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Biomedical subjects

E Hergon

Publications and source records attributed to E Hergon.

At least 19 recordsLinked to original sources
PubMed2001

[The fundamentals of precaution].

The precautionary principle appeared in the health vocabulary, especially in blood transfusion, at the beginning of the 1990s. It is applied to potential risks in case of scientific doubt and corresponds to an hypothesis of risk that must be completely distinguished from the case of an exceptional residual risk. This principle lies on two innovations: the breach of the link between scientific knowledge and decision, and the creation of a context for a new normative value. Because of their consequences, these innovations should generate a debate between professionals about the caution principle's foundations, its conditions of application, and its judicial drawbacks. This article, mainly dealing with the foundations of caution, will also present the social construction of the precaution, its judicial aspects, as well as the change in the relationship to risks induced by it.

Australia↗
PubMed2000

[Computer-based hospital transfusion process: why and how does one establish a link between continuous quality improvement and clinical information system?].

Within a hospital, the need for a computer-based transfusion system has became mandatory. It facilitates the tracing of healthcare activities, which is the basis of the security of the care and a functional element of continuous quality improvement procedures. In order to implement this traceability, reactive and real-time information systems are needed close to healthcare participants, which is not the case of current information systems which rely on a recorded collection of data, far from the needs of the caregiver, and mainly answering to an objective evaluation of results. In the context of continuous quality improvement programmes started in our hospital, hemovigilance was the first to use a process analysis approach, from the prescription of blood units to their administration and follow-up. Several questions arise from this: 1) how to use the process analysis work to specify the users' needs of a generalized and real-time transfusion information system? 2) how to spread this model to other healthcare activities? 3) how to integrate or interface the whole of these quality programmes with a clinical information system? A user-centered methodology was used, based on 'usage cases'. For each step of the transfusion process, this method allowed us to specify participants, data necessary for an activity (observed, deduced or decision-support data), data issuing from the activity, roles (the interaction between user and activity) and functions (the result of the interaction between user and activity).

Blood Transfusion↗
PubMed2000

[Blood transfusion audit methodology: the auditors, reference systems and audit guidelines].

The audit has become an essential aspect of the blood transfusion sector, and is a management tool that should be used judiciously. The main types of audit that can be envisaged in blood transfusion are the following: operational audit concerning a predetermined activity; systems quality audit; competence audit, combining the operational audit on a specific activity with quality management, e.g., laboratory accreditation; audit of the environmental management system; and social audit involving the organization of an activity and the management of human resources. However, the main type of audit considered in this article is the conformity audit, which in this context does not refer to internal control but to conformity with an internal guideline issued by the French National Blood Service. All audits are carried out on the basis of a predescribed method (contained in ISO 10 011). The audit is a system of investigation, evaluation and measurement, and also a means of continuous assessment and therefore improvement. The audit is based on set guidelines, but in fact consists of determining the difference between the directions given and what has actually been done. Auditing requires operational rigor and integrity, and has now become a profession in its own right.

Blood Banks↗
PubMed1999

[Risk management program in a health facility using a project approach: transfusion risk management].

Risk management in the hospital, which is one of the referentiels of the ANAES accreditation manual, may be considered on two levels. Firstly, risk management may be approached globally, in the same way as it is tackled in the accreditation process. Secondly, risk management may be more definite. A specific risk chosen in accordance with the priorities of a particular plan may be dealt with individually. In this respect, the tranfusion process allows the risk management method to be tested and developed. f1

Blood Banks↗
PubMed1999

[Quality in training].

Knowledge has become an essential resource in developed societies, and hence the role of training has become ever more important. Training is the basis of professional proficiency. This is of particular interest in a public service such as blood transfusion, which is rapidly developing. To remain competent, a professional must regularly update his (her) basic knowledge. This requires an efficient training support. To implement a quality assurance system in a training center, several factors must be considered: the choice of a reference system; the evaluation of the customer's needs; the control and the assessment procedures.

Blood Transfusion↗
PubMed1998

[Contribution of hemovigilance to immunologic safety of blood transfusions: assessment after 3 years].

The haemovigilance system has indirectly introduced three types of information: a more precise tally of accidents and risks (even if the total number of events remains difficult to assess); an evolution of the mode of collecting relevant information (even if, after 3 years, it has become important to define new objectives and collection procedures); the identification of the main causes of errors leading to immunological accidents allowing the elaboration of schemes pointing out the possible failures and critical points of the various processes, such as blood bag distribution, ABO control at bedside, the prescription of examinations prior to transfusion. The analysis of haemovigilance data has induced a number of important consequences, particularly clinical practitioners' awareness of blood transfusion risks; elaboration of reliable and documented tools for the training of professionals and the information of patients; implementation of corrective and preventive measures, particularly to reduce accidents due to ABO incompatibility. These haemovigilance data will provide more fruitful results when cross-analysed with data from the reactovigilance system which is being set up. Until then, they will largely be used to elaborate blood transfusion quality assurance standards.

ABO Blood-Group System↗
PubMed1998

[The quality audit in a blood transfusion center].

