Identificación de eventos centinela en atención primaria / Identification of sentinel events in primary care

Objetivo. Identificar y describir un listado de eventos centinela (EC) en atención primaria (AP). Metodología. Consenso de expertos estructurado mediante 2 cuestionarios online. Los expertos fueron elegidos por su experiencia en AP y conocimientos en seguridad del paciente. El primer cuestionario valoró la adaptación de los EC hospitalarios del National Quality Forum 2006 al ámbito de AP a través de las respuestas: sí, no, sí con adaptación; en este último caso se permitió una nueva redacción de los mismos y además el cuestionario permitía la incorporación de nuevos EC. El segundo cuestionario incluyó los EC con respuesta positiva (sí, sí con adaptación>55%) para que los expertos eligieran entre redacción original y alternativa y los nuevos EC descritos. Resultados. De los 47 expertos convocados 44 respondieron a ambos cuestionarios. Se identificaron en total 17 EC para AP. Primer cuestionario: de 28 EC hospitalarios 12 se consideraron adaptables para AP; 11 de ellos con redacción alternativa. Treinta y ocho expertos propusieron algún EC nuevo referidos principalmente a: problemas con la medicación/vacunas, retrasos/ausencia en la atención, retraso diagnóstico y problemas con pruebas diagnósticas, resumidos en 5 EC. Segundo formulario: los expertos escogieron en más del 65% la redacción alternativa de los 11 EC adaptados a AP. Los 5 nuevos EC fueron considerados adecuados con respuesta positiva entre 70-85%. Conclusión. Se identificaron 17 EC para AP, lo que disponer de un listado de EC permitirá llevar a cabo una mejor gestión del riesgo sanitario (AU)

Objective. To identify and describe a list of sentinel events (SEs) for Primary Care (PC). Methododology. A structured experts' consensus was obtained by using two online questionnaires. The participants were selected because of their expertise in PC and patient safety. The first questionnaire assessed the suitability of the hospital SEs established in the National Quality Forum 2006 for use in PC via responses of "yes", "no", or "yes but with modification". In the latter case, a re-wording of the SE was requested. Additionally, inclusion of new SEs was also allowed. The second questionnaire included those SEs with positive responses ("yes", "yes with modification"), so that the experts could choose between the original and alternative drafts, and evaluate the newly described SEs. Results. The questionnaires were completed by 44 out of a total of the 47 experts asked to participate, and a total of 17 SEs were identified as suitable for PC. For the first questionnaire, 12 of the 28 hospital SEs were considered adaptable to PC, of which 11 were re-drafts. Thirty-seven experts proposed new SEs. These mainly concerned problems with medication and vaccines, delay, or lack of assistance, diagnostic delays, and problems with diagnostic tests, and were finally summarised in 5 SEs. In the second questionnaire, ≥65% of the experts chose the alternative wording against the original cases for the 11 SEs suitable for PC. The 5 newly included SEs were considered adequate with a positive response of 70-85%. Conclusion. Having a list of SEs available in PC will help to improve the management of health care risks (AU)

[Identification of sentinel events in primary care]. / Identificación de eventos centinela en atención primaria.

OBJECTIVE: To identify and describe a list of sentinel events (SEs) for Primary Care (PC). METHODODOLOGY: A structured experts' consensus was obtained by using two online questionnaires. The participants were selected because of their expertise in PC and patient safety. The first questionnaire assessed the suitability of the hospital SEs established in the National Quality Forum 2006 for use in PC via responses of "yes", "no", or "yes but with modification". In the latter case, a re-wording of the SE was requested. Additionally, inclusion of new SEs was also allowed. The second questionnaire included those SEs with positive responses ("yes", "yes with modification"), so that the experts could choose between the original and alternative drafts, and evaluate the newly described SEs. RESULTS: The questionnaires were completed by 44 out of a total of the 47 experts asked to participate, and a total of 17 SEs were identified as suitable for PC. For the first questionnaire, 12 of the 28 hospital SEs were considered adaptable to PC, of which 11 were re-drafts. Thirty-seven experts proposed new SEs. These mainly concerned problems with medication and vaccines, delay, or lack of assistance, diagnostic delays, and problems with diagnostic tests, and were finally summarised in 5 SEs. In the second questionnaire, ≥65% of the experts chose the alternative wording against the original cases for the 11 SEs suitable for PC. The 5 newly included SEs were considered adequate with a positive response of 70-85%. CONCLUSION: Having a list of SEs available in PC will help to improve the management of health care risks.

