Percepciones de las enfermeras sobre la seguridad de medicamentos en los sistemas de salud / Percepções de enfermeiros sobre segurança de medicamentos nos sistemas de saúde / Nurses' perceptions of drug safety in health systems

Objective: To know the nurses' perception of the factors that influence the safe administration ofmedications in the work context of the General University Hospital of Elda (Alicante), Spain. Method:This is a qualitative phenomenological study through interviewssemi-structured in which 15 nurses chosen by deliberate sampling participated. Results: The participantsexpressed concern about the performance of the medication administration procedures, which made itpossible to perceive safety as the greatest concern in the study unit. A main category called “knowing”was established, which encompasses all the reflections about the nurse's performance during themedication administration process. The following subcategories are developed from this main category:work overload, insufficient training, distractions, and communication and information failures.Conclusion: Knowing the nurses' perception of the factors that influence the safe administration ofmedications could facilitate the use of instruments to standardize and reduce variability in the safeadministration of medications. As well as improving conditions in work environments and not favoringsocial, personal and professional stigmatization due to care error. (AU)

Objetivo: Conocer la percepción de las enfermeras sobre los factores que influyen en laadministración segura de medicamentos en el contexto laboral del Hospital General Universitario de Elda(Alicante), España. Método: Se trata de un estudio cualitativo fenomenológico mediante entrevistas semiestructuradas en donde participaron 15 enfermeras elegidas por muestreo intencionado. Resultados: Lasparticipantes manifestaron preocupación ante la realización de los procedimientos de administración demedicamentos, lo que permitió percibir la seguridad como la mayor preocupación en la unidad deestudio. Se estableció una principal categoría denominada “conocer” que engloba todas las reflexionesacerca de la actuación de la enfermera durante el proceso administración de medicamentos. A partir deesta categoría principal se desarrollan las siguientes subcategorías: sobrecarga de trabajo, formacióninsuficiente, distracciones y fallos de comunicación e información. Conclusión: Conocer la percepción delas enfermeras sobre los factores que influyen en la administración segura de medicamentos nos podríafacilitar el uso de instrumentos para estandarizar y disminuir la variabilidad en la administración segurade medicamentos. Así como mejorar las condiciones en los entornos laborales y no favorecer laestigmatización social, personal y profesional por el error asistencial. (AU)

Objetivo: Conhecer a percepção dos enfermeiros sobre os fatores que influenciam aadministração segura de medicamentos no contexto de trabalho do Hospital Geral Universitário de Elda(Alicante), Espanha. Método: trata-se de um estudo qualitativo fenomenológico por meio de entrevistas.semiestruturado no qual participaram 15 enfermeiras escolhidas por amostragem deliberada. Resultados:Os participantes expressaram preocupação com a realização dos procedimentos de administração demedicamentos, o que possibilitou perceber a segurança como a maior preocupação na unidade de estudo.Foi estabelecida uma categoria principal denominada “saber”, que engloba todas as reflexões sobre aatuação do enfermeiro durante o processo de administração de medicamentos. As seguintes subcategoriassão desenvolvidas a partir desta categoria principal: sobrecarga de trabalho, treinamento insuficiente,distrações e falhas de comunicação e informação. Conclusão: Conhecer a percepção dos enfermeirossobre os fatores que influenciam na administração segura de medicamentos pode facilitar a utilização deinstrumentos para padronizar e reduzir a variabilidade na administração segura de medicamentos. Alémde melhorar as condições nos ambientes de trabalho e não favorecer a estigmatização social, pessoal eprofissional por erro assistencial. (AU)

Risk Analysis for Patient Safety in Surgical Departments: Cross-Sectional Design Usefulness.

(1) Background: Identifying and measuring adverse events (AE) is a priority for patient safety, which allows us to define and prioritise areas for improvement and evaluate and develop solutions to improve health care quality. The aim of this work was to determine the prevalence of AEs in surgical and medical-surgical departments and to know the health impact of these AEs. (2) Methods: A cross-sectional study determining the prevalence of AEs in surgical and medical-surgical departments was conducted and a comparison was made among both clinical areas. A total of 5228 patients were admitted in 58 hospitals in Argentina, Colombia, Costa Rica, Mexico, and Peru, within the Latin American Study of Adverse Events (IBEAS), led by the Spanish Ministry of Health, the Pan American Health Organization, and the WHO Patient Safety programme. (3) Results: The global prevalence of AEs was 10.7%. However, the prevalence of AEs in surgical departments was 11.9%, while in medical-surgical departments it was 8.9%. The causes of these AEs were associated with surgical procedures (38.6%) and nosocomial infections (35.4%). About 60.6% of the AEs extended hospital stays by 30.7 days on average and 25.8% led to readmission with an average hospitalisation of 15 days. About 22.4% resulted in death, disability, or surgical reintervention. (4) Conclusions: Surgical departments were associated with a higher risk of experiencing AEs.

