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Prieto-Molina A, Aranda-Gallardo M, Moya-Suárez AB, Rivas-Ruiz F, Peláez-Cherino J, Canca-Sánchez JC. Patient transfers from emergency departments to other in-hospital areas: a failure mode and effects analysis. Emergencias 2023; 35:456-462. [PMID: 38116970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To perform an in-depth analysis of the process of transferring patients from an emergency department (ED) to other areas inside a hospital and identify possible points of failure and risk so that strategies for improvement can be developed. MATERIAL AND METHODS We formed a multidisciplinary group of ED and other personnel working with hospitalized adults. The group applied failure mode and effects analysis (FMEA) to understand the in-hospital transfer processes. A risk priority scoring system was then established to assess the seriousness of each risk and the likelihood it would appear and be detected. RESULTS We identified 8 transfer subprocesses and 14 critical points at which failures could occur. Processes related to administering medications and identifying patients were the components that received the highest risk priority scores. Improvement strategies were established for all risks. The group created a specific protocol for in-hospital transfers and a checklist to use during handovers. CONCLUSION The FMEA method helped the group to identify points when there is risk of failure during patient transfers and to define ways to improve patient safety.
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Affiliation(s)
| | - Marta Aranda-Gallardo
- Equipo de Dirección de Enfermería, Hospital Costa del Sol, Marbella, Málaga, España. Departamento de Enfermería, Facultad Ciencias de la Salud, Universidad de Málaga, España. Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España. Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud. Instituto de Salud Carlos III, España
| | - Ana Belén Moya-Suárez
- Equipo de Dirección de Enfermería, Hospital Costa del Sol, Marbella, Málaga, España. Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
| | - Francisco Rivas-Ruiz
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud. Instituto de Salud Carlos III, España. Unidad de Investigación, Hospital Costa del Sol, Marbella, Málaga, España
| | | | - José Carlos Canca-Sánchez
- Departamento de Enfermería, Facultad Ciencias de la Salud, Universidad de Málaga, España. Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
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López-Muñoz C, Aranda-Gallardo M, Rivas-Ruiz F, Moya-Suárez AB, Morales-Asencio JM, Canca-Sanchez JC. Clinical and functional assessment in patients admitted with pluripathological dysphagia according to the mode of feeding: Through a gastrostomy tube or oral. Enferm Clin (Engl Ed) 2023; 33:251-260. [PMID: 37394139 DOI: 10.1016/j.enfcle.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/28/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Multipathological patients are a vulnerable population with high comorbidity, functional impairment, and nutritional risk. Almost 50% of these hospitalized patients have dysphagia. There is no consensus on whether placement of a percutaneous endoscopic gastrostomy (PEG) tube provides greater clinical benefit. The purpose of this study was to know and compare 2 groups of multipathological patients with dysphagia according to the mode of feeding: PEG vs. oral. METHOD Retrospective descriptive study with hospitalized patients (2016-19), pluripathological, with dysphagia, nutritional risk, over 50 years with diagnoses of: dementia, cerebrovascular accident (CVA), neurological disease, or oropharyngeal neoplasia. Terminally ill patients with jejunostomy tube or parenteral nutrition were excluded. Sociodemographic variables, clinical situation, and comorbidities were evaluated. Bivariate analysis was performed to compare both groups according to their diet, establishing a significance level of p < .05. RESULTS 1928 multipathological patients. The PEG group consisted of 84 patients (n122). A total of 84 were randomly selected to form the non-PEG group (n434). This group had less history of bronchoaspiration/pneumonia (p = .008), its main diagnosis was stroke versus dementia in the PEG group (p < .001). Both groups had more than a 45% risk of comorbidity (p = .77). CONCLUSIONS multipathological patients with dysphagia with PEG usually have dementia as their main diagnosis, however, stroke is the most relevant pathology in those fed orally. Both groups have associated risk factors, high comorbidity, and dependence. This causes their vital prognosis to be limited regardless of the mode of feeding.
