Educação permanente para qualidade e segurança do paciente em hospital acreditado / Educación permanente para calidad y seguridad del paciente en hospital acreditado / Permanent education for quality and patient safety in an accredited hospital

Resumo Objetivo Compreender os desafios enfrentados pela educação permanente para o alcance da melhoria da qualidade e da segurança do paciente em um hospital público submetido à acreditação hospitalar. Métodos Estudo descritivo, transversal e com abordagem qualitativa. Realizaram-se entrevistas semiestruturadas com 22 profissionais, durando, em média, 22 minutos, as quais posteriormente foram analisadas e interpretadas por meio da análise de conteúdo temática de Bardin. Adotaram-se os softwares Iramuteq para a análise de corpus textual, e o BioEstat 5.3, para análise do perfil dos participantes. A coleta de dados ocorreu em junho de 2022, após aprovação nos Comitês de Ética em Pesquisa. Resultados Aplicou-se a análise de classificação hierárquica descendente, gerada pelo Iramuteq. Obtiveram-se três categorias: Desafios da Educação Permanente mediante o Processo de Melhoria Contínua; Educação Permanente para a Promoção da Qualidade e da Segurança do Paciente no Contexto da Acreditação Hospitalar; e Estratégias Educativas para a Melhoria da Qualidade e da Segurança do Paciente. Conclusão Identificaram-se desafios inerentes às ações de educação permanente em saúde, tais como resistência à mudança de cultura, adesão às atividades, alta rotatividade de profissionais e dificuldade para liberação da equipe de enfermagem para participar das atividades relacionadas à demanda de trabalho.

Resumen Objetivo Comprender los desafíos enfrentados por la educación permanente para lograr mejorar la calidad y la seguridad del paciente en un hospital público sometido a acreditación hospitalaria. Métodos Estudio descriptivo, transversal y con enfoque cualitativo. Se realizaron entrevistas semiestructuradas a 22 profesionales, con duración promedio de 22 minutos, que luego se analizaron e interpretaron mediante el análisis de contenido temático de Bardin. Se utilizaron los softwares Iramuteq para el análisis de corpus textual y BioEstat 5.3 para el análisis del perfil de los participantes. La recopilación de datos se llevó a cabo en junio de 2022, después de la aprobación de los Comités de Ética en Investigación. Resultados Se aplicó el análisis de clasificación jerárquica descendente, generado por Iramuteq. Se obtuvieron tres categorías: Desafíos de la educación permanente mediante el proceso de mejora continua, Educación permanente para la promoción de la calidad y de la seguridad del paciente en el contexto de la acreditación hospitalaria, y Estrategias educativas para la mejora de la calidad y la seguridad del paciente. Conclusión Se identificaron desafíos inherentes a las acciones de educación permanente en salud, tales como resistencia a cambios de cultura, adherencia a las actividades, alta rotación de profesionales y dificultad de autorizar al equipo de enfermería para participar en las actividades relacionadas con la demanda de trabajo.

Abstract Objective To understand the challenges faced in terms of permanent education in health, for achieving quality improvements and patient safety at a public hospital undergoing hospital accreditation. Methods This was a descriptive, cross-sectional study with a qualitative approach. Semi-structured interviews were conducted with 22 professionals, lasting an average of 22 minutes. The interviews were subsequently analyzed and interpreted using Bardin's thematic content analysis. The software Iramuteq was used to analyze the textual corpus, and BioEstat 5.3 was used to analyze the profile of the participants. The data collection took place in June 2022, following approval by the Research Ethics Committees. Results The descending hierarchical classification analysis, generated by Iramuteq, was applied, resulting in three categories: Challenges of Permanent Education through the Continuous Improvement Process, Permanent Education for the Promotion of Quality and Patient Safety in the Context of Hospital Accreditation, and Educational Strategies for Improving Quality and Patient Safety. Conclusion Challenges inherent to the actions of permanent education in health were identified, such as resistance to cultural change, adherence to activities, high turnover of professionals, and difficulty in releasing the nursing team to participate in activities, due to work demand.

Improvement in the quality of pressure injury prevention in an intensive care unit / Mejora de la calidad de la prevención de lesiones por presión en una unidad de cuidados intensivos / Melhoria da qualidade da prevenção de lesão por pressão em uma unidade de terapia intensiva

ABSTRACT Objective: to assess the effect of implementing a quality improvement project on the process of pressure injury prevention in an adult Intensive Care Unit. Method: a quality improvement project for the pressure injury prevention process was carried out in an adult Intensive Care Unit of a public hospital from November 2022 to July 2023. It was developed following the steps of an improvement cycle. The quality level of pressure injury prevention was measured before and after the interventions, using six quality criteria. Data collection for the first assessment was conducted in March 2023, retrospectively, referring to November and December 2022 and January 2023. Quality reassessment occurred in July 2023, also retrospectively, referring to April, May, and June 2023. Interventions included changes in records related to assistance in pressure injury prevention and education/awareness of the team on pressure injury prevention. Results: the initial quality assessment showed that the compliance level of pressure injury prevention was low, with virtually all criteria showing rates below 50%. After the interventions, there was an increase in compliance with almost all criteria. Conclusion: the use of a quality improvement project enabled the improvement of the pressure injury prevention process and contributed to the scientific community by corroborating the effectiveness of these projects in implementing pressure injury prevention programs, as well as prompting reflection on the multifactorial nature involved in this preventive process.

