[Perception of clinical practice derived risks compared to adverse effects detected in an internal medicine service]. / Percepción de riesgos derivados de la práctica clínica frente a los efectos adversos detectados en un servicio de medicina interna.

BACKGROUND AND OBJECTIVE: To know how the health care workers perceive the risks derived from the care practice. To estimate the most frequent adverse effects (AE) and establish differences and similarities between the perception of risks and the AE produced. MATERIAL AND METHOD: A self-administered questionnaire was applied to all the workers of an Internal Medicine Department of a General University Hospital on perception of risks and safety of the patient. After, and by using the screening guide of the IDEA project, edition 1, the clinical histories of the patients selected were analyzed by medical residents of preventive Medicine and Internal Medicine. RESULTS: Questionnaire. Fifty questionnaires we sent with a 42% response rate. Risks prioritized by obtaining a lower mean score: there is not action plan against catastrophes (2.79/10) and lack of spaces to report (3/10); those having greater percentage of open questions: long maintenance of urinary probes (47.61%) and inadequate prescription of antibiotics (33.33%). Study of AE. Incidence of patients with AE: 25% (95% CI 11.06-38.9). Incidence of AE: 26.6% (95% CI 12.6-40.6). 41.6% of AE was related to medication, 25% to nosocomial infection, 16.66% to technical problems in procedures and 16.66% were related to nursing cares. CONCLUSIONS: The perception of the health care workers on health care practice derived risks is different from the adverse events that really appear. The professionals are concerned about the information to patients than about scientific and technical quality. The most frequent adverse events produced are those related with medication. The only common point is concern for nosocomial infection.

Percepción de riesgos derivados de la práctica clínica frente a los efectos adversos detectados en un servicio de medicina interna / Perception of clinical practice derived risks compared to adverse effects detected in an internal medicine service

Fundamento y objetivos. Conocer la percepción que los profesionales sanitarios tienen sobre los riesgos derivados de la práctica asistencial, estimar los efectos adversos (EA) más frecuentes, y establecer las diferencias y similitudes entre la percepción de riesgos y los EA producidos. Material y método. Se realizó una encuesta autoadministrada sobre percepción de riesgos y seguridad del paciente a todo el personal de un servicio de medicina interna de un hospital general universitario. Posteriormente, y a través de la guía de cribado del proyecto IDEA 1ª edición, se analizaron las historias clínicas de los pacientes seleccionados por médicos residentes de medicina preventiva y de medicina interna. Resultados. Encuesta. Se enviaron 50 cuestionarios y se obtuvo una tasa de respuesta del 42%. Los riesgos priorizados por obtener una puntuación media más baja fueron la no existencia de plan de actuación frente a catástrofes (2,79 sobre 10) y la falta de espacios para informar (3 sobre 10.); y por mayor porcentaje en las preguntas abiertas, el mantenimiento prolongado de sondajes urinarios, con un 47.61% y la prescripción inadecuada de antibióticos (33,33%). Estudio sobre efectos adversos. Incidencia acumulada (IA) de pacientes con EA: 25% (intervalo de confianza [IC] 95% 11,06-38,9); IA de EA: 26,6% (IC 95% 12,6-40,6). El 41,6% de los EA estuvieron relacionados con la medicación, un 25% con la infección nosocomial, y con problemas técnicos de procedimientos y con fallos en los cuidados del paciente un 16,66% cada uno. Conclusiones. La percepción de los profesionales sanitarios sobre los riesgos derivados de la práctica asistencial es diferente a los sucesos adversos que realmente se terminan materializando. Los profesionales están más preocupados por la información a los pacientes y por la calidad científico-técnica. Los sucesos adversos más frecuentes que se producen son los relacionados con la medicación. El único punto común es la preocupación por la infección nosocomial (AU)

Background and objective. To know how the health care workers perceive the risks derived from the care practice. To estimate the most frequent adverse effects (AE) and establish differences and similarities between the perception of risks and the AE produced. Material and method. A self-administered questionnaire was applied to all the workers of an Internal Medicine Department of a General University Hospital on perception of risks and safety of the patient. After, and by using the screening guide of the IDEA project, edition 1, the clinical histories of the patients selected were analyzed by medical residents of preventive Medicine and Internal Medicine. Results. Questionnaire. Fifty questionnaires we sent with a 42% response rate. Risks prioritized by obtaining a lower mean score: there is not action plan against catastrophes (2.79/10) and lack of spaces to report (3/10); those having greater percentage of open questions: long maintenance of urinary probes (47.61%) and inadequate prescription of antibiotics (33.33%). Study of AE. Incidence of patients with AE: 25% (95% CI 11.06-38.9). Incidence of AE: 26.6% (95% CI 12.6-40.6). 41.6% of AE was related to medication, 25% to nosocomial infection, 16.66% to technical problems in procedures and 16.66% were related to nursing cares. Conclusions. The perception of the health care workers on health care practice derived risks is different from the adverse events that really appear. The professionals are concerned about the information to patients than about scientific and technical quality. The most frequent adverse events produced are those related with medication. The only common point is concern for nosocomial infection (AU)

Seguridad del paciente y gestión de riesgos. Réplica / No disponible

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[Patient safety and quality of care]. / Seguridad del paciente y calidad asistencial.

Adverse effects related to health care are common and partly avoidable. We need to identify how and why adverse events occur and how system defects may contribute to their occurrence. Systems and processes can be designed to help prevent errors and decrease harm that occurs when they are not intercepted. Tactics to reduce errors and mitigate their adverse effects include reducing complexity and optimizing information processing. Implementation of information technology may offer great promise but the most important is to make an effort to promote a culture of safety.

[Patient safety]. / Seguridad del paciente.

Ensuring patient safety is essential for better heath care. Safety have gripped public attention ever since the release of the report "To Err is Human". To find strategies of promotion of patient safety has stimulated models that improve knowledge of adverse events. Adverse drug events are the most common cause of injury to hospitalized patients and are often preventable. Many tactics are available to make system changes to reduce errors and adverse events; they fall into five categories: Reduce complexity, optimise information processing, automate wisely, use constraints, and mitigate the unwanted side effects of change. These tactics can be deployed to support any of the three strategic components of error prevention, detection, and mitigation. Although progress has been slow, the pace of change is likely to accelerate, particularly in implementation of electronic health records and diffusion of safe practices.

Clinical pathway for hip arthroplasty six years after introduction.

PURPOSE: This paper seeks to analyse clinical pathways (CP) as a useful tool for the improvement of all aspects of quality in medical assistance - in this case, hip arthroplasty. DESIGN/METHODOLOGY/APPROACH: The study was carried out on patients who had undergone scheduled hip arthroplasty included in CP during the years 1999 to 2004. Data on demographics, lengths of stay, complications, process and result variables were gathered, coverage was calculated and the evolution of the indicators was compared. FINDINGS: A total of 487 patients were enrolled, with five leaving the pathway and with unequal coverage, leading to a maximum peak of 77 per cent in 1999. A statistically significant decrease exists in the consumption of overall stays and in the pre-surgical stay, which dropped from a mean of 19.41 days in the pre-pathway situation to 10.12 days in 2004 and 4.5 days pre-surgery to 1.08 days. As a process indicator, the performance should be highlighted of post-operation check-up radiographies, which have been gaining high levels of compliance (p < 0.05) since 2001. The rate of complications has remained stable over the years. ORIGINALITY/VALUE: Implementing the CP has meant a sustained saving of resources over the years and an improvement in the organization of work.