[Patient safety in nursing homes. The experience of the Autonomous Community of the Region of Murcia]. / La seguridad del paciente en las residencias sociosanitarias. La experiencia de la Comunidad Autónoma de la Región de Murcia.

The pandemic has exposed the vulnerability of residential centers and the fragility of the population that lives there. In the Region of Murcia, care for this population group became a priority and a regional plan was drawn up to attend the needs of residents from the ethical framework of procedural justice. The immediacy imposed by the health crisis has meant that all this intervention is not without risks. Based on the Reason model, we have carried out a root cause analysis of the contributing factors that led the nursing homes to suffer a devastating impact, categorizing the security failures at three levels: infection control, social health environment and health-clinical environment. The pandemic has shown the urgency of strengthening the care model that we offer to our elders. A model that guarantees the coverage of the needs of extremely fragile patients that go beyond health and biomedical care and that considers their preferences and values.

Postpartum complications in women attended by midwives instead of obstetricians.

OBJECTIVE: The aim of this study was to evaluate changes in the frequency of visits to the hospital emergency department due to puerperal complications in low risk postpartum women attended by midwives instead of obstetricians. DESIGN: A quasi-experimental retrospective study with non-random allocation, comprising two groups: a control group of women attended by obstetricians and an intervention group of women attended by midwives. SETTING: A level 2 hospital in Madrid (España). PARTICIPANTS: Low risk postpartum women attended at the maternity unit of the Fuenlabrada University Hospital between 2013 and 2015. METHODS: We gathered variables to record the homogeneity of the groups and to assess for confounders and interactions. In the case of women with different behaviours and/or who generated confounders or interactions, a multivariate adjustment with logistic regression was performed. The Homer & Lemeshow goodness-of-fit test for logistic regression was used to determine the validity of the model. MEASUREMENTS AND FINDINGS: The intervention group comprised a total of 1308 women, whereas there were 1313 women in the control group. In the first 40-days postpartum, 33 women in the intervention group (2.5%) attended the hospital emergency department compared to 41 in the control group (3.1%). This difference was not statistically significant (p value 0.354). The relative risk of this decrease was 0.808 (95% CI 0.514; 1.270). The NNT was 167. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Care by midwives of low risk postpartum women did not lead to a worsening of puerperal complications requiring emergency department care. Furthermore, care by midwives was more effective than obstetrician care with lower emergency department attendance rates. Their qualification and capacity to provide health education were determinant factors.

Satisfacción en puérperas de bajo riesgo: obstetra frente a matrona / Satisfaction in low-risk postpartum: obstetrician versus midwife

Objetivo: El objetivo de este estudio fue comparar la satisfacción percibida por las puérperas de bajo riesgo en el momento del alta hospitalaria según hubiesen sido atendidas por obstetras o matronas. Material y método: Estudio cuasi-experimental de dos grupos sin asignación aleatoria. Se diseñó un cuestionario telefónico formado por ocho preguntas tipo Likert, que fue utilizado con puérperas atendidas en el Hospital Universitario de Fuenlabrada, a las que se realizó la encuesta entre mayo y junio de 2014. Considerando que un 70% de las encuestas tendrían respuestas positivas, con una precisión absoluta del 10% y un intervalo de confianza del 95%, se calcularon 71 casos necesarios. La fiabilidad se evaluó tanto por la consistencia interna (índice alfa de Cronbach) como con el procedimiento test-retest mediante el índice kappa y el coeficiente de correlación intraclase. Resultados: El cuestionario resultó fiable y con una elevada consistencia interna. Se pasó la encuesta telefónica a una muestra aleatoria de 80 mujeres del grupo control (atendidas por ginecólogos) y 80 del grupo de intervención (atendidas por matronas). Se obtuvieron mejores puntuaciones en las mujeres atendidas por matronas, con diferencias estadísticamente significativas en algunos de los ítems valorados, como en la recomendación global del hospital, al que contestaron favorablemente las 80 mujeres atendidas por matronas (100%) frente a 74 atendidas por obstetras (92,5%) (p= 0,028), en la identificación de los profesionales (p< 0,001) y en la información sobre signos y síntomas de alarma (p= 0,028) (AU)

Objective: The aim of the study was to compare the perceived satisfaction of puerperal women with low risk of hospital discharge as they had been attended by obstetricians or midwives. Methods: Quasi experimental study of two groups without random assignment. A telephone questionnaire was designed consisting of eight Likert-type questions that were used with puerperal patients attended at the Hospital Universitario de Fuenlabrada, where the survey was conducted between May and June 2014. Considering that 70% of the surveys would have positive responses with an absolute precision of 10% and a 95% confidence level, 71 cases were calculated. The telephone survey was passed to a random sample of 80 women in the control group (care by gynecologists) and 80 in the intervention group (care by midwives). Reliability was assessed both at internal consistency (Cronbach's alpha) and with test-retest using kappa index and intraclass correlation coefficient. Results: The questionnaire was reliable and with high internal consistency. Higher scores were obtained in women attended by midwives, with these differences being statistically significant in some of the items evaluated, as in the hospital's overall recommendation, where the 80 women attended by midwives (100%) responded favorably to 74 midwives attended by obstetricians (92.5%) (p= 0.028), in the identification of professionals (p< 0.001) or in information on signs and symptoms of alarm (p= 0.028) (AU)

Puesta en marcha del informe de alta emitido por matronas en el puerperio de bajo riesgo / Implementation of the discharge delivered by midwives in low-risk postpartum

En el Hospital Universitario de Fuenlabrada, un 70-75% de los partos son eutócicos con puerperio fisiológico. Al ser éste el diagnóstico más frecuente, el equipo se planteó que las matronas emitiesen el informede alta. El marco legal afirma que la matrona podría emitir el informe de alta, sin la firma y el número de colegiado médico, en un régimen de delegación de actuaciones previamente establecidas y con la aprobación de un protocolo. Con estas condiciones se inició la puesta en marcha del proyecto «Alta clínica a cargo de la matrona en el servicio de hospitalización obstétrica». Este proyecto consta de cinco fases: planificación, rotación interna, elaboración de documentos, formación e implementación. En España no hay antecedentes sobre este tema, por lo que se abre una nueva línea de actuación e investigación (AU)

At the University Hospital of Fuenlabrada, the births are vaginal deliveries, of which approximately 70-75% are normal deliveries. Following consultation under the current legal framework, the midwife can issue and prepare a postnatal discharge form in physiological puerperium, without the signature and number of medical college, provided under a "delegation of performances", and following the previously established adoption of a protocol of clinical practice. With this legal cover, the obstetric and gynecologist department starts the implementation of the protocol "Clinical discharge by the midwife at the postnatal ward". The development and implementation of this protocol has been implemented in five stages: planning, internal rotation, development of documents ,training and implementation. Currently in our area, there is no background on the proposed topic, so this work opens a new line of action, debate and inquiry (AU)