Analysis of the degree of implementation of medication error prevention practices in Spanish hospitals (2022)

OBJECTIVE

To assess the degree of implementation of medication error prevention practices in Spanish hospitals.

METHOD

Descriptive multicenter study of the degree of implementation of the safety practices included in the "Medication use-system safety self-assessment for hospitals. Version. II". Spanish hospitals that completed the questionnaire between October/2021 and September/2022 participated. The survey contains 265 items for evaluation grouped into 10 key elements. Mean score and mean percentages based on the maximum possible values for the overall survey, for the key elements and for each individual item of evaluation were calculated. The results were compared with those of the previous 2011 study.

RESULTS

A total of 131 hospitals from 15 autonomous regions participated in the study. The mean score of the overall questionnaire in all hospitals was 898.2 (57.4% of the maximum possible score). No differences were found according to dependency, size or type of hospital, either in the overall questionnaire or in the key elements. The lowest values were found for key elements 8, 1 and 6, on competence and training of health professionals in safety practices (45.1%), availability and accessibility of essential information on patients (48%), and devices for administering drugs (52.3%). With respect to 2011, significant increases were found both in the overall questionnaire and in the key elements, except 5 and 7, referring to standardization, storage and distribution of medications, and environmental factors and human resources. Several evaluation items on the safe management of high-risk drugs, medication reconciliation, incorporation of clinical pharmacists into the healthcare teams and implementation of technologies that allow full traceability throughout the medication system, showed low percentages CONCLUSIONS: There has been appreciable progress in the degree of implementation of some medication error prevention practices in Spanish hospitals, but many proven efficacy practices recommended by the World Health Organization and safety organizations are still poorly implemented. The information obtained can be useful for prioritizing the practices to be addressed and as a new baseline for monitoring progress.

Factors from healthcare delivery affecting breast cancer survival in a health area of Northern of Spain

OBJECTIVE

Clinical breast cancer decision-making significantly affects life expectancy and management of hospital resources. The aims of the present study were to estimate the time of survival for breast cancer patients and to identify independent factors from healthcare delivery associated with survival rates in a specific health area of Northern of Spain.

METHODS

Survival analysis was conducted among a cohort of 2545 patients diagnosed with breast cancer between 2006 and 2012 from the population breast cancer registry of Asturias-Spain and followed up till 2019. Adjusted Cox proportional hazard models were used to identify the independent prognostic factors of all-cause from death.

RESULTS

The 5-year survival rate was 80%. Advanced age (>80 years) (hazard ratio, HR: 4.35; 95% confidence interval, CI: 3.41-5.54), hospitalization in small hospitals (HR: 1.46; 95% CI: 1.09-1.97), treatment in oncology wards (HR: 3.57; 95% CI: 2.41-5.27), and length of stay >30 days (HR: 2.24; 95% CI: 1.32-3.79) were the main predictors of death. By contrast, breast cancer suspected via screening was associated with a lower risk of death (HR: 0.55; 95% CI: 0.35-0.87).

CONCLUSION

There is room for improvement in survival rates after breast cancer in the health area of Asturias (Northern of Spain). Some healthcare delivery factors, and other clinical characteristics of the tumor influence the survival of breast cancer patients. Strengthening population screening programs could be relevant to increasing survival rates.

[Primary care pathways and locations during the pandemic in a rural area of Alicante]

This paper describes the means of health care used in a primary health care centre (PHCC) in a rural area to care for patients during the COVID-19 pandemic. After conducting a cross-sectional study using health questionnaire with 243 patients (100 COVID-19 and 143 other pathologies), we observed that general medical care was 100% by telephone, and little use was made of the portal for citizen information and appointment requests of the Conselleria de Sanitat de la Comunidad Valenciana. Nursing attended 100% by telephone, as did the PHCC doctors and the PHCC emergencies; in the case of taking samples, blood samples and wound care it was face-to-face (men 91%, women 88%), and at home (9% and 12%). In conclusion, different care patterns are observed according to the PHCC professionals, and the need to improve the online pathway with care management.

Efficacy and marginal cost of treatment with tocilizumab in COVID-19 patients

OBJECTIVE

To describe the marginal cost and survival of patients treated with tocilizumab in a university hospital under real-life conditions and to evaluate factors that could influence costs and health outcomes will be evaluated.

METHODS

Observational, single-center, retrospective study of a cohort of adult patients infected with SARS-CoV-2 treated with tocilizumab. The one-year restricted mean survival time was analyzed in life-years gained (LYG). The influence of sex, age and severity on patient survival was evaluated. The marginal cost/LYG and marginal cost/survivor ratios were calculated.

RESULTS

508 patients (66 ± 13 years; 32% women) were included. Seventeen percent were admitted to the ICU. Overall survival was 77%. Age older than 71.5 years (HR = 1.08; 95% CI 1.07-1.10; p < 0.001) and ICU admission at initiation of treatment (HR = 2.01; 95% CI 1.30-3.09; p = 0.002) were identified as risk factors. The total budgetary impact of tocilizumab in the period analyzed was 206,466 euros. The patients with the highest cost per unit of health outcome were those admitted to the ICU and those over 71.5 years, with a marginal cost/LYG of € 966 and a marginal cost/survivor of € 1,136.

