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Román-Gálvez RM, Gámiz-González F, Matas-Matas FR, Rivas-Arquillo MM, Cobos-Vargas A, Bueno-Cavanillas A. [Ethics of care: Assessment of the ethical issues in the protocols or consensuses on mechanical restraint in force in Spain]. J Healthc Qual Res 2024; 39:188-194. [PMID: 38614936 DOI: 10.1016/j.jhqr.2024.02.006] [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: 05/17/2023] [Revised: 11/28/2023] [Accepted: 02/28/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION Mechanical restraints are widely used in health care practice, despite the numerous ethical conflicts they raise. The aim of this study is to evaluate the ethical considerations contemplated in the current protocols on mechanical restraint in Spain. METHOD Systematic review in PubMed, WOS and Scopus, Google and Google Scholar. An ad hoc list of 30 items was used to evaluate the ethical content of the protocols. The quality of guidelines was assessed with AGREE II. RESULTS The need for informed consent (IC) is reflected in 72% of the documents, the IC model sheet is included in only 41% of them, the rest of the analyzed characteristics on IC are fulfilled in percentages between 6% (the document includes the need to reevaluate the indication for IC) and 31% (the document contemplates to whom it should be requested). More than 20 ethical contents are reflected in 31% of them and less than 10 in 19% of the guidelines. The quality of the guides, according to AGREE II, ranged from 27 to 116 points (maximum possible 161), with a mean score of 68.7. Only 9% of the documents were classified as high quality. Finally, the correlation between ethical content and quality measured with AGREE II was 0.75. CONCLUSIONS The variability of ethical contents in guidelines on mechanical restraints is very high. The ethical requirements to be included in protocols, consensus or Clinical Practice Guidelines should be defined.
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Affiliation(s)
- R M Román-Gálvez
- Unidad Asistencial de Alhama de Granada, Granada, España; Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, España.
| | | | | | - M M Rivas-Arquillo
- Unidad de Protección de la Salud, Centro de Salud Albayda, Granada, España
| | - A Cobos-Vargas
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, España
| | - A Bueno-Cavanillas
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Granada, Granada, España; Instituto de Investigación Biosanitaria de Granada IBS, Granada, España; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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2
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Barea Mendoza JA, Valiente Fernandez M, Pardo Fernandez A, Gómez Álvarez J. Current perspectives on the use of artificial intelligence in critical patient safety. Med Intensiva 2024:S2173-5727(24)00080-8. [PMID: 38677902 DOI: 10.1016/j.medine.2024.04.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/11/2024] [Indexed: 04/29/2024]
Abstract
Intensive Care Units (ICUs) have undergone enhancements in patient safety, and artificial intelligence (AI) emerges as a disruptive technology offering novel opportunities. While the published evidence is limited and presents methodological issues, certain areas show promise, such as decision support systems, detection of adverse events, and prescription error identification. The application of AI in safety may pursue predictive or diagnostic objectives. Implementing AI-based systems necessitates procedures to ensure secure assistance, addressing challenges including trust in such systems, biases, data quality, scalability, and ethical and confidentiality considerations. The development and application of AI demand thorough testing, encompassing retrospective data assessments, real-time validation with prospective cohorts, and efficacy demonstration in clinical trials. Algorithmic transparency and explainability are essential, with active involvement of clinical professionals being crucial in the implementation process.
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Affiliation(s)
- Jesús Abelardo Barea Mendoza
- UCI de Trauma y Emergencias. Servicio de Medicina Intensiva. Hospital Universitario 12 de Octubre. Instituto de Investigación Hospital 12 de Octubre, Spain.
| | - Marcos Valiente Fernandez
- UCI de Trauma y Emergencias. Servicio de Medicina Intensiva. Hospital Universitario 12 de Octubre. Instituto de Investigación Hospital 12 de Octubre, Spain
| | | | - Josep Gómez Álvarez
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira i Virgili. Institut d'Investigació Sanitària Pere i Virgili, Tarragona, Spain
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Juarez-Sanchez A, Heras Hernando V, Brunete Jimenez T, Molina Mendoza CR, Arnal Velasco D, Fernández Téllez L. How a single perioperative delirium case can make the difference. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00064-7. [PMID: 38615714 DOI: 10.1016/j.redare.2024.04.003] [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] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/16/2024] [Indexed: 04/16/2024]
Abstract
This report describes how postoperative delirium in an elderly man during COVID-19 pandemic led to a serious event involving a central venous catheter. Delirium is a common cause of perioperative morbidity and mortality, and is characterised by an alteration in consciousness and perception and a reduced ability to focus, sustain or shift attention. The event was analysed by a multidisciplinary committee which developed a risk stratification delirium protocol in order to prevent similar events in the future.
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Affiliation(s)
- A Juarez-Sanchez
- Servicio de Anestesia, Reanimación y Terapéutica del Dolor, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), Spain.
| | - V Heras Hernando
- Servicio de Anestesia, Reanimación y Terapéutica del Dolor, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), Spain
| | - T Brunete Jimenez
- Servicio de Anestesia, Reanimación y Terapéutica del Dolor, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), Spain
| | - C R Molina Mendoza
- Servicio de Anestesia, Reanimación y Terapéutica del Dolor, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), Spain
| | - D Arnal Velasco
- Servicio de Anestesia, Reanimación y Terapéutica del Dolor, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), Spain
| | - L Fernández Téllez
- Servicio de Anestesia, Reanimación y Terapéutica del Dolor, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), Spain
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Rodriguez-Ruiz E, van Mol MMC, Latour JM, Fuest K. Caring to care: Nurturing ICU healthcare professionals' wellbeing for enhanced patient safety. Med Intensiva 2024:S2173-5727(24)00061-4. [PMID: 38594110 DOI: 10.1016/j.medine.2024.03.008] [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: 12/15/2023] [Accepted: 02/28/2024] [Indexed: 04/11/2024]
Abstract
Healthcare professionals working in the Intensive Care Unit (ICU) care for patients suffering from a critical illness and their relatives. Working within a team of people with different personalities, competencies, and specialties, with constraints and demands might contribute to a working environment that is prone to conflicts and disagreements. This highlights that the ICU is a stressful place that can threaten healthcare professionals' wellbeing. This article aims to address the concept of wellbeing by describing how the stressful ICU work-environment threatens the wellbeing of health professionals and discussing how this situation jeopardizes patient safety. To promote wellbeing, it is imperative to explore actionable interventions such as improve communication skills, educational sessions on stress management, or mindfulness. Promoting ICU healthcare professionals' wellbeing through evidence-based strategies will not only increase their personal resilience but might contribute to a safer and more efficient patient care.
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Affiliation(s)
- Emilio Rodriguez-Ruiz
- Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain; Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | | | - Joseph Maria Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK; Curtin School of Nursing, Curtin University, Perth, Australia; Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kristina Fuest
- Technical University of Munich, School of Medicine, Department of Anesthesiology and Intensive Care Medicine, Ismaninger Str. 22, 81675 Munich, Germany
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Gómez-Costas D, Romero-Jiménez RM, Lobato-Matilla ME, Culebras R, González JA, Herrero-Bermejo S, Herranz-Alonso AM, Sanjurjo M. Detection and reduction of errors in parenteral nutrition compounding through gravimetric and product control. Farm Hosp 2024:S1130-6343(24)00035-7. [PMID: 38531754 DOI: 10.1016/j.farma.2024.02.014] [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: 09/18/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE To analyze the errors in the preparation of parenteral nutrition in a Pharmacy Service, detected through an already consolidated gravimetric and product quality control, and compare them with those detected during the initial years of implementing this quality control. METHODS All errors detected through quality control in the compounding of pediatric and adult parenteral nutrition between 2019 and 2021 were prospectively analyzed. This quality control consisted of 3 sequential processes: a visual check, a gravimetric control, and a product control. Errors were classified as gravimetric, when the nutrition had a deviation of more than 5% from the theoretical weight, or as product errors when a qualitative or quantitative error was detected upon reviewing the remainder of the components used. These errors were analyzed in terms of type and the component involved. A comparison was made with the errors detected during the implementation phase of this quality control from 2016 to 2018. RESULTS A total of 41,809 parenteral nutritions were reviewed, and 345 errors were detected (0.83% of the preparations); of these, 59 errors were found in pediatric nutritions (0.68% of them), and 286 in adult nutritions (0.86% of them). Among these errors, 193 were of gravimetric nature, while 152 were detected through product control. The main components involved in product errors were electrolytes, primarily due to the addition of excessive volumes and the use of incorrect components. A significant absolute reduction of 0.71% (p < 0.05) in the total number of errors was observed when compared to the implementation phase. This reduction was consistent in both gravimetric errors (-0.59%) and product-related errors (-0.12%) (p < 0.05). CONCLUSIONS Comprehensive quality control of parenteral nutrition preparation is an easily implementable tool that effectively detected and prevented significant errors. Furthermore, its widespread adoption contributed to a reduction in the overall error count.
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Affiliation(s)
- Daniel Gómez-Costas
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | | | | | - Raquel Culebras
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | | | | | - María Sanjurjo
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España
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de Andrade FK, Ignacio Nunes RP, Barboza Zanetti MO, Barboza Zanetti AC, Dos Santos M, de Oliveira AM, Carson-Stevens A, Leira Pereira LR, Rossi Varallo F. Validated medication deprescribing instruments for patients with palliative care needs palliative care: A systematic review. Farm Hosp 2024; 48:T83-T89. [PMID: 38016841 DOI: 10.1016/j.farma.2023.08.010] [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: 01/19/2023] [Accepted: 08/01/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. METHODS A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by two independent researchers. Experimental and observational studies were eligible for inclusion. RESULTS Out of the 5,791 studies retrieved, after excluding duplicates (n = 1,050), conducting title/abstract screening (n = 4,741), and full reading (n = 41), only one study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to two groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. CONCLUSIONS Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only one of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.
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Affiliation(s)
- Frangie Kallas de Andrade
- Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil
| | | | | | | | - Márcia Dos Santos
- Biblioteca Central, Universidad de São Paulo (USP), Ribeirão Preto, São Paulo, Brasil
| | - Alan Maicon de Oliveira
- Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil.
| | - Andrew Carson-Stevens
- Centro PRIME de Gales, División de Medicina de la Población, Facultad de Medicina, Universidad de Cardiff, Cardiff, Reino Unido
| | | | - Fabiana Rossi Varallo
- Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil
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Urbano Gonzalo O, Marco Gómez B, Pérez Álvarez C, Gállego Royo A, Sebastián Sánchez I, Astier Peña MP. Why do physicians go to work when they are sick? Presenteeism at different career stages. J Healthc Qual Res 2024; 39:100-108. [PMID: 38402092 DOI: 10.1016/j.jhqr.2024.01.004] [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: 10/11/2023] [Revised: 01/02/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION AND OBJECTIVE Physicians find it difficult to take on the role of the patient and they show unusual behaviors when ill. One of these behaviors is presenteeism, which is working while sick. The objective of this research is to analyze the factors that contribute to the phenomenon of presenteeism in Spanish physicians. MATERIAL AND METHODS Mixed methodology study: one national survey through the General Council of Medical Associations website (quantitative part), 22 semistructured interviews with sick residents and practicing physicians, and three focus groups involving professionals from the occupational health services (qualitative). A bivariate analysis using parametric and non-parametric tests. The significance level was p<0.05 (95% confidence interval). Qualitative analysis using the comparative-constant method until saturation of information. RESULTS Presenteeism is reported by 89.4% of doctors who responded to the survey, and it is more common among women. Contributing factors include fear of overburdening colleagues (the main reason and more common among women 58.14% vs 48.35%), self-perception of doing one's duty (the second reason and more common among men, 44.63% vs 33.14%) and economic impact and difficulty in accepting the role of a sick person. This behavior has an impact on patient safety, and is part of the hidden curriculum that also affects the training of medical professionals. CONCLUSIONS Presenteeism is a widespread and accepted practice among medical professionals. Although normalized, and even appreciated as a way to avoid overburdening colleagues, presenteeism has important implications for clinical ethics and patient safety.
