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Collado-González B, Ferrero-García-Loygorri C, Escobar-Castellanos M, Barrera-Brito V, Salvador-Rodríguez M, Marañón R, Mora-Capín A. [Evolution of the perception of the safety culture of healthcare professionals in a pediatric emergency department]. J Healthc Qual Res 2024; 39:41-49. [PMID: 38123402 DOI: 10.1016/j.jhqr.2023.11.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/14/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND AIM Safety culture (SC) is a fundamental tool for minimizing adverse events and improving safety and quality of care. Our objective, therefore was to analyze the evolution of the SC of healthcare professionals in a pediatric emergency department (PED) after the implementation of a risk management system for patient safety based on the UNE:EN:ISO 179003 Standard and the execution of new safe practices for Joint Commission International accreditation. At the same time describe the current strengths and weaknesses. METHODS Quasi-experimental, single-center study. All PED professionals participated in the study. An initial measurement of SC was performed through the Hospital Survey on Patient Safety Culture (HSOPS) questionnaire of the Agency for Healthcare Research and Quality adapted to Spanish in 2014. Pro-patient safety strategies were implemented between 2015 and 2022. A subsequent measurement was performed in 2022. RESULTS The response rate in 2014 was 55% and 78% in 2022. On both occasions the group with the highest participation was nurses with 35.1% and 34.8%, respectively. Five dimensions improved after the interventions: frequency of adverse events (25.2%, p<0.001), organizational learning (25%, p<0.001), feedback and communication about errors (22.3%, p<0.001), non-punitive response to errors (6.5%, p = 0.176), and management support (4%, p = 0.333). CONCLUSIONS The actions carried out had a positive influence on organizational learning and the frequency of adverse events reported and communication within the team. In contrast, the perception of SC did not increase.
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Affiliation(s)
| | | | | | - V Barrera-Brito
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - R Marañón
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Mora-Capín
- Hospital General Universitario Gregorio Marañón, Madrid, España
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Mora-Capín A, Ignacio-Cerro C, Díaz-Redondo A, Vázquez-López P, Marañón-Pardillo R. Impact of risk mapping as a strategy for monitoring and improving patient safety in paediatric emergency care. An Pediatr (Barc) 2022; 97:229-236. [PMID: 36089491 DOI: 10.1016/j.anpede.2022.08.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE To design a risk map (RM) as a tool for identifying and managing risks in the paediatric emergency department and to assess the impact of the improvement actions developed based on the identified risks in terms of the level of risk to patient safety. METHODOLOGY A multidisciplinary working group reviewed the entire care process by applying the Failure Mode and Effects Analysis (FMEA) tool. Project phases: (1) RM 2017 and planning of improvement actions; (2) Development and implementation of improvement actions; (3) RM 2019; (4) Analysis: evolution of the RM and impact of improvement actions. RESULTS A total of 106 failure modes (FMs) were identified in the 2017 RM (54.7% high- or very high risk). We applied prioritization criteria to select the improvement actions to plan. Nineteen improvement actions were planned, with assigned responsible parties and deadlines, to address 46 priority FMs. One hundred percent were implemented. In the 2019 RM, we identified 110 FMs (48.2% high risk) and found an overall reduction of the risk level of 20%. Analysing the 46 priority FMs that had been addressed by the 19 planned improvement actions, we found that 60% had changed from high to medium risk level and that the risk level had decreased, both overall (-27.8%) and by process. CONCLUSION The FMEA is a useful tool to identify risks, analyse the impact of improvement strategies and monitor the risk level of a complex clinical care department. The improvement actions developed succeeded in reducing the level of risk in the processes in our unit, improving patient safety.