Eventos adversos relacionados con la medicación en los hospitales de la Comunidad Valenciana. Estudio EPIDEA 2005-2013 / Adverse events related to medication in hospitals from the Valencian Community. EPIDEA Study 2005-2013

Introducción. Determinar la prevalencia de eventos adversos relacionados con la medicación (EAM) en los hospitales de la Comunidad Valenciana en el periodo de estudio 2005-2013. Conocer los factores de riesgo asociados, su análisis e impacto. Material y métodos. El trabajo está basado en los datos y metodología del Estudio de Prevalencia de Eventos Adversos en los hospitales de la Comunidad Valenciana (EPIDEA), desde 2005 hasta 2013. Se analizaron los EAM producidos en cada año. Resultados. Se identificaron 344 EAM que ocurrieron a 337 pacientes, entre 35.103 pacientes estudiados, lo cual constituye una prevalencia de EAM de 0,96% (IC95% 0,89-1,07). Los factores de riesgo intrínseco para EAM más prevalentes fueron hipertensión, diabetes y neoplasia. Los factores de riesgo extrínseco más prevalentes fueron catéter venoso periférico, sonda urinaria cerrada y catéter venoso central. Los grupos terapéuticos más implicados fueron antibióticos sistémicos, fármacos cardiovasculares, y antineoplásicos. El 61,17% de los EAM fue clasificado como moderado, un 27,18% como leve y un 11,65 % como grave. El 33,99% de los EAM prolongaron la estancia del paciente y un 39,90% fueron causa de reingreso del paciente. Globalmente, el 58,5% de los EAM fueron evitables. Según gravedad, fueron evitables el 46.3% de los EAM leves, el 60.3% de los EAM moderados, y el 75% de los EAM graves (p=0.013). Conclusiones. La prevalencia de pacientes con EAM en la Comunidad Valenciana durante el periodo 2005-2013 fue de 0,96%. Más de la mitad de EAM fueron evitables, observándose una relación directa significativa entre la evitabilidad de los EAM con la gravedad de los mismos (AU)

Introduction. To determine the prevalence of Adverse Events related to Medication (AEM) in hospitals of the Valencian Community in the 2005-2013 study period, and to describe the associated risk factors and their impact. Material and methods. This study is based on data and methodology of the Study of Prevalence of Adverse Events in hospitals (EPIDEA), since its inception in 2005 until 2013. AEM produced in each year were analyzed. Results. We identified 344 AEM that occurred in 337 patients, among 35,103 patients studied, giving a prevalence of patients with AEM of 0.96% (IC95% 0.89-1.07). The most prevalent intrinsic risk factors for AEM were hypertension, diabetes and cancer. The most prevalent extrinsic risk factors were peripheral venous catheter, urinary catheter and central venous catheter. Therapeutic groups most frequently involved were systemic antibiotics, cardiovascular drugs and antineoplastics. The 61.17% of AEM was classified as moderate, followed by 27.18% as mild and 11.65% as severe. The 33.99% of EAM caused increase of the patient’s stay and 39.90% of EAM caused the re-entry of patient. The 58.5% of AEM were avoidable. Mild AEM were avoidable in 46.3%, moderate AEM were avoidable in 60.3% and severe AEM were in 75% (p = 0.013). Conclusions. The prevalence of patients with AEM in hospitals of the Community of Valencia for the period 2005- 2013 was 0.96%. More than half of AEM were preventable, and preventability increases significantly with the severity of the event (AU)

Factores asociados a la adherencia en el tratamiento de la infección tuberculosa / Factors associated with treatment adherence for tuberculosis infection