RESUMEN Objetivo: evaluar el efecto de la implementación de un proyecto de mejora de la calidad en el proceso de prevención de lesiones por presión en una Unidad de Cuidados Intensivos para adultos. Método: se llevó a cabo un proyecto de mejora de la calidad del proceso de prevención de lesiones por presión en una Unidad de Cuidados Intensivos para adultos de un hospital público, entre noviembre de 2022 y julio de 2023. Este proyecto se desarrolló siguiendo las etapas de un ciclo de mejora. El nivel de calidad en la prevención de lesiones por presión se midió antes y después de las intervenciones, utilizando seis criterios de calidad. La recopilación de datos para la primera evaluación se realizó en marzo de 2023, retrospectivamente, para los meses de noviembre y diciembre de 2022 y enero de 2023. La reevaluación de la calidad se llevó a cabo en julio de 2023, también retrospectivamente, para los meses de abril, mayo y junio de 2023. Las intervenciones incluyeron cambios en los registros relacionados con la asistencia en la prevención de lesiones por presión y la educación/concientización del equipo sobre la prevención de lesiones por presión. Resultados: la evaluación inicial de la calidad mostró que el nivel de conformidad en la prevención de lesiones por presión era bajo, con casi todos los criterios presentando tasas inferiores al 50%. Después de las intervenciones, hubo un aumento en la conformidad en casi todos los criterios. Conclusión: el uso de un proyecto de mejora de la calidad permitió mejorar el proceso de prevención de lesiones por presión y contribuyó con la comunidad científica, al corroborar la eficacia de estos proyectos en la implementación de programas de prevención de lesiones por presión, así como para promover la reflexión sobre los múltiples factores involucrados en este proceso preventivo.

RESUMO Objetivo: Avaliar o efeito da implementação de um projeto de melhoria da qualidade no processo de prevenção de lesão por pressão numa Unidade de Terapia Intensiva adulto. Método: Projeto de melhoria da qualidade do processo de prevenção de lesão por pressão, realizado em uma Unidade de Terapia Intensiva adulto, de um hospital público, no período de novembro/2022 a julho/2023. Foi desenvolvido seguindo as etapas de um ciclo de melhoria. O nível de qualidade da prevenção de lesão por pressão foi medido antes e depois das intervenções, utilizando seis critérios de qualidade. A coleta de dados da primeira avaliação foi realizada em março/2023, de forma retrospectiva, referente aos meses de novembro e dezembro/2022 e janeiro/2023. A reavaliação de qualidade ocorreu em julho de 2023, também de forma retrospectiva, referente aos meses de abril, maio e junho/2023. As intervenções incluíram mudanças nos registros relacionados à assistência na prevenção de LP e educação/sensibilização da equipe sobre prevenção de lesão por pressão. Resultados: A avaliação inicial da qualidade mostrou que o nível de conformidade de prevenção de lesão por pressão era baixo, com praticamente todos os critérios apresentando taxas inferiores a 50%. Após as intervenções, houve aumento na conformidade de quase todos os critérios. Conclusão: A utilização de um projeto de melhoria de qualidade possibilitou a melhora do processo de prevenção de lesão por pressão e contribuiu com a comunidade científica, ao corroborar a eficácia destes projetos na implementação de programas de prevenção lesão por pressão, bem como incitou a reflexão acerca da multifatorialidade envolvida neste processo preventivo.

Antibiotic stewardship and nosocomial infection prevention in critically ill patients: a quality improvement program

SUMMARY OBJECTIVE: The objective of this study was to evaluate the impact of the implementation of a bundle of interventions through a "Program for Antibiotic Management and Nosocomial Infection Prevention" in the intensive care unit on antibiotic and devices use and healthcare-associated infections. METHODS: This was a quasi-experimental study of consecutive series of cases in periods before and after the establishment of protocols and checklists for the use of antibiotics as well as other measures to prevent healthcare-associated infection as part of a quality improvement program. Antimicrobial consumption was assessed by the defined daily dose. RESULTS: A total of 1,056 and 1,323 admissions in the pre-intervention and post-intervention phases, respectively, were evaluated. The defined daily dose per 100 patient-day decreased from 89±8 to 77±11 (p=0.100), with a decrease in carbapenems, glycopeptides, polymyxins, penicillins, and cephalosporins. The rates of ventilator and central venous catheter use decreased from 52.8 to 44.1% and from 76 to 70%, respectively. The rates of healthcare-associated infection decreased from 19.2 to 15.5%. CONCLUSION: Quality improvement actions focused primarily on antimicrobial management and prevention of healthcare-associated infection are feasible and have the potential to decrease antibiotic use and healthcare-associated infection rates.

