Blood-sparing techniques prevalence in adult intensive care units: A multicentre survey study.

INTRODUCTION: Anaemia is a common condition in patients admitted to intensive care units (ICUs). It is also well known that a significant amount of the carbon dioxide produced by health services is likely attributable to blood donation, testing, and the manufacture, storage, and distribution of blood components. To mitigate this, prevention strategies such as blood-sparing techniques are available. There is a lack of knowledge regarding the use of such techniques in ICUs in Spain and Latin America, healthcare systems with very different health expenditures per capita. The aim is to assess the degree of implementation of blood-sparing techniques in these regions. METHODS: Cross-sectional online multicentre survey. 251 ICUs in Spain and 53 in Latin America (20 in Argentina, 20 in Colombia, 13 in Ecuador) participated. A 20-item survey on the use of point-of-care, small-volume tubes (SVT), and closed-blood sampling devices (CBSD) was validated. Effect sizes were calculated using Phi (φ) or Cramer's V (V). RESULTS: A response rate of 77% was obtained for Spain and 96% for Latin America. In Spain, the majority of ICUs were affiliated with public hospitals (88.1%, 171/194) while in Latin America, most were associated with private hospitals (56.9%, 29/51). Regarding the use of point-of-care testing, 67.5% of Spanish ICUs, compared to 35.3% of Latin Americans, reported frequent use (V=0.343). In 91.7% of Spanish ICUs and 58.9% of Latin Americans, SVTs were rarely or never used (V=0.380). The use of CBSD was significantly lower in Spain for both arterial and central venous catheters (V=0.336). Private hospitals used more CBSD in arterial catheter than public ones (27% vs 8.3%, V=0.278). CONCLUSION: Point-of-care testing can be improved in Latin America, while the use of CBSD and small-volume tubes can be enhanced in Spain. Private hospitals tend to implement blood-sparing techniques more effectively than public hospitals.

[Ethics of care: Assessment of the ethical issues in the protocols or consensuses on mechanical restraint in force in Spain]. / Ética de los cuidados: valoración de los contenidos éticos en los protocolos o consensos de contención mecánica vigentes en España.

INTRODUCTION: Mechanical restraints are widely used in health care practice, despite the numerous ethical conflicts they raise. The aim of this study is to evaluate the ethical considerations contemplated in the current protocols on mechanical restraint in Spain. METHOD: Systematic review in PubMed, WOS and Scopus, Google and Google Scholar. An ad hoc list of 30 items was used to evaluate the ethical content of the protocols. The quality of guidelines was assessed with AGREE II. RESULTS: The need for informed consent (IC) is reflected in 72% of the documents, the IC model sheet is included in only 41% of them, the rest of the analyzed characteristics on IC are fulfilled in percentages between 6% (the document includes the need to reevaluate the indication for IC) and 31% (the document contemplates to whom it should be requested). More than 20 ethical contents are reflected in 31% of them and less than 10 in 19% of the guidelines. The quality of the guides, according to AGREE II, ranged from 27 to 116 points (maximum possible 161), with a mean score of 68.7. Only 9% of the documents were classified as high quality. Finally, the correlation between ethical content and quality measured with AGREE II was 0.75. CONCLUSIONS: The variability of ethical contents in guidelines on mechanical restraints is very high. The ethical requirements to be included in protocols, consensus or Clinical Practice Guidelines should be defined.

Diseño de un modelo de ronda de seguridad para unidades de cuidados intensivos / Design of a safety round model for intensive care units

Introducción: Las rondas de seguridad (RS) son una herramienta operativa que permite conocer la adherencia a las buenas prácticas, ayuda a identificar riesgos e incidentes en seguridad del paciente (SP), permitiendo implementar acciones de mejora. El objetivo de este trabajo fue el diseño de un procedimiento para realizar RS en una unidad de cuidados intensivos (UCI). Métodos: Elaboración de un listado de verificación para el desarrollo de RS en una UCI mediante técnica de grupo nominal, con la participación de directivos, mandos intermedios y profesionales de diferentes disciplinas y categorías. En primer lugar, un grupo de expertos consensuó, atendiendo a las recomendaciones en buenas prácticas en SP, la definición de ítems, su codificación, los criterios de cumplimiento y el impacto de su incumplimiento. Posteriormente, determinó su viabilidad mediante un estudio transversal a través del pilotaje de 2 RS para ajustar los ítems en condiciones de práctica clínica real. Resultados: Se ha obtenido un modelo de RS específico para UCI mediante un listado de verificación. El grupo de expertos elaboró un primer listado compuesto por 39 ítems de 6 dimensiones esenciales y definió el modo de realización. El tiempo medio de realización de las 2 RS fue de 85minutos, incluyendo el briefing y debriefing posterior. Tras el pilotaje de validación se redujo las dimensiones a 5, se suprimió 3 ítems, se trasladó 2 ítems a otra dimensión y se modificó 3 ítems relativos a infecciones nosocomiales y consentimiento informado. Además, se redefinieron las fuentes de datos, los criterios de cumplimiento y su peso relativo. El listado definitivo fue considerado útil y relevante para mejorar la práctica. Conclusiones: Mediante una metodología de consenso se ha construido un listado de verificación para ser usado en las RS de una UCI. Este modelo puede servir de base para su empleo en servicios asistenciales de similares características.(AU)