El reto de sostener cultura de la seguridad del paciente en las instituciones sanitarias / The challange of upholding the culture of patient safety in the health institutions

No disponible

[Implementation of a patient safety strategy in primary care of the Community of Madrid]. / Despliegue de la estrategia de seguridad del paciente en atención primaria de la Comunidad de Madrid.

This paper describes the implementation of a patient safety strategy in primary care within the new organizational and functional structure that was created in October 2010 to cover the single primary health care area of the Community of Madrid. The results obtained in Patient Safety after the implementation of this new model over the first two years of its development are also presented.

[Adaptation of the Medical Office Survey on Patient Safety Culture (MOSPSC) tool]. / Adaptación de la herramienta del cuestionario Medical Office Survey on Patient Safety Culture (MOSPSC).

OBJECTIVE: To adapt the Medical Office Survey on Patient Safety Culture (MOSPSC) Excel(®) tool for its use by Primary Care Teams of the Spanish National Public Health System. METHODS: The process of translation and adaptation of MOSPSC from the Agency for Healthcare and Research in Quality (AHRQ) was performed in five steps: Original version translation, Conceptual equivalence evaluation, Acceptability and viability assessment, Content validity and Questionnaire test and response analysis, and psychometric properties assessment. After confirming MOSPSC as a valid, reliable, consistent and useful tool for assessing patient safety culture in our setting, an Excel(®) worksheet was translated and adapted in the same way. It was decided to develop a tool to analyze the "Spanish survey" and to keep it linked to the "Original version" tool. The "Spanish survey" comparison data are those obtained in a 2011 nationwide Spanish survey, while the "Original version" comparison data are those provided by the AHRQ in 2012. RESULTS: The translated and adapted tool and the analysis of the results from a 2011 nationwide Spanish survey are available on the website of the Ministry of Health, Social Services and Equality. It allows the questions which are decisive in the different dimensions to be determined, and it provides a comparison of the results with graphical representation. CONCLUSIONS: Translation and adaptation of this tool enables a patient safety culture in Primary Care in Spain to be more effectively applied.

Adaptación de la herramienta del cuestionario Medical Office Survey on Patient Safety Culture (MOSPSC) / Adaptation of the Medical Office Survey on Patient Safety Culture (MOSPSC) tool

Objetivo: Adaptar la herramienta Excel® del Medical Office Survey on Patient Safety Culture (MOSPSC) para su uso por los equipos de atención primaria del Sistema Nacional de Salud de España. Métodos: El proceso de traducción y adaptación del cuestionario MOSPSC de la Agency for Healthcare and Research in Quality (AHRQ) se realizó en 5 etapas: traducción de la versión original, evaluación de la equivalencia conceptual, valoración de la aceptabilidad y viabilidad, análisis de la validez del contenido y pilotaje del cuestionario adaptado y análisis de la respuesta y evaluación de las propiedades psicométricas. Tras comprobar que el cuestionario era un instrumento válido, fiable, consistente y útil para medir cultura de seguridad en nuestro ámbito, se procedió a la traducción y adaptación de la hoja de cálculo Excel® asociada con los mismos criterios. Se optó por desarrollar la herramienta para analizar la encuesta española «versión adaptada» y se conservó, vinculada, la herramienta en «versión original». En la «versión adaptada» se incluyeron como datos de comparación los del estudio realizado a nivel nacional en el año 2011, mientras que en la «versión original» los datos de comparación fueron los ofrecidos por la AHRQ en su informe de 2012. Resultados: La herramienta adaptada, así como los resultados de la explotación de la misma con el total de las encuestas del estudio nacional realizado en 2011, se encuentran disponibles en la página del Ministerio de Sanidad, Servicios Sociales e Igualdad. Permiten conocer las cuestiones más determinantes en las diferentes dimensiones y ofrecen, mediante representación gráfica, una comparación de resultados. Conclusiones: La traducción y adaptación de esta herramienta informática a nuestro entorno facilita difundir de una forma más eficiente la cultura de seguridad del paciente en atención primaria en España (AU)

