[How to improve the quality of healthcare services and patient safety by adopting strategies from the aviation sector?]

BACKGROUND AND OBJECTIVE

The World Health Organization recognizes patient safety as a priority as part of its global strategy to improve the quality of health services. However, several initiatives need to be integrated and systematized to increase the reliability of healthcare systems. This article discusses several management strategies developed in the aviation sector that have led to a drastic decrease in the accident rate. The aim is to describe each strategy and contrast them with their application in the healthcare sector.

METHODS

Different results and recommendations from the literature and institutions such as the World Health Organization and the International Civil Aviation Organization were consulted and compiled. A synthesis of the identified strategies was made, highlighting examples of their application and impact.

RESULTS

Five key strategies were identified: 1) no-blame incident reporting systems, 2) systematic use of checklists, 3) recurrent training and use of simulation, 4) management of fatigue and work schedules, and 5) management of teamwork.

CONCLUSIONS

The strategies from the aviation sector are presented as a valuable reference for improving patient safety and the quality of healthcare services. They should be consolidated and harmoniously integrated into the design and management of health systems.

[Impact of the COVID-19 pandemic on patient-reported patient safety in Primary Care]

OBJECTIVE

To evaluate the impact of the changes introduced in response to the pandemic on patient-reported patient safety in Primary Care.

DESIGN

Prospective observational panel study (health center) based on two cross-sectional surveys.

SETTING

29 Primary Health Care centers from three Spanish health regions (Mallorca, Catalunya Central and Camp de Tarragona).

PARTICIPANTS

Random sample of patients visiting their centers before (n=2199 patients) and during the pandemic (n=1955 patients) MAIN MEASUREMENTS: We used the PREOS-PC questionnaire, a validated instrument which assesses patient-reported patient safety in Primary Care. We compared mean scores of the "experiences of errors" and "harm" scales in both periods, and built multilevel regression analyzes to study the variations in patient and center characteristics associated with worse levels of safety. A qualitative (content) analysis of patients' experiences during the pandemic was also performed.

RESULTS

The "experiences of errors" and "harm" scales scores significantly worsened during the COVID-19 period (92.65 to 88.81 (Cohen's d=0.27); and 96.92 to 79.97 (d=0.70), respectively). Patient and center characteristics associated to worsened scores were: women, people with a lower educational level, worse health status, more years assigned to the center, and health region.

CONCLUSIONS

During the pandemic, a perceptible worsening in patient safety perceived by patients treated in Primary Care has been observed, which has differentially affected patients according to their sociodemographic characteristics or health center profiles.

The relationship between attitude of nurses toward the patient safety and missed nursing care: A predictive study

BACKGROUND

Positive attitude of nurses toward patient safety can play a major role in increasing the quality of nursing care and reducing missed nursing care. This study was conducted to determine the relationship between the Attitude of Nurses Toward Patient Safety and missed nursing care.

METHODS

This study was conducted in 2021 at the hospitals of Tabriz University of Medical Sciences (Iran). In the present study, 351 nurses were included in the study by using a stratified random sampling method. Data collection tools were demographic questionnaire, missed nursing care questionnaire, and patient safety attitudes questionnaire. Missed Nursing Care Questionnaire includes 24 items, such as patient movement, rotation, evaluation, training, discharge planning, medication prescription, scored on a 4-point Likert scale ranging from score 1 (I miss rarely), score 2 (I miss occasionally), score 3 (I miss usually), and score 4 (I miss always). The highest score is 96 and the lowest score is 24 on this scale. A higher score indicates a higher possibility of missed care.

RESULTS

The mean total (standard deviation) of missed nursing care was 32.76 (7.13) (score range: 24-96) and the mean total score of nurses' patient safety attitudes was 53.19 (18.71) out of 100. Results of the present study showed that nurses' patient safety attitudes are at a moderate level and have a significant inverse relationship with the incidence of missed nursing care (P<0.001).

CONCLUSION

According to the results and given the relationship between patient safety attitudes and missed nursing care, it is essential to use individual and organizational interventions to increase patient safety attitudes in various dimensions in nurses and consequently to reduce missed nursing care and improve the quality of healthcare.