CONCLUSION

The efficiency of treatment with tocilizumab is associated with the age and severity of the patients. The figures are lower in all subgroups than the thresholds usually used in cost-effectiveness evaluations. The results of the present study suggest that early first dose of tocilizumab is an efficient strategy.

[Translated article] Efficacy and marginal cost of treatment with tocilizumab in COVID-19 patients

OBJECTIVE

To describe the marginal cost and survival of patients treated with tocilizumab in a university hospital under real-life conditions and to evaluate factors that could influence costs and health outcomes will be evaluated.

METHODS

Observational, single-center, retrospective study of a cohort of adult patients infected with SARS-COV2 treated with tocilizumab. The 1 year restricted mean survival time was analyzed in life-years gained (LYG). The influence of sex, age and severity on patient survival was evaluated. The marginal cost/LYG and marginal cost/survivor ratios were calculated.

RESULTS

508 patients (66 ± 13 years; 32% women) were included. Seventeen percent were admitted to the ICU. Overall survival was 77%. Age older than 71.5 years (HR = 1.08; 95% CI 1.07-1.10; p < 0.001) and ICU admission at initiation of treatment (HR = 2.01; 95% CI 1.30-3.09; p = 0.002) were identified as risk factors. The total budgetary impact of tocilizumab in the period analyzed was 206,466 euros. The patients with the highest cost per unit of health outcome were those admitted to the ICU and those over 71.5 years, with a marginal cost/LYG of €966 and a marginal cost/survivor of €1136.

CONCLUSION

The efficiency of treatment with tocilizumab is associated with the age and severity of the patients. The figures are lower in all subgroups than the thresholds usually used in cost-effectiveness evaluations. The results of the present study suggest that early first dose of tocilizumab is an efficient strategy.

Assessment of the perception of healthcare barriers and the impact of intravitreal injections on neovascular age-related macular degeneration

AIM

To evaluate the perception of barriers in healthcare and the impact of intravitreal injections in patients with neovascular age-related macular degeneration (nAMD).

METHODS

Cross-sectional study including 108 patients with nAMD in treatment with intravitreal injections. The patients answered a questionnaire with 26 questions (score from 1 to 5) divided in three sections: 1) the disease and its treatment with injections, 2) healthcare barriers and 3) new technologies.

RESULTS

The mean age was 80.4 ± 7.0 years and visual acuity (VA) was 75.2 ± 12.4 letters. The main barriers in healthcare were long waiting times (72%), followed by other comorbidities (10%). Some 63% of patients have to wait between 3 and 5 h to attend their clinical visit. Significant anxiety due to the injections (2.8 ± 1.3) was observed, being present in 71% of the cases the day before. A great fear of blindness and losing independence was observed (4.4 ± 0.9 and 4.3 ± 1.1), with no differences in relation to VA, age or sex (p ≥ 0.135). Moreover, 28% of the patients reported that it was quite or very difficult for them to attend the clinical visit, with 69% of the total showing great interest in having a diagnostic device at home.

CONCLUSION

The nAMD and its treatment represent a significant burden on patients, among whom there is a great fear of blindness and of losing their independence, the main barrier being the long waiting time for the clinical visit.

[Perspectives of patients with Duchenne muscular dystrophy: A focal group to improve healthcare quality]

INTRODUCTION

Duchenne muscular dystrophy is a complex disease that requires a multidisciplinary and coordinated approach. Given that therapeutic efforts are centred on improving the quality of life of the patient, the aim of this study is to find out the views of young people and adolescents with Duchenne muscular dystrophy, their families, and health professionals as regards the healthcare provided by the hospital in order to improve their quality of life.

METHODS

A qualitative study was conducted using 3 focal groups consisting of patients, families, and healthcare professionals. A thematic guide was prepared, and the information from the interviews was gathered using a sound recorder. In order to analyse the information, the transcriptions were coded and the significant data of each interview were extracted and grouped into various topics.

RESULTS/CONCLUSIONS

The main worries of the 3 groups were along the same line. On the one hand, the importance of a coordinated multidisciplinary team in the same unit that provides the integral care. On the other hand, sport as a common interest in these adolescents, and the consideration of a positive relationship between leisure and quality of life, finding that their participation in physiotherapy groups of great use. To achieve this objective, it is necessary to improve the coordination between the hospital and the different groups. The parents also demanded better cover in the social and psychological care offered by the hospital. Lastly, the importance of humanising the care was mentioned (privacy, adapting of structures, transmission of information, sexuality…).

Impact of the COVID-19 pandemic on headache management in Spain: an analysis of the current situation and future perspectives

INTRODUCTION

The COVID-19 pandemic has had a great impact on healthcare systems. Spain, where headache is the main reason for outpatient neurology consultation, is one of the countries with the most reported cases of the disease.

OBJECTIVE

This study aimed to analyse the impact of the COVID-19 pandemic on headache units in Spain and to evaluate how neurologists see the future of these units.

METHODS

We conducted a cross-sectional online survey of headache units during the sixth week of the state of alarm declared in Spain in response to the pandemic.