Aseguramiento y control de la calidad de los datos en un estudio de cohorte en Colombia

Introducción: La calidad de los datos facilita garantizar la fiabilidad de los estudios observacionales. Objetivo: Describir el aseguramiento y el control de calidad para mantener la fiabilidad y la validez del dato en un estudio de cohorte. Métodos: Presentar el manejo de datos implementado dentro de un seguimiento de enfermos renales crónicos cuya exposición fue un programa de protección renal comparado con el tratamiento convencional y su asociación con desenlaces clínicos. Se evaluó el cambio en la frecuencia de errores después de implementar el plan y la reproducibilidad del ingreso de registros a las bases de datos. Resultados: Se documentó una disminución progresiva en los errores cometidos en la captación de datos. El valor de Kappa entre los recolectores de la información para las variables clínicas más importantes fue 0,960 para la depuración de creatinina 150 mg/dL; 0,730 para la alteración del sedimento urinario; 0,956 para la asignación de estadio al ingreso. Los coeficientes de correlación intraclase para la identificación de las cifras de presión arterial sistólica fue 0,996; para la de presión arterial diastólica 0,993 y para los niveles de creatinina sérica al diagnóstico 0,995. Discusión: La calidad de los datos comienza con el reconocimiento de los retos y dificultades que implica su responsable captación, de ahí el aporte de la estandarización de los procesos y el personal que los lleve a cabo en forma idónea. Estudios evidencian que muchos procesos de mejora surgen en el desarrollo de la investigación sin protocolos preestablecidos. Conclusión: La reducción en la proporción y el tipo de error durante el proceso de captación de datos se debe a su identificación temprana y la corrección de instructivos, del instrumento de control de diligenciamiento y de la capacitación continua del personal. El análisis mostró una buena concordancia interevaluador.

Introduction: Data quality makes it easier to ensure that observational studies are reliable. Objective: To describe assurance and quality control to maintain data reliability and validity in a cohort study. Methodology: We present the data management strategies implemented in a study that followed patients of chronic kidney disease who were in a renal protection program and compared them with those undergoing conventional treatment to observe its association with clinical outcomes. We assessed the changes in error frequency after implementing the plan along with the reproducibility of the strategies for entering records into the databases. Results: We documented a progressive decrease of data collection errors. The Kappa values among data collectors for the most important variables were: 0.960 for creatinine clearance 150 mg/dl; 0.730 for urinary sediment alteration and 0.956 for stage allocation upon admission. The intraclass correlation coefficient for the identification of systolic blood pressure was 0.996; for diastolic blood pressure, the coefficient was 0.993 and for serum creatinine levels at diagnosis, the value was 0.995. Discussion: Data quality begins with the recognition of the challenges and difficulties involved in responsible data collection, hence the contribution of standardized processes and personnel to carry them out in a suitable manner. Studies show that many improvement processes arise in the development of research without pre-established protocols. Conclusion: The reduction in error ratio and type during the data collection process are the result of the early identification of erroneously entered or missing data, the correction of the guidelines for completing forms as well as of the instruments for detecting errors and continuous training of the staff. The analysis showed good inter-rater reliability.

Priorities and root cause analysis of quality and safety problems in chilean hospitals / Prioridades y análisis de las causas de los problemas de calidad y seguridad en hospitales chilenos

BACKGROUND: Quality improvement is an important component of hospital operations. AIM: To prioritise clinical quality and safety problems in Chilean hospitals according to their severity, frequency, and detectability. MATERIAL AND METHODS: The study was conducted between December 2018 and June 2019. To identify quality and safety problems, an exploratory study was conducted using an online survey aimed to those responsible for clinical quality and safety in Chilean hospitals. The survey was sent to 94 hospitals and completed by quality management personnel at 34 hospitals, yielding a total of 25 valid surveys for analysis. Based on the information gathered, a risk priority score was computed to rank the problems surveyed. Focus groups were held to find the root causes of the quality and safety problem with the highest risk priority score. RESULTS: The three highest risk priorities were:1 ineffective interprofessional communication,2 lack of leadership for addressing frequently recurring safety issues, and3 antimicrobial resistance due to inappropriate use of antibiotics. For the communication problem, the focus group found two main root causes: those due to personnel and those relating to the hospitals themselves. CONCLUSIONS: Hospitals can systematically use the proposed approach to categorize their main clinical quality and safety problems, analyze their causes, and then design solutions.

ANTECEDENTES: La mejora continua de la calidad es un componente importante en las actividades hospitalarias. OBJETIVO: Priorizar los problemas de calidad y seguridad en hospitales chilenos de acuerdo a su severidad, frecuencia y detectabilidad. MATERIAL Y MÉTODOS: Se efectuó un estudio exploratorio con una encuesta en línea para detectar problemas de calidad y seguridad, dirigida a quienes están a cargo de los problemas de calidad y seguridad en los hospitales. La encuesta fue enviada a 94 hospitales y respondida por los encargados de calidad y seguridad en 34 de ellos, lográndose 25 encuestas válidas para análisis. El estudio se llevó a cabo entre diciembre de 2018 y junio de 2019. Se diseñó una escala de prioridades de riesgo para determinar la importancia relativa de los problemas detectados. Se llevaron a cabo grupos focales para determinar las causas del problema más importante. RESULTADOS: En Chile, los problemas de calidad y seguridad más importantes son la falta de comunicación interprofesional, falta de liderazgo para abordar los problemas de seguridad y calidad, y resistencia a antibióticos debido a su uso inapropiado. Problemas relacionados al personal y relacionados al hospital fueron las causas primarias de la falta de comunicación. CONCLUSIONES: Los hospitales podrían utilizar este enfoque de forma sistemática para categorizar sus principales problemas de calidad y seguridad, analizar las causas y diseñar soluciones.