Analysis of Critical Incident Reporting System as an indicator of quality healthcare in a cardiology center in Tbilisi, Georgia

Critical Incident Reporting System (CIRS) have become most common patient safety tools in healthcare. The purpose of this study was to determine how effectively CIRS is used and how well healthcare professionals recognize it as a risk management tool. A quantitative approach using a cross sectional survey was adopted. The most common critical incidents were due to lack of personal attention and related to individual errors. The most of the critical incidents arise from non-adherence to guidelines and standards. CIRS can be seen as an effective clinical risk management tool that can be used to identify potential sources of critical incidents and help ensure patient safety at a healthcare organization.

[Primary care organization in pandemic times]

La pandemia por COVID-19 ha forzado la adopción de cambios drásticos en Atención Primaria, modificando la organización y las dinámicas de trabajo establecidas hasta entonces. De un día para otro los profesionales tuvieron que adaptarse a la nueva situación para atender el aluvión de casos y contactos, evitar contagios y mantener la atención a otros problemas de salud. Al inicio de la pandemia los profesionales hubieron de instaurar en Atención Primaria nuevas prácticas y circuitos asistenciales de manera improvisada, por falta de orientaciones actualizadas, sin los medios de protección adecuados, evaluando sobre la marcha sus riesgos y beneficios. Abordamos cuáles han sido los principales cambios organizativos en el primer nivel asistencial y describimos, desde el punto de vista de la seguridad del paciente, las consecuencias para pacientes y profesionales de la atención prioritaria a la COVID-19. Finalmente, nos planteamos cómo incorporar el conocimiento adquirido durante la pandemia, analizando las ventajas e inconvenientes de las medidas adoptadas, para mantener en lo posible una Atención Primaria segura, accesible y de calidad.

CE: Single paragraph Abstract see JSS

[Interprofessional team training with in situ simulation to improve the quality of cardiopulmonary resuscitation]

INTRODUCTION

In situ simulation facilitates training in clinical settings under similar emotional pressure that occurs in real life situations. The objective of the present study was to assess the feasibility, implementation, facilitators self-confidence and teaching challenges of a training program of cardiopulmonary resuscitation through an in situ simulation plan.

METHOD

A training program was designed for the facilitators. The number of professionals trained and in situ simulations performed were recorded, as well as the logistical challenges. An ad hoc survey was designed to assess facilitators self-confidence and educational challenge which were classified using the debriefing assessment for simulation in healthcare©.

RESULTS

During a period of 3 years, 95 trained facilitators implemented 378 in situ simulations that allowed to train 1281 nursing professionals working at inpatient units. Integration of in situ simulations with daily activities and availability of facilitators were the main logistical challenges. Stablishing and maintaining a stimulating learning environment and structuring the debriefing in an organized way were the main educational challenges.

CONCLUSIONS

In situ simulation helps to train the coordination of nursing teams taking care of patients in cardiorespiratory arrest and to identify the risks that may affect patient safety. Identifying the educational challenges during the implementation of in situ simulation facilitates the design of specific educational and monitoring strategies.

Impact of the patient-nurse ratio on health outcomes in public hospitals of the Andalusian Health Service. Ecological study

OBJECTIVE

To analyse the patient-nurse ratio and its association with health outcomes in public hospitals of the Andalusian Health Service (SAS).

METHOD

Cross-sectional ecological study carried out in adult units of 26 Andalusian public hospitals. Data on structure (beds, type of unit, nursing control), management (average stay, index of use of stays, complexity index) and nursing staff were collected. They were extracted from official sources: CMBDA, SAS/Health Council (CS) publications and specific respondents to Nursing Directorates. The patient-nurse ratio was calculated and related to 19 indicators of hospital quality, safety, and mortality. Measures of central tendency and Spearman's correlation coefficient were used for statistical analysis.