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Affiliation(s)
- Cristina López-Muñoz
- Unidad de Pruebas Funcionales Digestivas, Hospital Costa del Sol, Marbella, Málaga, Spain.
| | - Marta Aranda-Gallardo
- Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Málaga, Spain
| | - Francisco Rivas-Ruiz
- Área de Asesoramiento Metodológico, Documental y Ético, Unidad de Investigación e Innovación, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Ana Belén Moya-Suárez
- Unidad de Pruebas Funcionales Digestivas, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - José Miguel Morales-Asencio
- Universidad de Málaga, Facultad Ciencias de la Salud, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Málaga, Spain
| | - José Carlos Canca-Sanchez
- Universidad de Málaga, Facultad Ciencias de la Salud, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Málaga, Spain
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Lupiáñez-Pérez I, Gómez-González AJ, Morilla-Herrera JC, Marfil-Gómez R, León-Campos Á, Caro-Bautista J, Villa-Estrada F, Aranda-Gallardo M, Moya-Suárez AB, Morales-Asencio JM. A protocol for a randomized trial measuring flowmetry in risk areas for pressure ulcer: Hyperoxygenated fatty acids vs olive oil. J Tissue Viability 2022; 31:501-505. [DOI: 10.1016/j.jtv.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/10/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022]
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Blanco-Mavillard I, de Pedro-Gómez JE, Rodríguez-Calero MÁ, Bennasar-Veny M, Parra-García G, Fernández-Fernández I, Bujalance-Hoyos J, Moya-Suárez AB, Cobo-Sánchez JL, Ferrer-Cruz F, Castro-Sánchez E. Multimodal intervention for preventing peripheral intravenous catheter failure in adults (PREBACP): a multicentre, cluster-randomised, controlled trial. Lancet Haematol 2021; 8:e637-e647. [PMID: 34450101 DOI: 10.1016/s2352-3026(21)00206-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND 2 billion peripheral intravenous catheters (PIVC) are inserted into inpatients worldwide each year. Almost one in two PIVCs fail before completion of intravenous therapy. We aimed to determine the efficacy and costs of a multimodal intervention to reduce PIVC failure among hospitalised patients. METHODS PREBACP was a cluster-randomised, controlled trial done at seven public hospitals in Spain. Clusters (hospital wards) had at least 70% permanent staff and data were collected from patients aged 18 years and older with one or more PIVCs at the start of intravenous therapy. Clusters were randomly assigned (1:1) to the multimodal intervention or control group using a centralised, web-based randomisation software, and stratified by type of setting. We concealed randomisation to allocation, without masking patients or professionals to the intervention. An intervention using a multimodal model and dissemination of protocols, education for health-care professionals and patients, and feedback on performance was implemented for 12 months in the intervention group. The control group received usual care. The primary outcome was all-cause PIVC failure at 12 months (phlebitis, extravasation, obstruction, or infections). Subsequently, through an amendment to the protocol approved on July 25, 2021, we included dislodgement as part of PIVC failure. Analysis was by modified intention to treat, which included all randomly assigned hospital wards for whom data on the primary endpoint were available. This trial is registered with the ISRCTN Registry, ISRCTN10438530. FINDINGS Between Jan 1, 2019, and March 1, 2020, we randomly assigned 22 eligible clusters to receive the multimodal intervention (n=11 clusters; 2196 patients, 2235 PIVCs, and 131 nurses) or usual practice in the control group (n=11 clusters; 2282 patients, 2330 PIVCs, and 138 nurses). At 12 months, the proportion of PIVC failures was lower in the intervention group than in the control group (37·10% [SD 1·32], HR 0·81 [95% CI 0·72 to 0·92] vs 46·49% [2·59], HR 1·23 [1·04 to 1·39]; mean difference -9·39% [95% CI -11·22 to -7·57]; p<0·0001). Per-protocol-prespecified analysis of the primary outcome excluding dislodgement also showed the intervention significantly reduced PIVC failure compared with the control group at 12 months (33·47% [SD 2·98], HR 0·85 [95% CI 0·75 to 0·96] vs 41·06% [4·62], HR 1·18 [1·04 to 1·33]; mean difference -7·59% [95% CI -11·05 to -4·13]; p<0·0001). INTERPRETATION A multimodal intervention reduced PIVC failure, thereby reducing potentially serious complications for hospitalised patients. The findings of PREBACP enabled a deeper understanding of decision making, knowledge mobilisation, and sense making in routine clinical practice. FUNDING The College of Nurses of the Balearic Islands. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Ian Blanco-Mavillard
- Quality, Teaching and Research Unit, Hospital de Manacor, Manacor, Spain; Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; Care, Chronicity and Evidence in Health Research Group, Health Research Institute of the Balearic Islands, Palma, Spain.