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Affiliation(s)
- Andrea Mora-Capín
- Sección de Urgencias Pediátricas, Hospital materno-infantil Gregorio Marañón, Instituto de Investigación Sanitaria GregorioMarañón, Madrid, Spain.
| | - Carmen Ignacio-Cerro
- Sección de Urgencias Pediátricas, Hospital materno-infantil Gregorio Marañón, Instituto de Investigación Sanitaria GregorioMarañón, Madrid, Spain
| | - Alicia Díaz-Redondo
- Servicio de Medicina Preventiva y Gestión de Calidad, Hospital materno-infantil Gregorio Marañón, Madrid, Spain
| | - Paula Vázquez-López
- Sección de Urgencias Pediátricas, Hospital materno-infantil Gregorio Marañón, Instituto de Investigación Sanitaria GregorioMarañón, Madrid, Spain
| | - Rafael Marañón-Pardillo
- Sección de Urgencias Pediátricas, Hospital materno-infantil Gregorio Marañón, Instituto de Investigación Sanitaria GregorioMarañón, Madrid, Spain
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Mora-Capín A, Lorente-Romero J, Hernanz-Lobo A, Rivas-García A, Vázquez-López P, Carrascosa-García P, González-Hermosa A, Mena-Huarte J, Pérez-Saez MA, Nadal G, García-de-Diego I, Marañón-Pardillo R. Risk Factors of Serious Bacterial Infection in Previously Healthy Children Older Than 90 Days Old With Fever and Neutropenia. Pediatr Emerg Care 2022; 38:e1378-e1383. [PMID: 35766931 DOI: 10.1097/pec.0000000000002758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The main objective was to determine the clinical or analytical factors that independently predict risk of serious bacterial infection (RSBI) in immunocompetent patients older than 90 days given a diagnosis of fever and for whom neutropenia was an incidental finding. The secondary objective was to describe the prevalence of serious bacterial infections (SBIs). METHODS This is a 3-year-long, multicenter, prospective analytical and observational study carried out at 6 pediatric emergency departments. Data for epidemiological, clinical, and analytical variables were collected. RESULTS One hundred forty patients with febrile neutropenia (60.7% mild, 39.3% moderate to severe) were recruited. Serious bacterial infection incidence was 15.0% (95% confidence interval [CI], 9-21): 1 Invasive Bacterial Infection (Staphylococcus epidermidis bacteremia), 10 urinary tract infections, 8 pneumonias, and 2 cellulitis. Median total neutrophil counts per microliter showed no statistically significant differences (P = 0.512; 1000 [750-1200] in SBI patients vs 1100 [800-1300] in non-SBI patients). Higher RSBI was observed in patients with neutrophils less than 20% relative to total leukocytes (SBI, 15, 26.3%) than in those with neutrophils of 20% or greater (SBI, 6, 7.2%) (odds ratio, 4.6; 95% CI, 1.7-12.7). In patients with greater than 5000 leukocytes/μL, a percentage of neutrophils less than 20% was related to a greater RSBI with a trend toward statistical significance (odds ratio, 6.1; 95% CI, 0.7-51.1; P = 0.066). The clinical variables did not show a significant association with RSBI. CONCLUSIONS None of the clinical or analytical variables assessed were associated with the RSBI. However, according to a post hoc analysis, in patients with greater than 5000 leukocytes/μL, a neutrophil percentage less than 20% could be an independent risk factor for SBI. A thorough physical examination and basic diagnostic tests (urinalysis and chest x-ray) may help to establish a diagnosis of SBI in the vast majority of cases.