RESULTS

A response was obtained from 100% of the Andalusian hospitals. The average patient-nurse ratio in the three shifts was lower in hospitals with a broader portfolio of services-regional scope (11.6), followed by those with a medium portfolio-specialties (12.7) and hospitals with a basic portfolio-county (13.5). By type of unit, the medical units were 11.8 (SD = 1.8) lower than the surgical ones 13.5 (SD = 2.7). Significant differences were only found in medical units of regional hospitals 10.5 (SD = 1.4) and district hospitals 13.03 (SD = 1.46) (p = .001). In critical care, the ratio was greater than 2 patients per nurse in the three groups. When relating the ratio to health outcomes, 5 significant associations were found: pressure ulcers (p = .005), prevalence of nosocomial infections (p = .036), postoperative sepsis (p = .022), zero bacteraemia verification (p = .045) and mortality from heart failure (p = .004).

CONCLUSIONS

The results indicate a high patient-nurse ratio in adult hospitalization units and that there is a positive association between the patient-nurse ratio and worse results related to nursing care.

«Do Not Do» recommendations for retinopathies: A mixed consensus study

PURPOSE

Among the main causes of blindness and severe vision loss are age-related macular degeneration, diabetic macular oedema, and retinal vein occlusion. The «Do Not Do» recommendations are strategies to improve quality of care and optimise healthcare costs. The aim of this study was to establish, by consensus, practices of low value in the above-mentioned pathologies, in addition to estimating their occurrence.

MATERIALS AND METHODS

Mixed methods study including a first phase of consensus of a multidisciplinary panel of experts using the Nominal Group technique. In the second phase, a retrospective observational study was conducted, by conducting a review of medical records.

RESULTS

A total of 7 recommendations were established for age-related macular degeneration, 4 for diabetic macular oedema, and 5 for retinal vein occlusion. A total of 1,012 medical records were reviewed by the 4 participating hospitals. The review of medical records revealed that agreed «Do Not Do's» occurred in a range between 0.6% and 31.4% of the cases included in the study.

CONCLUSIONS

This study identified «Do Not Do» recommendations in these pathologies that occur relatively often in clinical practice. It is necessary to review the healthcare processes that will enable these practices to be eradicated, and the quality of care to be improved.

Reporting of suspected adverse drug reactions by nursing in Spain. An observational-descriptive retrospective study

OBJECTIVE

This study aimed to gain knowledge of the nurses' involvement in the spontaneous report of suspected adverse drug reactions (ADR) in the Spanish Pharmacovigilance System for Medicinal Products for Human Use (SEFV-H), describing the principal characteristics of the reported cases, identifying points of improvement.

METHODS

A descriptive observational retrospective study was based on the data from FEDRA, the database created by the SEFV-H. The sample taken was the spontaneous adverse drug reactions reported to SEFV-H by nurses during the first 6 months of the 2018.

RESULTS

Complete data was provided by 6,370 suspicions of ADR reported to SEFV-H by all healthcare professionals. Only 4,8% of the samples were taken by nurses, 62,7% came from medical centers. The majority of the ADR were not considered a serious disease (78%). The most frequently adverse drug reactions reported by nurses were local reactions. The patients most involved were children and vaccines were the most reported drugs (58,3%), followed by the intravenous contrast agents used in diagnostic tests.

CONCLUSIONS

Nurses report very few cases to SEFV-H and are mostly related to the administration of vaccines and are sent by nurses working in the out-of-hospital setting. Most cases are not serious and usually report known adverse reactions to the suspected drug. This observed under-notification raises the need to promote increased pharmacovigilance training among these notifying nurses so that they can continue to report, and also for those who do not do so in their daily practice, so that they can begin to do so.

Second victim phenomenon in a surgical area: Online survey

BACKGROUND AND AIM OF STUDY

An effective and accessible first source of support for second victims (SV) is usually the colleagues themselves, who should have tools to help emotionally and detect the unusual course of a SV. The aim of this work is to assess health professionals' perception of the phenomenon, as well as their capability to apply psychological first aid.

MATERIAL AND METHODS

Observational descriptive study through online surveys answered anonymously. Participants were different health professionals from surgical area, mainly from a third-level hospital.

RESULTS

329 responses, 67 anaesthesiologists, 110 anaesthesiologists in training, 152 nurses. 78.4% had felt SV, more frequent among anaesthesiologists; however, 58% had never heard of the term. Guilt was the most frequent emotion. Residents were more afraid of judgmental colleagues and thought more about drop out their training. From those who sought help, most did it through a colleague, but most did not feel useful in helping a SV. 66% affirmed there is a still punitive, evasive or silent culture about medical incidents.