A quality audit is a systematic and independent examination used to determine whether quality activities and related results comply with planned arrangements, and whether these arrangements are implemented effectively and are suitable to achieve objectives. It typically applies to, but is not limited to, a quality system or elements thereof, to processes, products or services. Such audits are often called "quality system audit", "process quality audit", "product quality audit" or "service quality audit". Confidence is necessary between the quality auditor and auditees. In blood transfusion, the audit is a tool for improvement and risk management of processes, products or services.

Blood Banks↗
PubMed1996

[Quality assurance and prevention of immuno-hemolytic incidents in blood transfusion].

Direct and indirect measures of the reliability of the transfusion process are described. These measures can be used to assess the improvement of the transfusion process with a view to preventing hemolytic incidents. Quality assurance arrangements required by their use are made clear. The stress is put upon four points: processes must be formalized and standardised; quality audits must become a routine part of the transfusion process; the system of error reporting must be extended to include all failures; anonymity must be insured to improve reporting.

Anemia, Hemolytic↗
PubMed1996

[Improvement of transfusion safety in a health care service through the implementation of a quality program].

The quality policy brings with it an efficient method as well as relevant tools to improve transfusion safety in health care services. This article illustrates the details of the approach through the presentation of a project developed in the East Picardie region throughout several hospitals. It underlines the importance of the choice of a good reference system, of a pertinent method and the necessity of a real project management. Furthermore, the follow-up of the project has enabled us to identify a certain number of success criteria in the steering of the changing process.

France↗
PubMed1996

[Immuno-hemolytic transfusion reactions. IV. Analysis, risks and prevention].

The immunological risk of red blood cell transfusions now seems higher than the viral risk. According to studies, severe accidents due to blood incompatibility occur with a frequency estimated at 1/6000 to 1/29000; despite technical progress, the risk does not significantly diminish. The majority of accidents do not originate from laboratory or production stages but from defects in the application of clinical procedures. Preventive measures are based on (i) the elaboration of clinical guidelines, (ii) the compliance to strict rules in carrying out bedside ABO check, and (iii) the realization and interpretation of antibody screening tests. The implementation of quality assurance systems and of the epidemiological surveillance system, which define the basis of a prevention policy, leads to the expectation of an improvement of transfusion safety.

Adult↗
PubMed1994

[Failure mechanisms in the transfusion process. Importance of anticipatory operational safety analysis].

The methods used for the safety previsional analysis of operations represent an interesting set of tools to follow the so-called transfusion process, defined as all the steps from donors sensitization to recipients follow-up. FMECA (Failure Mode Effects and Criticality Analysis) can be used as a prevention tool, independently of any dysfunction in the process. Of course, it can also be used following a failure, in order to analyse its causes and to apply specific corrections. Operation safety, quality insurance, epidemiologic surveillance and safety monitoring act in synergy. These three aspects of transfusion safety constitute a dynamic system.

Blood Banks↗
PubMed1994

[Preventing deficiencies in the transfusion process].

The methods of system reliability analysis represent an interesting set of tools used to follow the so-called "transfusion process", defined as all the steps from donors sensitization to recipients follow-up. FMECA, (Failure Mode Effects and Criticality Analysis), can be used as a prevention tool, independently of any dysfunction in the process. Of course, it can equally be used following a failure, in order to analyse the causes and to apply the specific corrections. Quality insurance, system reliability analysis, epidemiologic surveillance and safety monitoring operate in synergy. These three issues pertaining to transfusion safety constitute a dynamic system.

Blood Banks↗
PubMed1994

[Blood transfusion and quality assurance].

Administrating safe blood products and being able to produce the evidence of procedures correctly employed, is today vital for healthcare professionals. Industrial quality assurance is an appropriate answer to this problem. Indeed, this approach allows the mastering of a processing system thanks to the combination of three elements: a detailed description of processes, control mechanisms and corrective measures. It relies on an information system and must be applied to all steps of blood transfusion.

Blood Banks↗
PubMed1994

[Immunologic risks of blood transfusion and public health].

The general objective is the study, through scientific approaches, of the main components of immunological risks linked to red blood cell transfusions, as well as their consequences, in order to define precise rules for prevention, taking into account that 2,700,000 units were transfused in 1992. To reach this general aim, five intermediary objectives have to be achieved: 1) The sentinel study of the methodology used to collect information about transfusion accidents, as well as their identification and their early clinical expression; 2) The analysis of the occurrence mechanisms of incompatibilities and transfusion accidents; 3) The up-date definition of post-transfusion alloimmunization, in particular regarding 3 parameters: a) the immunogenicity of the different erythrocyte antigens, that will have to be reassessed; b) the modes of occurrence of post-transfusion anti-erythrocyte alloimmunization; c) the different types of chronology in the appearance and the persistence of anti-erythrocyte antibodies. 4) The search for significant criteria in order to assess the immunopathological correlations of the consequences of antigen-antibody conflicts; 5) The elaboration of the principles for tests evaluation and identification of the techniques linked to blood groups and the study of anti-erythrocyte antibodies.

Blood Group Incompatibility↗