RESUMO
La seguridad de los pacientes se ha convertido en un componente central de la calidad asistencial. Una de las herramientas de seguridad más conocidas y extendidas en todos los ámbitos laborales son las listas de verificación (LV). Una LV es una herramienta que ayuda a no olvidar ningún paso durante la realización de un procedimiento, hacer tareas con un orden establecido, controlar el cumplimiento de una serie de requisitos o recoger datos de forma sistemática para su posterior análisis. Es una ayuda para mejorar la eficacia del trabajo en equipo, fomentar la comunicación, disminuir la variabilidad, estandarizar la atención y mejorar la seguridad de los pacientes. Se repasan las principales barreras para la implantación, como actitudes del personal, jerarquías, diseño deficiente, capacitación inadecuada, duplicación con otras listas de trabajo, sobrecarga de trabajo, barreras culturales, falta de replicación o tiempo de cierre de la LV. Finalmente se revisan sus aplicaciones en la edad pediátrica partiendo desde la más extendida, la LV de seguridad de la cirugía pediátrica, el parto y el periodo neonatal (LV de unidades de críticos neonatales, LV para el parto seguro), para procedimientos de riesgo, para cuidados intensivos pediátricos y para la patología emergente tiempo-dependiente; por ejemplo, el trauma pediátrico. Es importante remarcar el papel del liderazgo en la implantación de una LV en cualquier área de trabajo de la pediatría. Debe haber una o más personas del equipo con el apoyo de los jefes de servicio y directivos que lideren la formación del personal, dirijan la implantación de la LV, evalúen los resultados, informen al resto del equipo y puedan modificar los procesos en función de los problemas encontrados
Patient safety has become a central component of quality of care. One of the best known and most widely used security tool in all work settings is the checklist. The checklist is a tool that helps to not forget any step during the performance of a procedure, to do tasks with an established order, to control the fulfilment of a series of requirements or to collect data in a systematic way for its subsequent analysis. It is an aid to improve the efficiency of teamwork, promote communication, decrease variability, standardize care and improve patient safety. Main barriers to implementation are reviewed: staff attitudes, hierarchies, poor design, inadequate training, duplication with other work lists, work overload, cultural barriers, lack of replication or checklist closing time. Finally, its applications in Pediatrics are reviewed starting from the most widespread, the safety checklist of pediatric surgery, checklists in neonatal critical units, for safe delivery, for risk procedures, in pediatric intensive care and for pathology time-dependent emergent, e.g. pediatric trauma. It is necessary to highlight the role of leadership in the implantation of a checklist in any area of Pediatrics. There must be one or more people from the team with the support of the Heads of Service and Managers who lead the training of the personnel, direct the implementation of the LV, evaluate the results, inform the rest of the team and can modify the processes depending on the problems found
Assuntos
Humanos , Recém-Nascido , Criança , Lista de Checagem , Atenção à Saúde/normas , Segurança do Paciente/normas , Qualidade da Assistência à Saúde , Comunicação , Liderança , Pediatria/normasRESUMO
Patient safety has become a central component of quality of care. One of the best known and most widely used security tool in all work settings is the checklist. The checklist is a tool that helps to not forget any step during the performance of a procedure, to do tasks with an established order, to control the fulfilment of a series of requirements or to collect data in a systematic way for its subsequent analysis. It is an aid to improve the efficiency of teamwork, promote communication, decrease variability, standardize care and improve patient safety. Main barriers to implementation are reviewed: staff attitudes, hierarchies, poor design, inadequate training, duplication with other work lists, work overload, cultural barriers, lack of replication or checklist closing time. Finally, its applications in Pediatrics are reviewed starting from the most widespread, the safety checklist of pediatric surgery, checklists in neonatal critical units, for safe delivery, for risk procedures, in pediatric intensive care and for pathology time-dependent emergent, e.g. pediatric trauma. It is necessary to highlight the role of leadership in the implantation of a checklist in any area of Pediatrics. There must be one or more people from the team with the support of the Heads of Service and Managers who lead the training of the personnel, direct the implementation of the LV, evaluate the results, inform the rest of the team and can modify the processes depending on the problems found.
