La gestión por procesos en la Farmacia Hospitalaria para la mejora de la seguridad del paciente / Process management in the Hospital Pharmacy for the improvement of the patient safety

Objetivos. Definir un modelo de gestión por procesos de una Farmacia Hospitalaria para medir, analizar y realizar la mejora continúa en seguridad y calidad asistencial. Material y métodos. En el marco de implantación de la gestión por procesos, el Hospital de Igualada se dividió en varios procesos, uno de los cuales fue el proceso de Farmacia Hospitalaria. Primero se nombró un equipo de gestión para cada proceso. Después se definió un pequeño grupo de trabajo para cada subproceso con su respectivo responsable. Con la ayuda de estos grupos se realizaron el análisis de riesgos aplicando el Análisis Modal de Fallos y Efectos (AMFE) y la implantación de las acciones de mejora resultantes. Se definieron indicadores para cada subproceso y se establecieron diferentes mecanismos de gestión por procesos. Resultados. Primero, el análisis de riesgos con AMFE generó más de una treintena de acciones preventivas para mejorar la seguridad del paciente. Después, tanto el análisis semanal de incidencias como el análisis mensual de los indicadores nos permitió la monitorización y gestión basada en datos objetivos de los resultados claves. Además, el tener a una persona responsable de los resultados de cada subproceso nos permitió la implicación y compromiso del personal creándose la cultura de excelencia. Conclusiones. La introducción de diferentes mecanismos de gestión por procesos, con la participación del personal responsable para cada subproceso, introduce una herramienta de gestión participativa para la mejora continua de la seguridad y calidad asistencial(AU)

Objectives. To define a process management model for a hospital pharmacy in order to measure, analyse and make continuous improvements in patient safety and healthcare quality. Material and methods. In order to implement process management, Igualada Hospital was divided into different processes, one of which was the Hospital Pharmacy. A multidisciplinary management team was given responsibility for each process. For each sub-process one person was identified to be responsible, and a working group was formed under his/her leadership. With the help of each working group, a risk analysis using failure modes and effects analysis (FMEA) was performed, and the corresponding improvement actions were implemented. Sub-process indicators were also identified, and different process management mechanisms were introduced. Results. The first risk analysis with FMEA produced more than thirty preventive actions to improve patient safety. Later, the weekly analysis of errors, as well as the monthly analysis of key process indicators, permitted us to monitor process results and, as each sub-process manager participated in these meetings, also to assume accountability and responsibility, thus consolidating the culture of excellence. Conclusions. The introduction of different process management mechanisms, with the participation of people responsible for each sub-process, introduces a participative management tool for the continuous improvement of patient safety and healthcare quality(AU)

[Process management in the hospital pharmacy for the improvement of the patient safety]. / La gestión por procesos en la farmacia hospitalaria para la mejora de la seguridad del paciente.

OBJECTIVES: To define a process management model for a hospital pharmacy in order to measure, analyse and make continuous improvements in patient safety and healthcare quality. MATERIAL AND METHODS: In order to implement process management, Igualada Hospital was divided into different processes, one of which was the Hospital Pharmacy. A multidisciplinary management team was given responsibility for each process. For each sub-process one person was identified to be responsible, and a working group was formed under his/her leadership. With the help of each working group, a risk analysis using failure modes and effects analysis (FMEA) was performed, and the corresponding improvement actions were implemented. Sub-process indicators were also identified, and different process management mechanisms were introduced. RESULTS: The first risk analysis with FMEA produced more than thirty preventive actions to improve patient safety. Later, the weekly analysis of errors, as well as the monthly analysis of key process indicators, permitted us to monitor process results and, as each sub-process manager participated in these meetings, also to assume accountability and responsibility, thus consolidating the culture of excellence. CONCLUSIONS: The introduction of different process management mechanisms, with the participation of people responsible for each sub-process, introduces a participative management tool for the continuous improvement of patient safety and healthcare quality.

[Detecting adverse drug events during the hospital stay]. / Detección de acontecimientos adversos producidos por medicamentos durante la estancia hospitalaria.