CONCLUSIONS

Despite the frequency of the phenomenon there is still lack of knowledge of the term SV. Impact of the phenomenon is heterogenous and changes based on experience and responsibility. Colleagues are the first source of emotional help but there is a lack of tools to be able to provide it. Institutions are urged to create training programs so that professionals can guarantee «psychological first aid».

[Healthcare workers in intensive care units as second victims of SARS-CoV-2: results of a survey]

Introducción

La epidemia por el virus SARS-CoV-2 ha generado una situación extraordinaria en la asistencia sanitaria de nuestro país. La enorme sobrecarga de trabajo a la que han estado expuestos los profesionales sanitarios, la importante carga emocional, las situaciones estresantes y el miedo al contagio propio y de sus familiares, entre otros aspectos, han podido tener consecuencias en los profesionales, convirtiéndolos en segundas víctimas. El objetivo de este estudio es conocer la sobrecarga emocional de los trabajadores de áreas de pacientes críticos por SARS-CoV-2 en un hospital terciario de la Comunidad de Madrid.

Materiales y métodos

Estudio descriptivo transversal, realizado mediante la cumplimentación voluntaria por parte de los profesionales de áreas de cuidados críticos de un cuestionario adaptado a partir de la Escala de Estrés Agudo «EASE COVID-19», consistente en 10 preguntas cerradas tipo Likert a las que se añadieron cuatro preguntas: sexo, categoría profesional, si trabajan habitualmente en áreas de críticos y el sacrificio en sus rutinas. Los datos se recogieron en julio de 2020, para evaluar el impacto de la primera ola. Se realizó una descripción de los datos y se analizó la asociación entre las variables y la respuesta emocional.

Resultados

Un 54% de los encuestados mostró buen ajuste emocional. Lo que más preocupó a los participantes fue la posibilidad de contagiar a sus familiares. Los colectivos con puntuaciones medias más altas fueron los enfermeros, técnicos en cuidados auxiliares de enfermería (TCAE) y celadores, mostrando ajuste emocional el 100% de los médicos, sin encontrarse diferencias por sexo. El 60% de los participantes modificó su rutina familiar, siendo los médicos internos residentes (MIR) los que presentaron mayor porcentaje.

Conclusiones

La crisis sanitaria vivida ha convertido a los profesionales sanitarios en segundas víctimas del SARS-CoV-2. Su detección es fundamental para ofrecerles los recursos y ayuda necesaria para garantizar su bienestar emocional, eliminando barreras y ayudándoles a salir reforzados.

Incidence and characteristics of falls in hospitalized patients: A cohort study

OBJECTIVE

To estimate the incidence of falls and to know their characteristics in terms of location, temporality and injuries produced, and to analyse the sociodemographic and clinical characteristics of the patients who suffer falls.

METHODOLOGY

A retrospective observational cohort study was carried out in a level 2 hospital of the Madrid Health Service. Falls in hospitalized patients between July 1, 2018 and June 30, 2019 were studied. The incidence rate of falls per 1000 days of stay was estimated considering a Poisson distribution. The characteristics of the falls are described: temporality, injuries produced, location of the injuries and prescribed drugs. Sociodemographic and clinical characteristics of patients who suffered a fall were registered. A univariate analysis was performed to compare the results by gender. All data were obtained from the electronic medical record.

RESULTS

One hundred and thirty-two falls were studied, which represent a rate of 1.61 falls per 1,000 days of stay. Men, older age, and admission to a medical specialty showed a significantly higher fall rate. The patients who suffered a fall had a mean age of 77.5 years (SD: 11.7), and had a median of 12.5 drugs prescribed (IQR: 9.25-15). Of the falls, 63.6% did not present any injury. Difference in gender was only found in the situation in which the fall occurred.

CONCLUSIONS

Our data report an incidence of falls similar to other institutions in our environment. The profile of the patient who suffers a fall is an older man, admitted under the charge of a medical specialty, with longer hospital stay, with associated comorbidity and polymedicated, without an obvious temporal feature.