Introduction: Safety Rounds (SR) are an operational tool that allow knowing adherence to good practices, help identify risks and incidents in patient safety (PS), allowing improvement actions to be implemented. The objective of this work was the design of a procedure to perform SR in an Intensive Care Unit (ICU). Methods: Preparation of a checklist for the development of SR in the ICU through the nominal group technique, with the participation of managers, middle managers and professionals from different disciplines and categories. In the first place, a group of experts agreed, based on the recommendations on good practices in PS, the definition of items, their coding, the criteria for compliance and the impact of non-compliance. Subsequently, its viability was determined through a cross-sectional study through the piloting of two SRs to adjust the items in real clinical practice conditions. Results: A specific SR model for ICUs has been obtained through a checklist. The group of experts prepared a first list made up of 39 items of 6 essential dimensions and defined the method of implementation. Mean time to complete the two SRs was 85minutes, including the briefing and subsequent debriefing. After the validation pilot, the dimensions were reduced to 5, 3 items were deleted, 2 items were transferred to another dimension and 3 items related to nosocomial infections and informed consent were modified. In addition, the data sources, the compliance criteria and their relative weight were redefined. The final list was considered useful and relevant to improve practice. Conclusions: Through a consensus methodology, a checklist has been built to be used in the RS of an ICU. This model can serve as a basis for its use in healthcare services with similar characteristics.(AU)

Design of a safety round model for intensive care units.

INTRODUCTION: Safety Rounds (SR) are an operational tool that allow knowing adherence to good practices, help identify risks and incidents in patient safety (PS), allowing improvement actions to be implemented. The objective of this work was the design of a procedure to perform SR in an Intensive Care Unit (ICU). METHODS: Preparation of a checklist for the development of SR in the ICU through the nominal group technique, with the participation of managers, middle managers and professionals from different disciplines and categories. In the first place, a group of experts agreed, based on the recommendations on good practices in PS, the definition of items, their coding, the criteria for compliance and the impact of non-compliance. Subsequently, its viability was determined through a cross-sectional study through the piloting of two SRs to adjust the items in real clinical practice conditions. RESULTS: A specific SR model for ICUs has been obtained through a checklist. The group of experts prepared a first list made up of 39 items of 6 essential dimensions and defined the method of implementation. Mean time to complete the two SRs was 85 min, including the briefing and subsequent debriefing. After the validation pilot, the dimensions were reduced to 5, 3 items were deleted, 2 items were transferred to another dimension and 3 items related to nosocomial infections and informed consent were modified. In addition, the data sources, the compliance criteria and their relative weight were redefined. The final list was considered useful and relevant to improve practice. CONCLUSIONS: Through a consensus methodology, a checklist has been built to be used in the RS of an ICU. This model can serve as a basis for its use in healthcare services with similar characteristics.

En busca de la evidencia científica en úlceras por presión: cinco años, un objetivo, múltiples caminos / The quest for scientific evidence in pressure ulcers: five years, one goal, multiple ways