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Affiliation(s)
- O Urbano Gonzalo
- Department of Anaesthesiology and Resuscitation "Miguel Servet" Hospital, Health Service of Aragón, Zaragoza, Spain; "University of Zaragoza", Spain; Feminisation and Ethics in the Health Professions (FEPS) Research Group, H36_23D, Institute of Health Research of Aragón (IIS Aragón), Spain
| | - B Marco Gómez
- Department of Psychiatry "Royo Villanova" Hospital, Health Service of Aragón, Zaragoza, Spain; "University of Zaragoza", Spain; Feminisation and Ethics in the Health Professions (FEPS) Research Group, H36_23D, Institute of Health Research of Aragón (IIS Aragón), Spain
| | - C Pérez Álvarez
- Department of Psychiatry "Royo Villanova" Hospital, Health Service of Aragón, Zaragoza, Spain; "University of Zaragoza", Spain; Feminisation and Ethics in the Health Professions (FEPS) Research Group, H36_23D, Institute of Health Research of Aragón (IIS Aragón), Spain
| | - A Gállego Royo
- Department of Preventive Medicine "Miguel Servet" Hospital, Health Service of Aragón, Zaragoza, Spain; "University of Zaragoza", Spain; Feminisation and Ethics in the Health Professions (FEPS) Research Group, H36_23D, Institute of Health Research of Aragón (IIS Aragón), Spain.
| | - I Sebastián Sánchez
- "Universitas" Primary Health Care Centre, Health Service of Aragón, Zaragoza, Spain; "University of Zaragoza", Spain; Feminisation and Ethics in the Health Professions (FEPS) Research Group, H36_23D, Institute of Health Research of Aragón (IIS Aragón), Spain
| | - M P Astier Peña
- "Universitas" Primary Health Care Centre, Health Service of Aragón, Zaragoza, Spain; "University of Zaragoza", Spain; Feminisation and Ethics in the Health Professions (FEPS) Research Group, H36_23D, Institute of Health Research of Aragón (IIS Aragón), Spain
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Salgado-Garcia C, Moreno-Ballesteros A, Guardia-Jimena P, Sanchez-de-Mora E, Rebollo-Aguirre AC, Ramirez-Navarro A, Santos-Bueno A, Jimenez-Heffernan A. Role of the clinical radiopharmacist in patient safety during myocardial perfusion imaging with vasodilator stress agents. Rev Esp Med Nucl Imagen Mol 2024; 43:84-90. [PMID: 38184070 DOI: 10.1016/j.remnie.2023.12.005] [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: 08/08/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 01/08/2024]
Abstract
AIM To assess the radiopharmacist's role in a multidisciplinary team focused on the contraindications of regadenoson in order to ensure the safe use of pharmacologic vasodilator stress agents in patients undergoing SPECT-MPI. METHODS We ambispectively studied its safe use in 1905 patients (54.1% female, mean age: 66.6±11.7 years, range: 20-95 years). Sex, age, medical history, medications, drug allergies, and contraindications for stress testing were registered together with recommendations for the nuclear physician in charge. RESULTS Detected contraindications and corresponding recommendations were as follows: risk factors for QTc interval prolongation 7.5% - measurement of QTc interval previously to test and monitor ECG; prior stroke or TIA 4.2% - consider carotid stenosis assessment; salicylates/sulfonamides allergy 3.1% - use 99mTc-sestamibi; epilepsy or risk factors for seizures 2.4% - use of adenosine or reconsider test indication; systemic corticosteroid therapy for severe COPD 1.3% - reassessment of patient's condition; acute exacerbation of COPD 0.8% - defer test until acute episode is over; severe asthma 0.4% - do not perform test; methylxanthine ingestion 0.3% - avoid consumption previously; other 6.1% - evaluation of other contraindications. No contraindications were detected in 73.6% of patients. The test was canceled due to absolute contraindications in 2.9% of the requests. CONCLUSIONS Working in a systematic way, the radiopharmacist was able to detect a high number of issues related to regadenoson, with one out of four patients presenting some clinical contraindication. The recommendations given by the radiopharmacist were well accepted by the nuclear physicians who changed their approach contributing to increase the safety of patients referred for MPI.
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Affiliation(s)
- C Salgado-Garcia
- Radiopharmacy Unit (Department of Nuclear Medicine), Hospital Juan Ramon Jimenez, Huelva, Spain.
| | | | - P Guardia-Jimena
- Department of Nuclear Medicine, Hospital Juan Ramon Jimenez, Huelva, Spain
| | - E Sanchez-de-Mora
- Department of Nuclear Medicine, Hospital Juan Ramon Jimenez, Huelva, Spain
| | | | - A Ramirez-Navarro
- Radiopharmacy Unit (Department of Nuclear Medicine), Hospital Virgen de las Nieves, Granada, Spain
| | - A Santos-Bueno
- Department of Nuclear Medicine, Hospital Juan Ramon Jimenez, Huelva, Spain
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Crespo-Mirasol E, Llupià-García A, Bellart-Alfonso J, Peguero-Yus A, Figueras-Retuerta F, Hernández-Aguado AS. Impact of the implementation of a standardised interdisciplinary information transfer method in the delivery room and intermediate obstetric care unit. Enferm Intensiva (Engl Ed) 2024; 35:5-12. [PMID: 37598084 DOI: 10.1016/j.enfie.2023.07.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/21/2023] [Accepted: 04/10/2023] [Indexed: 08/21/2023]
Abstract
AIM This study aims to describe the implementation of the standard methodology for information transfer in the labour ward and Intermediate Obstetric Care Unit and to identify the impact of this implementation on the factors that act as facilitators and barriers in the procedure. METHOD Quasi-experimental pretest-posttest study without a control group in an Intermediate Obstetric Care Unit and delivery room of the Maternal-Fetal Medicine Service of a tertiary hospital in Barcelona. Healthcare staff self-completed an ad hoc questionnaire before and after implementing the standardised IDEAS methodology in the service during 2019 and 2020. Personal self-perception in the information transfer procedure was assessed. The Wilcoxon pairwise test was used for comparison before and after. RESULTS The use of a standardised methodology has shown an impact on improving the transmission of information. Significant differences were detected before and after the intervention in the following dimensions: location, people involved, time period of the procedure, structured, orderly and clear, and sufficient time for questions (p < 0.001); while no differences were observed in: transmission to the referring professional, well-defined actions, and completion of a summary. CONCLUSIONS There are factors such as structural and organisational aspects and lack of time that hinder effective communication and therefore act as barriers to the transfer of information. The implementation of a methodology with the health professionals involved, the time and the appropriate space allows for the improvement of communication aspects in the multiprofessional team and, therefore, patient safety.
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Affiliation(s)
- E Crespo-Mirasol
- Servicio de Medicina Maternofetal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Departament d'Infermeria de Salut Pública, Salut Mental i Maternoinfantil, Escola d'Infermeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Campus Bellvitge, Pavelló de Govern, Feixa Llarga, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - A Llupià-García
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic, Instituto de Salud Global de Barcelona (ISGlobal), Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - J Bellart-Alfonso
- Servicio de Medicina Maternofetal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - A Peguero-Yus
- Servicio de Medicina Maternofetal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - F Figueras-Retuerta
- Servicio de Medicina Maternofetal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - A S Hernández-Aguado
- Servicio de Medicina Maternofetal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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Brotons A, Mangas-Sanjuan C, Cubiella J, Cid-Gómez L, Díez-Redondo P, Seoane A, García-Mateo S, Suárez A, Nicolás-Pérez D, Lumbreras B, Mira JJ, Sola-Vera J, Jover R. Colonoscopy Satisfaction and Safety Questionnaire based on patient experience (CSSQP): A valuable quality tool for all colonoscopies. Gastroenterol Hepatol 2024; 47:1-13. [PMID: 36841528 DOI: 10.1016/j.gastrohep.2023.02.003] [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: 09/22/2022] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION The Colonoscopy Satisfaction and Safety Questionnaire based on Patient experience (CSSQP) was recently developed and validated within a Bowel Cancer Screening Program. We aimed to identify factor related to patient experience through the CSSQP, including all indications for colonoscopy. Indicators of satisfaction and perceived safety with colonoscopy were also assessed to compare the different centers. METHODS Multicenter study in nine Spanish hospitals. Consecutive patients who had undergone a colonoscopy completed the CSSQP adding a novel item on bowel preparation. Factors related to patient experiences and data from non-respondents were analyzed. RESULTS Of 2200 patients, 1753 filled out the questionnaire (response rate 79.7%, sample error 2%). Patients whose colonoscopy indication was a primary colorectal cancer screening (OR: 1.68, 95% CI: 1.15-2.44, p=0.007) or due to a +FIT (OR: 1.73, 95% CI: 1.18-2.53) reported higher satisfaction than patients with gastrointestinal symptoms. In addition, college-educated patients (OR: 2.11, 95% CI: 1.25-3.56) were more likely to report better overall satisfaction than patients with lower education level. Significant differences were observed in the majority of the CSSQP items between centers. Safety incidents were reported by 35 (2%) patients, and 176 (10%) patients reported that they received insufficient information. CONCLUSION The CSSQP identifies several significant factors on satisfaction and perceived safety in patients referred for colonoscopy for any reason. The CSSQP also allows comparison of patient-identified colonoscopy quality indicators between centers.
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Affiliation(s)
- Alicia Brotons
- Department of Gastroenterology, Hospital General Universitario de Elche, Elche, Spain; Department of Gastroenterology, Vega Baja Hospital of Orihuela, Spain.
| | - Carolina Mangas-Sanjuan
- Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Joaquín Cubiella
- Department of Gastroenterology, Complexo Hospitalario de Ourense, Instituto de Investigación Sanitaria Galicia Sur, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Ourense, Spain
| | - Lucía Cid-Gómez
- Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica, Xerencia Integrada de Vigo, Vigo, Spain
| | | | - Agustín Seoane
- Department of Gastroenterology, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
| | - Sandra García-Mateo
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Aragon Health Research Institute, Zaragoza, Spain
| | - Adolfo Suárez
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - David Nicolás-Pérez
- Department of Gastroenterology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Blanca Lumbreras
- Department of Public Health, Miguel Hernández University, Elche, Spain; CIBERESP, CIBER in Epidemiology and Public Health, Spain
| | - José Joaquín Mira
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - Javier Sola-Vera
- Department of Gastroenterology, Hospital General Universitario de Elche, Elche, Spain
| | - Rodrigo Jover
- Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
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11
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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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de Lorenzo-Pinto A, Redondo-Galán C, García-González X, Fernández-Álvarez C, Andueza-Lillo J, Sanjurjo-Sáez M. Presence of metallic components in transdermal drug delivery systems and risk of skin burns. Farm Hosp 2023:S1130-6343(23)00926-1. [PMID: 38057241 DOI: 10.1016/j.farma.2023.11.003] [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: 07/12/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE Skin burns are associated with the presence of metallic components in transdermal drug delivery systems during Magnetic Resonance Imaging, cardioversion, or defibrillation procedures. The aim of the study was to review the presence of metallic components in marketed products of transdermal drug delivery systems in Spain. METHOD For each pharmaceutical form, the summary of product characteristics was reviewed. If the information was not provided, manufacturers were contacted. RESULTS We identified 59 marketed products of transdermal drug delivery systems of 12 different active substances. 59.3% of patches contained metallic components or their presence could not be ruled out. Information regarding the need to remove the patch was only included in 8 summaries of product characteristics (13.6%) A table was elaborated and included the following aspects: product, active substance, manufacturer, need to remove the patch before the exposure to magnetic or electric fields, and references. CONCLUSION More than a half of the patches at the time of the study contained metals or their absence could not be confirmed by the manufacturer. However, this information was only included in 13.6% of summaries of product characteristics.