O preparo intestinal em dose dividida é superior à dose direta em pacientes hospitalizados submetidos à colonoscopia hospitalar / Split-dose bowel preparation is superior to straight-dose in hospitalized patients undergoing inpatient colonoscopy

ABSTRACT Background: There is a two-fold higher rate of failed colonoscopy secondary to inadequate bowel preparation among hospitalized versus ambulatory patients. Split-dose bowel preparation is widely used in the outpatient setting but has not been generally adapted for use among the inpatient population. Objective The aim of this study is to evaluate the effectiveness of split versus single dose polyethylene glycol bowel (PEG) preparation for inpatient colonoscopies and determine additional procedural and patient characteristics that drive inpatient colonoscopy quality. Methods: A retrospective cohort study was performed on 189 patients who underwent inpatient colonoscopy and received 4 liters PEG as either split- or straight-dose during a 6-month period in 2017 at an academic medical center. Bowel preparation quality was assessed using Boston Bowel Preparation Score (BBPS), Aronchick Score, and reported adequacy of preparation. Results: Bowel preparation was reported as adequate in 89% of the split-dose group versus 66% in the straight-dose group (P=0.0003). Inadequate bowel preparations were documented in 34.2% of the single-dose group and 10.7% of the split-dose group (P<0.001). Only 40% of patients received split-dose PEG. Mean BBPS was significantly lower in the straight-dose group (Total: 6.32 vs 7.73, P<0.001). Conclusion: Split-dose bowel preparation is superior to straight-dose preparation across reportable quality metrics for non-screening colonoscopies and was readily performed in the inpatient setting. Interventions should be targeted at shifting the culture of gastroenterologist prescribing practices towards use of split-dose bowel preparation for inpatient colonoscopy.

RESUMO Contexto: Há uma taxa duas vezes maior de colonoscopia com falha secundária ao preparo intestinal inadequado entre pacientes hospitalizados versus ambulatoriais. O preparo intestinal em dose dividida é amplamente utilizado em ambulatório, mas geralmente não foi adaptado para uso entre a população hospitalar. Objetivo: O objetivo deste estudo é avaliar a eficácia da preparação do intestino de polietilenoglicol (PEG) em dose única versus doses separadas para colonoscopias hospitalares e determinar características adicionais do procedimento e do paciente que promovam a qualidade da colonoscopia do paciente internado. Métodos Um estudo de coorte retrospectivo foi realizado em 189 pacientes que foram submetidos a colonoscopia hospitalar e receberam 4 litros de PEG como dose dividida ou direta durante um período de 6 meses em 2017 em um centro médico acadêmico. A qualidade do preparo intestinal foi avaliada usando-se o Boston Bowel Preparation Score (BBPS), o Aronchick Score, e relatório sobre a adequação do preparo. Resultados O preparo intestinal foi relatado como adequado em 89% do grupo de dose dividida versus 66% no grupo de dose direta (P=0,0003). Preparações intestinais inadequadas foram documentadas em 34,2% do grupo de dose única e 10,7% do grupo de dose dividida (P<0,001). Apenas 40% dos pacientes receberam PEG em dose fracionada. O BBPS médio foi significativamente menor no grupo de dose direta (total: 6,32 vs 7,73, P<0,001). Conclusão O preparo intestinal em dose dividida é superior ao preparo de dose única em todas as métricas de qualidade relacionadas para colonoscopias sem triagem e foi adequadamente realizado no ambiente de internação. As intervenções devem ser direcionadas para mudar a cultura das práticas de prescrição de gastroenterologistas para o uso de preparação intestinal em dose dividida para colonoscopia hospitalar.

Evaluación de la gestión de calidad de los servicios de Enfermería en un Centro de Restauración Neurológica / Evaluation of quality management of Nursing services at the International Center for Neurological Restoration

Introducción: La evaluación de la gestión de calidad de los servicios de Enfermería se perfila como una herramienta útil para trazar estrategias de mejora de los procesos organizacionales y satisfacer las necesidades del cliente. Objetivo: Evaluar la gestión de calidad de los servicios de Enfermería. Métodos: Estudio cuantitativo, descriptivo, de corte transversal, en el Centro Internacional de Restauración Neurológica, La Habana, en el año 2022. Participaron 60 enfermeras con 5 o más años de servicio, pertenecientes a los servicios lesiones estáticas, restauración biológica cerebral, atención a cubanos, lesiones raquimedulares, trastornos del movimiento y neurocirugía. Se aplicó una encuesta adaptada al contexto hospitalario basada en el Modelo Europeo de excelencia European Foundation for Quality Management. Se utilizó la media como medida de resumen. Se consideró la evaluación punto fuerte (aceptable) cuando el valor real alcanzado fue igual o superior al deseado y área de mejora (no aceptable) cuando el valor real no alcanzó el deseado. Resultados: La puntuación global fue de 977,88 de 1000 puntos que exige el Modelo. Se detectaron dos áreas de mejora a expensas de los criterios 3 (implicar los grupos de interés) y 5 (gestionar el funcionamiento y la transformación). Se evidenciaron puntos fuertes con énfasis en una cultura de calidad y elevada capacitación en los profesionales. Conclusión: La evaluación de gestión de la calidad en los servicios de Enfermería se considera aceptable. Los hallazgos obtenidos permiten plantearse acciones de mejora para fortalecer la calidad de la atención que se brinda a los clientes. La evaluación de la gestión de calidad en los servicios de enfermería es una estrategia metodológica útil para identificar errores y ayudar a identificar el camino hacia la excelencia(AU)

