Prevención del estrés y burn-out del equipo de salud: el nexo con la calidad de la atención sanitaria y la seguridad del paciente / Preventing stress and burn-out of healthcare staff: linkage with quality of healthcare systems and patient safety

Se destaca la importancia de la prevención del estrés y burn-out en los trabajadores que integran el equipo de salud. Se señala su directa relación con el error médico, la seguridad del paciente y la calidad de la atención sanitaria. (AU)

The purpose of this work is to point out the importance of preventing stress and burn-out of the healthcare staff and its relationship with medical errors, patient safety and quality of the healthcare systems. (AU)

Quality Use of Medicines among Makkah Residents, Saudi Arabia

Introduction:Quality Use of Medicines (QUoM) is of utmost importance regarding the safetyand overall healthcare of the consumers/patients. This study aimed to explore the general usage pattern and attitude of the Makkah community about the safe use of medicines i.e. QUoM Methods:Face to face interviewswere done to administer questionnaires among patients from two hospitals and four primary care centers dealing with patients from rural and urban areas in the Holly Makkah region.Results:A total of 554 patients were enrolled while the majority of them were lived in urban areas (n=457,82%). Around 419 (76%) responder were females and 531(96%) were living with their family and had up to college education(n=174,31%).We found that most of the respondents were diabetic(185,33%) and hypertensive (n=172,31%).Most of the patients (207,37%) stated that they preferred to get drug information from healthcare professionals.Conclusion:This periodic mapping of appropriate medication usage among patients/consumers is indeed an important effort to explore issues on QUoM

Prevalence, predictors and outcomes of potential drug-drug interactions in left ventricular failure: considerable factors for quality use of medicines

Hospitalized patients with left ventricular failure (LVF) are at high risk for potential drug-drug interactions (pDDIs) and its related adverse effects owing to multiple risk factors such as old age, comorbidities and polypharmacy. This cross-sectional study conducted in two tertiary care hospitals aim to identify frequency, levels and predictors of pDDIs in LVF patients. Data about patients' demographic, hospital stay, medication therapy, sign/symptoms and laboratory test results were collected for 385 patients with LVF. Micromedex Drug-Reax® was used to screen patients' medication profiles for pDDIs. Overall prevalence and severity-wise prevalence of pDDIs were identified. Chi-square test was performed for comparative analysis of various variables. Logistic regression was applied to determine the odds-ratios (OR) for predictors of pDDIs. The prevalence of pDDIs was 96.4% (n=371). Overall 335 drug-interacting pairs were detected, which were presented in a total of 2870 pDDIs. Majority of pDDIs were of major- (48.9%) and moderate-severity (47.5%). Logistic regression analysis shows significant association of >6 all types of pDDIs with >12 drugs as compared with <8 drugs (OR=16.5; p=<0.001). Likewise, there was a significant association of >4 major-pDDIs with men as compared with female (OR=1.9; p=0.007) and >12 drugs as compared with <8 drugs (OR=10.9; p=<0.001). Hypotension (n=57), impaired renal function (23) and increased blood pressure (22) were the most frequent adverse outcomes associated with pDDIs. This study shows high prevalence of pDDIs in LVF patients. Majority of pDDIs were of major- and moderate-severity. Male patients and those prescribed greater number of medicines were more exposed to major-pDDIs

Utility of failure mode and effect analysis to improve safety in patients with continuous renal replacement therapies / 中国实用护理杂志

Objective To identify the potential risks in patients receiving continuous renal replacement therapies (CRRT). Methods The concept of failure mode and effect analysis (FMEA) was used to analyze the management of CRRT, to find out the potential failure risks in all of the steps, risk priority numbers (RPNs) of each failure mode were calculated and countermeasures were implemented. Results Twenty-eight failure modes were analyzed, of which 8 modes RPN>125. After improvement of the nursing process in patients with CRRT, the RPN was lowered. The incidence of unplanned end of the CRRT was decreased from 10.86％ (24/221) to 5.81％ (14/241) (χ2=3.896, P<0.05). Conclusions Application of FMEA in risk management for CRRT can help to standardize the workflow and guarantee the safety of patients during CRRT, and is beneficial to continuous improvement of nursing.