Pitfalls of cubital electrical nerve stimulation for neuromuscular transmission monitoring: a case report of familial amyloid polyneuropathy

Transthyretin familial amyloid polyneuropathy (FAP) is a rare autosomal dominant disease that provokes systemic deposition of amyloid. It affects the nervous system and it is characterized by progressive sensory, motor, and autonomic neuropathy. Patients with FAP often require surgery and anesthetic care for hepatic transplantation and cardioverter-defibrillator/pacemaker implantation. Peripheric neuropathy is a common finding, but there are no reported cases of its interference with anesthetic neuromuscular transmission monitoring. We report a case of a FAP patient where lack of awareness and distracting factors led to misinterpretation of neuromuscular monitoring and unnecessary sedation and ventilation in the post anesthetic care unit. FAP may interfere with the usual cubital nerve neuromuscular monitoring. Anesthesiologists should be aware of potential neuromuscular compromise to find the best monitoring location for each patient. Sugammadex was safe and reliable in the antagonism of rocuronium neuromuscular blockade in this case, despite the lack of adequate quantitative monitoring.

Frequency of outpatient care adverse events in an occupational mutual insurance company in Spain

BACKGROUND

Occupational mutual insurance companies (OMICs), in collaboration with the Spanish Social Security System, provide healthcare and manage the economic benefits for the workers in Spain. They have ambulatory care centers that attend outpatient trauma pathology, although most of the studies published have focused on surgical and hospital activity. The aim of this study was to detect adverse events (AEs) in outpatient trauma care in the context of an OMIC.

METHODS

A cohort study designed to identify harmful safety incidents (adverse events, AEs) in 2017 was conducted. A random sample of 313 medical records among patients who were visited more than 3 medical and nursing attendances during their outpatient process. The AEs detected were classified according to category, severity and preventability.

RESULTS

We identified 48 AEs (15.3% of medical records, 95% CI 11.3-19.3), most of them procedure-related, while 27 (56.2%) were preventable and 46 mild (95.8%).

CONCLUSIONS

The AEs identified are double than those found in primary care general consultations in Spain and are close to the lower range of studies on surgical AEs in traumatology and orthopedics. Preventable AEs were within expected limits. Over half of AEs are preventable, within that group, the mild AEs have an increased rate of preventability. These results highlight the relevance of research of patient safety in the outpatient care of trauma and orthopaedic procedures in an OMIC for patient safety and contribute to introduce improvements in outpatient care.

[Patient safety: Patients perception at primary care level at an urban healthcare district]

OBJECTIVES

Patient safety is a quality objective and a priority in healthcare. Most of the research has focused on the hospital setting and from the professional perspective. The objective of our study is to know the opinion of the patient who attends primary care regarding its safety in this area.

MATERIAL AND METHODS

Cross-sectional observational study. A survey carried out with patients chosen through four health centres representing different socioeconomic levels of the same Basic Health Zone. Fifty patients per centre were surveyed.

RESULTS

Two hundred patients surveyed of whom more than 90% reported no negative experiences in terms of errors in medication, identification, diagnosis or clinical management, highlighting the good care received and the good resolution of their problem. However, only around half claimed to understand the explanations of the healthcare professionals or to have had the opportunity to give an opinion or have shared decision-making on their management. These factors were closely related to the perceived lack of time in consultation and constant change of physician.

CONCLUSIONS

The vast majority of our patients report no adverse effects or safety issues during their primary care attendance. However, there is evidence of the need to strengthen aspects related to consultation time and increase the number and stability of human resources in health centres to improve patient satisfaction with the health system.

Cross-cultural adaptation to the Spanish context and evaluation of the content validity of the Second Victim Experience and Support Tool (SVEST-E) questionnaire

OBJECTIVES

To carry out a cross-cultural adaptation of the Second Victim Experience and Support Tool (SVEST) questionnaire to the Spanish context, and to evaluate its content validity (CVI).

METHODS

The translation and cultural adaptation of a measuring instrument by means of translation and back translation conducted through the participation of 20 health professionals. The content validation was carried out through the participation of 10 experts. The content validity of each item (CVI-I), the content validity index per expert (CVI-E) and the content validity total (CVI-T) were calculated for the questionnaire. Corrections were carried out for probable random agreement and the statistical calculation Kappa (K*) modified for each item of the instrument.

