Reduction in the incidence of pressure ulcers upon implementation of a reminder system for health-care providers.

PURPOSE: To measure the clinical impact of the introduction of a reminder system for healthcare professionals to alert patients who are at risk for pressure ulcers (PU). METHODS: This was a pre- and post-test study of patients who were discharged from 6 medical-surgical units of the University Hospital of Fuenlabrada in 2009 and 2010. Beginning in January 2010, implementation of an on-screen list of reminders was automatically updated daily on the units' computers including patient arrival date, last assessment of ulceration risk and location of any PU. The cumulative incidence of PU was measured for patients discharged in 2009 (group A: healthcare professionals were not exposed to on-screen reminder) and 2010 (group B: healthcare professionals were exposed to on-screen reminder list). The relative risk (RR) was estimated. The study was completed with a stratified analysis and binary logistic regression. RESULTS: In group A, there were 84 cases of PU among 9263 patients discharged (0.9%); whereas in group B, there were 59 cases among 9220 patients discharged (0.6%). The RR of PU for group B/group A was 0.706 (p=0.038). In the logistic regression analysis, after adjusting for study variables, the odds ratio of PU B/A was 0.558. CONCLUSION: A list of on-screen reminders at the beginning of a healthcare professional's shift to inform them of patients at risk for developing a PU was effective at reducing the incidence of these clinical burdens.

Impacto de la implantación de recordatorios para disminuir eventos adversos en pacientes con accesos venosos periféricos / Impact of implementation of reminders to reduce adverse effects in patients with peripheral venous catheterizations

Fundamento. Medir el impacto clínico de la implantación de un sistema de recordatorios, que avise de los pacientes que tienen riesgo de presentar un evento adverso (EA) relacionado con los catéteres venosos periféricos. Métodos. A partir de los registros que se utilizan para seguimiento de los catéteres intravenosos se desarrolló una consulta automatizada que elabora un listado de los pacientes ingresados que incluye fecha de ingreso, fecha colocación, vía y tipo de vía. Se actualiza por turno en los ordenadores de la unidad. Se implantó en enero de 2010. Se ha realizado un estudio cuasi experimental midiendo la incidencia acumulada de flebitis, extravasaciones y obstrucciones en los pacientes dados de alta en 2009 y en 2010. Se ha evaluado la asociación entre variables cualitativas con el test de Chicuadrado, se ha estimado riesgo relativo (RR) y el número necesario de pacientes a tratar (NNT). Resultados. En el año 2009 fueron dados de alta en las unidades de estudio 9.263 pacientes y en 2010, 9.220 pacientes. Los resultados encontrados han sido: Pacientes que desarrollan flebitis 2010/2009: RR: 0,827 (p<0,001). Pacientes que presentan extravasaciones 2010/2009: RR: 0,804 (p<0,001).Pacientes que presentan obstrucciones 2010/2009: RR:0,954 (p=0,554). Conclusiones. Un listado de recordatorios que incluye los pacientes con acceso vascular y la fecha de éste, ha servido para disminuir el número de flebitis y extravasaciones, pero no las obstrucciones(AU)

Background. The main purpose of this paper is to measure the clinical impact of the implementation of a reminder system that would warn of patients who are at risk of presenting an adverse event (AE) related to the peripheral venous catheter. Method. On the basis of the registers used for monitoring intravenous catheters, an automated consultation was realized that elaborated a list of the patients admitted, including: date of admission, date of the insertion of the venous access device, and type of device. It was implanted in January 2010and updated three times a day with the computers of the unit. A quasi-experimental study has measured the cumulative incidence of phlebitis, extravasation and obstructions in the patients registered in 2009 and 2010. The association between qualitative variables was evaluated with the Chisquared test, and relative risk (RR) and Number Needed to Treat (NNT) were estimated. Results. Nine thousand two hundred and sixty-three patientswere registered in the studied units in the year 2009, and 9,220 patients in 2010. The results were the following: Patients with phlebitis 2010/2009: RR: 0.827 (p < 0.001). Patients with extravasations 2010/2009: RR: 0.804 (p < 0.001).Patients with obstructions 2010/2009: RR: 0.954 (p < 0.554).Conclusion. With the help of a reminder list (which includes the patients with vascular access and the date), there has been a decrease in the number of phlebitis and extravasations but not in the number of obstructions(AU)

Grado de conocimientos y actitudes de la enfermería de la Comunidad Autónoma de Madrid (cam) ante el dolor: diplomados en enfermería y profesionales / No disponible