Eventos adversos en un hospital pediátrico de tercer nivel de Bogotá / Adverse Events in a third level pediatric hospital in Bogotá / Eventos adversos num hospital pediátrico de terceiro nível de Bogotá

Resumen En Colombia la seguridad del paciente es una prioridad en la atención en salud; los eventos adversos e incidentes son una muestra de atención insegura en las instituciones. El compromiso interdisciplinario es fundamental para trabajo proactivo en promoción de prácticas seguras, prevención y detección de fallas latentes y activas en un hospital. Objetivo: determinar la frecuencia de eventos adversos mediante revisión de historias clínicas de un hospital pediátrico de tercer nivel de Bogotá, con el fin de fomentar prácticas seguras. Metodología: Investigación cuantitativa, transversal y descriptiva, dirigida a pacientes hospitalizados el 16 de mayo de 2013, sobre factores de riesgo, antecedentes hospitalarios, eventos adversos y complicaciones relacionados al cuidado de la salud. Resultados: Hubo 169 casos clasificados para algún suceso, de los cuales 59 Eventos Adversos, 57 incidentes, y 53 descartados por falsos positivos. Discusión: Se evidencia responsabilidad de prevención y control de infecciones por los profesionales de la salud, encargados de minimizar el riesgo del paciente vulnerable y, ante todo, proporcionar un manejo y mantenimiento adecuado de dispositivos médicos invasivos. Conclusiones: El 34,4% de historias clínicas presentaban algún tipo de evento adverso o incidente, revelando que algunos de estos fueron causados por la asistencia hospitalaria.

Abstract In Colombia, patients' safety is a priority in healthcare. Adverse events and incidents are an example of unsafe healthcare in institutions. An interdisciplinary commitment is fundamental in proactive work to promote safe practices, prevention, and detection of latent and active failures in hospital. Objective: To determine the frequency of Adverse Events by reviewing clinical histories in a third level pediatric hospital in Bogotá to foster safe practices. Methodology: A descriptive cross-sectional quantitative research was conducted focusing on hospitalized patients on May 16, 2013, working risk factors, hospital backgrounds, adverse events, and healthcare related complications. Results: There were 169 cases classified for a given event, of which 59 were Adverse Events, 57 were incidents and 53 were discarded as false positives. Discussion: Researchers evidenced the responsibility in infection prevention and control by healthcare professionals in charge of minimizing a vulnerable patient's risk, and above all, they provided a suitable use and maintenance of invasive medical devices. Conclusions: 34.4% of the clinical histories show some type of adverse event or incident, revealing evidence that in some cases they were caused by hospital care.

Resumo Na Colômbia a seguridade do paciente é uma prioridade na atenção em saúde; os eventos adversos e incidentes são uma mostra de atenção insegura nas instituições. O compromisso interdisciplinar e fundamental para trabalho proativo em promoção de práticas seguras, prevenção e detecção de falhas latentes e ativas num hospital. Objetivo: Determinar a frequência de eventos adversos mediante revisão de histórias clínicas dum hospital pediátrico de terceiro nível de Bogotá, com o fim de fomentar práticas seguras. Metodologia: Investigação quantitativa, transversal e descritiva, dirigida a pacientes hospitalizados o 16 de maio de 2013, sobre fatores de risco, antecedentes hospitalários, eventos adversos e complicações relacionados ao cuidado da saúde. Resultados: Houve 169 casos classificados para algum acontecimento, dos quais 59 Eventos Adversos, 57 incidentes, e 53 descartados por serem falsos positivos. Discussão: Se evidencia responsabilidade de prevenção e controle de infecções pelos professionais da saúde, encarregados de minimizar o risco do paciente vulnerável e, por acima de todo, proporcionar um manejo e mantimento adequado de dispositivos médicos invasivos. Conclusões: O 34.4% das histórias clínicas apresentavam algum jeito de Evento Adverso ou incidente, revelando evidência de que alguns destes foram causados pela assistência hospitalar.