RESULTS

The final instrument obtained (SVEST-E) has a CVI-Total of 0.87 and consists of 36 total items, subdivided into 7 dimensions, 2 outcome variables and a support option section maintaining the same structure as the original questionnaire. Thirty items had a CVI-I with values over ≥°0.79.

CONCLUSIONS

The SVEST-E questionnaire is an equivalent of the original and is an instrument that could help to evaluate the second victim experiences of healthcare professionals in our country. It is an instrument with adequate content validity to measure the experience of second victims in health professionals in our country.

Second victim phenomenon in a surgical area: online survey

BACKGROUND AND AIM OF STUDY

An effective and accessible first source of support for second victims (SV) is usually the colleagues themselves, who should have tools to help emotionally and detect the unusual course of a SV. The aim of this work is to assess health professionals' perception of the phenomenon, as well as their capability to apply psychological first aid.

MATERIAL AND METHODS

Observational descriptive study through online surveys answered anonymously. Participants were different health professionals from surgical area, mainly from a third-level hospital.

RESULTS

329 responses, 67 anaesthesiologists, 110 anaesthesiologists in training, 152 nurses. 78.4% had felt SV, more frequent among anaesthesiologists; however, 58% had never heard of the term. Guilt was the most frequent emotion. Residents were more afraid of judgmental colleagues and thought more about drop out their training. From those who sought help, most did it through a colleague, but most did not feel useful in helping a SV. 66% affirmed there is a still punitive, evasive or silent culture about medical incidents.

CONCLUSIONS

Despite the frequency of the phenomenon there is still lack of knowledge of the term SV. Impact of the phenomenon is heterogenous and changes based on experience and responsibility. Colleagues are the first source of emotional help but there is a lack of tools to be able to provide it. Institutions are urged to create training programs so that professionals can guarantee «psychological first aid».

The Study on Safety in Hospitals in the Region of Madrid (ESHMAD) design: Screening and analysis of incidents and adverse events

BACKGROUND

A Study related to Safety in Hospitals in the Region of Madrid (ESHMAD) was carried out in order to determine the prevalence, magnitude and characteristics of adverse events in public hospitals. This work aims to define a useful methodology for the multicenter study of adverse events in the Region of Madrid, to set out the preliminary results of the hospital enrollment and to establish a model of a strategy of training of trainers for its implementation.

METHODS

ESHMAD was a multicenter, double phase study for the estimation of adverse events and incidents prevalence across the Region of Madrid. First phase comprehended a 1-day cross-sectional prevalence study, in which it was collected, through a screening guide, information about admission, patient characteristics, intrinsic and extrinsic risk factors, and the possibility of an adverse event or incident had happened during the hospitalization. Second phase was a retrospective nested cohort study, in which it was used a Modular Review Form for reviewing the positive screenings of the first phase, identifying in each possible adverse event or incident the classification of the patient safety event, clinical onset, root, and associated causes and factors, impact, and preventability. A pilot study was performed in an Internal Medicine Unit of a tertiary hospital.

RESULTS

34 public hospitals participated, belonging to 6 healthcare categories and with more than 10,000 hospitalisations aggregate capacity. 72 coordinators were enrolled in the strategy of training of trainers, which was performed through five on-site training workshops. In the pilot study, 45.2% patients were identified with at least one positive event of the screening. Of them, 48.1% (25 positive events) were identified as truly AE, with a result of 0.29 EA per analyzed patient.

CONCLUSIONS

The ESHMAD protocol allows to estimate the prevalence of adverse events, and the strategy of training of trainers facilitated the spread of the research methodology among the participants.

[Transcultural adaptation of AGRASS questionnaire to evaluate the management of heathcare risks]

OBJECTIVE

To cross-culturally adapt the Questionário AGRASS for evaluation of healthcare risk management in health services.

MATERIAL AND METHODS

The work was carried out following 5 stages: 1) initial translation to Spanish; 2) Synthesis; 3) translation back to Portuguese; 4) experts review, and 5) pretest performed in a specialized Costa Rican hospital.

