Paciente ambulatorio y hospitalizado, estado actual de la evidencia para la prevención de caídas / Outpatient and hospitalized patient, actual state of evidence for fall prevention

Introducción: el envejecimiento de la población genera un incremento de la prevalencia de distintos procesos patológicos, generando un aumento de la estancia de los pacientes hospitalizados y demanda de atención ambulatoria. Estos mismos procesos patológicos se clasifican como factores de riesgos de caídas. Reportándose las caídas como el tercer evento adverso más notificado por la Joint Commission International para el año 2015. Objetivo: identificar los factores de riesgos, determinar las principales recomendaciones dadas por la literatura y correlacionar cuatro intervenciones NIC para disminuir las caídas. Metodología: revisión sistemática de literatura, con formato PICOT (Problema, Intervención, Comparador, Resultado y Tiempo) utilizando terminología DeCS y MeSH, Búsqueda en 5 bases de datos online e inclusión de estudios de los últimos 5 años, en tres idiomas. Inclusión de estudios secundarios, criterio de valoración crítica metodológica de la literatura CASPe, escala JADAD y AGREE. Resultados: se identifican 588 estudios, 83 cumplen con criterios de inclusión, valoración crítica de 55 y 31 estudios fueron seleccionados. Conclusión: la valoración del riesgo de caídas y las intervenciones de identificación del riesgo, son la piedra angular de prevención en la atención integral de seguridad del paciente hospitalizado y ambulatorio.

Introduction: The aging of population generates an increase in prevalence of different pathological processes, generating an increase in the stay of hospitalized patients and demand for outpatient care. These same pathological processes are classified as risk factors of fall. Reporting the falls as the third most reported adverse event by Joint Commission International for 2015. Objective: Identify risk factors, determine the main recommendations given by the literature and correlate four NIC interventions to reduce falls. Methods: Systematic review of literature, with PICOT format (Problem, Intervention, Comparator, Outcome and Time) using DeCS and MeSH terminology, Search in 5 online databases and inclusión of studies from the last 5 years, in three languages. Inclusión of secondary studies, criterion of critical methodological assessment of CASPe literature, JADAD and AGREE scale. Results: 588 studies are identified, 83 meet inclusión criteria, critical assessment of 55 and 31 studies were selected. Conclusión: The risk assessment of falls and risk identification interventions are the cornerstone of prevention in the integral safety care of the hospitalized and outpatient patient.

Método Tracer e a qualidade do cuidado na enfermagem: revisão integrativa da literatura / Método Tracer y la calidad del cuidado: revisión integral de la literatura / Tracer Methodology and the quality of care: integrative literature review

Resumo OBJETIVO Analisar a produção científica sobre o Método Tracer na área da enfermagem. MÉTODO Revisão integrativa, realizada com 22 artigos localizados nas bases de dados: Literatura Latino-Americana e do Caribe em Ciências e Saúde (LILACS); Medical Literature Analysis and Retrieval System Online(Medline/PubMed); Scientific Eletronic Library Online (SciELO); Cumulative Index to Nursing & Allied Health Literature (CINAHL) eWeb of Science. As estratégias de busca incluíram descritores e palavras-chave: Método Tracer, Método traçador, Método rastreador, Método de avaliação, Usuário Guia e Enfermagem correlacionados e combinados com operadores booleanos. RESULTADOS Organizaram-se os dados segundo os cenários de aplicação do método, a saber: agravos à saúde como condição traçadora para avaliar a qualidade dos cuidados, conformidades e não conformidades em relação aos protocolos institucionais, reflexão e capacitação para a acreditação. CONCLUSÃO O Método Tracer é utilizado para avaliação e melhoria da qualidade da assistência.

Resumen OBJETIVO Analizar la literatura científica sobre el Método Tracer en el área de enfermería. MÉTODO Revisión integrativa de la literatura, conducida con 22 artículos en las bases de datos: Literatura Latinoamericana y Caribe en Ciencias de la Salud (LILACS); Medical Literature Analysis and Retrieval System Online(Medline/PubMed); Scientific Electronic Library Online (SciELO); Cumulative Index to Nursing & Allied Health Literature (CINAHL) y Web of Science. La búsqueda incluyeron las palabras clave: trazador, método de evaluación, guía del usuario y enfermería relacionados y combinados con operadores booleanos. RESULTADOS Los datos se organizaron según los escenarios de aplicación del método: condición de salud estampados plotter para evaluar la calidad de atención, cumplimiento y no cumplimiento de protocolos, reflexión y formación para la acreditación. CONCLUSIÓN El Método Tracer se utiliza para mejorar la calidad de la atención.