El dolor se ha convertido en el quinto signo vital (1-3) y es hoy día un tema crítico en la atención del paciente. El tratamiento eficaz del mismo sigue siendo uno de los problemas más importantes y urgentes del sistema de asistencia sanitaria de los países desarrollados de todo el mundo. Si bien el dolor en los pacientes es un tema muy en boga actualmente, sin embargo, lo que es poco cuestionado es la formación de los futuros profesionales de Enfermería en el cuidado de dichos pacientes. El estudio y el tratamiento del dolor deberían ser inculcados en los estudiantes de Enfermería dentro de su formación, tanto teórica como práctica. Es muy importante la labor que asumen también los docentes en el tema. El reto para la profesión de Enfermería consistiría en este terreno en que organice, estructure y apoye un programa consistente en la activación de programas docentes para estudiantes y enfermeros en ejercicio. Para iniciar nuestro trabajo de investigación realizamos un análisis por una parte, de los actuales programas curriculares de las distintas escuelas de enfermería de la CAM, con asignaturas con contenidos en dolor, analizándose la similitud o no entre ellos, los epígrafes tratados, etc., todo ello comparado con el esbozo curricular que la IASP (International Association of Study of Pain) propuso para los estudios de enfermería; y por otra, se describen los conocimientos y las actitudes de ambos grupos en enfermería ante el dolor, tanto profesionales como estudiantes de enfermería. Para observar el grado de conocimientos y actitudes ante el dolor de ambos grupos, se introdujo como herramienta el NKAS-RP (Nurses' Knowledge and attitudes Survey Regarding Pain) (4). El grupo de trabajo se propuso, por tanto, tres objetivos generales: el primero, descripción de los temarios de las asignaturas de la carrera de enfermería con contenidos en dolor, y el 2.º y 3.º objetivos, definir los conocimientos y las actitudes ante el dolor de los estudiantes de enfermería y de los profesionales enfermeros de la CAM. Se trata de un estudio descriptivo, observacional, aleatorio y multicéntrico, que analiza los conocimientos actuales, así como las actitudes del grupo de enfermería, tanto entre estudiantes (futuros diplomados en enfermería) como entre profesionales. Se llevó a cabo entre los años 2008 al 2010, utilizándose para dar a conocer los resultados del mismo el paquete estadístico SPSS versión 17.0. Como resultados, se obtuvieron, al igual que en estudios previos, a nivel mundial, unos pobres conocimientos en dolor y unas malas actitudes ante dicho síntoma. Se propone para mejorarlos, en el caso de los estudiantes, cambios en los programas curriculares de la diplomatura (futuro grado) de enfermería, y en el caso de los profesionales, formación continuada, así como actualización de conocimientos en dicho tema (AU)

The pain has become the fifth vital sign and is now a critical issue in patient care. Effective treatment of it is still one of the most important and urgent health care system in developed countries worldwide. While pain in patients is a very in vogue these days, however, which is unchallenged is the education of future nursing professionals in the care of such patients. The study and treatment of pain should be instilled in nursing students in their training, both theoretical and practical. The work is very important that teachers also take on the subject. The challenge for the nursing profession in this field would you organize, structure and support a program involving the activation of educational programs for students and practicing nurses. To start our research we made an analysis on the one hand, the current curricula of different schools of nursing in the CAM, with subjects with pain content, analyzing the similarity or not between them, the treated sections, etc. all this curriculum outline compared to the IASP (International Association of Study of Pain) proposed for nursing studies and, secondly, we describe the knowledge and attitudes of both groups in nursing to pain, both professional and qualified nurses. To observe the degree of knowledge and attitudes towards pain in both groups, was introduced as a tool the NKAS-RP (Nurses’ Knowledge and Attitudes Survey Regarding Pain). The working group is proposed, therefore, three general objectives: The first description of the curricula of the courses in the career of nursing content in pain, and el2 and 3 goals, define the knowledge and attitudes to pain nursing students and nurses of the CAM. This is a descriptive, observational, multicenter, randomized, which analyzes the current knowledge and attitudes of the nursing staff, both among students (future graduates in nursing) and among professionals. Was carried out between 2008 and 2010, used to publicize the results of the statistical package SPSS version 17.0. As results were obtained, as in previous studies, worldwide, a poor knowledge of pain and a bad attitude before that symptom. It is proposed to improve: in the case of students, changes in the curriculum of the Diploma (future degree) nurses, and in the case of professionals, continuing education and refresher courses in that subject (AU)

[Impact of implementation of reminders to reduce adverse effects in patients with peripheral venous catheterizations]. / Impacto de la implantación de recordatorios para disminuir eventos adversos en pacientes con accesos venosos periféricos.

BACKGROUND: The main purpose of this paper is to measure the clinical impact of the implementation of a reminder system that would warn of patients who are at risk of presenting an adverse event (AE) related to the peripheral venous catheter. METHOD: On the basis of the registers used for monitoring intravenous catheters, an automated consultation was realized that elaborated a list of the patients admitted, including: date of admission, date of the insertion of the venous access device, and type of device. It was implanted in January 2010 and updated three times a day with the computers of the unit. A quasi-experimental study has measured the cumulative incidence of phlebitis, extravasation and obstructions in the patients registered in 2009 and 2010. The association between qualitative variables was evaluated with the Chi-squared test, and relative risk (RR) and Number Needed to Treat (NNT) were estimated. RESULTS: Nine thousand two hundred and sixty-three patients were registered in the studied units in the year 2009, and 9,220 patients in 2010. The results were the following: Patients with phlebitis 2010/2009: RR: 0.827 (p < 0.001). Patients with extravasations 2010/2009: RR: 0.804 (p < 0.001). Patients with obstructions 2010/2009: RR: 0.954 (p < 0.554). CONCLUSION: With the help of a reminder list (which includes the patients with vascular access and the date), there has been a decrease in the number of phlebitis and extravasations but not in the number of obstructions.