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Affiliation(s)
- Ana de Lorenzo-Pinto
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Carmen Redondo-Galán
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Juan Andueza-Lillo
- Servicio de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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13
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Garzón González G, Parra Ramírez LM. [Validation of a questionnaire to assess patient safety culture in healthcare managers: Psychometric properties and usability]. J Healthc Qual Res 2023; 38:354-365. [PMID: 37891095 DOI: 10.1016/j.jhqr.2023.09.004] [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: 06/25/2023] [Revised: 08/07/2023] [Accepted: 09/07/2023] [Indexed: 10/29/2023]
Abstract
AIM To validate a reduced and applicable to distinct location version of the only validated questionnaire of patient safety culture in managers in Spanish language. METHOD Questionnaire validation study. Community of Madrid 2022. Reduction/adaptation of the original questionnaire: Giménez-Aibar-Gutiérrez, 2013 Questionnaire was reduced from 85 items to 25; those local or not applicable were removed. Pre-test: Semi-structured survey on comprehension and response scale. There was no need to modify the questionnaire. VALIDATION It was tested in 39 primary care managers without care activity. Internal consistency (α Cronbach), content validity (experts) and construct validity (factor analysis) were analysed. Usability analysis: Survey on time spent and non-response rate. RESULTS α Cronbach=0.894. Content validity: Experts deemed questionnaire was complete. Factor analysis: five factors explain 68% of variance. The factors corresponded to the dimensions of the theoretical construct. Factors, internal consistency of each and correlation with global score were: commitment with patient safety: α Cronbach=0.793, r=0.778; P<.001; procedures/reporting: α Cronbach=0.83, r=0.806; P<.001; attitudes with patient safety: α Cronbach=0.766, r=0.596; P<.001; clinicians involving: α Cronbach=0.773, r=0.798; P<.001; patient safety communication: α Cronbach=0.615, r=0.518; P=.001; usability survey: 95% thought spent time was adequate. Non-response rate was 0%, except one item. CONCLUSION In this work, a reduced and adapted version of questionnaire of Giménez-Aibar-Gutiérrez was validated at distinct location (Madrid region). Psychometric properties and usability, which were found, suggest that the reduced questionnaire is a reliable, valid and usable instrument to assess patient safety culture in managers of any place.
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Affiliation(s)
- G Garzón González
- Unidad de Calidad y Seguridad del Paciente, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España.
| | - L M Parra Ramírez
- Unidad de Calidad y Seguridad del Paciente, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España
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González-González A, Redondo-González O, Domínguez-Osorio I, Quero Palomino V, León Velasco M, Polo Montes F. [Professional and psychological impact of second victims among hospital healthcare professionals]. J Healthc Qual Res 2023; 38:329-337. [PMID: 37422405 DOI: 10.1016/j.jhqr.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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/29/2023] [Accepted: 06/07/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To analyze the occupational and psychological consequences suffered by healthcare workers who are considered second victims (SV). MATERIAL AND METHODS Observational, descriptive and cross-sectional study among the healthcare workers of a university hospital. The answers collected in a specifically designed questionnaire about psychological consequences at work and the result of a post-traumatic stress scale, "Impact of Event Scale-Revised (IES-R, spanish version)" were evaluated. The variables between the groups were compared using the Chi square test (or Fisher's exact test) when both were qualitative and with the Student's T (or the Mann-Whitney U test for independent data), when one of them was quantitative. The level of statistical significance was P<.05. RESULTS 75.5% (148/207) of the participants in the study suffered some adverse event (AE) and, of these, 88.5% (131/148) were considered SV. Physicians had a 2.2 times higher risk of feeling SV than nurses (95% CI: 1.88-2.52). The impact on the patient related to the AE explained why the professionals involved in it felt SV (P=.037). 80.6% (N=104) of the SVs presented post-traumatic stress. Women were 2.4 times more likely to suffer from it (OR: 2.4; 95% CI: 1.5-4.0). Intrusive thoughts in the SV were almost three times more frequent when the damage suffered by the patient was permanent or death (OR: 2.5; 95% CI: 0.2-3.6). CONCLUSIONS Many healthcare workers, especially physicians, considered themselves to be SV, and many of them suffered from post-traumatic stress. The impact on the patient related to the AE was a risk factor for being SV and for suffering psychological consequences.
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Affiliation(s)
- A González-González
- Servicio de Endocrinología y Nutrición, Hospital Universitario Río Hortega, Valladolid, España.
| | - O Redondo-González
- Servicio de Medicina Preventiva, Hospital Universitario de Guadalajara, Guadalajara, España
| | - I Domínguez-Osorio
- Servicio de Medicina Interna, Hospital Santa Bárbara, Puertollano, Ciudad Real, España
| | - V Quero Palomino
- Servicio de Psiquiatría, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - M León Velasco
- Servicio de Psiquiatría, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - F Polo Montes
- Servicio de Psiquiatría, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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15
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Tomás-Vecina S, Reyes-Ramos MJ. [Challenges and initiatives in the prevention of healthcare associated infections: Expert consensus study]. J Healthc Qual Res 2023; 38:376-389. [PMID: 37925298 DOI: 10.1016/j.jhqr.2023.10.001] [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: 05/04/2023] [Revised: 09/04/2023] [Accepted: 10/03/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION The objective of the project was to identify new strategies, agreed upon by experts, that help reduce the prevalence of Health Care Related Infections (HAIs) given the increase in their prevalence as a result of the pandemic and improve patient safety. MATERIAL AND METHODS The project was developed in three phases. The first two are framed in a sequential explanatory mixed model. Phase 1 consisted of a quantitative study (anonymous survey) to find out the perception of healthcare professionals about HAIs, risk factors, preventive measures, protocols, disinfection products and approaches. Phase 2 consisted of a qualitative exploratory study in which a panel of 15 experts analyzed the results, using focus group techniques, integrating both phases through the elaboration of metainferences. Phase 3 consisted of a qualitative descriptive study where, through nominal group techniques, agreed proposals for strategies to prevent HAIs were prepared. RESULTS The panel of experts defined a total of 51 proposals for new strategies: 15 in hand hygiene, 13 in surface cleaning, 13 in the use of devices, and 10 in HAI prevention training. Of all of them, 13 were agreed upon as preferable (medium-high viability and high impact) and 7 as recommendable (low viability and high impact). CONCLUSIONS In the prevention of HAIs, experts recommend applying different strategies simultaneously, which include innovative, technological and humanization aspects, both in data collection, intervention and training, prioritizing those with the greatest impact. and feasibility.
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Affiliation(s)
- S Tomás-Vecina
- Fundación por la Investigación, Docencia e Innovación en Seguridad del Paciente (FIDISP), Barcelona, España; Unidad de Calidad y Seguridad del Paciente, Badalona Serveis Assistencials, Badalona, Barcelona, España.
| | - M J Reyes-Ramos
- Fundación por la Investigación, Docencia e Innovación en Seguridad del Paciente (FIDISP), Barcelona, España; Calidad, Docencia e Investigación, Fundación Sanitaria Mollet, Mollet, Barcelona, España
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Rodríguez-Delgado ME, Echeverría-Álvarez AM, Colmenero-Ruiz M, Morón-Romero R, Cobos-Vargas A, Bueno-Cavanillas A. Design of a safety round model for intensive care units. Enferm Intensiva (Engl Ed) 2023; 34:186-194. [PMID: 37248132 DOI: 10.1016/j.enfie.2023.01.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/26/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Safety Rounds (SR) are an operational tool that allow knowing adherence to good practices, help identify risks and incidents in patient safety (PS), allowing improvement actions to be implemented. The objective of this work was the design of a procedure to perform SR in an Intensive Care Unit (ICU). METHODS Preparation of a checklist for the development of SR in the ICU through the nominal group technique, with the participation of managers, middle managers and professionals from different disciplines and categories. In the first place, a group of experts agreed, based on the recommendations on good practices in PS, the definition of items, their coding, the criteria for compliance and the impact of non-compliance. Subsequently, its viability was determined through a cross-sectional study through the piloting of two SRs to adjust the items in real clinical practice conditions. RESULTS A specific SR model for ICUs has been obtained through a checklist. The group of experts prepared a first list made up of 39 items of 6 essential dimensions and defined the method of implementation. Mean time to complete the two SRs was 85 min, including the briefing and subsequent debriefing. After the validation pilot, the dimensions were reduced to 5, 3 items were deleted, 2 items were transferred to another dimension and 3 items related to nosocomial infections and informed consent were modified. In addition, the data sources, the compliance criteria and their relative weight were redefined. The final list was considered useful and relevant to improve practice. CONCLUSIONS Through a consensus methodology, a checklist has been built to be used in the RS of an ICU. This model can serve as a basis for its use in healthcare services with similar characteristics.
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Affiliation(s)
- M E Rodríguez-Delgado
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, Spain.
| | - A M Echeverría-Álvarez
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - M Colmenero-Ruiz
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - R Morón-Romero
- Servicio de Farmacia, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - A Cobos-Vargas
- Enfermero, Referente de Seguridad del Paciente, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - A Bueno-Cavanillas
- Cátedra de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
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Alcalá Minagorre PJ, Domingo Garau A, Salmerón Fernández MJ, Casado Reina C, Díaz Pernas P, Hernández Borges ÁA, Rodríguez Marrodán B. Safe handoff practices and improvement of communication in different paediatric settings. An Pediatr (Barc) 2023; 99:185-194. [PMID: 37640658 DOI: 10.1016/j.anpede.2023.08.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 08/31/2023] Open
Abstract
Inadequate information management, especially during patient handoff, contributes to a large part of health care-related adverse events. The Committee for Quality of Care and Patient Safety of the Asociación Española de Pediatría has developed this document to provide an overview of handover practices in different paediatric care settings (emergency, inpatient, intensive care, neonatal and primary care). It describes resources to achieve safe and effective communication in all these settings, such as standardised handoff tools. It also proposes recommendations for the prevention of medication errors during the handover process, to improve safety in interhospital and intrahospital patient transfer, and to optimise communication and continuity of care in chronically ill and medically complex children.
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Affiliation(s)
- Pedro J Alcalá Minagorre
- Unidad de Pediatría Interna Hospitalaria, Hospital General Universitario Dr Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - Araceli Domingo Garau
- Servicio de Urgencias de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | | | - Cristina Casado Reina
- Unidad de Farmacia de Atención Primaria, Dirección Asistencial Norte de la Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Pilar Díaz Pernas
- Centro de Salud Rosa Luxemburgo, San Sebastián de los Reyes, Madrid, Spain
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18
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Fraga Rivas P, de Miguel Criado J, García Del Salto Lorente L, Gutiérrez Velasco L, Quintana Valcarcel P. Patient safety in magnetic resonance imaging. Radiologia (Engl Ed) 2023; 65:447-457. [PMID: 37758335 DOI: 10.1016/j.rxeng.2023.01.009] [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: 10/12/2022] [Accepted: 01/29/2023] [Indexed: 10/03/2023]
Abstract
Image acquisition involves the use of static magnetic fields, field gradients and radiofrequency waves. These elements make the MRI a different modality. More and more centers work with 3.0 T equipment that present higher risks for the patient, compared to those of 1.5 T. Therefore, there is a need for updating for radiology staff that allows them to understand the risks and reduce them, since serious and even fatal incidents can occur. The objective of this work is to present a review and update of the risks to which patients are subjected during the performance of a magnetic resonance imaging (MRI) study.
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Affiliation(s)
- P Fraga Rivas
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain.
| | - J de Miguel Criado
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| | - L García Del Salto Lorente
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| | - L Gutiérrez Velasco
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| | - P Quintana Valcarcel
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
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Oms Arias M, Pons Mesquida MÀ, Dehesa Camps R, Abizanda Garcia J, Hermosilla Pérez E, Méndez Boo L. [Does recommending the dosing frequency in the electronic prescription improve its adequacy? Before and after study]. Aten Primaria 2023; 55:102683. [PMID: 37320954 PMCID: PMC10460898 DOI: 10.1016/j.aprim.2023.102683] [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: 04/06/2023] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To assess whether reporting the dosing frequency into the prescription module of the Institut Català de la Salut (ICS) primary care electronic clinical workstation improves the dosing frequency's adequacy of the prescriptions. DESIGN Before and after study with non-equivalent control of prescriptions without any change in the dosing frequency. The study periods includes from September 1st, 2019 to February 29th, 2020. LOCATION Primary care setting. PARTICIPANTS Prescriptions issued by ICS General Practitioner, during the study period of those medicines which indications have a single appropriate dosing frequency or mostly appropriate, are included. INTERVENTION Recommendation of the appropriate dosing frequency in the prescription module. MAIN MEASUREMENTS Adequacy defined as the coincidence between the prescribed dosing frequency and the appropriate dosing frequency. RESULTS After the intervention there was a 22.75% increase in prescriptions with adequate dosing frequency. The largest increase occurred in the medicines for the genitourinary system and sex hormones. In absolute terms, the group of anti infective for systemic use is the one that obtained more prescriptions with an adequate dosing frequency between the two periods. CONCLUSIONS The intervention increased the dosing frequency's adequacy leading to improvements in the safety and effectiveness of the treatments. It is evident that the design and implementation of improvements in electronic prescription systems contributes to increasing the quality of the prescription.