OBJETIVO: Analizar la adherencia al tratamiento de la infección tuberculosa (TIT) e identificar los factores de riesgo para su cumplimiento. DISEÑO: Estudio observacional de cohortes históricas. Emplazamiento: Hospital Universitari Sant Joan d'Alacant (Alicante). Participantes: Todos los sujetos con una prueba de tuberculina (PT) realizada durante el estudio de contactos (EC) de tuberculosis durante 6 años. RESULTADOS: Se incluyeron en el análisis 764 contactos. El 59,7% de los 566 pacientes que terminaron el EC presentaron infección tuberculosa (IT). De los pacientes con IT, el 45,6% no iniciaron tratamiento y los factores asociados fueron: edad (36-65 años; RR: 5,8; IC 95%: 1,2-27,5 y > 65 años; RR: 11,3; IC 95%: 2,0-64,0), relación social con el caso índice de tuberculosis (RR: 2,2; IC 95%: 1,2-3,8) e induración de la PT (≥ 15 mm; RR: 0,5; IC 95%: 0,3-0,9). La tasa de cumplimiento fue del 80,4% entre los que comenzaron el TIT. La pauta de tratamiento 7-9H se asoció con mayor cumplimiento del TIT (RR: 12,7; IC 95%: 1,5-107,3). CONCLUSIONES: La tasa de cumplimiento del TIT fue elevada entre los que iniciaron tratamiento. Casi la mitad de los contactos con IT no iniciaron tratamiento y los factores asociados fueron: edad, relación social e induración de la PT. La pauta de tratamiento se asoció con mayor cumplimiento. Debemos conocer con precisión los factores asociados a la adherencia al tratamiento de la IT en cada área de salud y actuar sobre los grupos de riesgo, y de esta manera aproximar el control global de la tuberculosis

OBJECTIVE: To analyze adherence to treatment of tuberculosis infection and to identify risk factors for its compliance. DESIGN: An observational historical cohort study. Setting: Hospital Universitari Sant Joan d'Alacant (Alicante). Participants: All patients with a tuberculin skin test (TST) done during tuberculosis contact tracing during 6 years. RESULTS: We included 764 tuberculosis contacts in the analysis. 59.7% of the 566 patients who completed the contact tracing, had tuberculosis infection (TI). Of the patients with TI, 45.6%had not started treatment for tuberculosis infection (TTBI). Factors associated with not starting TTBI were: age (36-65 years, RR: 5.8; 95% CI: 1.2-27.5, and > 65 years, RR: 11.3; 95% CI: 2.0-64.0), the social relationship with TB case (RR: 2.2; 95% CI 1.2-3.8), and the TST reaction (≥15 mm; RR: 0.5; 95% CI: 0.3-0.9). The completion rate for TTBI was 80.4% among people who started therapy. The treatment regimen was associated with greater compliance to TTBT (7-9H, RR: 12.7; 95% CI: 1.5-107.3). CONCLUSIONS: The treatment compliance rate of Tuberculosis infection was high among people who started therapy. Almost a half of the contacts with TI did not start treatment, and associated factors were: age, social relationship, and the TST reaction. The treatment regimen was associated with greater compliance. It is important to know the factors associated with adherence to treatment of TI in each health area, and focus efforts on risk groups; thereby approaching the global control of tuberculosis

[Factors associated with treatment adherence for tuberculosis infection]. / Factores asociados a la adherencia en el tratamiento de la infección tuberculosa.

OBJECTIVE: To analyze adherence to treatment of tuberculosis infection and to identify risk factors for its compliance. DESIGN: An observational historical cohort study. SETTING: Hospital Universitari Sant Joan d'Alacant (Alicante). PARTICIPANTS: All patients with a tuberculin skin test (TST) done during tuberculosis contact tracing during 6 years. RESULTS: We included 764 tuberculosis contacts in the analysis. 59.7% of the 566 patients who completed the contact tracing, had tuberculosis infection (TI). Of the patients with TI, 45.6% had not started treatment for tuberculosis infection (TTBI). Factors associated with not starting TTBI were: age (36-65 years, RR: 5.8; 95% CI: 1.2-27.5, and > 65 years, RR: 11.3; 95% CI: 2.0-64.0), the social relationship with TB case (RR: 2.2; 95% CI 1.2-3.8), and the TST reaction (≥ 15mm; RR: 0.5; 95% CI: 0.3-0.9). The completion rate for TTBI was 80.4% among people who started therapy. The treatment regimen was associated with greater compliance to TTBT (7-9H, RR: 12.7; 95% CI: 1.5-107.3). CONCLUSIONS: The treatment compliance rate of Tuberculosis infection was high among people who started therapy. Almost a half of the contacts with TI did not start treatment, and associated factors were: age, social relationship, and the TST reaction. The treatment regimen was associated with greater compliance. It is important to know the factors associated with adherence to treatment of TI in each health area, and focus efforts on risk groups; thereby approaching the global control of tuberculosis.

[Lights and shadows in patient safety: study and development of strategies. 2008 SESPAS Report]. / Luces y sombras en la seguridad de los pacientes: estudio y desarrollo de estrategias. Informe SESPAS 2008.