RESULTS

The AGRASS Questionnaire translated and adapted into Spanish has the same dimensional structure as the original, with 2 dimensions and 9 subdimensions. Thirty-nine of the 40 original items were approved (general validation index=100% per item). Its application was considered viable, with items well understood and with useful results that identify opportunities for improvement in healthcare risk management.

CONCLUSIONS

The AGRASS Questionnaire is culturally adapted to the Costa Rican reality and future studies can evaluate its contribution to other hospital contexts in Ibero-American countries.

[Evaluation of the effectiveness of a procedure for identifying patients with allergy in paediatric emergency rooms]

INTRODUCTION

Correct identification of the patient with an allergy is critical for patient safety, since it involves a potential risk of a serious adverse event (AE). Our Emergency Pediatric department has an integrated quality management and risk management system focused on the continuous improvement of patient care quality and safety, which incident reporting system could identified a potential risk arising from the registration of allergies in new computer softwares. As a safety barrier, an allergy identification procedure was implemented, using a sticker placed on the identification bracelet (RED: allergy; WHITE: non-allergies).

MATERIALS AND METHODS

A descriptive study was conducted to evaluate, by direct observation, the correct identification of patients with allergy using this new protocol. The reports of incidents related to this procedure were analyzed.

RESULTS

Of the 342 patients included, 327 (95.6% (95%:93.4-97.8%)) were correctly identified. Identification errors were most common in the group of patients with allergies [10 of 45; 22.2% (95%:10.1-34.4%) than in the non-allergic group: 5 of 297; 1.7% (95%:0.2-3.2); p<0.001)]. No AEs were reported. 2 quasi-incidents detected before reaching the patient were reported thanks of the protocol application.

CONCLUSIONS

This procedure is a useful safety barrier and can be easily exported to other units. Further work is needed to promote the professional's adherence to the protocol and improve the correct identification of the patient with allergy.

Prospective cohort study on the management and complications of peripheral venous catheter in patients hospitalised in Internal Medicine

OBJECTIVE

To analyse compliance with the recommendations on the insertion-maintenance of peripheral venous catheter (PVC) and the incidence of complications according to the healthcare department that inserted the PVCs.

PATIENTS AND METHODS

We conducted a prospective cohort follow-up study of PVCs, from their insertion in the emergency or internal medicine (IM) department until their withdrawal.

RESULTS

We monitored 590 PVCs, 274 from the emergency department and 316 from IM. In terms of compliance with the process indicators, there was a cannulation rate in the antecubital fossa of 3.5 and 1.6 per 100 catheters-day (P<.001) in the emergency and IM departments, respectively. The sterile placement rates were 1.6 and 12.4 (P<.001), and the rate for transparent dressing was 2.1 and 11.5 (P<.001) per 100 catheters-day in the emergency and IM departments, respectively. The complications rates showed no differences between the departments. The most common complication was phlebitis (95 cases, 16.1%).

CONCLUSIONS

Compliance with the insertion-maintenance recommendations for PVC showed differences between the departments; however, the incidence of complications was similar.

Cross-cultural adaptation to the Spanish context and evaluation of the content validity of the Second Victim Experience and Support Tool (SVEST-E) questionnaire

OBJECTIVES

To carry out a cross-cultural adaptation of the Second Victim Experience and Support Tool (SVEST) questionnaire to the Spanish context, and to evaluate its content validity (CVI).

METHODS

The translation and cultural adaptation of a measuring instrument by means of translation and back translation conducted through the participation of 20 health professionals. The content validation was carried out through the participation of 10 experts. The content validity of each item (CVI-I), the content validity index per expert (CVI-E) and the content validity total (CVI-T) were calculated for the questionnaire. Corrections were carried out for probable random agreement and the statistical calculation Kappa (K*) modified for each item of the instrument.

RESULTS

The final instrument obtained (SVEST-E) has a CVI-Total of 0.87 and consists of 36 total items, subdivided into 7 dimensions, 2 outcome variables and a support option section maintaining the same structure as the original questionnaire. Thirty items had a CVI-I with values over ≥̊0.79.

CONCLUSIONS

The SVEST-E questionnaire is an equivalent of the original and is an instrument that could help to evaluate the second victim experiences of healthcare professionals in our country. It is an instrument with adequate content validity to measure the experience of second victims in health professionals in our country.