Abstract OBJECTIVE To analyze the scientific literature about the Tracer Method in the area of nursing. METHOD Integrative literature review with 22 articles from the following databases: Latin American and Caribbean Literature in Health Sciences (LILACS); Medical Literature Analysis and Retrieval System Online(Medline/PubMed); Scientific Electronic Library Online (SciELO); Cumulative Index to Nursing & Allied Health Literature (CINAHL) and Web of Science. The search strategy included descriptors and keywords, as follows: Método Tracer, Método Traçador, Método Rastreador, Método de Avaliação, Usuário Guia amd Enfermagem correlated and combined with Boolean operators. RESULTS Data was organized according to the scenarios where the method was applied, namely: health condition as a tracer condition for assessing the quality of care, compliance and non-compliance regarding the institutional protocols, reflection and training for accreditation. CONCLUSION The Tracer Methodology is used for evaluating and improving the quality of care.

Assessment of the accreditation standards of the central board for accreditation of healthcare institutions in Saudi Arabia against the principles of the international society for quality in health care [ISQua]

Accreditation is usually a voluntary program, in which trained external peer reviewers evaluate health care organization's compliance with pre-established performance standards. Interest in accreditation is growing in developing countries, but there is little published information on the challenges faced by new programs. In Saudi Arabia, the Central Board for Accreditation of Healthcare Institutions [CBAHI] was established to formulate and implement quality standards in all health sectors across the country. The objective of this study was to assess a developing accreditation program [CBAHI standards] against the International Society for Quality in Health Care [ISQua] principles to identify opportunities for improvement of the CBAHI standards. A qualitative appraisal and assessment of CBAHI standards was conducted using the published ISQua principles for accreditation standards. The CBAHI standards did not describe the process of development, evaluation or revision of the standards. Several standards are repetitive and ambiguous. CBAHI standards lack measurable elements for each standard. CBAHI standards met only one criterion [11.1%] of the Quality Improvement principle, two criteria [22.2%] of Patient/Service User Focus principle, four criteria [40%] of the Organizational Planning and Performance principle, the majority [70%] of the criteria for the safety principle, only one criteria [7.1%] for the Standards Development principle, and two criteria [50%] of the Standards Measurement principle. CBAHI standards need significant modifications to meet ISQua principles. New and developing accreditation programs should be encouraged to publish and share their experience in order to promote learning and improvement of local accreditation programs worldwide

[ comparative study of the Iran ministry of health patient and family education standards with joint commission on accreditation of healthcare organizations]

According to role of patient and family education in the process of patient care, Joint Commission on Accreditation of Healthcare Organizations [JCAHO] has considered the patient and family education standards in the hospital accreditation program; on the otherwise conducted researches show that the Iran Ministry of Health and Medical Education [MOHME] hospital standards are not complete. We conducted this study to be aware of MOHME patient and family education standards. In this descriptive - comparative study the joint commission patient and family education standards [10 statements] were compared with hospital standards of Iran Health Ministry [4 statements]. Using available information through internet, e-mail and referrals to related references was the method of data gathering. Data gathering was carried out through checklist, on the basis of patient and family education standards. Data analysis was done through descriptive statistical methods. The comparative rate of the Health Ministry's hospital standards with joint commission patient and family education standards were 0% completely, 40% partially and 60% with out adaptability. Findings showed that there was a gap in Iran Ministry of Health and Medical Education hospital standards for patient and family education. Then compiling of patient and family education standards is essential

O uso do prontuário familiar como indicador de qualidade da atenção nas unidades básicas de saúde / Use of the family health record as a quality-of-care indicator in primary health care units

A expansão da estratégia do Programa Saúde da Família no Brasil torna necessária a construção de indicadores que avaliem a coerência da abordagem efetivamente realizada e os princípios que regem o programa. Associado ao prontuário familiar, o familiograma (genograma) possibilita melhoria no acompanhamento da saúde da clientela e na qualidade da atenção prestada. A pesquisa utiliza o prontuário familiar com base na avaliação externa (acreditação) das equipes de saúde da família e dos gestores. Os resultados mostram uma variação da conformidade do prontuário com o padrão de acreditação segundo a natureza da função avaliada. O estudo revela a importância da avaliação externa como sinalizadora do nível de conformidade aos padrões requeridos, sugerindo a necessidade de operar um indicador combinado entre a avaliação interna e externa das informações familiares como instrumento de gestão.