Introduction: The evaluation of quality management of Nursing services is emerging as a useful tool to outline strategies to improve organizational processes and meet customer needs, Objective: To evaluate the quality management of nursing services. Methods: Quantitative, descriptive, cross-sectional, cross-sectional study at the International Center for Neurological Restoration, Havana, Cuba, in the year 2022. Sixty nurses with 5 or more years of service, belonging to the services Static Injuries, Biological Brain Restoration, Care for Cubans, Rachimedullary Injuries, Movement Disorders and Neurosurgery participated. A survey was applied, adapted to the hospital context based on the European Model of Excellence EFQM. The mean was used as a summary measure. The evaluation was considered a strong point (acceptable) when the actual value achieved was equal to or higher than the desired value, and an area for improvement (not acceptable) when the actual value did not reach the desired value. Results: The overall score was 977.88 out of 1000 points required by the Model. Two areas for improvement were detected at the expense of criteria 3 (involve stakeholders) and 5 (manage operation and transformation). Strengths were evidenced with emphasis on a culture of quality and high qualification of professionals. Conclusion: The evaluation of quality management in nursing services is considered acceptable(AU)

Evaluación de la gestión de calidad de los servicios de Enfermería en un Centro de Restauración Neurológica / Evaluation of quality management of Nursing services at the International Center for Neurological Restoration

Introducción: La evaluación de la gestión de calidad de los servicios de Enfermería se perfila como una herramienta útil para trazar estrategias de mejora de los procesos organizacionales y satisfacer las necesidades del cliente. Objetivo: Evaluar la gestión de calidad de los servicios de Enfermería. Métodos: Estudio cuantitativo, descriptivo, de corte transversal, en el Centro Internacional de Restauración Neurológica, La Habana, en el año 2022. Participaron 60 enfermeras con 5 o más años de servicio, pertenecientes a los servicios lesiones estáticas, restauración biológica cerebral, atención a cubanos, lesiones raquimedulares, trastornos del movimiento y neurocirugía. Se aplicó una encuesta adaptada al contexto hospitalario basada en el Modelo Europeo de excelencia European Foundation for Quality Management. Se utilizó la media como medida de resumen. Se consideró la evaluación punto fuerte (aceptable) cuando el valor real alcanzado fue igual o superior al deseado y área de mejora (no aceptable) cuando el valor real no alcanzó el deseado. Resultados: La puntuación global fue de 977,88 de 1000 puntos que exige el Modelo. Se detectaron dos áreas de mejora a expensas de los criterios 3 (implicar los grupos de interés) y 5 (gestionar el funcionamiento y la transformación). Se evidenciaron puntos fuertes con énfasis en una cultura de calidad y elevada capacitación en los profesionales. Conclusión: La evaluación de gestión de la calidad en los servicios de Enfermería se considera aceptable. Los hallazgos obtenidos permiten plantearse acciones de mejora para fortalecer la calidad de la atención que se brinda a los clientes. La evaluación de la gestión de calidad en los servicios de enfermería es una estrategia metodológica útil para identificar errores y ayudar a identificar el camino hacia la excelencia.

Introduction: The evaluation of quality management of Nursing services is emerging as a useful tool to outline strategies to improve organizational processes and meet customer needs, Objective: To evaluate the quality management of nursing services. Methods: Quantitative, descriptive, cross-sectional, cross-sectional study at the International Center for Neurological Restoration, Havana, Cuba, in the year 2022. Sixty nurses with 5 or more years of service, belonging to the services Static Injuries, Biological Brain Restoration, Care for Cubans, Rachimedullary Injuries, Movement Disorders and Neurosurgery participated. A survey was applied, adapted to the hospital context based on the European Model of Excellence EFQM. The mean was used as a summary measure. The evaluation was considered a strong point (acceptable) when the actual value achieved was equal to or higher than the desired value, and an area for improvement (not acceptable) when the actual value did not reach the desired value. Results: The overall score was 977.88 out of 1000 points required by the Model. Two areas for improvement were detected at the expense of criteria 3 (involve stakeholders) and 5 (manage operation and transformation). Strengths were evidenced with emphasis on a culture of quality and high qualification of professionals. Conclusion: The evaluation of quality management in nursing services is considered acceptable.

