Development of a positron emission tomography risks map. / Desarrollo de un mapa de riesgos para la tomografía por emisión de positrones.

Patient safety is an essential component of quality of care, especially when the complexity of care has reached extreme levels. Currently achieving this safety is considered a basic strategy of the National Health System. Nuclear Medicine departments have certain peculiarities that make them special in terms of patient safety, with situations that go beyond the common healthcare practice of other departments. Namely, that both encapsulated and non-encapsulated ionizing radiation is used in daily practice, and numerous groups of professionals must be coordinated to undertake positron emission tomography (PET) specifically, from the clinical management unit itself, and from other departments of the hospital (as well as companies outside the hospital itself and the Public Health System). The objective of this paper was to identify the risks to which a patient who is to be explored through PET can be exposed in a Nuclear Medicine department and draw up a risk map for the PET process. The methodology used is part of the proposal of the Ministry of Health (2007), and its practical implementation (given the limited literature available on Nuclear Medicine), follows as far as possible that of related care areas (radiodiagnosis and radiotherapy). For this purpose, a multidisciplinary team of professionals directly related to the PET process was created, using the modal analysis of faults and effects methodology to identify possible failures, their causes and the potential adverse events causing each. As a final step, a risk map was created, locating the previously identified faults at each stage of the process. This paper exposes the PET process, and describes the risks that patients might run when a PET scan is required, as well as the adverse events deriving from it. All this is shown in a risk map of the PET process.

[Prevention of adverse events for patient safety in chronic pain treatment units]. / Prevención de eventos adversos para la seguridad del paciente en las unidades de tratamiento del dolor crónico.

OBJECTIVES: To identify preventive actions that minimise risk of patients safety in pain treatment units, and to cluster preventive actions into homogeneous groups. The current study is part of a project intended to improve patient safety in pain treatment units, and is aimed at identifying, prioritising and preventing patient safety risk. MATERIAL AND METHODS: A group of experts was selected from professionals with a specific clinical background and experience in pain treatment units. This group was provided with information on patient safety and on known adverse events, errors and related causes. Through a brainstorming method the participants were asked: What changes or improvements would need to be undertaken to absolutely prevent the occurrence of each adverse event? The participant's proposals were analysed and grouped according to their homogeneity. RESULTS: A total of 456 preventive actions were identified. The group that received the highest number of suggestions was the one including changes in the management of healthcare processes, followed by the group that considered improvements in clinical practice, training activities, protocols and policies, and patient communication. CONCLUSIONS: According to the consensus of the experts, management of healthcare processes and improvements in health care practices are the 2 interventions that are most likely to reduce patient safety risk in pain treatment units.

[Identifying and prioritising adverse episodes and failures related to patient safety in Pain Treatment Units]. / Identificación y priorización de episodios adversos y fallos relacionados con la seguridad del paciente en las Unidades de Tratamiento del Dolor.

OBJECTIVES: An expert group coordinated by the Andalusian School of Public Health identified the most serious and frequent adverse events in Pain Treatment Units (PTU), as well the failures and underlying causes, as a prior step to preparing preventive actions. The aims of the project were to identify potential adverse events in Pain Treatment Units, identify failures and their underlying causes, and prioritise these failures according to a failure modes and effects analysis (FMEA) tool. MATERIAL AND METHODS: The method employed consisted of a literature search, the selection of an expert group with experience in PTU, creating a catalogue of adverse events using the generation of ideas technique, and putting the FMEA and Risk Priority Index tools into practice. RESULTS: Up to 66 types of adverse events were identified associated with; medication (30), invasive techniques (15), care process (10), patient information and education (6), and clinical practice (5). It was found that up to 101 failures could be triggered by these adverse events, and that 242 causes could lead to these failures. CONCLUSIONS: The results indicated the need to work principally in two directions, improving the care process in the PTU (the health care organisation), and the professional work, this latter having two aspects, improving the clinical practice, and increase professional skills by means of specific training. Communication, whether inter-professional or inter-department, or with the patient and their family, is identified as a key aspect for improvement.

Effectiveness assessment of otosclerosis surgery.

CONCLUSIONS: The epidemiological characteristics of otosclerosis and its treatment in Andalusia resemble those of other populations with similar socioeconomic levels. Two complementary approaches, such as questionnaires and pure-tone audiometry, are required to assess the effectiveness of otosclerosis surgery (OS) reliably and precisely. OBJECTIVES: We describe a new method to assess effectiveness in OS. It is based on the results of pure-tone audiometry and a specially designed quality of hearing questionnaire (QHQ). The objectives of the study are: (i) to report the general epidemiologic profile of otosclerosis in Andalusia; (ii) to study the effectiveness of OS in our community using conventional methods; and (iii) to study the outcomes of OS using the QHQ and to compare them to those obtained using conventional methods. MATERIAL AND METHODS: All 31 hospitals in the public healthcare system of Andalusia were studied. They were graded into four groups using a specially designed grouping system. The data were obtained from the minimum basic dataset. The prevalence of otosclerosis in Andalusia was calculated from the incidence data, the duration of the disease and life expectancy. To assess the effectiveness of OS, 475 clinical records from 15 hospitals representing all 4 groups were analysed. Effectiveness was assessed by conventional methods, using data obtained from pure-tone audiometry, and by using version 1.02 p of the QHQ. RESULTS: The incidence of clinical otosclerosis was 5.67 patients/100,000 inhabitants/year. The calculated prevalence was 0.287%. The number of cases increased progressively during the study period (p<0.001). The 15-45-year age group was the largest (62.2%) and 68.4% of patients were females. The most frequent type of otosclerosis was estapediovestibularis (fenestral), non-obliterative (91.8%). Only 48 cases (2.3%) of cochlear and 45 (2.2%) of obliterative otosclerosis were reported. The most frequently employed therapeutic procedures were stapedectomy and stapedotomy (75.70%). The average total and preoperative lengths of stay were 3.59 and 1.04 days, respectively. There were significant differences between the different types of otosclerosis. Improvement in the air-bone gap was 15.37+/-1.19 dB (n=164) and the overclosure or operative damage was 0.49+/-0.85 dB (n=164). A gap improvement of 10-40 dB was observed in 61.4% of patients. The > 65 years age group showed the best gap improvement but the largest variability. The quality of hearing measured by the QHQ showed that, in general, a better gap improvement was associated with a higher quality of hearing (Pearson correlation r=0.183; p<0.05). The 15-45-year age group had the worst gap improvement but, in contrast, the better quality of hearing.