[Advantages and disadvantages of different methods for the implementation and the support of standard operating procedures: From PDF files to an app- and webbased SOP management system]

Organisation und Durchführung der Schmerztherapie in deutschen Notaufnahmen – eine Onlineumfrage

Einleitung

Obwohl Schmerzen der häufigste Grund für eine Vorstellung in der Notaufnahme sind, ist ihre Erfassung und Therapie sehr heterogen organisiert und wird vielfach von Patienten als unzureichend beschrieben. Eine spezielle Leitlinie existiert bislang nicht und so wird beispielsweise die Delegation an die Notfallpflege nach Standard Operating Procedure (SOP) sehr unterschiedlich gehandhabt.

Methode

Mithilfe einer Umfrage erfolgte eine Ist-Analyse zur Organisation und Durchführung der akuten Schmerztherapie in deutschen Notaufnahmen. 18 Fragen wurden onlinebasiert erstellt und über das Notaufnahmeverzeichnis der DGINA e. V. (Deutsche Gesellschaft für interdisziplinäre Notfall- und Akutmedizin) und DIVI e. V. (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) an die Leiter von 951 deutschen Notaufnahmen verschickt.

Ergebnis

Es konnten 166 vollständige Fragebögen ausgewertet werden. Die Erfassung der Schmerzen erfolgt bei 77,7 % der Notaufnahmen innerhalb der ersten 10 min nach Erstkontakt, meist mit der numerischen Rating-Skala (46,4 %). Obwohl 17,7 % nicht dauerhaft ärztlich besetzt sind, dürfen in insgesamt 32,5 % der Notaufnahmen Pflegekräfte keine eigenständige Schmerztherapie durchführen. Eine spezielle SOP gab es nur in 44,8 % der befragten Notaufnahmen. Die am häufigsten verwendeten Analgetika sind Piritramid und Morphin sowie Metamizol und Ibuprofen.

Schlussfolgerung

Eine entsprechende nationale Leitlinie könnte Handlungssicherheit geben und als Grundlage für angepasste, örtliche SOP helfen, Verzögerungen bei der akuten Schmerztherapie zu vermeiden.

[Errors in medicine. Causes, impact and improvement measures to improve patient safety]

The guarantee of quality of care and patient safety is of major importance in hospitals even though increased economic pressure and work intensification are ubiquitously present. Nevertheless, adverse events still occur in 3-4 % of hospital stays and of these 25-50 % are estimated to be avoidable. The identification of possible causes of error and the development of measures for the prevention of medical errors are essential for patient safety. The implementation and continuous development of a constructive culture of error tolerance are fundamental.The origins of errors can be differentiated into systemic latent and individual active causes and components of both categories are typically involved when an error occurs. Systemic causes are, for example out of date structural environments, lack of clinical standards and low personnel density. These causes arise far away from the patient, e.g. management decisions and can remain unrecognized for a long time. Individual causes involve, e.g. confirmation bias, error of fixation and prospective memory failure. These causes have a direct impact on patient care and can result in immediate injury to patients. Stress, unclear information, complex systems and a lack of professional experience can promote individual causes. Awareness of possible causes of error is a fundamental precondition to establishing appropriate countermeasures.Error prevention should include actions directly affecting the causes of error and includes checklists and standard operating procedures (SOP) to avoid fixation and prospective memory failure and team resource management to improve communication and the generation of collective mental models. Critical incident reporting systems (CIRS) provide the opportunity to learn from previous incidents without resulting in injury to patients. Information technology (IT) support systems, such as the computerized physician order entry system, assist in the prevention of medication errors by providing information on dosage, pharmacological interactions, side effects and contraindications of medications.The major challenges for quality and risk management, for the heads of departments and the executive board is the implementation and support of the described actions and a sustained guidance of the staff involved in the modification management process. The global trigger tool is suitable for improving transparency and objectifying the frequency of medical errors.

[Standard operating procedures (SOPs) for palliative care : Presence and relevance of palliative SOPs within the network of German Comprehensive Cancer Centers (CCCs) funded by the German Cancer Aid]

BACKGROUND

Standard operating procedures (SOPs) can contribute to the improvement of patient care.

OBJECTIVES

Survey the presence and relevance of SOPs for palliative care (PC) within the network of German Comprehensive Cancer Centers (CCCs) funded by the German Cancer Aid.

MATERIALS AND METHODS

In a descriptive survey, palliative care services within 15 CCCs funded by the German Cancer Aid were asked to rate availability and thematic relevance of (1) symptom-related, (2) clinical pathways and (3) measures- and processes-oriented SOPs using a structured questionnaire.

RESULTS

Pain management SOPs were the most common (n =11; 73 %). The most thematic relevance showed SOPs dedicated to pain management, care in the last days of life and delirium and other neuro-psychiatric diseases (each n =13; 87 %), followed by bowel obstruction, dyspnoea, nausea and palliative sedation (each n =12; 80 %).

CONCLUSIONS

There is a wide gap between availability and perceived relevance of palliative care SOPs within the network of German CCCs funded by the German Cancer Aid. It is obvious that there is a need for further development of relevant SOPs in palliative care.