Programa de capacitación dirigido a estudiantes de ciencias médicas para la prevención contra la COVID-19 / Villa Clara medical science students trained for prevention against COVID-19

Fundamento: constituyó una necesidad el incremento de acciones de preparación a los estudiantes de ciencias médicas para realizar la pesquisa "casa a casa", teniendo en cuenta que el municipio Santa Clara de la provincia Villa Clara reportó la mayor cantidad de casos de COVID-19, entre los primeros meses de 2021. Objetivo: determinar la efectividad de un programa de capacitación para estudiantes de ciencias médicas en las acciones de prevención contra la COVID-19, durante las pesquisas activas "casa a casa". Métodos: se elaboró y ejecutó un programa de capacitación a partir de la investigación-acción, insertado en las acciones de prevención realizadas por los estudiantes en los escenarios de la comunidad; fueron agrupados en 132 Consultorios Médicos de la Familia (CMF), pertenecientes a los seis policlínicos del municipio Santa Clara. La intervención se efectuó del 8 de marzo al 10 abril de 2021. El universo estuvo constituido por 809 estudiantes, quienes pesquisaron 126 475 personas. Resultados: al finalizar el programa, 508 estudiantes obtuvieron calificaciones de Muy Bien y 132 de Bien, con diferencias significativas entre el nivel de conocimientos antes y después de su aplicación. Conclusiones: el programa de capacitación demostró efectividad porque se modificó el nivel de conocimientos de los estudiantes que participaron, mejoraron sus conocimientos y habilidades para realizar acciones de prevención; ellos lograron la detección precoz de pacientes en riesgo y enfermos de COVID-19.

Background: the increase in preparation actions for medical science students to carry out the "house to house" research was a necessity, taking into account that Santa Clara municipality in Villa Clara province reported the highest number of COVID-19 cases, in the first months of 2021. Objective: to determine the effectiveness of a training program for medical science students in preventive actions against COVID-19, during active "house-to-house" investigations. Methods: a training program based on action research was developed and implemented, inserted in the prevention actions carried out by the students in community settings; they were grouped into 132 Doctor´s Offices, belonging to the six polyclinics of Santa Clara municipality. The intervention was carried out from March 8 to April 10, 2021. The universe consisted of 809 students, who investigated 126,475 people. Results: at the end of the program, 508 students obtained ratings of Very Good and 132 of Good, with significant differences between the level of knowledge before and after its implementation. Conclusions: the training program demonstrated effectiveness because the level of knowledge of the students who participated was modified, their knowledge and skills to carry out preventive actions improved; they achieved early detection of patients at risk and sick with COVID-19.

Researchers' Knowledge About the Ethical Norms of National Natural Science Foundation of China Funded Medical Research:Current Status and Suggestions / 中国医学科学院学报

Objective To understand the current status of Chinese medical researchers' knowledge regarding the ethical norms of the research involving humans or laboratory animals,and provide reference for further improving the ethics review norms. Methods The questionnaire method was employed to survey the applicants for the 2019 projects supported by the Department of Medical Sciences,National Natural Science Foundation of China (NSFC) about their knowledge of ethical requirements.Furthermore,the ethical supervision of the NSFC and affiliations at the project application and implementation stages was analyzed. Results The survey showed that 29.9% medical researchers were familiar with NSFC's ethical requirements for research involving human or laboratory animals.During the project application stage,59.0% affiliations adopted the simplified review method.Regarding the ethical supervison,95.5% medical researchers believed that the affiliations should fulfill the ethical supervision obligations and take relevant measures during the project implementation period.In addition,55.0% medical researchers fully agreed to discuss with the review experts about the ethical issues involved in the project. Conclusions The NSFC should establish rules and regulations to improve institutional management responsibilities and institutionalize the training about research ethics to comprehensively strengthening the training.Taking the management of research project ethics as a starting point,the NSFC should form a multi-party linkage between project funding and management and establish an accountability mechanism for ethics management.Furthermore,the NSFC should double the endeavors at the review of ethical issues during expert review and process management and attach importance to the research,judgment,and prevention of ethical risks.

Construction of foreign medical quality and safety management models based on qualitative text analysis / 中华医院管理杂志

Objective:To systematically construct the foreign medical quality and safety management model by searching the English literature related to medical quality and safety management, so as to provide reference for improving the level of medical quality and safety management in China.Methods:The Web of Science database was used as the data source, the English literature related to medical quality and safety management in foreign countries was screened following the PRISMA guidelines, and the content of the screened literature was analyzed using qualitative text analysis based on the Structure Process System Outcome (SPSO) theoretical model.Results:In this study, a total of 37 articles were screened, 5 first-level themes of structure, process, system, outcome and continuous quality improvement were identified, 16 second-level themes were found, and their functional relationships were established. A theoretical model of the SPSO-Extension (SPSO-E) for medical quality and safety management was constructed, added new elements of the external environment, organizational outcome and employee outcome, and refined the continuous quality improvement into three segments of quality checking, problem handling and quality consolidation.Conclusions:In order to improve medical quality and safety management in China, the internal management model of the hospital should be dynamically adjusted according to the changes of external environment, and the result dimension should pay attention to the improvement of organization′s operational effectiveness and the physiological and psychological aspects of the staff. The final management results have a feedback effect on the hospital′s resource allocation, service delivery, organizational arrangements and cultural construction, promoting continuous improvement and enhancement of the hospital′s quality.