Objective: To adapt the Medical Office Survey on Patient Safety Culture (MOSPSC) Excel® tool for its use by Primary Care Teams of the Spanish National Public Health System. Methods: The process of translation and adaptation of MOSPSC from the Agency for Healthcare and Research in Quality (AHRQ) was performed in five steps: Original version translation, Conceptual equivalence evaluation, Acceptability and viability assessment, Content validity and Questionnaire test and response analysis, and psychometric properties assessment. After confirming MOSPSC as a valid, reliable, consistent and useful tool for assessing patient safety culture in our setting, an Excel®worksheet was translated and adapted in the same way. It was decided to develop a tool to analyze the “Spanish survey” and to keep it linked to the “Original version” tool. The “Spanish survey” comparison data are those obtained in a 2011 nationwide Spanish survey, while the “Original version” comparison data are those provided by the AHRQ in 2012. Results: The translated and adapted tool and the analysis of the results from a 2011 nationwide Spanish survey are available on the website of the Ministry of Health, Social Services and Equality. It allows the questions which are decisive in the different dimensions to be determined, and it provides a comparison of the results with graphical representation. Conclusions: Translation and adaptation of this tool enables a patient safety culture in Primary Care in Spain to be more effectively applied (AU)

Despliegue de la estrategia de seguridad del paciente en atención primaria de la Comunidad de Madrid / Implementation of a patient safety strategy in primary care of the Community of Madrid

En este trabajo se describe el despliegue de la estrategia de seguridad del paciente (SP) en atención primaria (AP) dentro de la nueva estructura organizativa y funcional que se crea en octubre de 2010, para dar cobertura al área única de salud de AP de la Comunidad de Madrid (CM). Así mismo, se detallan cuáles han sido los resultados obtenidos en SP tras la implantación de este nuevo modelo a lo largo de los 2 primeros años de su desarrollo (AU)

This paper describes the implementation of a patient safety strategy in primary care within the new organizational and functional structure that was created in October 2010 to cover the single primary health care area of the Community of Madrid. The results obtained in Patient Safety after the implementation of this new model over the first two years of its development are also presented (AU)

[Cutaneous cryosurgery in family medicine: dimethyl ether-propane spray versus liquid nitrogen]. / Criocirugía cutánea en medicina familiar: spray de dimetiléter-propano frente al nitrógeno líquido.

OBJECTIVE: To compare the efficacy, tolerance and safety of two types of cryotherapy, performed by family physicians, for benign cutaneous lesions: low freezing (-59 degrees C) with dimethyl either-propane cryogenic spray (DMEP) and intense freezing (196 degrees C) with conventional liquid nitrogen (LN). DESIGN: A randomised, multi-centered, controlled clinical trial, with single-blind assessment. SETTING: Three primary care teaching teams in the Community of Madrid. PATIENTS AND OTHER PARTICIPANTS: Ten MIR from family & community medicine intervened. There were 124 patients, who had 174 benign cutaneous lesions, suitable for cryotherapy. There were 3 voluntary withdrawals, none because of an adverse reaction. Interventions, in each case there was local application for a standard time of the randomised agent. Control-group intervention, 81 cases: swab soaked in LN. Study-group intervention, 93 cases: swab saturated with DMEP spray. Maximum of three freezings per case, at weekly intervals. MEASUREMENTS AND MAIN RESULTS: A doctor made a blind assessment of the results (elimination, adverse reaction, aesthetic result) 15 days after treatment. CONCLUSIONS: No clinically relevant differences between the efficacy, tolerance and safety of the two cryogenic agents used in primary care were found. The low freezing of DMEP was sufficient for the cryotherapy of benign lesions.