Introducción y objetivo: Las úlceras por presión (UPP) son objeto de múltiples publicaciones en nuestro país. Pero... ¿conocemos en realidad la calidad y la evidencia científica de estas investigaciones?, ¿la evidencia aportada es suficiente para reforzar o modificar planteamientos clínicos existentes? Nuestro objetivo es cuantificar y analizar dichas investigaciones. Fijamos nuestro análisis en su estructura, fuerza de la evidencia, publicaciones, autores, ámbito de estudio y concordancia con los objetivos iniciales. Material y método: Estudio cuantitativo-descriptivo de los artículos indexados en la base de datos CUIDEN, con el descriptor “úlceras por presión”, durante el período enero 1999-diciembre 2003. De los mismos, se realizó una lectura crítica y análisis del grado de evidencia utilizando como referencia la documentación aportada en el Curso de enfermería basada en la evidencia de F.P. García Fernández y P.L. Pancorbo Hidalgo (1). Resultados: En la búsqueda bibliográfica realizada en la base de datos CUIDEN con el descriptor “úlceras por presión” se encontraron 242 artículos de los cuales se seleccionaron 85. La producción se repartió de la siguiente forma: artículos originales, 62; casos clínicos, 2; editoriales, 4; cartas al director, 1; comunicaciones, 4; guías de práctica clínica (GPC), 12. Centramos nuestro estudio en el análisis de los artículos originales que supusieron un 72,94% del total de la producción. Encontramos que el 22,95% de los artículos no presentaban un resumen estructurado, en cuanto a la calidad de evidencia el 6,55% correspondía a una evidencia A. Alta, el 18,03% B. Media y el 78,68% C. Baja. En el 13,11% de los artículos se reflejaban opiniones del autor. En cuanto a la discusión/conclusión, en el 13,11% no existía concordancia con los objetivos. En el 40,98% no se comparaban los resultados con otros estudios y en el 9,83% no se justificaban las conclusiones con los resultados. En cuanto a las revistas, la publicación se distribuyó del siguiente modo: Gerokomos, 35,48%; Rol, 19,35% y Metas, 6,45. Las Comunidades Autónomas que más publicaron fueron: Andalucía, 32,25%; Cataluña, 17,74% y Madrid, 14,51%. En lo que respecta a la adscripción de los autores, en el 85,48% de los casos se trataba de enfermeras, y en el 3,22% de médicos. En cuanto al ámbito asistencial, el 74,19% pertenecía a atención especializada, el 12,90% a atención primaria, el 1,61% a atención sociosanitaria y el 9,67% a atención primaria y especializada conjuntamente. Discusión y conclusiones: La investigación sobre UPP utiliza fundamentalmente métodos que aportan una evidencia C, insuficiente para reforzar o modificar prácticas asistenciales. Encontramos que existe un importante número de trabajos cuyas conclusiones no coinciden con los objetivos propuestos; en un alto porcentaje no se establecen comparaciones con otros estudios. Los investigadores son personal de enfermería que trabaja en atención especializada y desarrolla su labor en Andalucía, Cataluña y Madrid. Gerokomos sigue siendo un pilar básico para la publicación de artículos originales de UPP. El crecimiento de la investigación ha sido lineal en los últimos cinco años

Introduction and objectives: Pressure ulcers (PU) are the object of numerous scientific papers in our country. However…, do we really know the scientific quality and evidence of such investigations?; is this evidence sufficient to strengthen or modify the current treatment patterns? Our objective is to rate and analize these investigations; assessing the structure, the level of evidence, journals, authors, field of study and cosistency with initial objectives. Methods: A quantitative –descriptive study of articles indexed in the CUIDEN data base, entering “pressure ulcers” as a search term, over the period stretching from January 1999 to December 2003. Items obtained were critically read and their level of evidence was analyzed using as a reference the texts and materials supplied in F.P. García Fernández’s and P.L. Pancorbo Hidalgo’s course on evidence based nursing. Results: The search of the terms “pressure ulcers” in the CUIDEN data base produced 242 articles. Of these, 85 were selected and subsequently classified as original papers (62), case reports (2), editorials (4), letters to the director (1), communications (4), clinical practice guidelines, CPG (12). Our analysis focused on the original papers, which represented 72.94% of the search results. Of these, 22.95% of the papers failed to present an structured summary. As for the quality of the evidence, the level of evidence was A or high in 6.55% of the papers, B or medium in 18.03% of the papers and C or low in 76.68% of the papers. The author included a statement of opinion in 13.11% of the papers. As for the conclusion/discussion, 13.11% of the articles lacked consistency with the objectives. Results were not compared with those of other studies in 40.98% of the papers and 9.83% of them did not produce results that justified the conclusions. Regarding the journals of publication, the papers appeared in Gerokomos, 35.48%; Rol, 19.35% and Metas, 6.45%. Geographically, publication was distributed in this way: Andalusia, 32.25%; Catalonia, 17.74% and Madrid, 14.51%. Overall, 85.48% of the authors were nurses and 3.22% were MDs. Secondary care accounted for 74.19% of the authorship, a total of 12.90% was primary care, 1.61% of the papers were signed by social workers and 9.67% were authored by primary and secondary care professionals jointly. Discusion: Methods used in research on PU are fundamentally rated as providing a C level of evidence, which is insufficient to strengthen or modify treatment patterns. We found that numerous reports produce conclusions that are not consistent with the objectives initially set out. No comparison with other studies is provided in a high percentage of papers. The investigators are nursing staff working in secondary care sites located in Andalusia, Catalonia and Madrid. Gerokomos continues to be a corner stone in the publication of original papers on PU. Over the last five years, research has experienced a linear progression