INTRODUCTION: The principal objective was to determine the incidence rate of adverse drug events (ADEs) in hospitalised patients and evaluate the event prevention percentage. METHODS: Multi-centre, prospective observational study lasting four months, performed in five hospitals providing different levels of care. We included all adult patients who were admitted to one of the selected centres for longer than 48 hours and who required pharmacological treatment. ADEs were identified by direct observation and the use of previously defined alarm signals. The Karch-Lasagna scale was used to determine the causality relationship, and the Schumock and Thornton questionnaire adapted by Otero was used to evaluate ADE preventability. Preventable drug-induced adverse events were classified according to the taxonomy that the Ruiz-Jarabo 2000 group defined, and coordinated by ISMP-Spain. RESULTS: We included 1,550 patients, 159 of whom experienced at least one ADE (10.3 %). The preventability percentage was 51.6 %, which represented 5.3 % of the total sample. The endocrine system (34.8 %) and the cardiovascular system (20.7 %) were the most affected by preventable ADEs. Antibiotics were responsible for 16.5 % of all ADEs. 9.3 % of all preventable ADEs were triggered by use of opiates. The vast majority of preventable ADEs (36.3 %) resulted from omitting a necessary medication. Only 4.4 % of preventable ADEs are considered to be serious. CONCLUSIONS: There is a high incidence rate of ADEs during patients' hospital stay (10.3 %), and half of them (51.6 %) could have been prevented. Implementation of an automatic alarm system and certain best practices for problem spots along the care circuit will help detect and avoid preventable ADEs.

Detección de acontecimientos adversos producidos por medicamentos durante la estancia hospitalaria / Detecting adverse drug events during the hospital stay

Introducción: El objetivo principal ha sido determinar la incidencia de acontecimientos adversos producidos por medicamentos (AAM) en pacientes hospitalizados y evaluar su porcentaje de prevención. Métodos: Estudio multicéntrico, prospectivo y observacional de 4 meses de duración, realizado en cinco hospitales de distinto nivel asistencial. Se incluyó a todos los pacientes adultos que ingresaron por más de 48 h en alguna de las unidades seleccionadas y requirieron tratamiento farmacológico. La identificación de los AAM se realizó mediante la observación directa y la utilización de unas señales de alerta, previamente definidas. Se utilizó el algoritmo de Karch-Lasagna, para determinar la relación de causalidad, y el cuestionario de Schumock y Thornton adaptado por Otero et al para evaluar la evitabilidad del AAM. Los AAM prevenibles se clasificaron siguiendo la taxonomía definida por el Grupo Ruiz-Jarabo 2000, coordinado por el ISMP-España. Resultados: Se incluyó a 1.550 pacientes, de los que 159 presentaron, al menos, un AAM (10,3 %). La tasa de evitabilidad fue del 51,6 %, lo que representa un 5,3 % de la muestra total. El sistema endocrino (34,8 %) y el cardiovascular (20,7 %) fueron los más afectados por los AAM prevenibles. Los antibióticos representaron el 16,5 % de todos los AAM. En cuanto a los AAM prevenibles, el 9,3 % de ellos se desencadenaron por la utilización de opiáceos. La gran mayoría de los AAM evitables fue consecuencia de la omisión de un medicamento necesario (36,3 %). Sólo un 4,4 % de los AAM evitables se consideró graves. Conclusiones: La incidencia de pacientes con AAM durante la estancia hospitalaria es alta (10,3 %), y la mitad de ellos (51,6 %) se podría haber prevenido. La implantación de un sistema automático de alertas y ciertas prácticas de mejoras en los puntos conflictivos del circuito sanitario ayudarían a la detección y la prevención de los AAM evitable (AU)

Introduction: The principal objective was to determine the incidence rate of adverse drug events (ADEs) in hospitalised patients and evaluate the event prevention percentage. Methods: Multi-centre, prospective observational study lasting four months, performed in five hospitals providing different levels of care. We included all adult patients who were admitted to one of the selected centres for longer than 48 hours and who required pharmacological treatment. ADEs were identifi ed by direct observation and the use of previously defi ned alarm signals. The Karch-Lasagna scale was used to determine the causality relationship, and the Schumock and Thornton questionnaire adapted by Otero was used to evaluate ADE preventability. Preventable drug-induced adverse events were classifi ed according to the taxonomy that the Ruiz-Jarabo 2000 group defi ned, and coordinated by ISMP-Spain. Results: We included 1,550 patients, 159 of whom experienced at least one ADE (10.3 %). The preventability percentage was 51.6 %, which represented 5.3 % of the total sample. The endocrine system (34.8 %) and the cardiovascular system (20.7 %) were the most affected by preventable ADEs. Antibiotics were responsible for 16.5 % of all ADEs. 9.3 % of all preventable ADEs were triggered by use of opiates. The vast majority of preventable ADEs (36.3 %) resulted from omitting a necessary medication. Only 4.4 % of preventable ADEs are considered to be serious. Conclusions: There is a high incidence rate of ADEs during patients’ hospital stay (10.3 %), and half of them (51.6 %) could have been prevented. Implementation of an automatic alarm system and certain best practices for problem spots along the care circuit will help detect and avoid preventable ADEs (AU)