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Résumé: En France, les connaissances épidémiologiques des évènements indésirables associés aux soins dans le secteur des Ehpad sont parcellaires. Une étude observationnelle descriptive a été menée au sein de 25 Ehpad pendant 15 jours entre 2016 et 2017. Elle avait pour objectif de décrire les types d'évènements indésirables associés aux soins et d'en évaluer leur gravité, fréquence de survenue et criticité. Quatre-vingt-six types d'évènements indésirables associés aux soins appartenant à 13 domaines de risques ont été identifiés (dont 31 par un médecin-enquêteur). Parmi ces types d'évènements, 11 présentaient une criticité « non acceptable » en l'état et 39 une criticité « à surveiller ». Le travail des Ehpad devrait s'orienter autour des types d'évènements indésirables associés aux soins : perte/altération de dispositif médical, défaut d'administration de médicament, défaut de coordination inter structures, défaut de planification/continuité des soins, défaillance du système d'information, perte/altération du linge et sortie inopinée. La préconisation d'axes prioritaires de prévention et d'amélioration dans les Ehpad doit être étudiée. Knowledge in France on the subject of care-related adverse events in the nursing home sector is sparse. An observational descriptive study was conducted in 25 nursing homes over a period of 2 weeks over periods of two weeks between 2016 and 2017. It aimed to describe the types of care-related adverse event, and to assess their seriousness, frequency of occurrence, and criticality. Eighty-six types of care-related adverse event belonging to 13 risk domains were identified (31 by the investigating physician). Among these types of event, 11 corresponded to an unacceptable level of criticality, and 13 were categorised as warranting surveillance. Efforts in nursing homes should focus on the various types of care-related adverse event: loss of or damage to a medical device; failure to administer a medication; failure to coordinate between structures; shortfalls in planning and care continuity; shortfalls in the information system; loss of or damage to laundry items; unplanned escapade. Recommendations on the main lines of prevention and improvement in nursing homes should be the subject of future study. [ABSTRACT FROM AUTHOR]

Résumé: L'augmentation du nombre de personnes âgées dépendantes confère aux établissements d'hébergement pour personnes âgées dépendantes (Ehpad) une place importante au sein de notre système de soins. La question de la sécurité et du bien-être des résidents, via la lutte contre les événements indésirables associés aux soins (EIAS) est prégnante. Afin d'estimer des premiers taux d'incidence de survenue d'EIAS en Ehpad, nous avons réalisé un suivi de 536 résidents sur 15 jours entre novembre 2016 et mai 2017 au sein de 8 Ehpad. Les déclarations par les professionnels complétées d'investigations d'un enquêteur médecin ont mis en évidence les typologies et gravités des EIAS. Les 149 EIAS survenus relevaient de 13 domaines de risque. Quatre de ces domaines de risque rassemblaient 60 % des EIAS : « Médicaments et dispositifs médicaux », « Lieu de vie », « Soins techniques et d'accompagnement », « Coordination et organisation des soins ». Quatre EIAS sur les 149 (2,7 %) avaient une gravité 4 ; 16 EIAS (10,7 %) une gravité 3. Enfin, une attention particulière devrait être portée au domaine de risque « Suicide ». Ces premiers résultats méritent d'être enrichis mais vont permettre d'élaborer des messages de prévention à l'attention des professionnels. A rise in the number of dependent elderly people has made nursing homes an important part of the French health system. Through the struggle against adverse events associated with treatments, the question of the residents' safety and wellbeing has been paramount. To get an estimation of the highest incidence rates of adverse events in nursing homes, we carried out a follow-up study on 536 residents over 15-day periods between November 2016 and May 2017 in 8 French nursing homes. Notifications by professionals coupled with explorations by an investigating physician helped evidence the different typologies and degrees of seriousness of treatment-related adverse events. The 149 treatment-related adverse events that were identified belonged to 13 risk domains. Four of these domains accounted for 60% of treatment-related adverse events: 'medication and medical provision', 'living environment', 'technical care and accompaniment', 'care organization and coordination'. Four treatment-related adverse events out of the 149 (2.7%) had a level of seriousness rated as 4; 16 (10.7%) had a seriousness level rated as 3. Finally, particular attention should be paid to suicide risk. These first results need to be corroborated, but they will help develop messages of prevention aimed at professionals. [ABSTRACT FROM AUTHOR]

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A rise in the number of dependent elderly people has made nursing homes an important part of the French health system. Through the struggle against adverse events associated with treatments, the question of the residents' safety and wellbeing has been paramount. To get an estimation of the highest incidence rates of adverse events in nursing homes, we carried out a follow-up study on 536 residents over 15-day periods between November 2016 and May 2017 in 8 French nursing homes. Notifications by professionals coupled with explorations by an investigating physician helped evidence the different typologies and degrees of seriousness of treatment-related adverse events. The 149 treatment-related adverse events that were identified belonged to 13 risk domains. Four of these domains accounted for 60% of treatment-related adverse events: 'medication and medical provision', 'living environment', 'technical care and accompaniment', 'care organization and coordination'. Four treatment-related adverse events out of the 149 (2.7%) had a level of seriousness rated as 4; 16 (10.7%) had a seriousness level rated as 3. Finally, particular attention should be paid to suicide risk. These first results need to be corroborated, but they will help develop messages of prevention aimed at professionals.

The French Federation of Regional and Territorial Bodies for the Improvement of Health Practices and Organisations and the French National Authority for Health have produced a guide and tools devoted to the promotion of compassionate care in health institutions. The assessment of the use of the guide has shown increasing awareness of compassionate care on the part of institutions but a paradoxical exclusion of users from the approaches undertaken. An analysis of the reasons for this partial achievement of the objectives has resulted in a revision of the working methods and opens up new perspectives for development., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)