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Affiliation(s)
- Míriam Oms Arias
- Unitat de Coordinació i Estratègia del Medicament (UCEM), Institut Català de la Salut, Barcelona, Catalunya, España.
| | - M Àngels Pons Mesquida
- Unitat de Coordinació i Estratègia del Medicament (UCEM), Institut Català de la Salut, Barcelona, Catalunya, España
| | - Rosa Dehesa Camps
- Unitat de Coordinació i Estratègia del Medicament (UCEM), Institut Català de la Salut, Barcelona, Catalunya, España
| | - Judith Abizanda Garcia
- Unitat de Coordinació i Estratègia del Medicament (UCEM), Institut Català de la Salut, Barcelona, Catalunya, España
| | - Eduardo Hermosilla Pérez
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalunya, España
| | - Leonardo Méndez Boo
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalunya, España
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20
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Peradejordi-Torres RM, Valls-Matarín J. Perception of the safety culture in a critical area. Enferm Intensiva (Engl Ed) 2023; 34:148-155. [PMID: 37246107 DOI: 10.1016/j.enfie.2022.11.001] [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: 07/10/2022] [Accepted: 11/04/2022] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Critical care Area (CCA) is one of the most complex in the hospital system, requiring a high number of interventions and handling of amounts of information. Therefore, these areas are likely to experience more incidents that compromise patient safety (PS). AIM To determine the perception of the healthcare team in a critical care area about the patient safety culture. METHOD Cross-sectional descriptive study, September 2021, in a polyvalent CCA with 45 beds, 118 health workers (physicians, nurses, auxiliary nursing care technicians). Sociodemographic variables, knowledge of the person in charge in PS and their general training in PS and incident notification system were collected. The validated Hospital Survey on Patient Safety Culture questionnaire, measuring 12 dimensions was used. Positive responses with an average score ≥75%, were defined as an area of strength while ≥50% negative responses were defined as an area of weakness. Descriptive statistics and bivariate analysis: X2 and t-Student tests, and ANOVA. Significance p ≤ 0.05. RESULTS 94 questionnaires were collected (79.7% sample). The PS score was 7.1 (1.2) range 1-10. The rotational staff scored the PS with 6.9 (1.2) compared to 7.8 (0.9) for non-rotational staff (p = 0.04). A 54.3% (n = 51) was familiar with the incident reporting procedure, 53% (n = 27) of which had not reported any in the last year. No dimension was defined as strength. There were three dimensions that behaved like a weakness: security perception: 57.7% (95% CI: 52.7-62.6), staffing: 81.7% (95% CI: 77.4-85.2) and management support: 69 .9% (95% CI: 64.3-74.9). CONCLUSIONS The assessment of PS in the CCA is moderately high, although the rotational staff has a lower appreciation. Half of the staff do not know the procedure for reporting an incident. The notification rate is low. The weaknesses detected are perception of security, staffing and management support. The analysis of the patient safety culture can be useful to implement improvement measures.
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Affiliation(s)
- R M Peradejordi-Torres
- Unidad de Cuidados Intensivos del Hospital Universitari Mútua Terrassa, Barcelona, Spain.
| | - J Valls-Matarín
- Unidad de Cuidados Intensivos del Hospital Universitari Mútua Terrassa, Barcelona, Spain
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Beatriz GC, María José O, Inés JL, Yolanda HG, Concha ÁDV, Javier TS, Cecilia M FL. Medication errors in children visiting pediatric emergency departments. Farm Hosp 2023; 47:141-147. [PMID: 37164795 DOI: 10.1016/j.farma.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/28/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES Medication safety represents an important challenge in children. There are limited studies on medication errors in pediatric patients visiting emergency departments. To help bridge this gap, we characterized the medication errors detected in these patients, determining their severity, the stages of the medication process in which they occurred, the drugs involved, and the types and causes associated with the errors. METHODS We conducted a multicenter prospective observational study in the pediatric emergency departments of 8 Spanish public hospitals over a 4-month period. Medication errors detected by emergency pediatricians in patients between 0 and 16 years of age were evaluated by a clinical pharmacist and a pediatrician. Each medication error was analyzed according to the updated Spanish Taxonomy of Medication Errors. RESULTS In 99,797 visits to pediatric emergency departments, 218 (0.2%) medication errors were detected, of which 74 (33.9%) resulted in harm (adverse drug events). Preschoolers were the age group with the most medication errors (126/218). Errors originated mainly in the prescribing stage (66.1%), and also by self-medication (16.5%) and due to wrong administration of the medication by family members (15.6%). Dosing errors (51.4%) and wrong/improper drugs (46.8%) were the most frequent error types. Anti-infective drugs (63.5%) were the most common drugs implicated in medication errors with harm. Underlying causes associated with a higher proportion of medication errors were "medication knowledge deficit" (63.8%), "deviation from procedures/guidelines" (48.6%) and "lack of patient information" (30.3%). CONCLUSIONS Medication errors presented by children attending emergency departments arise from prescriptions, self-medicationand administration, and lead to patient harm in one third of cases. Developing effective interventions based on the types of errors and the underlying causes identified will improve patient safety.
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Affiliation(s)
- Garrido-Corro Beatriz
- Pharmacy Department, Virgen de la Arrixaca Clinical University Hospital, Murcia, Spain.
| | - Otero María José
- Pharmacy Department, ISMP-Spain, Salamanca University Hospital-IBSAL, Salamanca, Spain
| | | | - Hernández Gago Yolanda
- Pharmacy Department, Maternal-Insular Hospital Complex of Gran Canaria, Gran Canaria, Spain
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22
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Beatriz GC, María José O, Inés JL, Yolanda HG, Concha ÁDV, Javier TS, Cecilia M FL. Medication errors in children visiting pediatric emergency departments. Farm Hosp 2023; 47:T141-T147. [PMID: 37453917 DOI: 10.1016/j.farma.2023.06.001] [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: 12/28/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES Medication safety represents an important challenge in children. There are limited studies on medication errors in pediatric patients visiting emergency departments. To help bridge this gap, we characterized the medication errors detected in these patients, determining their severity, the stages of the medication process in which they occurred, the drugs involved, and the types and causes associated with the errors. METHODS We conducted a multicenter prospective observational study in the pediatric emergency departments of 8 Spanish public hospitals over a 4-month period. Medication errors detected by emergency pediatricians in patients between 0 and 16 years of age were evaluated by a clinical pharmacist and a pediatrician. Each medication error was analyzed according to the updated Spanish Taxonomy of Medication Errors. RESULTS In 99,797 visits to pediatric emergency departments, 218 (0.2%) medication errors were detected, of which 74 (33.9%) resulted in harm (adverse drug events). Preschoolers were the age group with the most medication errors (126/218). Errors originated mainly in the prescribing stage (66.1%), and also by self-medication (16.5%) and due to wrong administration of the medication by family members (15.6%). Dosing errors (51.4%) and wrong/improper drugs (46.8%) were the most frequent error types. Anti-infective drugs (63.5%) were the most common drugs implicated in medication errors with harm. Underlying causes associated with a higher proportion of medication errors were "medication knowledge deficit" (63.8%), "deviation from procedures/guidelines" (48.6%) and "lack of patient information" (30.3%). CONCLUSIONS Medication errors presented by children attending emergency departments arise from prescriptions, self-medication, and administration, and lead to patient harm in one third of cases. Developing effective interventions based on the types of errors and the underlying causes identified will improve patient safety.
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Affiliation(s)
- Garrido-Corro Beatriz
- Servicio de Farmacia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - Otero María José
- Servicio de Farmacia, ISMP-España, IBSAL-Hospital Universitario de Salamanca, Salamanca, España
| | - Jiménez-Lozano Inés
- Servicio de Farmacia, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Hernández Gago Yolanda
- Servicio de Farmacia, Hospital Universitario Insular de Gran Canaria, Gran Canaria, España
| | | | - Trujillo-Santos Javier
- Servicio de Medicina Interna, Hospital General Universitario Santa Lucía, Cartagena, España
| | - Fernández-Llamazares Cecilia M
- Servicio de Farmacia, Instituto de Investigaciones Sanitarias, Hospital General Universitario Gregorio Marañón, Madrid, España
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23
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Añel Rodríguez RM, Astier Peña MP, Coll Benejam T. [Why is it increasingly difficult to "do the right thing" and to "stop doing the wrong thing"? Strategies for reversing low-value practices]. Aten Primaria 2023; 55:102630. [PMID: 37119777 PMCID: PMC10154973 DOI: 10.1016/j.aprim.2023.102630] [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: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 05/01/2023] Open
Abstract
This manuscript describes the factors that have led to the spread of low-value practices (LVP) and the main initiatives to reverse them. The paper highlights the strategies that have proven to be most useful over the years, from the alignment of clinical practice with "do not do" recommendations, to quaternary prevention and the risks associated with interventionism. Reversing LVP requires a planned process with a multifactorial approach engaging the different actors involved. It considers the barriers to de-implementation of low-value interventions and incorporates tools that facilitate adherence to "do not do" recommendations. Family doctor has an especially relevant role in LVP prevention, detection and de-implementation, due to their coordinating and integrating nature in the patients' healthcare, and because most of the citizens' healthcare demands are managed and resolved at the first level of care.
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Affiliation(s)
- Rosa María Añel Rodríguez
- Medicina Familiar y Comunitaria. Centro de Salud Landako, Durango. Osakidetza/Servicio Vasco de Salud, País Vasco, España; Grupo de trabajo de Seguridad del Paciente de semFYC.
| | - María Pilar Astier Peña
- Grupo de trabajo de Seguridad del Paciente de semFYC; Medicina Familiar y Comunitaria. Unidad de Calidad de la Dirección Territorial de Camp de Tarragona. Instituto Catalán de la Salud, Cataluña, España
| | - Txema Coll Benejam
- Grupo de trabajo de Seguridad del Paciente de semFYC; Medicina Familiar y Comunitaria. Centro de Salud Verge del Toro. Área de Salud de Menorca. Ibsalut, Islas Baleares, España
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24
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Ruiz Ramos J, Santos Puig M, López Vinardell L, Pedemonte I Pons M, Gil Carbo E, Puig Campmany M, Mangues-Bafalluy MA, Juanes Borrego A. [Translated article] Usefulness of ICD-10 diagnostic triggers to identify adverse drug events in emergency care. Farm Hosp 2023; 47:T75-T79. [PMID: 36934016 DOI: 10.1016/j.farma.2023.02.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 03/20/2023] Open
Abstract
OBJECTIVES To assess the usefulness of a tool based on ICD-10 diagnostic codes to identify patients who consult an emergency department for adverse drug events (ADE). METHODS Prospective observational study, in which patients discharged from an emergency department during May to August 2022 with a diagnosis coded with one of the 27 ICD-10 diagnoses considered as triggers were included. ADE confirmation was carried out by analyzing drugs prescribed prior to admission, and through a discussion among experts and a phone interview with patients after hospital discharge. RESULTS 1143 patients with trigger diagnoses were evaluated, of which 310 (27.1%) corresponded to patients whose emergency visit was attributed to an ADE. A 58.4% of ADE consultations were found with three diagnostic codes: K59.0-Constipation (n = 87; 28.1%), I16.9-Hypertensive Crisis (n = 72; 23.2%) and I95.1-Orthostatic hypotension (n = 22; 7.1%). The diagnoses with the highest degree of association with consultations attributed to ADE were E16.2-Hypoglycemia, unspecified (73.7%) and E11.65-Type 2 diabetes mellitus with hyperglycemia (71.4%), while diagnoses D62-Acute posthemorrhagic anemia and I74.3-Embolism and thrombosis of arteries of the lower limbs were not attributed to any case of ADE. CONCLUSIONS The ICD-10 codes associated with trigger diagnoses are a useful tool to identify patients who consult the emergency services with ADE and could be used to apply secondary prevention programs to avoid new consultations to the health care system.