Assuntos
Lista de Checagem , Atenção à Saúde/normas , Segurança do Paciente/normas , Qualidade da Assistência à Saúde , Criança , Comunicação , Humanos , Recém-Nascido , Liderança , Pediatria/normasRESUMO
The difficulty to keep our patients' skin intact combined with few articles on this topic in pediatrics led the authors to carry out a study in their Pediatrics Intensive Care Unit "UCIP" at the Central University Hospital of Asturias, HUCA. The objective of this study consisted in determining if a decrease in the appearance of bed sores in children checked into their unit after a program whose purpose was to prevent bed sores had been applied occurred. This retrospective/prospective, comparative, observational study dealt with patients checked in their UCIP from September 2004 to September 2007; patients were broken into two groups, before and after applying a protocol and comparing the following variables: the number of patients checked in during each of the periods of this study; patients who had bed sores; average time kept in this ward for each group; pathologies patients who suffered from bed sores had when checked into this ward; the site and degree of these bed sores. Although there was an increase in the number of patients checked into this unit, the number of bed sores among children in this unit decreased 24.6% during the second period after the application of the protocol. Among the study observations noted there was a reduction in the severity of lesions patients manifested, as well as important differences as to where their lesions were located. Based on the results of the authors' study, one may conclude that the measures included in the bed sore prevention protocol, as well as the use of Mepentol hyperoxygenated fatty acids, have proven effective in their UCIP leading to a decrease in the number of patients which evidenced bed sores and the severity of these lesions was much less.
Assuntos
Unidades de Terapia Intensiva Pediátrica , Úlcera por Pressão/prevenção & controle , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Estudos RetrospectivosRESUMO
La dificultad para mantener íntegra la piel de nuestros pacientes y la poca literatura al respecto en pediatría nos llevó a realizar un estudio en nuestra Unidad de Cuidados Intensivos Pediátricos (UCIP) del Hospital Univer-sitario Central de Asturias (HUCA). El objetivo consiste en determinar si se produjo una disminución en la aparición de Úlceras por Presión (UPP) en los niños ingresados en nuestra unidad después de la aplicación de un programa destinado a la prevención de las mismas. Se trata de un estudio retrospectivo/prospectivo, comparativo, ob-servacional de los pacientes ingresados en el periodo comprendido entre el mes de septiembre de 2004 y septiembre de 2007, separándolos en dos grupos, antes y después de la implantación de un protocolo y comparando las siguientes variables: número de pacientes ingresados en cada uno de los dos periodos a estudio; pacientes que presentaron UPP; edad media de cada grupo; estancia media de cada grupo; patologías de ingreso de los pacientes en los que aparecen dichas heridas; localización y grado de las mismas. Aunque se produjo un aumento del número de pacientes ingresados, descendió en un 24,6% la incidencia de aparición en los niños en el segundo periodo tras la aplicación del protocolo. También se constató una disminución de la severidad de las lesiones presentes, así como diferencias importantes en cuanto a sus localizaciones. A tenor de los resultados de nuestra evaluación se puede concluir que las medidas incluidas en el protocolo de prevención como el uso de los ácidos grasos hiperoxigenados (Mepentol®), han sido efectivas en nuestra unidad, con una disminución en el número de pacientes que las presentaron y la gravedad de las lesiones fue mucho menor(AU)
The difficulty to keep our patients skin intact combined with few articles on this topic in pediatrics led the authors to carry out a study in their Pediatrics Intensive Care Unit «UCIP» at the Central University Hospital of Asturias, HUCA. The objective of this study consisted in determining if a decrease in the appearance of bed sores in children checked into their unit after a program whose purpose was to prevent bed sores had been applied occurred. This retrospective/prospective, comparative, observational study dealt with patients checked in their UCIP from September 2004 to September 2007; patients were broken into two groups, before and after applying a protocol and comparing the following variables: the number of patients checked in during each of the periods of this study; patients who had bed sores; average time kept in this ward for each group; pathologies patients who suffered from bed sores had when checked into this ward; the site and degree of these bed sores. Although there was an increase in the number of patients checked into this unit, the number of bed sores among children in this unit decreased 24.6% during the second period after the application of the protocol. Among the study observations noted there was a reduction in the severity of lesions patients manifested, as well as important differences as to where their lesions were located. Based on the results of the authors' study, one may conclude that the measures included in the bed sore prevention protocol, as well as the use of Mepentol® hyperoxygenated fatty acids, have proven effective in their UCIP leading to a decrease in the number of patients which evidenced bed sores and the severity of these lesions was much less(AU)
