ABSTRACT
Resumo Introdução: A Autoavaliação das Práticas de Segurança do Paciente é um ato regulatório para melhoria da qualidade do cuidado. Porém, há dúvidas sobre a validade das suas informações. O objetivo deste estudo foi analisar a sua confiabilidade. Método: Estudo piloto de análise da confiabilidade de 21 indicadores simples e um composto da autoavaliação como forma de embasar uma amostra nacional em estudos futuros. Participaram hospitais com leitos de terapia intensiva e comparou dados da Autoavaliação (AA) e Autoavaliação Revisada (AR) pela vigilância sanitária (Visa) com a Inspeção Presencial (IP). A análise incluiu os coeficientes Kappa e de correlação intraclasse. Resultados: Comparando com a IP, a concordância foi aceitável (Kappa≥0,4) em 12 indicadores da AA e em 18 da AR. Os indicadores menos confiáveis são relativos a protocolos de prevenção de infecções. Quanto ao indicador composto do nível de adesão, a confiabilidade melhorou com revisão da Visa (AA=0,89 e AR=0,94), embora a concordância da classificação de alta conformidade tenha sido baixa. Conclusões: A AR se mostrou essencial para melhorar a confiabilidade da Autoavaliação. Ademais, identificou-se necessidade de revisar alguns indicadores e o instrumento de verificação pela Visa.
Abstract Introduction: The Patient Safety Self-Assessment Practices is a regulatory action to enhance quality of care. However, validation of its information requires attention. This study aimed to analyze reliability of the Patient Safety Self-Assessment Practices. Methods: Pilot study analyzing the reliability of 21 simple indicators and 1 composite of self-assessment to provide a national sample in future studies. Hospitals with intensive unit care beds participated in the study, and data from self-assessment (SA) and revised self-assessment (RSA) by the health surveillance (HS) were compared with on-site inspection (OSI). Analyses included Kappa and intraclass correlation coefficients. Results: Concordance was satisfactory (Kappa ≥ 0.4) in 12 indicators of SA and 18 indicators of RSA compared with OSI. The least reliable indicators were related to infection prevention protocols. Reliability of the adherence level composite indicator improved with HS revision (SA = 0.89 and RSA = 0.94), despite the low concordance of the high compliance classification. Conclusion: RSA was essential to improve reliability of SA. In addition, some indicators and assessment tools of the HS need revision.
Subject(s)
Health Evaluation , Health Care Coordination and Monitoring , National Health Surveillance System , Brazilian Health Surveillance Agency , Patient Safety/legislation & jurisprudence , Data Accuracy , BrazilSubject(s)
Humans , Male , Female , Infant, Newborn , Adult , Aged , Cross Infection/complications , Endocarditis/epidemiology , Endocarditis/prevention & control , Infections/epidemiology , Infections/history , Infections/therapy , Comorbidity , Hand Hygiene/methods , Patient Safety/legislation & jurisprudence , Public Health , Risk Factors , VaccinesABSTRACT
Parte sustancial de la mejora de la calidad asistencial está en garantizarla seguridad de los pacientes, evitando en lo posible los incidentes imprevistos durante la estancia hospitalaria derivados de la asistencia sanitaria y no de la enfermedad del paciente. El presente trabajo tiene el objetivo de describir las metas internacionales de la seguridad del paciente en el ámbito de la estomatología. Aunque dichas metas fueron diseñadas originalmente para el ámbito hospitalario, reflexionandosobre cada una de ellas, se puede distinguir que todas son adaptables alentorno de la práctica estomatológica e identificar el momento propicio en que aplican. La seguridad del paciente es además una obligación ética que mejora la seguridad legal de los estomatólogos y disminuye las reclamaciones...