Expansion of the Family Health Program in Brazil requires indicators to evaluate the consistency of the approach actually adopted and the program's underlying principles. Together with the family health chart, the family health history (medical genealogy) allows improved follow-up of the clientele's health and the quality of care provided. This study used the family health chart based on external evaluation (accreditation) of family health teams and managers. The results showed variation in the health charts' conformity to the accreditation standard according to the nature of the function evaluated. The study showed the importance of external evaluation to signal the level of conformity to the required standards, suggesting the need to operate with a combined indicator, including internal and external evaluation of family health data as a management instrument.

Development and Application of Timeout Protocol on OR / 성인간호학회지

PURPOSE: This study was conducted to develop a timeout protocol as the process of patients verification in the operating room, and to evaluate its effects. METHODS: The timeout protocol was developed based on the experience of practices and the universal protocol of JCAHO 2004. The subjects of this study were 192 surgical members working in the operating room at an university hospital in Daegu, Korea. RESULTS: The timeout protocol was developed in six steps; participants verification, encouragement of compliance, verification of right 3 PSP, agreement of surgical team members, verification of the parties to a patient, patient agreement. The data which have been resulted from the experimental group show significantly higher than those of control group as follows; cognition(t = -6.580, p = .000), contents of performance; progress of anesthesiologist as leader(chi-square = 29.029, p = .000), verification of right patient, right site and right procedure(chi-square = 40.663, p = .000), participation of surgical team(chi-square = 68.412, p = .000), and the number of cases of performance(chi-square = 242.900, p = .000). CONCLUSION: It suggests that medical accidents caused by failures in a preoperative verification process can be prevented if a timeout is conducted active involvement and effective communication among surgical team members for a final verification of the correct patient, procedure, and site.

Development and Application of Timeout Protocol on OR / 성인간호학회지

PURPOSE: This study was conducted to develop a timeout protocol as the process of patients verification in the operating room, and to evaluate its effects. METHODS: The timeout protocol was developed based on the experience of practices and the universal protocol of JCAHO 2004. The subjects of this study were 192 surgical members working in the operating room at an university hospital in Daegu, Korea. RESULTS: The timeout protocol was developed in six steps; participants verification, encouragement of compliance, verification of right 3 PSP, agreement of surgical team members, verification of the parties to a patient, patient agreement. The data which have been resulted from the experimental group show significantly higher than those of control group as follows; cognition(t = -6.580, p = .000), contents of performance; progress of anesthesiologist as leader(chi-square = 29.029, p = .000), verification of right patient, right site and right procedure(chi-square = 40.663, p = .000), participation of surgical team(chi-square = 68.412, p = .000), and the number of cases of performance(chi-square = 242.900, p = .000). CONCLUSION: It suggests that medical accidents caused by failures in a preoperative verification process can be prevented if a timeout is conducted active involvement and effective communication among surgical team members for a final verification of the correct patient, procedure, and site.

Dangerous and unapproved abbreviations at a joint commission international accredited hospital in Saudi Arabia

Abbreviations which resulted in harmful patient errors or death are termed dangerous abbreviations. These abbreviations were included in The Joint Commission "Do Not Use" list of abbreviations launched in May 2005. The aim of the present study is to assess physicians' and nurses' use of unapproved and dangerous abbreviations and to explore physicians' and nurses' opinion regarding the use of these abbreviations. The study was conducted in a Joint Commission International [JCI] accredited hospital in Eastern Saudi Arabia. Two study designs were used: retrospective descriptive and cross-sectional descriptive. Data were collected through reviewing 384 paper records and distributing a questionnaire to a random sample of 58 physicians and nurses. The study revealed that the average number of dangerous abbreviations per record was 2.2 while the average number of unapproved abbreviations per record was 1 .96. The most frequent dangerous abbreviation reported in the present study was Discharge/Discontinue D/C accounting for 73% of the total identified dangerous abbreviations for both physicians and nurses. The ability of physicians and nurses to correctly identify the meaning of the most commonly used dangerous abbreviation and unapproved abbreviation ranged between 37.9% and 69.0%. The study revealed high use of dangerous and unapproved abbreviations at the study hospital. Few dangerous abbreviations constitute the majority of identified abbreviations. A quality improvement intervention needs to be instituted to reduce abbreviation use at the study hospital

[Health services accreditation standards for information management in Canada, New Zealand and USA: a comparative study]

