{"id":799,"date":"2020-04-30T11:17:04","date_gmt":"2020-04-30T09:17:04","guid":{"rendered":"https:\/\/fhu-premimpact.org\/?page_id=799"},"modified":"2020-04-30T12:44:34","modified_gmt":"2020-04-30T10:44:34","slug":"les-crex-et-rmm-a-louis-mourier","status":"publish","type":"page","link":"https:\/\/fhu-premimpact.org\/en\/soins\/les-rmm\/les-crex-et-rmm-a-louis-mourier\/","title":{"rendered":"Les CREX et RMM \u00e0 Louis Mourier"},"content":{"rendered":"\n<p>L\u2019analyse des \u00e9v\u00e8nements ind\u00e9sirables s\u2019organise dans le service de fa\u00e7on structur\u00e9e, l\u2019essentiel \u00e9tant de r\u00e9pondre au mieux aux objectifs des RMM, qui sont une \u00e9valuation des pratiques professionnelles&nbsp;: elles consistent \u00e0 apprendre de ce qui se passe et de ce qui s\u2019est pass\u00e9 (performances, erreurs \u00e9vit\u00e9es, incidents et accidents), pour mieux maitriser l\u2019avenir. Deux instances de d\u00e9cisions s\u2019articulent entre elles.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Le Comit\u00e9 de Retour d\u2019Exp\u00e9rience (CREX)<\/h2>\n\n\n\n<p>C\u2019est un groupe restreint, constitu\u00e9 d\u2019une dizaine de professionnels m\u00e9dicaux ou param\u00e9dicaux qui se sont port\u00e9s volontaires. Il se r\u00e9unit selon une p\u00e9riodicit\u00e9 bien d\u00e9finie (tous les deux mois), et r\u00e9pond \u00e0 un ordre du jour bien pr\u00e9cis&nbsp;:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>R\u00e9colter les \u00e9v\u00e8nements ind\u00e9sirables d\u00e9clar\u00e9s par l\u2019ensemble du personnel sous forme de d\u00e9clarations OSIRIS.<br>Ces OSIRIS sont souvent des \u00e9v\u00e8nements ind\u00e9sirables sans gravit\u00e9, dits \u00ab&nbsp;pr\u00e9curseurs&nbsp;\u00bb. Le CREX effectue un tri et une analyse. Le CREX pr\u00eate une attention particuli\u00e8re aux sujets r\u00e9currents qui sont alors consid\u00e9r\u00e9s comme une faille dans le syst\u00e8me organisationnel au sein du service. l\u2019objectif est de d\u00e9finir une ou des actions correctrices afin de poser un filtre pour \u00e9viter la propagation des d\u00e9faillances pouvant conduire \u00e0 l\u2019accident (cf mod\u00e8le de J. Reason).<\/li><li>Choisir un \u00e9v\u00e8nement ind\u00e9sirable grave parmi ceux r\u00e9pertori\u00e9s prospectivement lors des staffs quotidiens dans un registre.<br>Un pilote d\u2019analyse sera alors d\u00e9sign\u00e9 pour effectuer l\u2019analyse syst\u00e9mique de ce cas selon une m\u00e9thode pr\u00e9cise, la m\u00e9thode ORION. Cette m\u00e9thode consiste \u00e0 reconstituer la chronologie de ce qui s\u2019est pass\u00e9 gr\u00e2ce \u00e0 un interrogatoire pr\u00e9cis aupr\u00e8s des personnes qui \u00e9taient pr\u00e9sentes, identifier les \u00e9carts, rechercher les facteurs contributifs et influents (humains, environnementaux, techniques, organisationnels).<\/li><li>Ecouter l\u2019analyse syst\u00e9mique de l\u2019\u00e9v\u00e8nement grave, choisi lors du CREX pr\u00e9c\u00e9dent, par le pilote d\u2019analyse d\u00e9sign\u00e9 et valider les actions correctrices propos\u00e9es par ce dernier.<\/li><li>Suivre les actions correctrices des CREX pr\u00e9c\u00e9dents et r\u00e9diger un rapport d\u2019analyse.<\/li><\/ul>\n\n\n\n<p>Le CREX est donc une instance de d\u00e9cision et de pilotage des \u00e9v\u00e8nements ind\u00e9sirables, r\u00e9alis\u00e9 en comit\u00e9 restreint. Ce comit\u00e9 g\u00e8re la mise en \u0153uvre des RMM au sein du service.