Survey on cognitive status quo of nursing staffs on patients safety culture in second-class and tertiary hospitals of Nanchang City / 重庆医学

Objective To investigate the current situation of nursing staffs in second-class and tertiary hospitals of Nanchang City and influencing factors in order to provide a basis for the management and research of patients safety.Methods The convenience cluster sampling method was adopted to extract the whole nursing staffs from 7 hospitals(4 second-class hospitals and 3 tertiary hospitals)in Nanchang City as the research subjects.Then the multiple regression method was adopted to analyze the influencing factors of patients safety culture in the second-class and tertiary hospitals of Nanchang City.Results The advantage fields of cognition of the nursing staffs in the second-class hospitals on the patients safety culture were the intra-department teamwork,expectation actions of managers for promoting safety,organizational learning and continuous improvement,feedback and communication of mistakes,while the fields needing to be improved were the communication openness,personnel allocation,non-penalty reactions on mistakes;the advantage fields in the tertiary hospitals were same to those in the second-class hospitals,and the fields needing to be improved included the inter-department cooperation,personnel allocation,non-penalty reactions on mistakes.Conclusion The cognition of nursing staffs in 7 hospitals of Nanchang City on the patients safety culture is in a higher level,but insufficiency still exists,partial fields need to be continuously improved.

Research progress on the nursing safety management of patients in the operating room / 中国实用护理杂志

The operating room is a high-risk department whose nursing management focus is to ensure the safety of patients. This study gave an overview of the research progress on the nursing safety management in the operating room by the published literature. More effective basis and preferred plans were put forward for the safety nursing through the analysis of the current situation of nursing safety management and related factors affecting the safety of patients.As a result,it is to strengthen the nursing safety management and guarantee the safety of patients in the operating room.

The Development and Effects of Timeout Protocol for Safety in Cataract Surgery Patients / 재활간호학회지

PURPOSE: This study was conducted to develop effective timeout protocol in coordination with current practice and test its clinical effectiveness in pursuit of safety management for patients undergoing cataract surgery. METHODS: A total of subjects were 60 women, 50~65 years old, who visit C ophthalmology clinic in D city. They were assigned to 30 experimental group and 30 control group, respectively. Based on the comprehensive literature review, timeout protocol that was suitable for patients undergoing cataract surgery was developed, and then test its effectiveness by measuring blood pressure, pulse, anxiety and sense of well-being among surgical patients. RESULTS: The timeout protocol was found to reduce blood pressure, pulse, and anxiety and increase well-being among surgical patients. CONCLUSION: As a results, it is necessary to introduce an effective timeout protocol giving positive responses to surgical patients, hence it should be develop a timeout protocol and explore the effectiveness of the protocol.

Pharmaceutical care as a strategy to improve the safety and effectiveness of patients? pharmacotherapy at a pharmacy school: a practical proposal

Several patients experience at least one drug-related problem and Pharmaceutical Care can change this reality. This work describes a model for structuring the pharmaceutical care service at a pharmacy training unit of the Brazilian Public Health System based on pharmacotherapy follow-up program of Parkinson’s disease patients’ results. From the follow-up results (phase 1), a Therapy Management Scheme was designed (phase 2). Of the 57 patients followed-up, 30 presented at least one drug-related problem and 42% were non-adherent to treatment, which supported the need of pharmacotherapy management. The Pharmacotherapy Management Scheme was proposed as a pharmaceutical care service model, which presents 6 steps: first, the pharmacist fills out the dispensing form and assesses patient´s pharmacotherapy, if there is a suspect problem, he is invited to the follow-up (steps 1 and 2) and they agree the first appointment. After that, pharmacist studies the patient’s case (study phase, steps 3 and 4). At the second meeting, the pharmacist proposes the intervention needed, and at the third, assesses the intervention results and new problems (steps 5 and 6, respectively). The process ends when all therapeutics outcomes are reached. This practical model can significantly contributed to the development and organization of pharmaceutical care services.