«Do Not Do» recommendations for retinopathies: A mixed consensus study

BACKGROUND AND OBJECTIVE

Among the main causes of blindness and severe vision loss are age-related macular degeneration, diabetic macular oedema, and retinal vein occlusion. The «Do Not Do» recommendations are strategies to improve quality of care and optimise healthcare costs. The aim of this study was to establish, by consensus, practices of low value in the above-mentioned pathologies, in addition to estimating their occurrence.

MATERIALS AND METHODS

Mixed methods study including a first phase of consensus of a multidisciplinary panel of experts using the Nominal Group technique. In the second phase, a retrospective observational study was conducted, by conducting a review of medical records.

RESULTS

A total of 7 recommendations were established for age-related macular degeneration, 4 for diabetic macular oedema, and 5 for retinal vein occlusion. A total of 1,012 medical records were reviewed by the 4 participating hospitals. The review of medical records revealed that agreed «Do Not Do's» occurred in a range between 0.6% and 31.4% of the cases included in the study.

CONCLUSIONS

This study identified «Do Not Do» recommendations in these pathologies that occur relatively often in clinical practice. It is necessary to review the healthcare processes that will enable these practices to be eradicated, and the quality of care to be improved.

Does Skilled Nursing Facility Trigger Tool used with Global Trigger Tool increase its value for adverse events evaluation?

OBJECTIVE

To assess the additional value in the evaluation of incidents and adverse events by adding the IHI Skilled Nursing Facility Trigger Tool (SNFTT) to the Institute for Healthcare Improvement's Global Trigger Tool (GTT) in an acute geriatric hospital.

MATERIAL AND METHODS

A one-year retrospective study reviewing 240 electronic clinical records using the general GTT, either alone or combined with SNFTT.

MAIN OUTCOME MEASURES

Number of triggers and identified adverse events (AEs), categories of severity and preventability of AEs, GTT incidence rates, and the number needed to alert (NNA).

RESULTS

One hundred and thirty-seven AEs were identified in 107 patients (57.1 AEs per 100 admissions). Of these, 127 (92.7%) occurred 3 or more days after admissions; 49.6% of the harm events were preventable. The NNA for GTT plus SNFTT was 8.6. No significant difference was found using the general GTT alone versus the general GTT plus SNFTT in terms of the main outcome measures. Eleven categories of triggers were better identified when using GTT plus SNFTT because with GTT alone they were allocated to a category of "Other": 9 from the care module (C15) and 2 from the medication module (M13).

CONCLUSIONS

The study demonstrates that adding the SNFTT to the GTT did not increase its effectiveness as regards the evaluation of AEs. However, some triggers are better described in SNFTT and now have now been added into the general GTT method in our hospital.

Reporting of suspected adverse drug reactions by nursing in Spain. An observational-descriptive retrospective study

OBJECTIVE

This study aimed to gain knowledge of the nurses' involvement in the spontaneous report of suspected adverse drug reactions (ADR) in the Spanish Pharmacovigilance System for Medicinal Products for Human Use (SEFV-H), describing the principal characteristics of the reported cases, identifying points of improvement.

METHODS

A descriptive observational retrospective study was based on the data from FEDRA, the database created by the SEFV-H. The sample taken was the spontaneous adverse drug reactions reported to SEFV-H by nurses during the first 6 months of the 2018.

RESULTS

Complete data was provided by 6,370 suspicions of ADR reported to SEFV-H by all healthcare professionals. Only 4,8% of the samples were taken by nurses, 62,7% came from medical centers. The majority of the ADR were not considered a serious disease (78%). The most frequently adverse drug reactions reported by nurses were local reactions. The patients most involved were children and vaccines were the most reported drugs (58,3%), followed by the intravenous contrast agents used in diagnostic tests.

CONCLUSIONS

Nurses report very few cases to SEFV-H and are mostly related to the administration of vaccines and are sent by nurses working in the out-of-hospital setting. Most cases are not serious and usually report known adverse reactions to the suspected drug. This observed under-notification raises the need to promote increased pharmacovigilance training among these notifying nurses so that they can continue to report, and also for those who do not do so in their daily practice, so that they can begin to do so.