Prospective study of the barriers to nutritional support in a paediatric intensive care unit : P16

Introduction and aim: Children hospitalised in a paediatric intensive care unit (PICU) are mainly fed by nutritional support (NS) which may often be interrupted. The aims of the study were to verify the relationship between prescribed (PEI) and actual energy intake (AEI) and to identify the reasons for NS interruption. Methods: Prospective study in a PICU. PEI and AEI from day 1 to 15, type of NS (enteral, parenteral, mixed), position of the feeding tube, interruptions in NS and reasons for these were noted. Inter - ruptions were classified in categories of barriers and their frequency and duration were analysed. Results: Fifteen children (24 ± 25.2 months) were studied for 84 days. The NS was exclusively enteral (69%) or mixed (31%). PEI were significantly higher than AEI (54.7 ± 32.9 vs 49.2 ± 33.6 kcal/kg, p = 0.0011). AEI represented 93% of the PEI. Ninety-eight interruptions were noted and lasted 189 h, i.e. 9.4% of the evaluated time. The most frequent barriers were nursing procedures, respiratory physiotherapy and unavailability of intravenous access. The longest were caused by the necessity to stop NS for surgery or diagnostic studies, to treat burns or to carry out medical procedures. Conclusion: AEI in PICU were inferior by 7% to PEI, considerably lower than in adult studies. Making these results available to medical staff for greater anticipation and compensation could reduce NS interruptions. Starving protocols should be reconsidered.

Drug utilisation in a neonatal intensive care unit of a swiss university hospital

Introduction Medication errors in hospitalsmay occur at any step of the medication process including prescription, transcription, preparation and administration, and may originate with any of the actors involved. Neonatal intensive care units (NICU) take care of extremely frail patients in whom errors could have dramatic consequences. Our objective was to assess the frequency and nature of medication errors in the NICU of a university hospital in order to propose measures for improvement.Materials & Methods The design was that of an observational prospective study over 4 consecutivemonths. All patients receiving C 3drugs were included. For each patient, observations during the different stages were compiled in a computer formulary and compared with the litterature. Setting: The 11-bed NICU of our university hospital.Main outcome measures:(a) Frequency and nature of medication errors in prescription,transcription, preparation and administration.(b) Drugs affected by errors.Results 83 patients were included. 505 prescriptions and transcriptions, 447 preparations and 464 administrations were analyzed. 220 medications errors were observed: 102 (46.4%) at prescription, 25 (11.4%) at transcription, 19 (8.6%) at preparation and 73 (33.2%) at administration. Uncomplete/ambiguous orders (24; 23.5%) were the most common errors observed at prescription, followed by wrong name (21; 20.6%), wrong dose (17; 16.7%) and omission (15; 14.7%). Wrong time (33; 45.2%) and wrong administration technique (31; 42.5%) were the most important medication errors during administration. According to the ATC classification, systemic antibacterials (53; 24.1%) were the most implicated, followed by perfusion solutions (40; 18.2%), respiratory system products (30; 13.6%), and mineral supplements and antithrombotic agents (20; 9.1%).Discussions, Conclusion Proposed recommendations: ? Better teaching of neonatal prescription to medical interns;? Improved prescription form to avoid omissions and ambiguities;? Development of a neonatal drug formulary, including prescription,preparation and administration modalities to reduce errors at different stages;? Presence of a clinical pharmacist in the NICU.Disclosure of Interest None Declared

La co-production dans les prestations relevant de la puissance publique : l'exemple de la police de proximité en Suisse

Si dans certains domaines (ex. les services de l'emploi) la co-production est bien implantée, elle paraît plus ardue dans d'autres types de services publics, comme la police. La co-production de la sécurité est-elle faisable ? Quelles sont les volontés de part et d'autre pour développer ce partenariat ? À l'aune de la police de proximité en Suisse et sur la base de données quantitatives et qualitatives, cet article apporte des résultats innovants. If in some administrations (eg. employment services) it is clearly well established, the co-production seems to be more difficult in other services, like the police. Thus, is the co-production of security services feasible ? Are both parties (police forces and citizens) ready for such a process ? In the light of community policing in Switzerland and on the basis of quantitative and qualitative data, this article will provide innovative results and research avenues in the field.