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">La Revue de Morbidit\u00e9-Mortalit\u00e9 (RMM)<\/h2>\n\n\n\n<p>La RMM a lieu la semaine suivant la r\u00e9union du CREX. Le pilote d\u2019analyse du CREX expose son analyse de l\u2019\u00e9v\u00e8nement ind\u00e9sirable grave. C\u2019est un espace de discussion en \u00e9quipe o\u00f9 l\u2019on r\u00e9fl\u00e9chit coll\u00e9gialement aux actions correctrices propos\u00e9es par le pilote d\u2019analyse, le but \u00e9tant de retenir la ou les action(s) r\u00e9alisable(s) qui permettrai(en)t d\u2019\u00e9viter la reproduction d\u2019un tel \u00e9v\u00e8nement.<\/p>\n\n\n\n<p>Le CREX et les RMM s\u2019articulent parfaitement entre eux et sont compl\u00e9mentaires. En effet, le CREX travaille \u00e0 partir de pr\u00e9curseurs afin d\u2019\u00e9viter un accident et la RMM travaille \u00e0 partir de l\u2019accident afin d\u2019en \u00e9viter sa reproductibilit\u00e9.<\/p>\n\n\n\n<p>Il s\u2019agit donc de d\u00e9crire les faits et d\u2019analyser des situations s\u2019\u00e9tant produites, pour apprendre et comprendre, afin d\u2019agir ensemble pour renforcer la qualit\u00e9 et la s\u00e9curit\u00e9 des soins, sans porter de jugement sur les personnes, ni rechercher un coupable ou un responsable.<\/p>\n\n\n\n<p>La rigueur dans la m\u00e9thode et le respect des dates fix\u00e9es permettent la p\u00e9rennit\u00e9 du syst\u00e8me qui peut largement contribuer au maintien de la boucle qualit\u00e9 au sein du service.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Ressources<\/h4>\n\n\n\n<p>Pour approfondir le sujet, vous pouvez t\u00e9l\u00e9charger le fichier suivant<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a href=\"https:\/\/fhu-premimpact.org\/wp-content\/uploads\/2020\/04\/Modalit\u00e9s_RMM_LMR_20140311_siteDHU.pdf\" class=\"ek-link\">Les CREX et RMM \u00e0 la Maternit\u00e9 de Louis Mourier<\/a>&nbsp;fichier PDF<\/li><\/ul>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>L\u2019analyse des \u00e9v\u00e8nements ind\u00e9sirables s\u2019organise dans le service de fa\u00e7on structur\u00e9e, l\u2019essentiel \u00e9tant de r\u00e9pondre au mieux aux objectifs des RMM, qui sont une \u00e9valuation des pratiques professionnelles&nbsp;: elles consistent \u00e0 apprendre de ce qui se passe et de ce qui s\u2019est pass\u00e9 (performances, erreurs \u00e9vit\u00e9es, incidents et accidents), pour mieux maitriser l\u2019avenir. Deux instances [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":468,"menu_order":40,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_editorskit_title_hidden":false,"_editorskit_reading_time":2,"_editorskit_is_block_options_detached":false,"_editorskit_block_options_position":"{}","_uag_custom_page_level_css":"","footnotes":""},"class_list":["post-799","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Les CREX et RMM \u00e0 Louis Mourier - FHU Prem&#039;IMPACT<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/fhu-premimpact.org\/en\/soins\/les-rmm\/les-crex-et-rmm-a-louis-mourier\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Les CREX et RMM \u00e0 Louis Mourier - FHU Prem&#039;IMPACT\" \/>\n<meta property=\"og:description\" content=\"L\u2019analyse des \u00e9v\u00e8nements ind\u00e9sirables s\u2019organise dans le service de fa\u00e7on structur\u00e9e, l\u2019essentiel \u00e9tant de r\u00e9pondre au mieux aux objectifs des RMM, qui sont une \u00e9valuation des pratiques professionnelles&nbsp;: elles consistent \u00e0 apprendre de ce qui se passe et de ce qui s\u2019est pass\u00e9 (performances, erreurs \u00e9vit\u00e9es, incidents et accidents), pour mieux maitriser l\u2019avenir. 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