title: Morbidity-mortality conference for adverse events associated with totally implanted venous access for cancer chemotherapy.
abstract: OBJECTIVE
  Although considered safer than central venous catheters for administration of cancer chemotherapy, totally implanted venous access (TIVA) is associated with adverse events that may impair prognosis and quality of life of patients receiving chemotherapy. Our aim was to assess the feasibility and interest of surveillance of cancer chemotherapy TIVA-adverse events (AE), associated with morbidity-mortality conferences (MMCs) on TIVA-AE.
  
  
  METHODS
  We performed a prospective interventional study in two hospitals (a university hospital and a comprehensive care center). For each cancer chemotherapy care pathway within each hospital, we set up surveillance of TIVA-AE and MMC on these events. Patients included in surveillance were those with a TIVA either placed or used for chemotherapy cycles in one of the participating wards. Feasibility of MMC was assessed by the number of MMC meetings that actually took place and the number of participants at each meeting. The interest of MMC was assessed by the number of TIVA-AE identified and analyzed, and the number and type of improvement actions selected and actually implemented.
  
  
  RESULTS
  We recorded 0.41 adverse events per 1000 TIVA-day. MMCs were implemented in all care pathways, with sustained pluriprofessional attendance throughout the survey; 39 improvement actions were identified during meetings, and 18 were actually implemented.
  
  
  CONCLUSIONS
  Surveillance of TIVA-AE associated with MMC is feasible and helps change practices. It could be useful for improving care of patients undergoing cancer chemotherapy.
authors.affiliation: Department of Epidemiology and Public Health, Rouen University Hospital, 1 rue de Germont, 76031, Rouen cedex, France. Veronique.merle@chu-rouen.fr.
authors.forename: Véronique
authors.initials: V
authors.lastname: Merle
authors.affiliation: Department of Epidemiology and Public Health, Rouen University Hospital, 1 rue de Germont, 76031, Rouen cedex, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Marini
authors.affiliation: Department of Hepatogastroenterology, Rouen University Hospital, Rouen, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Di Fiore
authors.affiliation: Department of Epidemiology and Public Health, Rouen University Hospital, 1 rue de Germont, 76031, Rouen cedex, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Lottin
authors.affiliation: Henri Becquerel Comprehensive Cancer Center, Rouen, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Gray
authors.affiliation: Henri Becquerel Comprehensive Cancer Center, Rouen, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Loeb
authors.affiliation: Department of Epidemiology and Public Health, Rouen University Hospital, 1 rue de Germont, 76031, Rouen cedex, France.
authors.forename: Akpéné
authors.initials: A
authors.lastname: Fred
authors.affiliation: Henri Becquerel Comprehensive Cancer Center, Rouen, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Contentin
authors.affiliation: Department of Pneumology and Intensive Respiratory Care, Rouen University Hospital, Rouen, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Muir
authors.affiliation: Department of Pneumology, Rouen University Hospital, Rouen, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Thiberville
authors.affiliation: Department of Urology, Rouen University Hospital, Rouen, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Pfister
authors.affiliation: Department of Digestive Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Huet
authors.affiliation: Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Peillon
authors.affiliation: Department of Hepatogastroenterology, Rouen University Hospital, Rouen, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Michel
authors.affiliation: Department of Epidemiology and Public Health, Rouen University Hospital, 1 rue de Germont, 76031, Rouen cedex, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Czernichow
mesh_terms: D062905:Central Venous Catheters / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D009017:Morbidity; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D011446:Prospective Studies; D011788:Quality of Life
keywords: Adverse events; Morbidity-mortality conference; Quality improvement; Totally implanted venous access