the mode and route of administration) allows management risk from preventable medication errors .

Review relevance

Planned caesarean section for term maximize the relevance of the course of the patient
Carpal Tunnel : maximize the relevance of the patient journey
Program to improve the quality
PAQ - Methodological Guide 1996 This is project management provided by a common methodological framework incorporating the key stages of the implementation of a program to improve the quality , suitable both to establishment that theme clinic.
Programs to improve practices : methodological overview

Registers, observatories , databases and EPP - 4 pages: the collection and analysis of data from standardized business practices , about a given topic , allow health professionals to analyze and assess their practices , to decide on the implementation of improvement actions .

Health networks : they deploy with health professionals and patients a multidisciplinary clinical expertise at the bedside , tools for information sharing and multidisciplinary meetings.

Multidisciplinary meeting Cancer ( RCP ) gives a multidisciplinary therapeutic advice for all new cancer patients .

Review of mortality and morbidity : the method based on the collective and systemic analysis of adverse events occurring during patient care , to reduce the risk of recurrence , aims the implementation and monitoring of actions improve the care of patients and safety of care.

Review appropriateness of care : This method is used to evaluate the adequacy of care needs of patients.

Staff EPP - hospital teams : regular meetings ( every 2 to 3 months ) allow professionals after reviewing records associated with a literature review (or vice versa) , to identify one (or more ) stakes improving the implementation by integrating the best available references, the expertise of practitioners and patient choice.

Monitoring indicators

An indicator is a tool for measuring a condition, practice, or the occurrence of an event that provides an estimate of how valid and reliable quality of care and its variation over time. A comparison is necessary to assess changes in connection with the improvement plans . Some indicators are intended to be generalized , under cover of a suitable methodology for comparisons in space ( space refers to a comparison between different structures or experiences using the same indicator). They can typically focus on clinical data , the organization of care and patient satisfaction . Can also be considered as meeting the objectives of health professionals.
Methodological Guide : construction and use of indicators in the field of health , general principles , 2002

Methodological guide : design and role of quality indicators in the EPP : the experience COMPAQH , 2005
IPAQSS : generalized indicators in health facilities
Methodological Guide : Statistical mastery of process health , 2005
Indicators of clinical practice : methodological overview

Academic visit: it can transmit messages preventive education , screening or treatment of patients , in order to improve practices , through individual contact, primarily during an exchange in the office , 6 to 8 times / year .
Clinical audit : this evaluation method is used to compare the care practices of listed references, with assessment of the quality of these practices and the results of care criteria , with the aim of improving them. The clinical audit are 6 steps: choice of theme , choice of criteria, choice of measurement protocol , data collection , analysis of results and action plan for improvement with monitoring its impact. CD- Rom "Audit targeted clinic ( ACC ) 2007 "
CD- Rom "Clinical Audit 2006 "
4 pages " Clinical audit target in 2006 "
4 pages "Clinical Audit 2004"
Methodological Guide : Successful clinical audit and improvement plan , 2003
Methodological Guide : Clinical audit , methodological bases of the EPP , 1999

Checklist " patient safety in the operating room " adapted from that proposed by the World Health Organization ( WHO) has made instructional videos on its use in the Patient Safety program.
The checklist is integrated inter -specialty certification program for doctors and applicable to all specialties.
Clinical pathway (Clinical pathway ) centered around the patient , describe, for a given disease , all elements of the process of care following the route of the patient clinical pathway aims . This method is to plan, rationalize and standardize the multidisciplinary management of patients with similar health problems .

Protocol and coordinated home health exercise, health center and health centers : a single or multi -professional group of doctors and health professionals organize a coordinated around a common project of treatments including implementing outpatient exercise and monitoring protocols , with reference to recommendations in order to improve practice and patient care .

Risk Management : This approach aims to improve the safety of care provided to patients . It is to structure a collective approach , identify risks and subsequently a priori , to assess and prioritize in order to treat and then follow capitalizing on feedback.

How to evaluate and improve your practice

Evaluating your practice requires the ability to measure , in the medical record or by observation.
The gap analysis is required with at best , mono or multi professional practice, to implement improvement actions within the team or network , with a calendar and dedicated resources .
HAS encourages all health professionals to assess their practical value to existing groups by formalizing a component evaluation practices .
The evaluation of professional practices is integrated into the certification of health facilities .

In variants of a program evaluation and improvement practices are:

The theme is stated and the objectives.
The method used is specified and used professional recommendations 

Confidentiality is guaranteed.

The program consists of three phases: the development of actions, implementation and monitoring.
The quality of the program involves : acceptability / feasibility and validity / effectiveness .
The impact of interventions to improve the quality and safety of care should be evaluated. A methodological guide produced in June 2007 developing quantitative methods to evaluate interventions to improve practices.

wheel quality - large format
Wheel of Quality - View diagram in large format

Accreditation of the quality of professional practice : the voluntary medical device risk management for physicians practicing a specialty or activity called "at risk" in health care institutions . These specialties are listed in Decree No. 2006-909 of 21 July 2006.
Programs to reduce risk specialties are defined by professional bodies approved by the HAS (one per specialty concerned with the device ) .

Announcement of damage associated with care : this HAS is in line with the guide " Bad News " published in 2008 and the recommendation "Access to information about the health of a person . Practicalities of support " as well as the methodological guide " RMM "published in 2009.

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Author: Dr IM

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