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Affiliation(s)
- Jesús Ruiz Ramos
- Servicio de Farmacia, Hospital Santa Creu i Sant Pau, Barcelona, Spain.
| | - Marc Santos Puig
- Servicio de Farmacia, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Eduard Gil Carbo
- Direcció de Gestió i Sistemes d'Informació, Hospital Santa Creu i Sant Pau, Spain.
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25
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Morán-Pozo C, Luna-Castaño P. Shift change handovers between nurses in Critical Care Units. Enferm Intensiva (Engl Ed) 2023:S2529-9840(23)00012-5. [PMID: 36934076 DOI: 10.1016/j.enfie.2022.02.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/17/2022] [Indexed: 03/18/2023]
Abstract
AIM To know the characteristics of the handover performed by nurses working in Critical Care Units in Spain. METHODS Descriptive and cross-sectional study, whose population was nurses working in Critical Care Units in Spain. An ad hoc questionnaire was used to explore the characteristics of the process, the training received, the information forgotten and the influence of this activity on patient care. The questionnaire was online and dissemination was done through social networks. The sample was selected by convenience. A descriptive analysis was performed according to the nature of the variables and comparison of groups through ANOVA with R software version 4.0.3 (R Project for Statistical Computing). RESULTS The sample was 420 nurses. Most of them answered that (79,5%) perform this activity in an individual way, from outgoing nurse to incoming nurse. Location varied according to the size of the unit (p<0,05). Interdisciplinary handover was rare (p<0.05). In the last month, with regard to the time of data collection, 29,5% had to contact the unit due to forgetting relevant information, using WhatsApp as the first channel to transmit this information. CONCLUSIONS There is a lack of standardization in the handoff between shifts, in terms of the physical space where it is done, tools to structure the information, participation of other professionals and the use of unofficial communication channels to contact for omitted information during the handover. Shift change was identified as a vital process to ensure continuity of care and patient safety, so further researchs are important for patients handoffs.
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Affiliation(s)
- C Morán-Pozo
- Responsable de Investigación de Enfermería, Hospital Central Cruz Roja, Madrid, Spain.
| | - P Luna-Castaño
- Supervisora de Investigación en Cuidados, Hospital Universitario La Paz, Madrid, Spain
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26
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de la Torre-Pérez L, Granés L, Prat Marín A, Bertran MJ. A hospital incident reporting system (2016-2019): Learning from notifier's perception on incidents' risk, severity and frequency of adverse events. J Healthc Qual Res 2023; 38:93-104. [PMID: 36151046 DOI: 10.1016/j.jhqr.2022.08.004] [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: 04/18/2022] [Revised: 06/28/2022] [Accepted: 08/14/2022] [Indexed: 11/16/2022]
Abstract
Incident reporting systems (IRSs) are considered safety culture promoters. Nevertheless, they have not been contemplated to monitor professionals' perception about patient safety related risks. This study aims to describe the characteristics and evolution of incident notifications reported between 2016 and 2019 in a high complexity reference hospital in Barcelona and explores the association between notifications' characteristics and notifier's perception about incidents severity, probability of occurrence and risk. The main analysis unit was notifications reported. A descriptive analysis was performed and taxes by hospital activity were calculated. Odds ratios were obtained to study the association between the type of incident, the moment of incident, notifiers' professional category, reported incident's severity, probability and incidents' calculated risk. Through the study period, a total of 6379 notifications were reported, observing an annual increase of notifications until 2018. Falls (21.22%), Medical and procedures management (18.91%) and Medication incidents (15.49%) were the most frequently notified. Departments reporting the highest number of notifications were Emergency room and Obstetrics & Gynaecology. Incident type and notifiers' characteristics were consistently included in the models constructed to assess risk perception. Pharmaceutics were the most frequent notifiers when considering the proportion of staff members. Notification patterns can inform professionals' patient risk perception and increase awareness of professionals' misconceptions regarding patient safety.
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Affiliation(s)
| | - L Granés
- Preventive Medicine and Epidemiology Department, Clinic Institute of Medicine and Dermatology (ICMiD), Hospital Clínic of Barcelona, Barcelona, Spain
| | - A Prat Marín
- Preventive Medicine and Epidemiology Department, Clinic Institute of Medicine and Dermatology (ICMiD), Hospital Clínic of Barcelona, Barcelona, Spain; Medicine Department, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - M J Bertran
- Preventive Medicine and Epidemiology Department, Clinic Institute of Medicine and Dermatology (ICMiD), Hospital Clínic of Barcelona, Barcelona, Spain
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27
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Borque-Fernando A, Calleja-Hernández MA, Cózar-Olmo JM, Gómez-Iturriaga A, Pérez-Fentes DA, Puente-Vázquez J, Rodrigo-Aliaga M, Unda M, Álvarez-Ossorio JL. A multidisciplinary consensus statement on the optimal pharmacological treatment for metastatic hormone-sensitive prostate cancer. Actas Urol Esp 2023; 47:111-126. [PMID: 36720305 DOI: 10.1016/j.acuroe.2022.12.004] [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: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 01/30/2023]
Abstract
Androgen deprivation therapy (ADT) is the mainstay treatment for metastatic hormone-sensitive prostate cancer (mHSPC). The addition of docetaxel or new hormone therapies (abiraterone, apalutamide, or enzalutamide) improves overall survival and is currently the standard of care. However, the decision on the specific regimen to accompany ADT should be discussed with the patient, considering factors such as possible associated toxicities, duration of treatment, comorbidities, patient preferences, as there is no sufficient evidence to recommend one regimen over the other in most cases. This paper summarizes the evidence on the management of mHSPC and provides consensus recommendations on the optimal treatment in combination with ADT in mHSPC patients, with special attention to the patient's clinical profile.
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Affiliation(s)
- A Borque-Fernando
- Servicio de Urología, Hospital Universitario Miguel Servet, Zaragoza, Spain, IIS-Aragón, Spain.
| | | | - J M Cózar-Olmo
- Servicio de Urología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - A Gómez-Iturriaga
- Servicio de Oncología Radioterápica, Hospital Universitario Cruces, Biocruces Bizkaia Health Research Insitute, Barakaldo, Bizkaia, Spain
| | - D A Pérez-Fentes
- Servicio de Urología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - J Puente-Vázquez
- Servicio de Oncología Médica, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - M Rodrigo-Aliaga
- Servicio de Urología, Hospital General Universitario de Castellón, Castellón. Spain
| | - M Unda
- Servicio de Urología, Hospital Universitario Basurto, Bilbao, Bizkaia, Spain
| | - J L Álvarez-Ossorio
- Servicio de Urología Hospital Universitario Puerta del Mar., Presidente de la Asociación Española de Urología, Cádiz, Spain
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28
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Ramos JR, Puig MS, Vinardell LL, Pons MPI, Carbo EG, Campmany MP, Mangues-Bafalluy MA, Borrego AJ. Usefulness of ICD-10 diagnosis triggers to identify adverse drug events in emergency care. Farm Hosp 2023:S1130-6343(23)00001-6. [PMID: 36702641 DOI: 10.1016/j.farma.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To assess the usefulness of a tool based on ICD-10 diagnostic codes to identify patients who consult an emergency department for adverse drug events (ADE). METHODS Prospective observational study, in which patients discharged from an emergency department during May to August 2022 with a diagnosis coded with one of the 27 ICD-10 diagnoses considered as triggers were included. ADE confirmation was carried out by analyzing drugs prescribed prior to admission, and through a discussion among experts and a phone interview with patients after hospital discharge. RESULTS 1,143 patients with trigger diagnoses were evaluated, of which 310 (27.1%) corresponded to patients whose emergency visit was attributed to an ADE. A 58.4% of ADE consultations were found with three diagnostic codes: K59.0-Constipation (n = 87; 28.1%), I16.9-Hypertensive Crisis (n = 72; 23.2%) and I95.1-Orthostatic hypotension (n = 22; 7.1%). The diagnoses with the highest degree of association with consultations attributed to ADE were E16.2-Hypoglycemia, unspecified (73.7%) and E11.65-Type 2 diabetes mellitus with hyperglycemia (71.4%), while diagnoses D62-Acute posthemorrhagic anemia and I74.3-Embolism and thrombosis of arteries of the lower limbs were not attributed to any case of ADE. CONCLUSIONS The ICD-10 codes associated with trigger diagnoses are a useful tool to identify patients who consult the emergency services with ADE and could be used to apply secondary prevention programs to avoid new consultations to the health care system.
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29
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Hernández Borges ÁA, Jiménez Sosa A, Pérez Hernández R, Ordóñez Sáez O, Aleo Luján E, Concha Torre A. Paediatric intensive care 'do not do' recommendations in Spain: Selection by Delphi method. An Pediatr (Barc) 2023; 98:28-40. [PMID: 36509646 DOI: 10.1016/j.anpede.2022.08.014] [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: 05/22/2022] [Accepted: 08/21/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Health care is not free of ineffective, unsafe or inefficient diagnostic and therapeutic practices. To address this, different scientific societies and health authorities have proposed 'do not do' recommendations (DNDRs). Our goal was the selection by consensus of a set of DNDRs for paediatric intensive care in Spain. MATERIAL AND METHOD The research was carried out in 2 phases: first, gathering potential DNDRs; second, selecting the most important ones, using the Delphi method, based on the prevalence of the practice to be modified, the severity of its potential risks and the ease with which it could be modified. Proposals and evaluations were both made by members of working groups of the Sociedad Española de Cuidados Intensivos Pediátricos (SECIP, Spanish Society of Paediatric Intensive Care), coordinated by email. The initial set of DNDRs was reduced based on the coefficient of variation (<80%) of the corresponding evaluations. RESULTS A total of 182 DNDRs were proposed by 30 intensivists. The 14 Delphi evaluators managed to pare down the initial set to 85 DNDRs and, after a second round, to the final set of 26 DNDRs. The care quality dimensions most represented in the final set are clinical effectiveness and patient safety. CONCLUSIONS This study allowed the selection by consensus of a series of recommendations to avoid unsafe, inefficient or ineffective practices in paediatric intensive care in Spain, which could be useful for improving the quality of clinical care in our field.
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Affiliation(s)
| | - Alejandro Jiménez Sosa
- Unidad de Investigación, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Rosalía Pérez Hernández
- UCIP, Servicio de Pediatría, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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30
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Sá AF, Pereira R, Lourenço S, Barros F, Oliveira C, Esteves S. Pitfalls of cubital electrical nerve stimulation for neuromuscular transmission monitoring: A case report of familial amyloid polyneuropathy. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:578-582. [PMID: 36241515 DOI: 10.1016/j.redare.2021.01.007] [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: 11/22/2020] [Accepted: 01/24/2021] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- A F Sá
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - R Pereira
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - S Lourenço
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - F Barros
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - C Oliveira
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - S Esteves
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Macías Maroto M, Garzón González G, Navarro Royo C, Navea Martín A, Díaz Redondo A, Santiago Saez A, Pardo Hernández A. [Impact of the COVID-19 pandemic on patient safety incident and medication error reporting systems]. J Healthc Qual Res 2022; 37:397-407. [PMID: 35654722 PMCID: PMC9149769 DOI: 10.1016/j.jhqr.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/01/2022] [Accepted: 03/14/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND AIM To determine the impact of the COVID-19 pandemic on the epidemiology of safety incidents (SI) and medication errors (ME) reported to the CISEMadrid notification system in the hospital and primary care settings of the Madrid Health Service (SERMAS). MATERIALS AND METHODS Observational and descriptive study with a retrospective analysis of data including all CISEMadrid notifications from 01-Jan-2018 to 31-Dec-2020, from 33 hospitals and 262 health care centres of the SERMAS. The two periods in 2020 with the greatest increase in COVID-19 cases were identified to compare incidents reported in the pre-pandemic and pandemic periods. RESULTS 36,494 incidents were reported. Comparing both periods, an overall decrease in pandemic notifications of 60.7% was observed, being higher in primary care, falling to 33% of previous levels. The reduction in notifications was similar in the peaks and valleys of the waves. The three most frequent SIs in both periods and care settings were: diagnostic tests, medical devices/equipment/clinical furniture and organisational management/citations. In ME, dose failure and inappropriate selection were the most frequent in both settings and periods. There were no relevant differences in patient consequences in both periods. CONCLUSIONS During the pandemic, patient safety notifications decreased although the most frequent types remained the same, as did their impact on the patient, both in hospitals and in primary care. The safety culture of organisations is a critical aspect for the maintenance of reporting systems.