Muitos pacientes vivenciam pelo menos um problema relacionado ao medicamento e à atenção farmacêutica pode mudar este fato. Este trabalho descreve um modelo para estruturar o serviço de atenção farmacêutica numa farmácia escola do Sistema Único de Saúde brasileiro baseado nos resultados de um programa de seguimento farmacoterapêutico de pacientes com Doença de Parkinson. A partir dos resultados do seguimento, um esquema de gerenciamento da farmacoterapia foi desenhado. Dos 57 pacientes acompanhados, 30 apresentaram um problema relacionado ao medicamento e 42% não aderiram ao tratamento, o que reforça a necessidade de gerenciar a farmacoterapia. O esquema proposto apresenta 6 passos: primeiro, o farmacêutico preenche o formulário de dispensação e avalia a farmacoterapia do paciente; caso haja suspeita de um problema, ele é convidado a participar do seguimento farmacoterapêutico (passos 1 e 2) e marcam a primeira consulta. Após esta, o farmacêutico estuda o caso (fase de estudo, passos 3 e 4). Na segunda consulta, o farmacêutico propõe as intervenções necessárias e, na terceira, avalia seus resultados e novos problemas (passos 5 e 6, respectivamente). O processo termina quando todos os objetivos terapêuticos são alcançados. Este modelo de prática pode contribuir significativamente para o desenvolvimento e organização de serviços de atenção farmacêutica.

A Delphi Study to Elicit Policies for Nurse Workforce based on Patient Safety / 간호행정학회지

PURPOSE: This study was done to suggest policies for nurse workforce based on patient safety. METHODS: The two steps in developing the items were items related to what would be desirable policies and items on how the policies should be developed for patient safety regarding nurse workforce. A literature review was done and suggestions from experts through two rounds using the Delphi technique were outlined. The fifteen experts who participated in this study were six representatives of service consumers and nine representatives of service providers (four medical doctors and fives nurses). RESULTS: To guarantee patient safety, accreditation of nursing practice and nursing education were found to be necessary, and to prevent medical and nursing accidents in clinical practice, the professional judgement of the nurses was found to be pivotal to the provision of safe nursing services. CONCLUSION: Polices on nursing for the nurse workforce based on patient safety in clinical settings should be established to ensure that nursing care is provided according to the nurses' clinical judgements based on their professional knowledge and assessment skills.

Discussions on patients' safety education in the nursing undergraduate education / 中华医学教育探索杂志

Patients' safety is a hot topic of hospital management all over the word. Strengthening the patients' safety education for medical students and nursing students is an effective measure to protect patients' safety. In nursing school of Chongqing Medical University,patients' safety education was con-ducted through the course of undergraduate education. Contents of patients' safety education were com-bined with the professional courses,which are taught step by step in the professional course learning phase for different grades. Patients' safety education took a lot of teaching forms to cultivate the students' patient safety consciousness and preliminary results were achieved.

Guías de práctica clínica "herramientas" para mejorar la calidad de la atención médica / Clinical guidelines "tools" for better medical care quality

Introducción: con el propósito de mejorar la calidad de la atención médica y garantizar la seguridad de los pacientes, en los últimos tiempos se han ido incorporando un grupo de "herramientas metodológicas", entre las que se encuentran las guías de práctica clínica. Objetivo: determinar el lugar que ocupan las guías de práctica clínica en la asistencia médica actual. Material y métodos: Se realiza una revisión de la literatura disponible sobre el tema, de donde se seleccionan de manera opinática, un conjunto de trabajos que se consideraron como los más importantes, así como se incluyen las opiniones recogidas por el autor de colegas relacionados con el tema en diversos intercambios formales e informales, a lo que se añade la experiencia y criterios propios del autor en más de 15 años. Resultados: se exponen las razones del surgimiento de las guías de práctica clínica, los requisitos que deben cumplir, los métodos para su elaboración, las etapas del proceso de su implementación y evaluación. Finalmente se brindan algunos consejos prácticos para uso, insistiendo que, aunque es común hablar de las buenas prácticas clínicas, la primera debe ser siempre la aplicación con excelencia del método clínico, del cual las guías son subsidiarias. Conclusiones: las guías de práctica clínica, como herramientas auxiliares de la atención médica, cuando son adecuadamente concebidas, elaboradas y utilizadas, pueden contribuir a mejorar la calidad de la asistencia médica que se brinda, aunque siempre como complemento de la aplicación con excelencia del método clínico.