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Affiliation(s)
- Andrea Mora-Capín
- From the Hospital Gregorio Marañón, IisGM (Health Research Institute Gregorio Marañón), Madrid
| | - Jorge Lorente-Romero
- From the Hospital Gregorio Marañón, IisGM (Health Research Institute Gregorio Marañón), Madrid
| | - Alicia Hernanz-Lobo
- From the Hospital Gregorio Marañón, IisGM (Health Research Institute Gregorio Marañón), Madrid
| | - Arístides Rivas-García
- From the Hospital Gregorio Marañón, IisGM (Health Research Institute Gregorio Marañón), Madrid
| | - Paula Vázquez-López
- From the Hospital Gregorio Marañón, IisGM (Health Research Institute Gregorio Marañón), Madrid
| | - Paula Carrascosa-García
- From the Hospital Gregorio Marañón, IisGM (Health Research Institute Gregorio Marañón), Madrid
| | | | | | | | | | | | - Rafael Marañón-Pardillo
- From the Hospital Gregorio Marañón, IisGM (Health Research Institute Gregorio Marañón), Madrid
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Mora-Capín A, López-López R, Guibert-Zafra B, de Ceano-Vivas La Calle M, Porto-Abad R, Molina-Cabañero JC, Gilabert-Iriondo N, Ferrero-García-Loygorri C, Montero-Valladares C, García-Herrero MÁ. Recommendation document on rapid intravenous rehydration in acute gastroenteritis. An Pediatr (Barc) 2022; 96:523-535. [PMID: 35624005 DOI: 10.1016/j.anpede.2021.04.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/30/2021] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION The efficacy and safety of the Rapid Intravenous Rehydration (RIR) guidelines in children affected by dehydration secondary to acute gastroenteritis is supported by current scientific evidence, but there is also great variability in its use in clinical practice. OBJECTIVE To prepare a document with evidence-based recommendations about RIR in paediatric population. METHODS The project was developed based on GRADE methodology, according to the following work schedule: Working Group training; creation of a catalogue of questions about research and definition of "relevant outcomes"; score and selection criteria for each item; bibliographic review; scientific evidence evaluation and synthesis (GRADE); review, discussion and creation of recommendations. 10 clinical questions and 15 relevant outcomes were created (7 about efficacy and 8 about security). RESULTS 16 recommendations were set up, from which we can highlight as the main ones: 1) RIR is safe for children affected by mild-moderate dehydration secondary to acute gastroenteritis, unless expressly contraindicated or acute severe comorbidity (strong recommendation, moderate evidence). 2) Its use is recommended in this situation when oral rehydration has failed or due to contraindication (strong, high). 3) Isotonic fluids are recommended (strong, high), suggesting saline fluid as the first option (light, low), supplemented by glucose (2.5%) in those patients showing normoglycemia and ketosis (strong, moderate). 4) A rhythm of 20cc/kg/h is recommended (strong, high) during 1-4 h (strong, moderate). CONCLUSIONS This document establishes consensus recommendations, based on the available scientific evidence, which could contribute to the standardisation of the use of RIR in our setting.
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Affiliation(s)
- Andrea Mora-Capín
- Urgencias Pediátricas, Hospital materno-infantil Gregorio Marañón, Madrid, Spain.
| | | | - Belén Guibert-Zafra
- Urgencias Pediátricas, Hospital Universitario General de Alicante, Alicante, Spain
| | | | - Raquel Porto-Abad
- Urgencias Pediátricas, Hospital Universitario Puerta de Hierro, Madrid, Spain
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Mora-Capín A, Ignacio-Cerro C, Díaz-Redondo A, Vázquez-López P, Marañón-Pardillo R. Impacto del mapa de riesgos como estrategia de monitorización y mejora de seguridad del paciente en urgencias. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.03.001] [Citation(s) in RCA: 2] [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] [Indexed: 11/29/2022] Open
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Mora-Capín A, López-López R, Guibert-Zafra B, de Ceano-Vivas La Calle M, Porto-Abad R, Molina-Cabañero JC, Gilabert-Iriondo N, Ferrero-García-Loygorri C, Montero-Valladares C, García-Herrero MÁ. [Recommendation document on rapid intravenous rehydration in acute gastroenteritis]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00190-9. [PMID: 34167904 DOI: 10.1016/j.anpedi.2021.04.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The efficacy and safety of the rapid intravenous rehydration (RIR) guidelines in children affected by dehydration secondary to acute gastroenteritis is supported by current scientific evidence, but there is also great variability in its use in clinical practice. OBJECTIVE To prepare a document with evidence-based recommendations about RIR in paediatric population. METHODS The project was developed based on GRADE methodology, according to the following work schedule: Working Group training; creation of a catalogue of questions about research and definition of «relevant outcomes»; score and selection criteria for each item; bibliographic review; scientific evidence evaluation and synthesis (GRADE); review, discussion and creation of recommendations. 10 clinical questions and 15 relevant outcomes were created (7 about efficacy and 8 about security). RESULTS Sixteen recommendations were set up, from which we can highlight as the main ones: (1) RIR is safe for children affected by mild-moderate dehydration secondary to acute gastroenteritis, unless expressly contraindicated or acute severe comorbidity (strong recommendation and moderate evidence). (2) Its use is recommended in this situation when oral rehydration has failed or due to contraindication (strong and high). (3) Isotonic fluids are recommended (strong and high), suggesting saline fluid as the first option (light and low), supplemented by glucose (2.5%) in those patients showing normoglycemia and ketosis (strong and moderate). (4) A rhythm of 20 cc/kg/h is recommended (strong and high) during 1-4 h (strong and moderate). CONCLUSIONS This document establishes consensus recommendations, based on the available scientific evidence, which could contribute to the standardisation of the use of RIR in our setting.