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Affiliation(s)
- M Macías Maroto
- Unidad de Calidad, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - G Garzón González
- Área de Procesos y Calidad, Gerencia Asistencial de Atención Primaria, SERMAS, Consejería de Sanidad, Madrid, España
| | - C Navarro Royo
- Subdirección General de Calidad Asistencial, Consejería de Sanidad, Madrid, España
| | - A Navea Martín
- Subdirección General de Calidad Asistencial, Consejería de Sanidad, Madrid, España
| | - A Díaz Redondo
- Servicio de Medicina Preventiva y Gestión de Calidad, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Santiago Saez
- Servicio de Medicina Legal, Hospital Clínico San Carlos, Madrid, España
| | - A Pardo Hernández
- Subdirección General de Calidad Asistencial, Consejería de Sanidad, Madrid, España
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32
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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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Mallea Salazar F, Ibaceta Reinoso I, Vejar Reyes C. [Second victims: Perceived support quality and its relationship with the consequences of the adverse event]. J Healthc Qual Res 2022; 37:117-124. [PMID: 34736894 DOI: 10.1016/j.jhqr.2021.09.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 09/03/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Second victims are health workers who have been involved in an adverse event (AE), or have been injured by physical, emotional, psychological and/or work conditions. To avoid these conditions, it is important to receive supportive measures. OBJECTIVE To determine the relationship between the consequences of an AE on the second victims and quality support measures perceived from public and private health institutions of the Metropolitan Region of Chile during the second semester of 2018. MATERIALS AND METHOD Quantitative, exploratory, descriptive, correlational and cross-sectional study, convenience sample type. Through an online platform, a questionnaire with sociodemographic variables and the Second Victim Experience and Support Tool (SVEST) instrument were applied, which consists of 9dimensions related to consequences of AE and quality of perceived support. RESULTS There were 301 health workers from public and private institutions, 39.2% were involved in an AE and of these, 73.0% manifested themselves in second victim; 69.1% was female sex and 45.7% work as a nursing professional. There is a negative relationship between the quality of perceived support and the psychological and occupational consequence of AE (public and private; p<0.05) and an increased risk of having serious consequences when receiving low quality of support (OR=3.8, 95% CI: 1.32-11.47). CONCLUSIONS It is very important to know this phenomenon and deliver adequate support measures to the second victim, in order to reduce the physical, psychological, emotional and/or work impact involved in being involved in an AE.
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Affiliation(s)
| | | | - C Vejar Reyes
- Magíster en Salud Pública, Pontificia Universidad Católica de Chile, Universidad de Chile, Santiago, Chile
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Quintero de Charry M, Tovar-Cuevas JR, Leon H, Ocampo CE. Incidence and risk factors of adverse events in pediatric hemato-oncological patients: A cohort study. J Healthc Qual Res 2022; 37:110-116. [PMID: 34756523 DOI: 10.1016/j.jhqr.2021.09.001] [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: 05/18/2021] [Revised: 08/26/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Pediatric hemato-oncological (HO) patients are highly susceptible to the occurrence of adverse events (AE), nevertheless few research has been done in this field. Our aim was to describe the incidence, type, severity and preventability of AE in these patients, including bone marrow transplant (BMT) patients, and to identify patient's risk factors for having an AE. METHODS Retrospective cohort study. Children under 18yo hospitalized at the HO or BMT ward in 2016 were eligible for the study. Type of AE, severity and preventability were described as absolute and relative frequencies. Cumulative incidence of patients with at least one AE (CI_AE) and the rate of occurrence of all AE were calculated. Risk factors (sex, recovery probability, comorbidities and being a BMT patient) were analyzed using logistic regression. RESULTS 114 patients were included, 58% were male, average age was 8.7yo and 25 were BMT patients. 44 had at least one AE, with CI_AE of 38.6% (95%CI 29.7-47.5). Overall rate of occurrence of AE was 2.5 cases per 100 patients-day (95%CI 2.15-2.98). For BMT and non-BMT patients they were 2.8 (95%CI 2.2-3.6) and 2.5 (95%CI 1.98-3.1) respectively. Healthcare related infection was the most frequent AE. Most AE were moderate and with high preventability. Being a BMT patient was the only independent factor associated with the occurrence of at least one AE (OR=11.5, p<0.001). CONCLUSIONS Our findings suggest that AE tend to be moderate and preventable in HO pediatric patients. BMT patients seem to be at greater risk of having an AE. Strategies focused on patient safety need to account for their specific characteristics.
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Affiliation(s)
| | | | - H Leon
- Universidad Libre Carrera 109 No. 22 -00 - Valle del Lili. A.A. 1040. Cali - Valle, Colombia
| | - C E Ocampo
- Clínica Imbanaco, Grupo Quirónsalud, Cra. 38 Bis #5B2-04, Cali, Valle, Colombia.
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Riera-Vázquez NA, Gutiérrez-Alba G, Reyes-Morales H, Pavón-León P, Gogeascoechea-Trejo MC, Muños-Hernandez J. [Adverse events and essential actions for patient safety]. J Healthc Qual Res 2022; 37:239-246. [PMID: 35039248 DOI: 10.1016/j.jhqr.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/17/2021] [Revised: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The adverse events (AE) in hospitalized patients occur with increasing frequency due to the increase in complexity of medical care, which implies a greater risk of committing a human error inherent to the care, constituting a serious threat to the safety of the patient. MATERIAL AND METHODS Cross-sectional study, including patients older than 16years, with hospital stay longer than 24h and discharge from the general surgery service, patients treated in emergency observation units or other hospital services were not considered. AE were identified, classified by cause according to the essential actions for patient safety (EAPS), and compliance with the EAPS was verified. RESULTS 352 clinical records were reviewed, 61 (17%) were positive on screening. Of the positives, 66% resulted in AE (47 cases). The prevalence of AE was 13%. The AE were: 40% related to procedures; 39% with infections; 17% with medication; 4% with patient identification. The EAPS with the best rating was EAPS5 and the lowest rating was EAPS4. The night shifts with the greatest opportunity area, only with 40% and 44% correct procedures. CONCLUSIONS The study shows that the two methodologies used, one to identify AE and the other to establish its causes and classification according to the EAPS, demonstrated usefulness and synergy for patient safety, when detecting AE, as well as determining their causes and evaluate compliance with the EAPS.
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Affiliation(s)
- N A Riera-Vázquez
- Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, México.
| | - G Gutiérrez-Alba
- Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, México
| | - H Reyes-Morales
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - P Pavón-León
- Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, México
| | | | - J Muños-Hernandez
- Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, México
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Domingo L, Sala M, Miret C, Montero-Moraga JM, Lasso de la Vega C, Comas M, Castells X. Perceptions from nurses, surgeons, and anesthetists about the use and benefits of the surgical checklist in a teaching hospital. J Healthc Qual Res 2022; 37:52-59. [PMID: 34344625 DOI: 10.1016/j.jhqr.2021.06.003] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess attitudes and perceptions from nursing staff, surgeons and anesthetists about compliance, utility, and impact on patient's safety of the surgical checklist in a teaching hospital. We also aimed to identify improvement opportunities for strengthening the usefulness of the checklist in the operating theater. METHODS We carried out a questionnaire-based an observational cross-sectional study. A questionnaire was distributed to operating room staff, including nursing staff, surgeons, and anesthetists. In addition to the information about surgical checklist, We also collected information regarding years of experience in the operating theater. Fisher's exact was used to compare proportions in each statement. Group discussion meetings with key professionals were held to jointly assess the results, propose improvement actions, and evaluate their feasibility. RESULTS The overall response rate was 36.2% (131/362). Nursing staff was perceived as the most supportive group in the use of surgical checklist. A 64.3% of surgeons considered that using the checklist prevented adverse events vs 84.2% and 85.7% among anesthetists and nurses, respectively; p=0.028. Junior staff showed a supportive attitude toward the use of surgical checklist, considering it as a tool that gives them confidence. We ended up with a list of improvement actions aiming at strengthening the surgical checklist reliability and compliance. CONCLUSIONS The perception of the surgical checklist usefulness as a tool to prevent adverse events was moderate among surgeons, but well appreciated by junior staff. Nursing staff were especially critical regarding compliance and support by other professionals. To reinforce the usefulness perception of the surgical checklist it is needed to increase the involvement of all professionals, especially senior staff and surgical leaders.
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Affiliation(s)
- L Domingo
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain.
| | - M Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - C Miret
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - J M Montero-Moraga
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - C Lasso de la Vega
- Methodology, Quality and Nursing Research Department, Consorci Parc de Salut MAR de Barcelona, Barcelona, Spain
| | - M Comas
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - X Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
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de Oliveira NPG, Tavares JMAB, Fassarella CS, de Souza PA, Lins SMSB. Safety culture in a nephrology service at a university hospital: A mixed method study. Enferm Clin (Engl Ed) 2022; 32:33-44. [PMID: 35148877 DOI: 10.1016/j.enfcle.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the safety culture from the perception of the multidisciplinary team of the nephrology service of a university hospital. METHOD Mixed methods study with concomitant triangulation of data, with 56 participants. In the adopted approach, data are weighted with QUAN+qual notation. Quantitative data were collected using the Hospital Survey on Patient Safety Culture instrument and analyzed using simple descriptive statistics. Qualitative data were obtained from recorded interviews and analyzed using the content analysis technique proposed by Bardin. RESULTS The answers obtained in the quantitative instrument pointed out that of the twelve dimensions of the service, three were neutral, nine were fragile, and none was strong. From the qualitative analysis, similarities and divergences were identified in the statements about the quantitative data. The intersection of the data resulted in the category "Safety culture in the work environment of Nephrology". CONCLUSION Knowing the level of safety culture through the perception of nephrology health professionals allowed the identification of a critical and problematic scenario that needs improvements in the dimensions classified as fragile in order to advance in the perspectives of safety and in the polishing of actions aimed at safer care.
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Torijano Casalengua ML, Calvo Pita C, Maderuelo-Fernández JÁ. [A safe use of medications in Primary Care, in COVID-19 pandemic as well]. Aten Primaria 2021; 53 Suppl 1:102223. [PMID: 34961581 DOI: 10.1016/j.aprim.2021.102223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/21/2022] Open
Abstract
The third Global Patient Safety Challenge, Medication Without Harm, was launched in 2017 by the World Health Organization with the goal of reducing the already well-known severe preventable medication-related harm by 50% over the next 5 years. Nothing suggested that, two years later, the world would suffer a terrible pandemic, which has been a much greater challenge than the aforementioned one and that would put it to test from the first stages of the medication use process. The rapid pace imposed by the pandemic has created new risks in the use of medication in those affected by COVID-19 and in the population due to organizational changes in the provision of health care in health services. Therefore, prudent prescribing is becoming more important than ever in health systems. This article aims to analyze the main risks produced during the pandemic period and offer Primary Care professionals an update and a reminder of the main aspects related to the safety use of medications.