Introduction: in order to improve the medical care quality and at the same time quarantee patients' safety,lately, it has been incorporated a group of methodological tools such as the clinical guidelines. Objective: Determine the role played by the clinical guidelines in present day medical practice. Methods: i was made a review of the available literature about this topic selecting a group of works considered as the most importants. There were also included different opinions of colleagues as well as the author's criteria based on the experience of more than 15 years. Results: the reasons of the appearance of clinical guidelines, their requirements to fulfill, the methods of elaboration and their implementation and assessment are exposed in this work. Finally, some practical advises are offered making emphasis on a good aplication of the clinical method playing the clinical guidelines a subsidiary role. Conclusions: when linical guidelines are conceived and used adequately they can contribute to improve the Quality of medical care as a complement of a clinical method of excelence.

Eventos adversos en cirugía / Adverse events in surgery

Objetivo: Analizar los eventos adversos reportados en el Sistema de Notificación de Evento Centinela, Evento Adverso y Cuasifalla ''VENCER II'' del Instituto Mexicano del Seguro Social. Sede: Unidad de Atención Médica Instituto Mexicano del Seguro Social. Diseño: Estudio transversal, retrospectivo, observacional, descriptivo. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas. Material y métodos: Se presenta una revisión de los eventos adversos reportados durante un mes. En esta investigación fueron incluidos dos apartados, eventos adversos relacionados con procedimientos quirúrgicos y procesos infecciosos. Resultados: Total de eventos adversos 78, el grupo de edad más afectado fue de 16 a 45 años (49%), el género predominante fue el femenino con 66%, en el turno en el que ocurrieron con mayor frecuencia fue el matutino con 77%, especialidad de mayor incidencia fue cirugía general con el 51%. En relación al origen, la infección en sitio quirúrgico correspondió al 69%, otras infecciones nosocomiales 1.5% y causas no infecciosas 29.5% (lesión de órgano), la severidad moderada en el 71% de los casos y el personal involucrado con mayor frecuencia fue el médico con el 57%. Conclusión: El sistema prevé retroalimentación permanente, análisis para identificar la causa raíz y las acciones de mejora tendientes a reducir y prevenir los eventos adversos.

Objective: To analyze the adverse events reported to the Notification System of sentinel event, adverse event, and quasi-failure ''VENCER II'' of the Mexican Institute of Social Security (IMSS, for its initials in Spanish). Setting: Medical Care Unit, IMSS Design: Cross-sectional, retrospective, observational, descriptive study. Statistical analysis: Percentages as summary measure for qualitative variables. Material and methods: We present a review of the adverse events reported in one month. In this investigation, we included two types of events: those related to surgical procedures and those to infectious processes. Results: Total of adverse events, 78, the most affected age group was that of 16 to 45 years (49%), the predominating gender was the female with 66%; the shift during which they occurred most frequently was the morning shift with 77%, the specialty with the highest incidence was general surgery with 51%. In regard to origin, infections of the surgical site corresponded to 69%, other nosocomial infections represented 1.5%, and non-infectious cases corresponded to 29.5% (organ lesion); severity was moderate in 71%, and the medical personnel was the most infrequently involved with 57%. Conclusion: The system provides permanent feedback, as well as an analysis to identify the root cause and the improvement actions to reduce and prevent adverse events.

