Évaluation de la prescription des anticoagulants, dans le service de médecine vasculaire de l’hôpital Saint-André de Bordeaux, à travers une démarche d’audit clinique, et les indicateurs de qualité mis en place

Abstract : Introduction: improving the quality and safety of care requires the evaluation of professional practice. To gain a greater understanding of the quality of care approach, we studied the prescription of anticoagulants by carrying out a clinical audit approach of prescriptions in the Department of Vascular Medicine at the Saint-André Hospital in Bordeaux. The objectives of this work are: to identify and evaluate simple and reliable quality indicators for the prescription of anticoagulants in this department, highlight a quality approach which will enable us to evaluate professional practice, discover if the criteria for anticoagulation have been adhered to and identify action points to minimize errors detected. Material and methods: A retrospective study reports cases was carried out on those patients requiring anticoagulation in the Department of Vascular Medicine of the University Hospital (CHU) Bordeaux. From a study carried out in 2013, which was intended to investigate the prescription of anticoagulants in the service due to the arrival on the market of DOAC’s, we identified quality indicators when prescribing these anticoagulants, and in 2016 we completed a clinical audit from 09/01/2016 to 31/12/2016. Results: The study of quality indicators in 2016 shows that age and weight are two easily applicable and feasible indicators. Atrial fibrillation, pulmonary embolism and deep vein thrombosis remain, respectively, the main pathologies for the prescription of anticoagulants. The range of INR’s found in the 2013 study was confirmed in this 2016 study which shows that ¾ of INR’s are outside normal range. By looking at the duration of treatment and frequency of follow up we found that 85% of patients had been followed up. The length of treatment itself was poorly recorded. Identification of allergies was rarely found. Evidence of risk-benefit analysis was only present in 17%. Recorded evidence of a history of bleeding is very low at 5%.The criteria for consideration of drug interactions is the most delicate indicator and the lengthiest to evaluate; it is probably underestimated in this study. This shows the difficulty in managing these interventions. Creatinine clearance is practical and relevant but rarely recorded in patient documents (4%). Patient education is seldom found (9%), and is acquired mainly through educational therapeutic sessions. Conclusion: the prescription of anticoagulants continues to increase over the years. The targeted clinical audit requires quality indicators based on criteria of practicality, relevance, feasibility with regards to data availability and cost. The criteria we considered are based on a relevant clinical study, with an acceptable feasibility and will also improve quality of care. They are reproducible, understandable and representative criteria, which would improve the prescribing of anticoagulants when they are used by practitioners for future assessment.
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Master Thesis
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Anthony Blasac. Évaluation de la prescription des anticoagulants, dans le service de médecine vasculaire de l’hôpital Saint-André de Bordeaux, à travers une démarche d’audit clinique, et les indicateurs de qualité mis en place. Médecine humaine et pathologie. 2017. ⟨dumas-01601672⟩

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