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Gens-Barberà M, Hernández-Vidal N, Castro-Muniain C, Hospital-Guardiola I, Oya-Girona EM, Bejarano-Romero F, Rey-Reñones C, Martín-Luján F. [Patient safety incidents reported before and after the start of the COVID-19 pandemic in Primary Care in Tarragona]. Aten Primaria 2021; 53 Suppl 1:102217. [PMID: 34961580 PMCID: PMC8708815 DOI: 10.1016/j.aprim.2021.102217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Abstract
Objetivo Analizar y comparar la epidemiologia de los incidentes de seguridad del paciente notificados en centros de atención primaria, antes y después del inicio de la pandemia COVID-19. Diseño y emplazamiento Estudio descriptivo analítico comparando los incidentes notificados del 01-marzo-2019 al 28-febrero-2020, y del 01-marzo-2020 al 28-febrero-2021, realizados a través de la plataforma TPSC Cloud™ accesible desde la Intranet corporativa en 25 centros de atención primaria del distrito de Tarragona, Cataluña, España. Mediciones Registros obtenidos a partir de notificaciones voluntarias mediante formulario electrónico, estandarizado y anonimizado. Variables: centro sanitario, profesional, tipo de incidente, matriz de riesgo, factores causales, contribuyentes y evitabilidad. Análisis estadístico: Se realizó análisis descriptivo del total de notificaciones y otro específico de los eventos adversos, comparando ambos períodos. Resultados Se notificaron un total de 2.231 incidentes. Comparando ambos períodos, en el de pandemia se observó una reducción del número de incidentes notificados (solo representaron un 20% del total), pero en proporción se incrementó el porcentaje de notificaciones por parte de profesionales sanitarios y el de eventos adversos que requirieron observación. También aumentaron los factores causales relacionados con los cuidados y el diagnóstico, y disminuyeron los de medicación. Además, se observó un incremento de los factores contribuyentes relacionados con el profesional. La evitabilidad fue elevada (>95%) en ambos períodos. Conclusiones Durante la pandemia, se han notificado un menor número de incidentes de seguridad del paciente, pero en proporción, más eventos adversos, siendo en su mayoría evitables. El propio profesional se convierte en el principal factor contribuyente.
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Affiliation(s)
- Montserrat Gens-Barberà
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España.
| | - Núria Hernández-Vidal
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Carles Castro-Muniain
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Inmaculada Hospital-Guardiola
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España; Centro de Atención Primaria Dr. Turró, Valls, Direcció d'Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Eva Maria Oya-Girona
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España; Centre d'Alta Resolució, Salou, Direcció d'Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Ferran Bejarano-Romero
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Cristina Rey-Reñones
- Unitat de Suport a la Recerca Camp de Tarragona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España; Facultad de Medicina y Ciencias de la Salud, Universitat Rovira i Virgili, Tarragona, España
| | - Francisco Martín-Luján
- Unitat de Suport a la Recerca Camp de Tarragona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España; Facultad de Medicina y Ciencias de la Salud, Universitat Rovira i Virgili, Tarragona, España
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Saura Llamas J, Astier Peña MP, Puntes Felipe B. [Patient safety training and a safe teaching in primary care]. Aten Primaria 2021; 53 Suppl 1:102199. [PMID: 34961575 PMCID: PMC8721339 DOI: 10.1016/j.aprim.2021.102199] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022] Open
Abstract
Este artículo de revisión y actualización tiene como objetivo plantear las dificultades y oportunidades para la formación en seguridad del paciente del personal de ciencias de la salud (grado, posgrado, formación especializada y continua), y algunas propuestas para llevarla a cabo. Muy brevemente trata esta formación específica y la situación actual en atención primaria, destacando que la seguridad del paciente es una necesidad, un área competencial y una oportunidad formativa para los residentes. Establece el marco general de la seguridad del paciente en atención primaria, teniendo como referencia el documento «Siete Pasos para la Seguridad del Paciente en Atención Primaria», planteando la necesidad de un abordaje sistémico. Destaca la elaboración y presentación de casos sobre errores clínicos como la estrategia formativa más frecuente. Los escenarios clínicos reales se relacionan con los pacientes de trato difícil, los incidentes críticos y la bioética en el ejercicio profesional. Estos escenarios presentan como característica común el hecho de producir dificultades y sufrimiento a todos los actores participantes. Se incluyen varios instrumentos para la formación en seguridad del paciente (SP). La meta, a medio plazo, es la consolidación de la seguridad clínica en la formación sanitaria especializada. Finalmente, se analiza la repercusión de la pandemia en la formación en seguridad del paciente, especialmente sobre la formación sanitaria especializada, haciendo propuestas de cómo llevar a cabo una docencia segura en tiempos de pandemia de COVID-19.
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Affiliation(s)
- José Saura Llamas
- Especialista en Medicina Familiar y Comunitaria, Exjefe de Estudios de la Unidad Docente Multiprofesional de Atención Familiar y Comunitaria de las Áreas V, VI y IX de Murcia, Servicio Murciano de Salud, IMIB - Arrixaca (Instituto Murciano de Investigación Biomédica), Murcia, España; Grupo de Seguridad del Paciente de semFYC
| | - María Pilar Astier Peña
- Grupo de Seguridad del Paciente de semFYC; CS Universitas, Zaragoza, Servicio Aragonés de Salud, Universidad de Zaragoza, GIBA-IIS Aragón.
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Astier-Peña MP, Martínez-Bianchi V, Torijano-Casalengua ML, Ares-Blanco S, Bueno-Ortiz JM, Férnandez-García M. [The Global Patient Safety Action Plan 2021-2030: Identifying actions for safer primary health care]. Aten Primaria 2021; 53 Suppl 1:102224. [PMID: 34961576 PMCID: PMC8721340 DOI: 10.1016/j.aprim.2021.102224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/01/2022] Open
Abstract
The 74th World Health Assembly adopted in May 2021 the "Global Patient Safety Action Plan: 2021-2030" to enhance patient safety as an essential component in the design, procedures and performance evaluation of health systems worldwide. It is a strategic plan that guides country governments, health sector entities, health organisations and the World Health Organisation secretariat on how to implement the assembly's patient safety resolution. Deployment of the plan will strengthen the quality and safety of health systems worldwide by spanning the entire continuum of people's health care from diagnosis to treatment and care, reducing the likelihood of harm in the course of care. The Declaration on Primary Health Care during the Global Conference on Primary Health Care in Astana, 2018, urged countries to strengthen their primary health care systems as an essential step towards achieving universal health coverage and providing access to safe, quality care without financial loss. The deployment of the Global Patient Safety Action Plan in primary care is therefore a high-priority health policy action. The Action Plan is structured into 6 strategic objectives with 35 strategic actions. We present an analysis of the strategic actions regarding healthcare organizations and the challenges ahead for their particular deployment in primary health care settings.
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Affiliation(s)
- María Pilar Astier-Peña
- Medicina Familiar y Comunitaria. Centro de Salud Universitas, Servicio Aragonés de Salud, Aragon, España; Universidad de Zaragoza. GIBA-IIS Aragón, Aragón, España; Grupo de Seguridad del Paciente de Semfyc (Sociedad Española de Medicina Familiar y Comunitaria) y de Calidad y Seguridad de Wonca World (Global Family Doctors).
| | - Viviana Martínez-Bianchi
- Equidad en la Unidad Docente de Medicina Familiar y Comunitaria, Universidad de Duke, Duke, EE. UU.; WONCA-World Health Organization Liason. WONCA (World Organization of Family Doctors), Bruselas, Bélgica
| | - María Luisa Torijano-Casalengua
- Medicina Familiar y Comunitaria y Medicina Preventiva y Salud Pública, Servicio de Salud de Castilla-La Mancha (SESCAM), Castilla-La Mancha, España
| | - Sara Ares-Blanco
- Centro de Salud Federica Montseny, Servicio Madrileño de Salud (SERMAS), Madrid, España; Representante de semFYC (Sociedad Española de Medicina Familiar y Comunitaria) en EGPRN (European General Practitioner Research Network), Maastricht, Netherlands
| | - José-Miguel Bueno-Ortiz
- WONCA-World Health Organization Liason. WONCA (World Organization of Family Doctors), Bruselas, Bélgica; Centro de Salud Fuente Álamo, Servicio Murciano de Salud (SMS), Murcia, España; Representante de la Sección Internacional de semFYC (Sociedad Española de Medicina Familiar y Comunitaria), Barcelona, España
| | - María Férnandez-García
- Representante de semFYC (Sociedad Española de Medicina Familiar y Comunitaria) en EGPRN (European General Practitioner Research Network), Maastricht, Netherlands; C.S. Las Cortes, Servicio Madrileño de Salud (SERMAS), Madrid, España
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Añel Rodríguez RM, Aibar Remón C, Martín Rodríguez MD. [Patient participation in its own safety]. Aten Primaria 2021; 53 Suppl 1:102215. [PMID: 34961579 PMCID: PMC8721344 DOI: 10.1016/j.aprim.2021.102215] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022] Open
Abstract
El enfoque de atención centrada en el paciente y los avances normativos desarrollados en los últimos años han promovido la implicación del paciente en la toma de decisiones sobre pruebas diagnósticas y tratamientos. En otros aspectos, como la participación en su seguridad, aún queda mucho por hacer. Hasta hace poco tiempo se ha considerado al paciente como mero receptor de los servicios sanitarios, no como parte activa del sistema, ni mucho menos como barrera de seguridad frente a los fallos y errores que acontecen durante la asistencia. Algunos pacientes se han activado con base en sus experiencias. Pero muchos otros no. Por eso es necesario sensibilizar, informar y formar al paciente de forma proactiva para que participe en su seguridad. No se trata de traspasarle la responsabilidad, sino de facilitar y promover su participación reforzando su seguridad durante el proceso asistencial. El sistema sanitario debe estar comprometido, y el paciente informado y formado. Aportamos herramientas y recursos online para su aplicación en atención primaria.
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Affiliation(s)
- Rosa María Añel Rodríguez
- Especialista en Medicina Familiar y Comunitaria, Máster en Participación y Desarrollo Comunitario, Médica de familia, Centro de Salud Landako, Durango, País Vasco, España; Grupo de trabajo de Seguridad del Paciente de semFYC.
| | - Carlos Aibar Remón
- Especialista en Medicina Preventiva y Salud Pública, Profesor titular de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Aragón, España; Grupo de trabajo de Seguridad del Paciente de semFYC
| | - María Dolores Martín Rodríguez
- Especialista en Medicina Familiar y Comunitaria, Maestría Universitaria en Seguridad del Paciente y Calidad Asistencial, Médico Coordinador, Central de Coordinación de Urgencias y Emergencias, Fundación Pública Urxencias Sanitarias de Galicia-061, Galicia, España; Grupo de trabajo de Seguridad del Paciente de semFYC
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Añel Rodríguez RM, García Alfaro I, Bravo Toledo R, Carballeira Rodríguez JD. [Electronic medical record and prescription: risks and benefits detected since its implementation. Safe designing, rollout and use]. Aten Primaria 2021; 53 Suppl 1:102220. [PMID: 34961584 PMCID: PMC8721342 DOI: 10.1016/j.aprim.2021.102220] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/03/2022] Open
Abstract
Las nuevas tecnologías de la información han transformado la manera de prestar la asistencia en los servicios de salud, impregnando casi todos los aspectos de la atención sanitaria. A medida que la complejidad del sistema aumenta, es más difícil trabajar de manera óptima sin la asistencia de las nuevas tecnologías. Su implantación supone un avance, bien por el adelanto que entraña el uso adecuado de cualquier nueva tecnología en el cuidado de la salud, bien por el desarrollo de aplicaciones específicas que mejoran la seguridad de la asistencia. Sin embargo, factores como un diseño incorrecto, implementación y mantenimiento deficientes, capacitación inadecuada, junto al exceso de confianza y dependencia, pueden hacer que las tecnologías comprometan, más que favorecer, la seguridad del paciente. Este artículo describe los efectos beneficiosos, y los que no lo son tanto, de la introducción en nuestro país de la historia clínica y la receta electrónicas en la calidad y la seguridad de la asistencia sanitaria.
