Mejora continua de la seguridad en el ámbito de un Servicio de Anestesiología y Cuidados Intensivos a través de la certificación según la norma de UNE 179003:2013: 8 años de experiencia / Continuous improvement of safety in the Intensive Care and Surgical environment according to UNE 179003:2013 standard: 8 years experience

Introducción: La norma UNE 179003:2013 exige el cumplimiento de normas que permiten reducir los riesgos de los pacientes frente a eventos adversos. Métodos: Presentamos el procedimiento elaborado para la certificación en la norma UNE 179003:2010 del Bloque Quirúrgico, Unidad de Cuidados Intensivos de Anestesia y Unidad de Recuperación Postanestésica (URPA) en base a un sistema de gestión de riesgos basado en el análisis proactivo mediante la realización de AMFE con la descripción de causas, consecuencias, ponderación del riesgo y medidas específicas que minimicen los riesgos. Además, presentamos el análisis de los eventos adversos declarados (análisis reactivo) en el sistema de notificación SENSAR y las medidas implementadas durante 8 años. Resultados: Se ha obtenido la certificación UNE 179003:2010 en julio del 2012 y la recertificación en julio del 2015. Se han establecido 66 riesgos potenciales que se han ponderado a través de un índice de probabilidad del riesgo (IPR) y se han implementado medidas que han permitido reducir dicho IPR a la mitad. También se refleja el análisis de 1.114 eventos declarados en el sistema SENSAR durante los últimos 8 años que ha permitido la implantación de 2.681 medidas, de las cuales el 98,4% están completamente implantadas. Conclusión: La aplicación de la metodología para la gestión del riesgo nos ha permitido en primer lugar mejorar la seguridad en nuestro ámbito de actuación reduciendo el riesgo al que están sometidos nuestros pacientes y, en segundo lugar, la certificación en la norma UNE 179003

Introduction: The UNE 179003:2013 standard requires compliance with protocols to reduce the risks of patients from adverse events. Methods: A description is presented of the procedure used in the Hospital Povisa to achieve UNE 179003:2010 certification for the intensive care unit, surgical division, and post-anaesthesia recovery unit (PARU). This was based on a risk management system, focusing on pro-active analysis using failure modes and effects analysis (FMEA) with the description of causes, consequences, risk weighting, and specific risk-minimising measures. A description is also presented of the analysis of reported adverse events (reactive analysis) in the Safety in Anesthesia and Resuscitation (SENSAR) notification system and the measures implemented over an eight-year period. Results: The UNE 179003:2010 certification was obtained in July 2012, and the re-certification was achieved in July 2015. A total of 66 potential risks were established, which were weighted using a risk probability index (RPI), and measures were implemented that reduced this RPI by half. It also reflects the analysis of 1114 events declared in the SENSAR system over the past eight years, allowing for the introduction of 2681 measures, of which 98.4% are fully implemented. Conclusion: The application of the risk management methodology allowed (a) to improve safety in the area of action by reducing the risk to which the patients are subject, and (b) to gain certification in the UNE 179003 standard

Continuous improvement of safety in the Intensive Care and Surgical environment according to UNE 179003:2013 standard: 8 years experience. / Mejora continua de la seguridad en el ámbito de un Servicio de Anestesiología y Cuidados Intensivos a través de la certificación según la norma de UNE 179003:2013: 8 años de experiencia.

INTRODUCTION: The UNE 179003:2013 standard requires compliance with protocols to reduce the risks of patients from adverse events. METHODS: A description is presented of the procedure used in the Hospital Povisa to achieve UNE 179003:2010 certification for the intensive care unit, surgical division, and post-anaesthesia recovery unit (PARU). This was based on a risk management system, focusing on pro-active analysis using failure modes and effects analysis (FMEA) with the description of causes, consequences, risk weighting, and specific risk-minimising measures. A description is also presented of the analysis of reported adverse events (reactive analysis) in the Safety in Anesthesia and Resuscitation (SENSAR) notification system and the measures implemented over an eight-year period. RESULTS: The UNE 179003:2010 certification was obtained in July 2012, and the re-certification was achieved in July 2015. A total of 66 potential risks were established, which were weighted using a risk probability index (RPI), and measures were implemented that reduced this RPI by half. It also reflects the analysis of 1114 events declared in the SENSAR system over the past eight years, allowing for the introduction of 2681 measures, of which 98.4% are fully implemented. CONCLUSION: The application of the risk management methodology allowed (a) to improve safety in the area of action by reducing the risk to which the patients are subject, and (b) to gain certification in the UNE 179003 standard.

[Current status of arterial hypertension as a cardiology topic: point of view of the cardiologist. Task force on Arterial Hypertension of the Spanish Cardiology Society]. / Estado actual de la hipertensión arterial como materia de la cardiología: punto de vista del cardiólogo. Grupo de Trabajo de HTA de la SEC.

Even if arterial hypertension (HT) is a process of multiorganic involvement, it is nevertheless in practice, one of the most powerful factors for the development of cardiovascular complications that increases very seriously, both cardiovascular morbidity and mortality. Paradoxically, in Spain, a significant proportion of cardiologists have neglected for many years this disease, at least, at its initial phase, acting mainly, only when the usual and severe cardiovascular complications of HT were clinically well established. Currently, this attitude is changing in such a way, that in the near future, the cardiologist's commitment to HT, will be definitely engaged in both; basic research and clinical aspects. The Spanish Hypertension Working Group, has worked out in an inquiry sent to all Spanish cardiologists, in order to know their point of view in relation to the main aspects involving HT and cardiological practice. This paper collects the results of the answers given anonymously by the doctors.

[Rehabilitation in ischemic cardiopathy. Results at the level of quality of life and prognosis]. / Rehabilitación en la cardiopatía isquémica. Resultados a nivel de calidad de vida y sobre el pronóstico.

Cardiac rehabilitation programs, by means of physical, psychosocial and risk control factors, intend to improve the life style and prognosis of coronary patients. In this study, we analyzed the results obtained from 349 patients, 310 with acute myocardial infarction and 39 after coronary artery surgery. The average follow up period was 36 months and the average age was 53.9 years. The results showed that 84.3% stopped smoking, 60% returned to work after a heart attack and 51.36% after coronary artery bypass. Functional capacity improved significantly with p < 0.001. Although 50% of the patients considered themselves sexually incapacitated, the number of coitus per month is similar to that of healthy people of the same age. There were 12 new infarctions (1.28 por 100 patients per year), and 11 cardiac-related deaths (1.18 per 100 patients per year). All the deaths occurred in the group of patients with myocardial infarction, and with a significant increase in the elevation of the ST in the necrosis area, during an exercise testing, indicating extensive areas of dyskinesis. Based on these results, we have reached the conclusion that steps must be taken to reduce the high percentage of patients who leave the program. In our study this was significantly low at 21.5%.

[Isolated mitral valve substitution with Beall prosthesis. Long term results]. / Sustitución valvular mitral aislada con la prótesis de Beall. Resultados a largo plazo.

During a three-year period (1970 to 1973) the Beall mitral prosthesis (103, 104 & 105 series) was used in 97 patients for isolated mitral valve replacement. The early surgical mortality rate within the first 30 days of operation was 11.34%. Among the 86 survivors, 7 developed thromboembolic complications (8.14 per cent), and there were 20 late deaths. Incidence of other complications such as prosthetic malfunction and significant intravascular hemolysis are commented. The 92.42 per cent of the late survivors are in Class I or II of the N.Y.H.A. functional classification.