Study of the frequency of healthcare-related adverse events (AE) and of their effect on patients and impact on healthcare systems has markedly increased in recent years. Indepth individual analysis of the factors contributing to these events has allowed strategies to prevent or minimize the impact of AE to be developed. However, an epidemiologic perspective is needed to explore possible associations and generalize the recommendations that can be drawn from this type of analysis. Some aspects that should been considered while developing future strategies are discussed. These aspects include the importance of patient age and comorbidities on producing AE and the use of highly technological medicine, which is sometimes unnecessary. A culture of trust and confidentiality and a spirit of collaboration among organizations are indispensable to share and learn about the initiatives prompted by the study of AE and thereby improve patient safety in the national health service.

Luces y sombras en la seguridad de los pacientes: estudio y desarrollo de estrategias. Informe SESPAS 2008 / Lights and shadows in patient safety: study and development of strategies. 2008 SESPAS Report

El estudio sobre la frecuencia de los efectos adversos (EA) ligadosa la asistencia, su efecto en los pacientes y el impactoen los sistemas de salud ha experimentado un intenso impulsoen los últimos años. El análisis individual profundo de susfactores contribuyentes ha permitido el desarrollo de múltiplesestrategias para prevenirlos o minimizar su impacto, pero es necesariauna perspectiva epidemiológica para explorar estas posiblesasociaciones y generalizar las recomendaciones que sederiven de este análisis.Se comentan algunos de los aspectos que se deberían teneren cuenta para el desarrollo de estrategias futuras, como la importanciade la edad o las comorbilidades del paciente en la génesisde los EA y el alto grado de la instrumentalización de laasistencia (a veces innecesaria). Son imprescindibles una culturade confianza y confidencialidad y un espíritu de colaboraciónentre las organizaciones para poder compartir y aprenderde las iniciativas derivadas del estudio de los EA, y así mejorarla seguridad de los pacientes en el Sistema Nacional de Salud(AU)

Study of the frequency of healthcare-related adverseevents (AE) and of their effect on patients and impact on healthcaresystems has markedly increased in recent years. Indepthindividual analysis of the factors contributing to theseevents has allowed strategies to prevent or minimize the impactof AE to be developed. However, an epidemiologic perspectiveis needed to explore possible associations and generalizethe recommendations that can be drawn from thistype of analysis.Some aspects that should been considered while developingfuture strategies are discussed. These aspects include the importanceof patient age and comorbidities on producing AEand the use of highly technological medicine, which is sometimesunnecessary. A culture of trust and confidentiality anda spirit of collaboration among organizations are indispensableto share and learn about the initiatives prompted by thestudy of AE and thereby improve patient safety in the nationalhealth service(AU)

[Adverse events in general and digestive surgery departments in Spanish hospitals]. / Sucesos adversos en cirugía general y de aparato digestivo en los hospitales españoles.

OBJECTIVE: To determine the incidence of patients with adverse events (AE) in Spanish general surgery units, describe the immediate causes of AE, identify avoidable AE, and determine the impact of these events. MATERIAL AND METHOD: We performed a retrospective cohort study of a randomized stratified sample of 24 hospitals. Six of the hospitals were small (fewer than 200 beds), 13 were medium-sized (between 200 and 499 beds) and five were large (500 or more beds). Patients admitted for more than 24 hours to the selected hospitals and who were discharged between the 4th and 10th of June 2005 were included. AE detected during hospitalization and those occurring as a consequence of previous admissions in the same hospital were analyzed. RESULTS: The incidence of patients with AE associated with medical care was 10.5% (76/735; 95%CI: 8.1%-12.5%). The presence of intrinsic risk factors increased the risk of AE (14.8% vs 7.2%; P=.001). Likewise, 16.2% of patients with an extrinsic risk factor had an AE compared with 7.0% of those without these risk factors (P< .001). Comorbidity influenced the occurrence of AE (33.7% of AE vs. 2.2% without comorbidity; P< .001). The severity of the AE was related to ASA risk (P=.036). AE were related to nosocomial infection (41.7%), procedures (27.1%) and medication (24%). A total of 31.3% of the AE were mild, 39.6% were moderate, and 29.2% were severe. Preventable AE accounted for 36.5%. AE caused an additional 527 days of stay (6.3 additional days of stay per patient), of which 216 were due to preventable AE. CONCLUSIONS: Patients in general and digestive surgery units have an increased risk of AE. Risk factors for these events are age, comorbidity, and the use of external devices. A substantial number of AE are related to nosocomial infection (especially surgical wound infection) and to surgical procedures. AE have an important impact on patients and a considerable proportion of these events are preventable. AE have strong health, social and economic repercussions and until recently have constituted a silent epidemic in Spain. Consequently, study of these events should be a public health priority.