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Affiliation(s)
- Rosa María Añel Rodríguez
- Centro de Salud Landako, Servicio Vasco de Salud, Durango, País Vasco, España; Grupo de Trabajo de Seguridad del Paciente de semFYC.
| | | | - Rafael Bravo Toledo
- Grupo de Trabajo de Seguridad del Paciente de semFYC; Centro de Salud Linneo, Servicio Madrileño de salud, Madrid, España
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Torijano Casalengua ML, Maderuelo-Fernández JA, Astier Peña MP, Añel Rodríguez R. [Health worker safety as an essential condition for patient safety]. Aten Primaria 2021; 53 Suppl 1:102216. [PMID: 34961585 PMCID: PMC8709022 DOI: 10.1016/j.aprim.2021.102216] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 12/03/2022] Open
Abstract
El mayor activo de cualquier sistema sanitario son sus profesionales, y estos deben ser cuidados para poder cuidar. Es necesario resaltar que son clave para la resiliencia de nuestros sistemas de salud. Esto es particularmente importante en momentos de crisis, y especialmente trascendente para la atención primaria de salud. Durante la pandemia de la COVID-19, las condiciones de trabajo han sido el principal factor latente común para los incidentes de seguridad del paciente. Los profesionales de atención primaria han trabajado en condiciones laborales inseguras, con escasez de medios de protección, gran incertidumbre, falta de conocimiento científico y protocolos de trabajo rápidamente cambiantes para el abordaje de los casos y contactos de infección por la COVID-19, con una alta presión asistencial, largas jornadas de trabajo, suspensión de permisos y vacaciones, e incluso cambios de sus puestos de trabajo. Todo ello ha contribuido a que se conviertan, no solo en primeras víctimas de la pandemia, sino también en segundas víctimas de los eventos adversos sucedidos durante la misma. Por ello, en este artículo analizamos los principales riesgos y daños sufridos por los profesionales en atención primaria y aportamos claves para contribuir a su protección en futuras situaciones parecidas.
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Affiliation(s)
- María Luisa Torijano Casalengua
- Servicio de Salud de Castilla-La Mancha (SESCAM), Castilla la Mancha, España; Grupo de Trabajo de Seguridad del Paciente de semFYC.
| | - Jose Angel Maderuelo-Fernández
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACyL), Salamanca, España; Grupo de Trabajo de Seguridad del Paciente de semFYC
| | - María Pilar Astier Peña
- Servicio Aragonés de Salud. Profesora de la Universidad de Zaragoza, GIBA-IIS Aragón, España; Grupo de Trabajo de Seguridad del Paciente de semFYC
| | - Rosa Añel Rodríguez
- Grupo de Trabajo de Seguridad del Paciente de semFYC, Centro de Salud Landako, Osakidetza/Servicio Vasco de Salud, Durango, País Vasco, España; Grupo de Trabajo de Seguridad del Paciente de semFYC
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Minúe Lorenzo S, Astier-Peña MP, Coll Benejam T. [Diagnostic error and overdiagnosis in Primary Care. Proposals for the improvement of clinical practice family medicine]. Aten Primaria 2021; 53 Suppl 1:102227. [PMID: 34961577 PMCID: PMC8721341 DOI: 10.1016/j.aprim.2021.102227] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 10/24/2022] Open
Abstract
Family doctors see a wide range of patients, with a wide range of complexity, in a short time and with few diagnostic resources. This situation makes primary care professionals more vulnerable to diagnostic errors. For this reason, an adequate clinical reasoning process is the most powerful tool family doctors have to safely guide the patient care process. Considering these errors as missed opportunities for a correct diagnosis, which may cause harm to the patient, leads us as professionals to review how to improve this process. The review includes, among other aspects, identifying cognitive biases, analysing the ways in which work is organised in primary care teams, and situations in the care context that may contribute to such errors. In this article we describe the most frequent diagnostic errors and their causal factors in primary care, the impact of cognitive process failures, situations of overdiagnosis and the diagnostic and therapeutic cascades associated with them. Finally, we propose a set of tools to improve decision-making in the diagnostic process in primary care.
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Affiliation(s)
- Sergio Minúe Lorenzo
- Escuela Andaluza de Salud Pública, Jefe del Servicio Integrado de Salud basado en la Atención Primaria de Salud. Centro Colaborador de la OMS, Granada, España
| | - Maria Pilar Astier-Peña
- Servicio Aragonés de Salud, Universidad de Zaragoza, GIBA-IIS Aragón, Zaragoza, España; Grupo de Seguridad del Paciente de la Sociedad Española de Medicina de Familia y Comunitaria (semFYC), Barcelona, España.
| | - Txema Coll Benejam
- Grupo de Seguridad del Paciente de la Sociedad Española de Medicina de Familia y Comunitaria (semFYC), Barcelona, España; Atención Primaria, Área de Salut de Menorca, IB-SALUT, Mahón, Menorca, España
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Luzón Oliver L, Molina Pérez de Los Cobos E, Novoa Jurado A, Pérez Martínez E, Martínez Monreal D. [Patient safety in nursing homes. The experience of the Autonomous Community of the Region of Murcia]. Aten Primaria 2021; 53 Suppl 1:102228. [PMID: 34961574 PMCID: PMC8721345 DOI: 10.1016/j.aprim.2021.102228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/08/2021] [Indexed: 01/10/2023] Open
Abstract
La pandemia ha expuesto la vulnerabilidad de los centros residenciales y la fragilidad de la población que en ellos viven. En la Región de Murcia la atención a este grupo poblacional se convirtió en una prioridad y se elaboró un plan regional para atender las necesidades de los residentes desde el marco ético de la justicia procedimental. La inmediatez impuesta por la crisis sanitaria ha hecho que toda esta intervención no esté exenta de riesgos. A partir del modelo de Reason hemos realizado un análisis causal de los factores que llevaron a las residencias a sufrir un impacto devastador. La pandemia ha evidenciado la urgencia de fortalecer el modelo de cuidados que ofrecemos a nuestros mayores. Un modelo que garantice la cobertura de unas necesidades a unos pacientes extremadamente frágiles que van más allá de una atención sanitaria y biomédica y que tenga en cuenta sus preferencias y sus valores.
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Affiliation(s)
- Lourdes Luzón Oliver
- Grupo CORECAAS. Coordinación Regional para la Cronicidad Avanzada y la Atención Sociosanitaria, Murcia, España; IMIB: Instituto Murciano de Investigación Biosanitaria, Murcia, España; Medicina Familiar y Comunitaria, Murcia, España; Grupo de Trabajo de Seguridad del Paciente de semFYC, Murcia, España.
| | - Enrique Molina Pérez de Los Cobos
- Grupo CORECAAS. Coordinación Regional para la Cronicidad Avanzada y la Atención Sociosanitaria, Murcia, España; IMIB: Instituto Murciano de Investigación Biosanitaria, Murcia, España; Medicina Familiar y Comunitaria, Murcia, España
| | - Abel Novoa Jurado
- Grupo CORECAAS. Coordinación Regional para la Cronicidad Avanzada y la Atención Sociosanitaria, Murcia, España; IMIB: Instituto Murciano de Investigación Biosanitaria, Murcia, España; Medicina Familiar y Comunitaria, Murcia, España; CORECAAS, Murcia, España; Grupo de Trabajo de Bioética de semFYC, Murcia, España
| | - Eva Pérez Martínez
- Grupo CORECAAS. Coordinación Regional para la Cronicidad Avanzada y la Atención Sociosanitaria, Murcia, España; IMIB: Instituto Murciano de Investigación Biosanitaria, Murcia, España; DUE, Murcia, España
| | - Damián Martínez Monreal
- Grupo CORECAAS. Coordinación Regional para la Cronicidad Avanzada y la Atención Sociosanitaria, Murcia, España; IMIB: Instituto Murciano de Investigación Biosanitaria, Murcia, España; DUE, Murcia, España
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Palacio Lapuente J, Martín Rodríguez MD, Aibar Remón C, Jurado Balbuena JJ, Torijano Casalengua ML, Añel Rodríguez R. [Prevention of infections related to health care in primary care. Lessons from the pandemic]. Aten Primaria 2021; 53 Suppl 1:102225. [PMID: 34961578 PMCID: PMC8721357 DOI: 10.1016/j.aprim.2021.102225] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2022] Open
Abstract
The health system failed to guarantee the safety of both professionals and citizens who came to the centers at the beginning of the pandemic. The lack of materials and guidelines for the prevention of infections caused in Spain the worst catastrophe in the history of patient safety and occupational health in healthcare. It also happened in other countries but Spain had the highest rates of infected health workers in the world. It was a largely avoidable event. We review what measures have been taken to prevent infections in primary care centers, such as hand hygiene, masks and personal protection material or the maintenance of social distance, among others. We update the recommendations and raise the perspectives in a situation that requires flexibility and adaptability to maintain quality and safe care.
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Affiliation(s)
- Jesús Palacio Lapuente
- WONCA World Working Party on Quality and Safety on Family Medicine, Bruselas, Bélgica; Grupo de Trabajo de Seguridad del Paciente de semFYC.
| | - María Dolores Martín Rodríguez
- Central de Coordinación, Fundación Pública Urgencias Sanitarias de Galicia-061, Servicio Gallego de Salud (SERGAS), A Estrada, Pontevedra, España; Grupo de Trabajo de Seguridad del Paciente de semFYC
| | - Carlos Aibar Remón
- Universidad de Zaragoza, Zaragoza, España; Grupo de Trabajo de Seguridad del Paciente de semFYC
| | - Juan José Jurado Balbuena
- Centro de Salud Alicante, Servicio Madrileño de Salud, Fuenlabrada, Madrid, España; Grupo de Trabajo de Seguridad del Paciente de semFYC
| | | | - Rosa Añel Rodríguez
- Centro de Salud Landako, Osakidetza/Servicio Vasco de Salud, Durango, Vizkaya, España; Grupo de Trabajo de Seguridad del Paciente de semFYC
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Torres Y, Rodríguez Y, Pérez E. [How to improve the quality of healthcare services and patient safety by adopting strategies from the aviation sector?]. J Healthc Qual Res 2021; 37:182-190. [PMID: 34887228 DOI: 10.1016/j.jhqr.2021.10.009] [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: 03/30/2021] [Revised: 06/26/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Y Torres
- Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Canadá.
| | - Y Rodríguez
- Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - E Pérez
- Facultad de Ingeniería Industrial, Universidad Pontificia Bolivariana, Medellín, Colombia
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Fiol-deRoque MA, Serrano-Ripol MJ, Gens-Barberà M, Sánchez E, Mayer MA, Martín-Luján F, Valderas JM, Ricci-Cabello I. [Impact of the COVID-19 pandemic on patient-reported patient safety in Primary Care]. Aten Primaria 2021; 53 Suppl 1:102222. [PMID: 34961582 PMCID: PMC8708814 DOI: 10.1016/j.aprim.2021.102222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/08/2023] Open
Abstract
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.
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Affiliation(s)
- Maria A Fiol-deRoque
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Gerencia de Atención Primaria de Mallorca, Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España
| | - Maria J Serrano-Ripol
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Gerencia de Atención Primaria de Mallorca, Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Universidad de las Islas Baleares (UIB), Departamento de Psicología, Palma, Islas Baleares, España.
| | - Montserrat Gens-Barberà
- Unitat de Qualitat i Seguretat dels Pacients, Gerència Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Encarna Sánchez
- Unitat de Qualitat i Seguretat, Gerència Territorial Catalunya Central, Institut Català de la Salut, Departament de Salut, Barcelona, España
| | - Miguel A Mayer
- Research Programme on Biomedical Informatics (GRIB) del Instituto Hospital del Mar de Investigaciones Médicas y la Universitat Pompeu Fabra, Barcelona, España
| | - Francisco Martín-Luján
- Unitat de Suport a la Recerca de Tarragona, Institut de d'investigació en l'Atenció Primària Jordi Gol (IDIAP Jordi Gol), Institut Català de la Salut, Tarragona, España
| | - José M Valderas
- Health Services & Polic Research Group, Exeter Collaboration for Academic Primary Care, University of Exeter, National Institute for Health Research School for Primary Care Research
| | - Ignacio Ricci-Cabello
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Gerencia de Atención Primaria de Mallorca, Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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Rahmani P, Molaei Tavani F, Sheikhalipour Z, Behshid M, Khodayari MT, Zadi Akhuleh O. The relationship between attitude of nurses toward the patient safety and missed nursing care: A predictive study. J Healthc Qual Res 2021:S2603-6479(21)00105-6. [PMID: 34857498 DOI: 10.1016/j.jhqr.2021.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 11/21/2022]
Abstract
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.
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