Subject(s)
Humans , Adult , Child , Patient Harm/prevention & control , Medical Errors/prevention & control , Patient Safety/legislation & jurisprudence , Patient Safety/standards , Quality of Health Care/standards , Iatrogenic Disease , Legislation, Dental , Liability, Legal , MalpracticeABSTRACT
In Germany, the commission D recommends in its current dosage guidelines from March 17, 2004, that homeopathic dilutions higher than 24x will be prescribed in a daily application of five drops once. This recommendation is decisive for the German Regulatory Authority. Even though the homochord Acidum L(+)-lacticum 4x/6x/12x/30x/200x contains dilutions above 24x, it is commonly used in clinical practice for over 30 years in a dosage of 60 drops three times daily. In order to explore the clinical safety and tolerability of Acidum L(+)-lacticum 4x/6x/12x/30x/200x at a dosage of 60 drops three times daily, as well as lower dosages, a therapist survey was designed to address the questions. Highly experienced and licensed therapists, including general and alternative practitioners, reported their usual dosage of homochord, incidences of drug reactions, initial homeopathic aggravations as well as the diagnoses that led to the prescription of Acidum L(+)-lacticum 4x/6x/12x/30x/200x. 167 therapist responses were analyzed. Only four therapists reported occurrences that classify as initial aggravation, (2.40 %), compared to 159 with no incidences (95.21 %). Four therapists made no statement. Nevertheless, there were no adverse drug reactions documented in the survey. Consequently, Acidum L(+)-lacticum 4x/6x/12x/30x/200x at a dosage of 60 drops three times daily or lower dosages may be construed to be clinically tolerable and safe. This evidence might lead to further re-evaluations of other homochords, and rigorous clinical trials for its safety and tolerability...
Subject(s)
Humans , Therapeutic Human Experimentation , Lactis Acidum/administration & dosage , Drug Prescriptions/standards , Administration, Oral , Patient Safety/legislation & jurisprudenceABSTRACT
Se realizó un estudio conocido como investigación ex post facto, se trabajó en series de tiempo y evaluación, el objetivo de este estudio fue determinar el impacto sobre el comportamiento de los indicadores de la calidad sensibles a enfermería después de la implementación de la política de seguridad del paciente en una institución prestadora de servicios de salud de tercer nivel de la ciudad de Bogotá. Se analizaron 5 años de indicadores divididos en: 2 años anteriores a la implementación, el año de implementación y los dos años posteriores a la implementación de la política de seguridad del paciente en la institución, para tener 60 meses de observación, además es de tipo retrospectiva, ya que retrocede en el tiempo en busca de información, descriptiva por que busca ilustrar al lector respecto de la situación de la institución y el impacto que tiene la implementación de la política. Para optimizar el análisis se presentan dos variables: Variable 1: Indicadores de calidad de atención sensibles a enfermería Variable 2: Acciones de Gestión de enfermería, estas acciones se evalúan durante y después de la implementación se organizó sistemáticamente en: capacitación, adecuación y motivación. La seguridad del paciente en la institución genero un impacto positivo en los indicadores sensibles a la atención de enfermería, que aunque este no surge de un departamento de enfermería, es coordinado, dirigido y evaluado por enfermeras y es de ellas, las líderes de cada programa de donde descienden todas las acciones de gestión para lograr impactar los indicadores.
The purpose of this ex post facto research based on time and evaluation series, was to understand the impact on the behavior of nursing quality indicators after a patient security policy was implemented at a third level health service institution in the city of Bogotá, Colombia. Analysis of indicators of a 5-year period included 2 years before the implementation of the policy, 1 year during the implementation and 2 years after, for a total of 60 months of observation. This retrospective investigation also offers descriptive information to give a context on the institution and the impact of the program implementation. The two variables presented for the analysis, are: Variable 1: Indicators on the quality of nursing assistance. Variable 2: Nursing management activity such as training, adaptation and motivation. Security for the patient generated a positive impact on all indicators related to nursing. Although the program did not start in this department, it was coordinated, directed and evaluated by nurses who lead all management actions.
Subject(s)
Humans , Male , Female , Quality of Health Care , Nursing Care , Total Quality Management , Policy , Patient Safety/legislation & jurisprudenceABSTRACT
Negligence is the breach of a duty caused by the omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do. The definition involves three constituents of negligence: (1) A legal duty to exercise due care on the part of the party complained of towards the party complaining the former's conduct within the scope of the duty; (2) breach of the said duty; and (3) consequential damage. Cause of action for negligence arises only when damage occurs; for, damage is a necessary ingredient of this tort. Hon’ble Supreme Court Bench comprising B.N. Agrawal, P.P. Naolekar & Dalveer Bhandari, pronounced a Judgment on May 8, 2007 on this issue. Other relevant decisions of various Consumer Forums including National Consumer Disputes Redressal Commission are discussed. This paper will help in enlightening medical fraternity on new dimensions of scope of COPRA 1986, meaning and interpretations of term ‘service’ ‘consumer’ and ‘jurisdiction’.