Sucesos adversos en cirugía general y de aparato digestivo en los hospitales españoles / Adverse events in general and digestive surgery departments in Spanish hospitals

Objetivo. Determinar la incidencia de pacientes con efectos adversos (EA) en los servicios de cirugía general, describir las causas inmediatas del EA, definir los evitables y conocer su impacto. Material y método. Estudio retrospectivo de cohortes. Muestra aleatoria estratificada de 24 hospitales, 6 de tamaño pequeño (de menos de 200 camas), 13 de tamaño mediano (de 200 a 499 camas) y 5 de tamaño grande (500 camas o más). Pacientes ingresados, cuya hospitalización fuera superior a 24 h, que fueron dados de alta del 4 al 10 de junio de 2005. Se incluyeron los EA detectados durante la hospitalización y los que fueron consecuencia de episodios de hospitalización previa en el mismo hospital. Resultados. La incidencia de pacientes con EA fue del 10,5% (76/735), con un intervalo de confianza (IC) del 95%, 8,1%-12,5%. La presencia de factores de riesgo intrínsecos aumenta el riesgo de EA (el 14,8 frente al 7,2%; p = 0,001), y también lo hace la presencia de factores de riesgo extrínseco (el 16,2 frente al 7,0%; p < 0,001). La comorbilidad influyó en la aparición de EA (el 33,7 de EA frente al 2,2% sin comorbilidad; p < 0,001). La gravedad del EA se relacionó con el riesgo ASA (p = 0,036). El 41,7% de los EA se relacionó con la infección nosocomial; el 27,1%, con procedimientos, y el 24%, con la medicación. El 31,3% de los EA se consideraron leves; el 39,6%, moderados, y el 29,2%, graves. Un 36,5% se valoraron como evitables. El total de estancias adicionales provocadas por EA fueron de 527 (6,3 estancias adicionales por paciente), de las cuales 216 correspondieron a EA evitables. Conclusiones. Los pacientes de cirugía general y aparato digestivo tienen más riesgo de EA. Existen factores de vulnerabilidad, como son la edad, la comorbilidad y la aplicación de dispositivos externos. Una parte importante de los EA se relacionan con la infección nosocomial (especialmente infección de la herida quirúrgica) y también con el propio procedimiento. Finalmente, los EA tienen un impacto notable en el paciente y en una proporción considerable de casos pueden evitarse. El impacto sanitario, social y económico de los EA, hasta hace poco una epidemia silenciosa en nuestro país, convierte la necesidad de su estudio en una prioridad de salud pública (AU)

Objective. To determine the incidence of patients with adverse events (AE) in Spanish general surgery units, describe the immediate causes of AE, identify avoidable AE, and determine the impact of these events. Material and method. We performed a retrospective cohort study of a randomized stratified sample of 24 hospitals. Six of the hospitals were small (fewer than 200 beds), 13 were medium-sized (between 200 and 499 beds) and five were large (500 or more beds). Patients admitted for more than 24 hours to the selected hospitals and who were discharged between the 4th and 10th of June 2005 were included. AE detected during hospitalization and those occurring as a consequence of previous admissions in the same hospital were analyzed. Results. The incidence of patients with AE associated with medical care was 10.5% (76/735; 95%CI: 8.1%-12.5%). The presence of intrinsic risk factors increased the risk of AE (14.8% vs 7.2%; P=.001). Likewise, 16.2% of patients with an extrinsic risk factor had an AE compared with 7.0% of those without these risk factors (P<.001). Comorbidity influenced the occurrence of AE (33.7% of AE vs. 2.2% without comorbidity; P<.001). The severity of the AE was related to ASA risk (P=.036). AE were related to nosocomial infection (41.7%), procedures (27.1%) and medication (24%). A total of 31.3% of the AE were mild, 39.6% were moderate, and 29.2% were severe. Preventable AE accounted for 36.5%. AE caused an additional 527 days of stay (6.3 additional days of stay per patient), of which 216 were due to preventable AE. Conclusions. Patients in general and digestive surgery units have an increased risk of AE. Risk factors for these events are age, comorbidity, and the use of external devices. A substantial number of AE are related to nosocomial infection (especially surgical wound infection) and to surgical procedures. AE have an important impact on patients and a considerable proportion of these events are preventable. AE have strong health, social and economic repercussions and until recently have constituted a silent epidemic in Spain. Consequently, study of these events should be a public health priority (AU)