Comparison of Adverse Events due to Differences in NICU Nursing Expertise

PURPOSE: Nursing quality influences patient' outcomes in the neonatal intensive care unit (NICU). We compared differences in adverse events (AEs) by differences in the level of nursing experience at the NICU, developed guidelines to prevent AE, and then investigated the change in AE. METHODS: AEs related to nursing were investigated from January 1, 2009 to December 31 2009 at the NICU of the newly established A hospital and B hospital that has been operating for 14 years. We also assessed the level of nursing experience. Guidelines to prevent nursing-related AEs were prepared at A hospital, and the change in the incidence of AE was investigated after 1 year. RESULTS: Twenty nurses (80%) had <2 years experience at A hospital, whereas 13 nurses (65%) had 2 years or longer but less than 4 years experience at B hospital (P<0.001). The number of incidences of AE that occurred in 2009 in A hospital was higher (46) than that at B hospital (10). Intravenous (IV) injection-related incidents had the highest share in both hospitals: 24 incidents (52.2%) at hospital A and eight incidents (80%) at hospital B. After the guidelines were instituted in 2009, the number of nursing AEs decreased to 17, of which the number of IV incidents was the highest (6, 35%), athough its share decreased. CONCLUSION: Supervision and prevention guidelines should be in place to reduce nursing AEs, which would improve the quality of NICU service.

Patient Safety Curriculum in Medical Education / 한국의학교육

Since release of the Institute of Medicine (IOM) report, To Err Is Human: Building a Safer System, patient safety has emerged as a global concern in the provision of quality health care. In response to growing recognition of the importance of patient safety, some medical schools in other countries have created and/or implemented patient safety curricula. In Korea, however, patient safety medical curriculum has not been actively discussed by medical educators. The purpose of this article is to introduce patient safety concepts and the global efforts on patient safety medical education. Specifically, this article describes; 1) current concepts in patient safety, 2) global trends of patient safety movement and education, 3) contents, instructional and assessment methods of patient safety education for both undergraduate medical education and graduate medical education, suggested in the previous studies, 4) WHO Patient Safety Guide for Medical Curriculum developed by the Medical Education Team within the World Alliance for Patient Safety and 5) known barriers against patient safety education. Patient safety is a major priority for all healthcare providers. In reality, however, teaching and learning about patient safety in medical curriculum offers a challenge to all medical schools, especially, the health care environment is not favorable to physicians such as Korea. More attention and recognition about patient safety by all health personnel and medical educators is needed. In addition, the national conversation about medical errors and patient safety and how best to incorporate it to the existing curriculum should be discussed.

Patient Safety Curriculum in Medical Education / 한국의학교육

Since release of the Institute of Medicine (IOM) report, To Err Is Human: Building a Safer System, patient safety has emerged as a global concern in the provision of quality health care. In response to growing recognition of the importance of patient safety, some medical schools in other countries have created and/or implemented patient safety curricula. In Korea, however, patient safety medical curriculum has not been actively discussed by medical educators. The purpose of this article is to introduce patient safety concepts and the global efforts on patient safety medical education. Specifically, this article describes; 1) current concepts in patient safety, 2) global trends of patient safety movement and education, 3) contents, instructional and assessment methods of patient safety education for both undergraduate medical education and graduate medical education, suggested in the previous studies, 4) WHO Patient Safety Guide for Medical Curriculum developed by the Medical Education Team within the World Alliance for Patient Safety and 5) known barriers against patient safety education. Patient safety is a major priority for all healthcare providers. In reality, however, teaching and learning about patient safety in medical curriculum offers a challenge to all medical schools, especially, the health care environment is not favorable to physicians such as Korea. More attention and recognition about patient safety by all health personnel and medical educators is needed. In addition, the national conversation about medical errors and patient safety and how best to incorporate it to the existing curriculum should be discussed.

Innovation Research and Practical Application of Critical Values Monitor in Medical Security Alert System / 医疗卫生装备

Objective The application of modern information technology to manage critical values of clinical examination,in order to improve the management level of patients safety and reduce the medical risk.Methods The critical values reminder in medical security alert system is developed and applied,the core module of the system are warning monitor of equipment record and SMS warning monitor of alerting in testing critical value.Results Through the application of system,the information of testing critical values are obtained duly,comprehensively and accurately,the notification time of clinical testing critical values are abbreviated,the notification scopes are spread and achieved the management of critical value at different levels.Conclusion The application of the system can be perfected the management of critical values,ensured patients safety,improved the medical quality and enhanced the management level of hospital,and then the system has become another example of informationization creating value.