Promotion and application of clinical microbiology related standards and guidelines in clinical practice / 中华检验医学杂志

Under the circumstances of the rapid development of etiological diagnostic technology and the increasing application of new testing technologies to microbial detection, laboratory workers and clinical related departments should promptly propose Chinese standards, Chinese guidelines, and Chinese diagrams, and always adhere to the promotion and application of clinical microbiology related standards and guidelines in clinical practice, to continue to promote the virtuous cycle of standardization of etiology diagnosis, and gradually improve the laboratory diagnosis ability and technological progress of infectious diseases in China.

Application of PDCA cycle in quality improvement of neonatal resuscitation / 中国新生儿科杂志

Objective:To study the effects of plan-do-check-action (PDCA) cycle in quality improvement of neonatal resuscitation.Methods:From 2016 to 2020, the clinical data of neonates born in our hospital were analyzed. Neonates born during 2016 to 2017 were pre-PDCA group and neonates born during 2018 to 2020 were post-PDCA group. PDCA quality improvement included step-by-step, high-frequency and low-dose training, strengthening teamwork and adding equipment.Results:A total of 7 728 live-birth neonates were delivered before PDCA with 319 cases (4.1%) of asphyxia. 10 174 live-birth neonates were delivered after PDCA with 422 cases (4.1%) of asphyxia. The asphyxia rates showed no significant difference between the two groups ( P>0.05). The incidences of severe asphyxia before and after PDCA were both 0.8% without significant difference ( P>0.05). The success rates of resuscitation for severe asphyxia before and after PDCA was 27.9% and 44.9%, respectively, and the differences were statistically significant ( P<0.05). The mortality rates within 7 d before and after PDCA were 0.5‰ and 0.1‰ respectively, without significant differences ( P>0.05). Conclusions:The implementation of PDCA cycle and step-by-step, high-frequency, low-dose neonatal resuscitation training can effectively improve the success rate of resuscitation in newborns with severe asphyxia.

The effect of the quality improvement project of admission hypothermia on short-term outcomes of preterm infants less than 34 weeks gestational age / 中国小儿急救医学

Objective:To study the high risk factors of hypothermia in premature infants with gestational age ≤34 weeks, and to analyze the incidence of hypothermia before and after the implementation of the quality improvement program of hypothermia in hospital and its influence on various systemic complications, aiming to improve the early identification of hypothermia and to reveal the important clinical significance of temperature management in time.Methods:Clinical data of preterm infants born in Maternal and Child Health Hospital of Hubei Province from May 2017 to December 2018, with gestational age ≤34 weeks, and admitted within 1 hour after birth were collected.According to the admission temperature, the infants were divided into normal temperature group (36.5-37.5 ℃), mild hypothermia group (36.0-36.4 ℃), moderate hypothermia gsroup (32.0-35.9 ℃), and severe hypothermia group (<32.0 ℃). The high risk factors of hypothermia in premature infants were analyzed.The incidence and degree of hypothermia and the effects on the systemic complications before and after the implementation of the hypothermia quality improvement program were compared.Results:A total of 306 premature infants were enrolled in the study, including 63(20.6%)cases in the normal temperature group, 115(37.6%) cases in the mild hypothermia group, and 128(41.8%) cases in the moderate hypothermia group, without severe hypothermia.Infants with birth asphyxia were at higher risk for hypothermia( OR=0.195, 95% CI 0.046-0.833, P=0.027); the lower the Apgar score at 1 min( r=0.123, P=0.032)and 5 min after birth( r=0.136, P=0.017), the higher the risk of admission hypothermia.After the quality improvement project, the incidence of admission hypothermia decreased from 82.3% to 73.8%( χ2=32.67, P<0.001), and the use of pulmonary surfactant in infants with respiratory distress syndrome was significantly reduced(70.0% vs. 32.0%, χ2=40.11, P<0.001), and the incidence of hypotension within 72 hours after birth decreased(11.8% vs. 4.9%, χ2=3.87, P<0.049). Conclusion:Birth asphyxia is a risk factor for admission hypothermia in premature infants, and Apgar score is associated with admission hypothermia in premature infants.Temperature management of preterm infants can significantly reduce the incidence of hypothermia and hypotension, and reduce the use of pulmonary surfactant in respiratory distress syndrome infants.

Research on quality improvement based on action research study to reduce unplanned interruption during continuous renal replacement therapy / 中国实用护理杂志