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Affiliation(s)
- Andrea Mora-Capín
- Urgencias Pediátricas, Hospital materno-infantil Gregorio Marañón, Madrid, España.
| | | | - Belén Guibert-Zafra
- Urgencias Pediátricas, Hospital Universitario General de Alicante, Alicante, España
| | | | - Raquel Porto-Abad
- Urgencias Pediátricas, Hospital Universitario Puerta de Hierro, Madrid, España
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García-Moreno FJ, Escobar-Castellanos M, Marañón R, Rivas-García A, Manrique-Rodríguez S, Mora-Capín A, Fernández-Llamazares CM. [Adecuacy of pediatric antimicrobial prescribing in the Emergency Department at discharge]. An Pediatr (Barc) 2021; 96:S1695-4033(20)30507-5. [PMID: 33583763 DOI: 10.1016/j.anpedi.2020.11.019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION In January 2019, Community of Madrid's Health Department published a guide about the use of antimicrobials in outpatient children. Taking this regional Guide as reference, this study was aimed at estimating the adequacy of the antimicrobial stewardship at discharge from a pediatric Emergency Department (ED). Secondarily, the differences in adequacy according to the diagnosis and the prescriber were studied, and the agreement between this Guide and the protocols of the ED was assessed. MATERIAL AND METHODS An observational, descriptive, retrospective study was conducted on patients under 16 years old, with a diagnosis included in the regional Guide who were discharged from a pediatric ED between March of 2018 and February of 2019. Prescription was considered adequate when the indication, the antibiotic and the posology (dosage, dosing interval, length of treatment and route of administration) were correct. RESULTS 165 out of 648 (25,5%) infectious diseases processes analyzed received antimicrobial treatment. In 23 processes treated with antimicrobial, the adequacy could not be evaluated due to the absence of data necessary to assess any aspect of posology. Therapy was considered appropriate in 550/625 processes (88.0%). When antimicrobial treatment was prescribed, 70/142 (49.3%) were appropriate and no statistically significant differences in adequacy were found between prescribers. Posology was the worst handled point of the prescription (26.3%). Tract urinary infection, conjunctivitis and otitis media were the pathologies with the lowest adecuacy (44.4%; 50.0% and 52.2%) and presented the highest discrepancy between the Guide and the center protocols (k=0.308; k=0.000; k=0.586). CONCLUSIONS The adequacy of the management of infectious processes to the reference Guide in our pediatric ED was high, but it was below 50% when antimicrobial treatment was required. The degree of adequacy to the local protocols of the center was greater than to the regional Guide. This reveals a discrepancy between the 2documents that should be analyzed and corrected according to the available scientific evidence.
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Affiliation(s)
- Félix Jesús García-Moreno
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | | | - Rafael Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España; Sección de Urgencias de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Arístides Rivas-García
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España; Sección de Urgencias de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Silvia Manrique-Rodríguez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España; RETIC SAMID Carlos III (RD16/0022/0004), Madrid, España
| | - Andrea Mora-Capín
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España; Sección de Urgencias de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Cecilia M Fernández-Llamazares
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España; RETIC SAMID Carlos III (RD16/0022/0004), Madrid, España
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Castro-Rodríguez C, Solís-García G, Mora-Capín A, Díaz-Redondo A, Jové-Blanco A, Lorente-Romero J, Vázquez-López P, Marañón R. Briefings: A Tool to Improve Safety Culture in a Pediatric Emergency Room. Jt Comm J Qual Patient Saf 2020; 46:617-622. [DOI: 10.1016/j.jcjq.2020.08.004] [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: 05/09/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
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