Implementación de un programa de mejoramiento de la seguridad de los pacientes: resultados preliminares / Implementation of a program of improvement of the security of the patients: preliminary results

Tradicionalmente, el error ha servido para aprender lo que no había que hacer y lo que no era verdad. Luego se sumó la reacción de castigar al responsable del error suponiendo que éste era producto de la incapacidad o irresponsabilidad individual. La búsqueda, explícita o no, del "culpable" ha promovido mayor temor en los profesionales de la salud y generado una creciente tendencia a ocultar los errores. Desde 2001, la Academia Nacional de Medicina, a través de su Centro de Investigaciones Epidemiológicas, desarrolló e implementó un programa para el mejoramiento de la seguridad en la atención de los pacientes, en cuatro instituciones sanitarias de nuestro país de diferentes características. El propósito del programa es: "diseñar, validar y evaluar metodologías que permitieran identificar errores, casi errores y eventos adversos; analizar el mecanismo de su producción y contribuir a señalar los procesos correctivos". El mismo está organizado en cuatro componentes: a) cultura organizacional para la seguridad del paciente; b) sistemas de información para la vigilancia del error durante el proceso de atención, c) mejoramiento continuo de la seguridad del paciente y d) gestión de conocimiento.

Components of effective youth violence prevention programs for 7- to 14-year-olds.

OBJECTIVE: To classify features of effective violence prevention programs for 7- to 14-year-olds according to children's risk groups and targeted behaviors. DATA SOURCES: Articles published between 1980 and 1999 were identified via electronic databases (MEDLINE, ERIC, PsychINFO) using the key words violence, violence prevention, youth violence, or aggressive behavior. Reference lists were hand-searched for additional publications. STUDY SELECTION: One hundred fifty-three articles were reviewed with a modified scale by one of the principal investigators/authors (W.O.C. or M.L.) and a research assistant (K.F.); the other principal investigator resolved any discrepancies. Articles were included if they reported prevention efforts in 7- to 14-year-olds and compared outcome measures, met requirements for scientific rigor, and reported significant improvements (effect size, >0.1 or P< or =.05). Sixty-seven percent (n = 102) did not meet the inclusion criteria. Of the remaining 51 articles (33%), 38 met requirements for scientific rigor, and 32 articles describing 25 programs reported significant improvements in at least 1 area. RESULTS: Twenty-five programs indicated significant improvements in attitudes, knowledge, or intentions (n = 10) and/or reduction in delinquency rates and violent and/or aggressive behavior (n = 11); significant changes in both types of outcomes were indicated in 4 programs. Most programs (n = 13) targeted older children (aged 11-14 years) and focused on fighting (n = 13) and conflict management (n = 14). Classroom teaching was the most common process (n = 18) used. Few programs (n = 7) involved family intervention. CONCLUSIONS: Although limited in number, effective youth violence prevention programs were identified from current literature. Study findings were compiled into a database outlining effective processes for specific sociodemographic and risk behavior groups that will be helpful to future program planning.