| | - Joan Ernest de Pedro-Gómez
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; Care, Chronicity and Evidence in Health Research Group, Health Research Institute of the Balearic Islands, Palma, Spain
| | - Miguel Ángel Rodríguez-Calero
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; Care, Chronicity and Evidence in Health Research Group, Health Research Institute of the Balearic Islands, Palma, Spain; Health Care Office, Balearic Islands Health Service, Palma, Spain
| | - Miquel Bennasar-Veny
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | | | - Ana Belén Moya-Suárez
- Department of Nursing, Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain; Biomedical Research Institute of Málaga, Málaga, Spain
| | | | | | - Enrique Castro-Sánchez
- City, University of London, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
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Enríquez de Luna-Rodríguez M, Aranda-Gallardo M, Canca-Sánchez JC, Moya-Suárez AB, Vázquez-Blanco MJ, Morales-Asencio JM. Profile of the patient who suffers falls in the hospital environment: Multicenter study. Enferm Clin (Engl Ed) 2019; 30:236-243. [PMID: 31208928 DOI: 10.1016/j.enfcli.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/16/2019] [Accepted: 05/01/2019] [Indexed: 11/24/2022]
Abstract
AIMS To analyse the profile of patients suffering from falls in the hospital environment. METHOD Longitudinal study, prospective follow-up of a cohort of patients recruited from May 2014 to March 2016. Medical, surgical and intensive care units of 5 acute hospitals of the Community of Andalusia participated. Patients older than 16 years were included. The variables of characterization were: age, sex, unit, stay, preventive measures, and those of result: level of consciousness, sensory deficits, mobility, number of falls, circumstances and consequences, medications, previous falls. RESULTS 1,247 patients were recruited, of whom 977 completed the study. The incidence of falls was 2.35%. The average age of the faller was 73.6 years (P=.015). The event occurred mostly in women (56.5%) and in medical units (79%). The falls caused minor damage. Rearrangement of the furniture proved to be the only protective measure (OR= 3.95, 95% CI 1.46-10.68, P=.015). The predictors of the event were: having been admitted to the hospital after a fall (HR= 5.88, 95% CI 3.23-10.67, P<.001), followed by visual problems, frequent visits to the bathroom and having suffered previous falls. CONCLUSIONS The profile of the patient suffering falls in the hospital is presented as aged over 70 years old, female, admitted to a medical unit, during the night shift, being in bed and alone, without impaired level of consciousness and with a history of falls.
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Affiliation(s)
| | - Marta Aranda-Gallardo
- Dirección de Enfermería, Agencia Sanitaria Costa del Sol, Marbella, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA)
| | - Jose Carlos Canca-Sánchez
- Dirección de Enfermería, Agencia Sanitaria Costa del Sol, Marbella, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA)
| | - Ana Belén Moya-Suárez
- Dirección de Enfermería, Agencia Sanitaria Costa del Sol, Marbella, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA)
| | - M José Vázquez-Blanco
- Instituto de Investigación Biomédica de Málaga (IBIMA); Unidad de residencias Distrito Málaga-Guadalhorce, Málaga, España
| | - Jose Miguel Morales-Asencio
- Instituto de Investigación Biomédica de Málaga (IBIMA); Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, España
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Moya-Suárez AB, Canca-Sánchez JC, Enríquez de Luna-Rodríguez M, Aranda-Gallardo M, Morales-Asencio JM. Factors associated with variability in the prevention of pressure ulcers. J Tissue Viability 2018; 27:211-216. [PMID: 30389336 DOI: 10.1016/j.jtv.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 07/25/2018] [Accepted: 10/24/2018] [Indexed: 10/28/2022]
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Moya-Suárez AB, Morales-Asencio JM, Aranda-Gallardo M, Enríquez de Luna-Rodríguez M, Canca-Sánchez JC. Development and psychometric validation of a questionnaire to evaluate nurses' adherence to recommendations for preventing pressure ulcers (QARPPU). J Tissue Viability 2017; 26:260-270. [PMID: 28911962 DOI: 10.1016/j.jtv.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 05/29/2017] [Accepted: 09/01/2017] [Indexed: 12/15/2022]
Abstract
AIM OF THE STUDY The main objective of this work is the development and psychometric validation of an instrument to evaluate nurses' adherence to the main recommendations issued for preventing pressure ulcers. MATERIAL AND METHODS An instrument was designed based on the main recommendations for the prevention of pressure ulcers published in various clinical practice guides. Subsequently, it was proceeded to evaluate the face and content validity of the instrument by an expert group. It has been applied to 249 Spanish nurses took part in a cross-sectional study to obtain a psychometric evaluation (reliability and construct validity) of the instrument. The study data were compiled from June 2015 to July 2016. RESULTS From the results of the psychometric analysis, a final 18-item, 4-factor questionnaire was derived, which explained 60.5% of the variance and presented the following optimal indices of fit (CMIN/DF: 1.40 p < 0.001; GFI: 0.93; NFI: 0.92; CFI: 0.98; TLI: 0.97; RMSEA: 0.04 (90% CI 0.025-0.054). CONCLUSIONS The results obtained show that the instrument presents suitable psychometric properties for evaluating nurses' adherence to recommendations for the prevention of pressure ulcers.