Objective:To explore the effect of quality improvement based on action research study to reduce unplanned interruption during continuous renal replacement therapy.Methods:From June 2020 to December 2021, 175 patients who were treated CRRT in SICU of Beijing Chaoyang Hospital Affiliated to Capital Medical University were selected as research objects. The objects were divided into control group, observation group 1 and observation group 2 according to the time of admission. Routine nursing was used in the control group (55 cases), the first cycle of plan-action-observation-reflection according to the problems of unplanned interruption was used in the observation group 1(62 cases), the quality improvement was carried out on the basis of the first cycle, and then formulated the second cycle used in the observation group 2(58 cases). The incidence of unplanned interruption of CRRT, the duration of hemofiltration line and the ability of nurses to prevent unplanned interruption of CRRT were compared before and after implementation.Results:The baseline data of CRRT patients in the three groups were comparable ( P>0.05). After cycle quality improvement, the alarm frequencies of unplanned interruption in the observation group 1 and 2 was (8.87 ± 2.66) times and (8.07 ± 2.80) times respectively, which was significant lower than the (12.04 ± 4.23) times in the control group ( t = 3.17 and 3.97, both P<0.01). The cases of coagulation filter≥Ⅱ in the observation group 1 and 2 were 25 cases and 20 cases, which were significant lower than the 32 cases in the control group ( χ2 = 3.72, 6.38, both P<0.05). The duration of blood purification line use was (15.04 ± 7.51) h and (18.16 ± 7.67) h in the observation group 1 and 2, which were significant better than the (11.75 ± 6.84) h in the control group ( t = 3.29 and 6.41, both P<0.01). The ability of nurse to prevent unplanned interruption of CRRT in the control group, the observation group 1 and 2 were (72.62 ± 6.03), (84.77 ± 5.59) and (89.64 ± 4.54), the difference was sigaificant ( F = 146.97, P<0.001). Conclusions:The application of action research study in CRRT quality improvement could reduce the occurrence of unplanned interruption of CRRT and related complications, prolong the use time of hemofiltration line, improve the therapeutic effect of CRRT, improve the quality of nursing, and is worthy of clinical promotion.

Door-to-needle time for intravenous thrombolysis in acute ischemic stroke / 国际脑血管病杂志

Intravenous thrombolysis is an effective treatment for acute ischemic stroke, but its benefits are time-dependent. The time from onset to intravenous thrombolysis is divided into onset-to-door time (ODT) and door-to-needle time (DNT). The former reflects pre-hospital delay, while the latter reflects in-hospital delay and can be controlled by stroke improvement plan. This article reviews the influence of DNT on clinical outcomes, the influencing factors of DNT and the stroke improvement plan to shorten DNT.

Progress of golden hour strategy in preterm infants / 国际儿科学杂志

The "golden hour" strategy is an important measure to improve the short-term and long-term prognosis of neonates.It refers to optimizing interventions within one hour after birth, including neonatal resuscitation, transportation and early active treatment measures.Preterm birth and its complications are one of the main causes of neonatal death.Studies about "golden hour" strategy in premature infants have confirmed that it can increase the early stability, reduce complications and improve prognosis of preterm infants.This article reviews recent progress of "golden hour" in preterm infants and provide more information about quality improvement in premature infants care.

Exploration and Reflection on Informatization Construction in Optimizing the Ethical Review Process / 中国医学伦理学

Currently, the number of clinical research projects continues to grow. Both sponsors and researchers hope to accelerate medical ethical review efficiency, and the regulatory agencies strengthen the control over the ethical review quality. The ethics committee (EC) offices of medical institutions are relatively insufficient in terms of human resource allocation and archiving space. Combined with the development goals of the EC and the requirements of the homogeneity construction of ethical review, it was urgent to optimize the ethics review process and accelerate the efficiency of ethics review through informatization construction. Through informatization construction, the process management of ethical review could be strengthened, the work steps could be simplified, the ethical review level could be improved, and the supervision ability and efficacy of EC on clinical research could be strengthened, which may provide continuous quality improvement strategies and specific optimization measures for the operation and management of the EC, so as to effectively protect the safety, the rights and interests of subjects.

Evaluation and improvement of blood station quality management system: based on external audit / 中国输血杂志

【Objective】 To identify the main unqualified items in the external audit of blood station quality management system (referred to as external audit), in order to take necessary measures to continuously improve the quality system. 【Methods】 Unqualified items(data) in the national and Shandong provincial blood safety technical audits (referred to as national and provincial audits) and four blood station blood safety technical joint audits (referred to as inter station mutual audits) from 2017 to 2019 were collected and analyzed by Excel and Pareto curves (graphs). Corresponding corrective and preventive measures were developed and implemented, and then tracked and evaluated by the quality management department three months after the external audit to verify their effectiveness. 【Results】 In a total of 7 external audits of blood station quality management system that our blood station has participated in over the past 3 years (including 2 national audits, 2 provincial audits, and 3 inter station mutual audits), the main unqualified terms were "12 monitoring and continuous improvement" 11.90% (15/126), "13 blood donation services" 11.90% (15/126), "06 equipment" 10.32% (13/126), "11 records" 10.32% (13/126), "03 organization and personnel" 8.73% (11/126), "15 blood preparation" 7.94% (10/126), "08 safety and health" 7.14% (9/126), and "14 blood testing" 7.14% (9/126). Among them, "monitoring and continuous improvement" ranked first in two national audits and two provincial audits, with 16.67% (5/30) and 14.71% (5/34), respectively, and was 8.06% (5/62) in inter station mutual audit, and the difference between the three kinds of audits was not statistically significant (P>0.05). "Records" accounted the highest proportion in inter station mutual review of 19.35% (12/62), while was respectively 0 and 2.94% (1/34) in national and provincial audits, with statistically significant difference between the three kinds of audits (P<0.05). 【Conclusion】 External audit against unqualified items is important for quality improvement. By analyzing the unqualified terms, taking corresponding measures to improve weak links, and evaluating the effectiveness of those measures, it can effectively ensure the effective operation of blood station quality management system.