RESULTS

The response rate was 74%, with the participation of centres with different characteristics and from all Autonomous Communities of Spain. Limitations in face-to-face activity were reported by 95.8% of centres, with preferential face-to-face consultation being maintained in 60.4%, and urgent procedures in 45.8%. In 91.7% of centres, the cancelled face-to-face activity was replaced by telephone consultation. 95.8% of respondents stated that they would use personal protection equipment in the future, and 86% intended to increase the use of telemedicine. The majority foresaw an increase in waiting lists (93.8% for initial consultations, 89.6% for follow-up, and 89.4% for procedures) and a worse clinical situation for patients, but only 15% believed that their healthcare structures would be negatively affected in the future.

CONCLUSIONS

As a consequence of the pandemic, headache care and research activity has reduced considerably. This demonstrates the need for an increase in the availability of telemedicine in our centres in the near future.

Defensive practices among non-medical health professionals: An overview of the scientific literature

INTRODUCTION

Defensive medicine (DM) is used when a doctor deviates from good practices to prevent complaints from patients or caregivers. This is a structured phenomenon that may not only affect the physician, but all healthcare personnel. The aim of this review was to determine whether DM is also performed by Non-Medical Health Professionals (NMHP), and the reasons, features, and effects of NMHP-DM.

MATERIALS AND METHODS

The review was conducted according to PRISMA guidelines, and specific inclusion criteria were used to search for relevant documents published up to 12 April 2018 in the main biomedical databases.

RESULTS

A total of 91 potentially relevant studies were identified. After the removal of duplicates, 72 studies were screened for eligibility, separately by two of the authors. Finally, 14 qualitative and quantitative studies were considered relevant for the purpose of the present review. These last studies were assessed for their methodological quality.

CONCLUSIONS

NMHP-DM is quite similar to DM practiced by doctors, and is mainly caused by fear of litigation. Midwives and nursing personnel practiced both active and passive DM, such as over-investigation, over-treatment, and avoidance of high-risk patients. NMHP-DM could increase risks for patient health, costs, risk of burnout for healthcare employees. Further studies are needed to better understand prevalence and features of NMHP-DM in all health professional fields, in order to apply appropriate preventive strategies to contrast DM among health care personnel.

[Spanish patients with central hypoventilation syndrome included in the European Registry. The 2015 data]

INTRODUCTION

Congenital Central Hypoventilation Syndrome (CCHS) is a very rare genetic disease. In 2012 the European Central Hypoventilation Syndrome (EuCHS) Consortium created an online patient registry in order to improve care.

AIM

To determine the characteristics and outcomes of Spanish patients with CCHS, and detect clinical areas for improvement.

MATERIALS AND METHOD

An assessment was made on the data from Spanish patients in the European Registry, updated on December 2015.

RESULTS

The Registry contained 38 patients, born between 1987 and 2013, in 18 hospitals. Thirteen (34.2%) were older than 18 years. Three patients had died. Genetic analysis identified PHOX2B mutations in 32 (86.5%) out of 37 patients assessed. The 20/25, 20/26 and 20/27 polyalanine repeat mutations (PARMs) represented 84.3% of all mutations. Longer PARMs had more, as well as more severe, autonomic dysfunctions. Eye diseases were present in 47%, with 16% having Hirschsprung disease, 13% with hypoglycaemia, and 5% with tumours. Thirty patients (79%) required ventilation from the neonatal period onwards, and 8 (21%) later on in life (late onset/presentation). Eight children (21%) were using mask ventilation at the first home discharge. Five of them were infants with neonatal onset, two of them, both having a severe mutation, were switched to tracheostomy after cardiorespiratory arrest at home. Approximately one-third (34.3%) of patients were de-cannulated and switched to mask ventilation at a mean age of 13.7 years. Educational reinforcement was required in 29.4% of children attending school.

CONCLUSION

The implementation of the EuCHS Registry in Spain has identified some relevant issues for optimising healthcare, such as the importance of genetic study for diagnosis and assessment of severity, the high frequency of eye disease and educational reinforcement, as well as some limitations in ventilatory techniques.

[Preventive measures for avoiding transmission of microorganisms between hospitalised patients. Hand hygiene]

Health-care associated infections are an important public health problem worldwide. The rates of health-care associated infections are indicators of the quality of health care. The infection control activities related to prevention of transmission of hospital microorganisms can be grouped in 4 mayor areas: standard precautions, specific precautions (including isolation if appropriate), environmental cleaning and disinfection, and surveillance activities (including providing infection rates and monitoring procedures). Hand hygiene and the correct use of gloves are the most important measures to prevent health-care associated infections and to avoid the dissemination of multidrug-resistant microorganisms. Continuous educational activities aimed at improving adherence to hand hygiene are needed. Periodical assessment of adherence to hand hygiene recommendations with feed-back have been shown to provide sustained improvement. Several complementary activities are being evaluated, including skin decolonization prior to certain surgeries, a package of measures in patients with central venous catheters or mechanical ventilation, and universal body hygiene with chlorhexidine. The present area of discussion concerns in which situations and in which groups would such measures be effective and efficient.