Accreditation and evaluation play a critical role in quality management. In this regards health records are among the primary documents used by health care facilities to evaluate compliance with the standards set by accreditation agencies. To compare the strengths, weaknesses, and the general functionality of IM standards of three well-established accreditation agencies in Canada, USA and New Zealand. This was a comparative-descriptive study in which the IM standards of Canada, USA and New Zealand were collected and investigated through the internet and e-mails during 2003-2004. The data indicated that the JCAHO has adopted maximum standards related to patients-specific information. The data also described that the CCHSA has regarded the most complete and suitable standards related to educational and staff development standards. Considering other data, the maximum standards related to achieving positive outcomes and making improvement has been adopted by the CCHSA and QHNZ. All together, the findings of this comparative study revealed that while the CCHSA and QHNZ have adopted the same standards with emphasis on information management planning standards and achieving positive outcomes, the strong points of JCAHO's standards are specific information and evidence-based decision making

Programas de qualidade em hospitais do Município de Säo Paulo / Programs of Quality in Hospitals of the City of Sao Paulo

Este estudo foi realizado em amostra constituída por Instituçöes públicas e privadas do município de Säo Paulo, com o objetivo de entender como os Gestores de Qualidade compreendem conceitualmente a Qualidade no Setor Saúde. Outro objetivo a destacar foi o mapeamento das práticas de Qualidade adotadas nas Instituiçöes, e os valores atribuídos a estes Sistemas por seus Gestores. O trabalho de campo foi realizado com oito hospitais, do referido município, escolhidos intencionalemte, utilizando-se como critério fundamental a existência de Programas de Qualidade. As entrevistas ocorreram com o profissional indicado pelo hospital, ligado à Gestäo de Qualidade. O método de pesquisa foi quali-quantitativa, e a estratégica metodológica para análise foi o Discurso do Sujeito Coletivo - DSC, além de análise quantitativa. Diferentes repesentaçöes sociais foram extraídas dos discursos dos entrevistados, e demosntram os diferentes olhares existentes, no tocante à Qualidade na Saúde. Identificou-se que os métodos de certificaçäo têm tido mais adesäo dentre os pesquisadores, destacando-se a ISO, na maior parte deles, seguida da Acreditaçäo. Näo foi encontrado nenhum dos hospitais trabalhando com Sistemáticas de Premiaçäo, como o Prêmio Nacional da Qualidade - PNQ ou Programa de Qualidade do Governo Federal - PQGF. Na análise constatou-se que as Instituiçöes iniciam seus processos de Qualidade optando por uma determinada linha de trabalho e ferramentas de caráter dirigido e focado. Em seguida, tendem a optar por instrumentos mais abrangentes, agregando novos elementos em seu sistema de Qualidade.

Timeliness of Operation as Audit Filters in Trauma Care

While Joint Commission on Accreditation of Healthcare Organizations(JCAHO) and American College of Surgeon(ACS) have identified certain audit filters in trauma care, there are few studies to substantiate the value of these audit filters. Some researchers found that audit filters qualifiers were significantly associated with adverse outcomes, however, others were unable to reproduce such association. It is also necessary to test their validity and applicability in Korea. The purpose of this present study was to validate two trauma audit filters proposed by the JCAHO and the ACS, through the analysis of the relationship between timeliness of operation and risk-adjusted mortality. Among trauma audit filters, timeliness of operation in epidural or subdural hematoma(EDH/SDH) and intraabdominal injury were selected. By stratified random cluster sampling, 19 emergency medical centers (EMCs) were selected from 30 EMCs and all patients who received craniotomy or laparotomy in 1996 were evaluated in each hospital. Six medical records administrators reviewed medical records of 463 patients with EDH/SDH and of 508 patients with intraabdominal injury retrospectively. In other to adjust risk of mortality, timeliness of operation, age, Revised Trauma Score(RTS), ICD-9CM based ICISS, and experiences of transfer were included in logistic regression model. In the logistic regression models of all EDH/SDH or intraabdominal injury patients, timeliness of operation was not significant predictor of mortality. However, if patients who have been operated later than 12 hours were excluded from the statistical model, timeliness of operation showed significant or marginally significant relationship with mortality in the following situations; craniotomy > 4 hours in EDH(OR=30.46, p=0.032), craniotomy > 8 hours in SDH(OR=6.50, p=0.020), laparotomy > 2 hours in shock patients(OR=9.26, p=0.055). In addition to timeliness of operation, RTS and ICISS were significant variables in every logistic regression model, and experience of transfer and types of EMC were significant or marginally significant only in EDH. Timeliness of operation as audit filters for trauma care could not be applied to all cases. Early operations seem to improve clinical outcome only in the patients for whom emergent craniotomy or laparotomy were indicated. It could be interpreted as a phenomenon of 'confounding by indication'. Additional studies to establish more objective eligibility criteria for these audit filiters are needed.