[Adverse events and essential actions for patient safety]. / Eventos adversos y acciones esenciales para la seguridad del paciente.

INTRODUCTION: The adverse events (AE) in hospitalized patients occur with increasing frequency due to the increase in complexity of medical care, which implies a greater risk of committing a human error inherent to the care, constituting a serious threat to the safety of the patient. MATERIAL AND METHODS: Cross-sectional study, including patients older than 16years, with hospital stay longer than 24h and discharge from the general surgery service, patients treated in emergency observation units or other hospital services were not considered. AE were identified, classified by cause according to the essential actions for patient safety (EAPS), and compliance with the EAPS was verified. RESULTS: 352 clinical records were reviewed, 61 (17%) were positive on screening. Of the positives, 66% resulted in AE (47 cases). The prevalence of AE was 13%. The AE were: 40% related to procedures; 39% with infections; 17% with medication; 4% with patient identification. The EAPS with the best rating was EAPS5 and the lowest rating was EAPS4. The night shifts with the greatest opportunity area, only with 40% and 44% correct procedures. CONCLUSIONS: The study shows that the two methodologies used, one to identify AE and the other to establish its causes and classification according to the EAPS, demonstrated usefulness and synergy for patient safety, when detecting AE, as well as determining their causes and evaluate compliance with the EAPS.

The day care center as a risk factor for acute respiratory infections.

BACKGROUND: This study was conducted to assess the magnitude of the risk of high morbidity (> or = 7 episodes/year) for acute respiratory infections (ARI) in infants attending day care centers (DCC), and to compare the incidence, duration, and severity of ARI in children staying at home (Home). METHODS: Using a cohort design, 282 infants (DCC, 138 and Home, 144) were followed for a year. Age at entry into the study ranged from 43 days to 4 months. During follow-up, social workers interviewed the mothers weekly to register whether the infants had an ARI. Also, infant health conditions and physical growth were updated monthly. RESULTS: ARI incidence was 14 episodes per child/year among DCC infants with a median of 74 sick days, while among children at home, the ARI incidence was 6 episodes, and the median was 40 days. The incidence density ratio for DCC children was 2.33 (95% CI, 2.13-2.54); after adjusting for other covariates, the relative risk increased to 5.27 (95% CI, 3.54-7.83). CONCLUSIONS: Infants attending DCCs will suffer ARI more frequently than children cared for at home. We did not find seasonal variations in the incidence rates among DCC infants. The quality of care provided at these facilities should be analyzed in more depth for proposing measures to decrease ARI incidence.

[Design and applicability of a clinical guide for appropriate attention in acute respiratory infections]. / Diseño y aplicabilidad de una guía clínica para la atención apropiada en las infecciones respiratorias agudas.

Clinical guidelines provide continuing education and help physicians in the clinical decision-making process. Clinical guidelines to manage acute respiratory infections (ARI) were developed comprehensively from a perspective where prevention, diagnosis, treatment and the patient's education were considered. Methodology. The guideline development process was comprised of two stages: 1. The building stage consisted of several steps: definition of the problem, definition of the potential users of the guidelines, and the appropriate level of care; review of updated bibliographies, and validation using the Delphi technique. 2. The start-up stage consisted of evaluating the guidelines applicable to out-patient settings. Twenty family physicians participated, using the guidelines with 115 patients. Agreement between the family physicians' diagnosis and the criteria stated in the guidelines was tested using unweighted kappa. Differences in the use of the guidelines to manage ARI patients were tested by using the X2 test or the exact Fisher test. Results. Development of guidelines considered the patient's age group. Therefore, guidelines to manage patients under five years of age and to manage patients above this age were constructed. The application of the guidelines was increased from 40 to 60%. As a result, inappropriate prescribing of antibiotics and cough syrups decreased. Although the guidelines could be helpful in treating ARI, its efficacy and effectiveness remain to be tested.