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Affiliation(s)
- Ana Belén Moya-Suárez
- Department of Nursing, Agencia Sanitaria Costa del Sol, Ctra. Nacional 340, Km. 187 Marbella, Málaga, Spain.
| | - José Miguel Morales-Asencio
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, C/Arquitecto Francisco Peñalosa, Ampliación del Campus de Teatinos, 29071, Málaga, Spain.
| | - Marta Aranda-Gallardo
- Department of Nursing, Agencia Sanitaria Costa del Sol, Ctra. Nacional 340, Km. 187 Marbella, Málaga, Spain.
| | | | - José Carlos Canca-Sánchez
- Department of Nursing, Agencia Sanitaria Costa del Sol, Ctra. Nacional 340, Km. 187 Marbella, Málaga, Spain.
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García-Mayor S, Morilla-Herrera JC, Lupiáñez-Pérez I, Kaknani Uttumchandani S, León Campos Á, Aranda-Gallardo M, Moya-Suárez AB, Morales-Asencio JM. Peripheral perfusion and oxygenation in areas of risk of skin integrity impairment exposed to pressure patterns. A phase I trial (POTER Study). J Adv Nurs 2017; 74:465-471. [DOI: 10.1111/jan.13414] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Silvia García-Mayor
- Department of Nursing; Faculty of Health Sciences; University of Málaga; Málaga Spain
| | - Juan Carlos Morilla-Herrera
- Department of Nursing; Faculty of Health Sciences; University of Málaga; Málaga Spain
- Málaga Nursing-home Unit; Primary Healthcare District; Andalusian Health Service; Málaga Spain
| | - Inmaculada Lupiáñez-Pérez
- Department of Nursing; Faculty of Health Sciences; University of Málaga; Málaga Spain
- Malaga-Guadalhorce Primary Healthcare District; Andalusian Health Service; Málaga Spain
| | | | | | - Marta Aranda-Gallardo
- Department of Nursing; Faculty of Health Sciences; University of Málaga; Málaga Spain
- Department of Nursing; Agencia Sanitaria Costa del Sol; Málaga Spain
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Enríquez de Luna-Rodríguez M, Aranda-Gallardo M, Canca-Sánchez JC, Vazquez-Blanco MJ, Moya-Suárez AB, Morales-Asencio JM. Cross-cultural adaptation of the STRATIFY tool in detecting and predicting risk of falling. Enferm Clin 2016; 27:101-105. [PMID: 27595459 DOI: 10.1016/j.enfcli.2016.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 11/18/2022]
Abstract
AIMS To adapt to Spanish language the STRATIFY tool for clinical use in the Spanish-speaking World. METHOD A multicenter, 2 care settings cross-sectional study cultural adaptation study in acute care hospitals and nursing homes was performed in Andalusia during 2014. The adaptation process was divided into 4 stages: translation, back-translation, equivalence between the 2 back-translations and piloting of the Spanish version, thus obtaining the final version. The validity of appearance, content validity and the time required to complete the scale were taken into account. For analysis, the median, central tendency and dispersion of scores, the interquartile range, and the interquartile deviation for the possible variability in responses it was calculated. RESULTS Content validity measured by content validity index reached a profit of 1. For the validity aspect the clarity and comprehensibility of the questions were taken into account. Of the 5 questions of the instrument, 2 had a small disagreement solved with the introduction of an explanatory phrase to achieve conceptual equivalence. Median both questions were equal or superior to 5. The average time for completion of the scale was less than 3 minutes. CONCLUSION The process of adaptation to Spanish of STRATIFY has led to a semantic version and culturally equivalent to the original for easy filling and understanding for use in the Spanish-speaking world.
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