Impulso de la seguridad del paciente a partir del contrato programa de centro / Boost for patient safety with the centre agreement program

Objetivo. Identificar y definir un conjunto mínimo y normalizado de objetivos de seguridad en el contrato programa de centro (CPC) de la Comunidad de Madrid, cuya implantación y seguimiento permita garantizar la mejora de la calidad asistencial y la seguridad del paciente en Atención Primaria. Material y métodos. El elemento clave es el CPC elaborado con el modelo EFQM como referente. Metodológicamente, se han seguido las etapas del ciclo de mejora. En la planificación, se ha incluido en el CPC objetivos normalizados de seguridad. El seguimiento de los indicadores se ha realizado con una aplicación informática. Resultados. En el CPC 2009 se han definido 12 objetivos de seguridad y 21 indicadores. En todos los criterios del modelo se ha contemplado la inclusión de algún objetivo de seguridad. Destacamos los siguientes resultados: en el criterio de procesos, la cobertura del programa del polimedicado es del 59,22%, en el 93% de las consultas se utiliza solución bioalcohólicas y el 89% de los Centros de Salud (CS) realizan control y mantenimiento de carros de parada. En comunicación, se han notificado 1.096 errores de medicación en toda la Comunidad de Madrid, 239 reacciones adversas a medicamentos y 1.945 incidentes de seguridad. En el criterio 6, clientes, el 66,22% de los INR están en rango. Se ha obtenido 19,46 DHD osteoporosis en mujeres de 45-65 años y 16,9 DHD neurolépticos en personas mayores. El indicador referente a BEERS es del 11,9%. Se han adoptado una 1,19 medidas de seguridad por CS. En resultados personas, el 14,44% de los profesionales se han formado en calidad y seguridad del paciente. Con la aplicación e-SOAP los CS conocen resultados para adoptar mejoras. Se han introducido mejoras en el CPC 2010. Conclusiones. Con el CPC elaborado con el modelo EFQM como referente, se han implantado y seguido indicadores de seguridad de forma sistematizada en los CS de la Comunidad de Madrid. Se han generalizado buenas prácticas que garantizan la seguridad del paciente, y se ha empezado a evaluar el impacto de la atención sanitaria prestada en Atención Primaria con la medición de indicadores que la evidencia científica revela que afectan a la seguridad del paciente(AU)

Objective. To identify and define a minimum and standard set of safety objectives in the Centre Agreement Program (CAP) of the Community of Madrid, the introduction of which has led to improved follow-up and an improvement in quality of care and patient safety in Primary Care. Material and Methods. The key element is the Centre Agreement Program developed with the EFQM model as a reference. Methodologically, this project has followed the steps set out in the PDCA cycle., Standardised safety objectives were included in the CAP during the planning phase. Indicators have been monitored by the e-SOAP application. Results. We have identified 12 safety goals and 21 indicators. All the criteria of the model included some safety objectives. We highlight the following results: in the criteria relating to processes, the program cover of patients who were on several medications was 59.22%, a bio-alcohol solution was used in 93% of health facilities, 89% of Health Centres had performed a control and maintenance of vital emergency equipment. As regards communication, 1096 medication errors were notified throughout the Community of Madrid. There were 239 adverse reactions to medication and 1945 safety incidents were reported. In criterion 6, 66.22% of INR determinations were within range. There were 19.46 defined daily doses (DDD) for women of 45-65 years, and 16.9 DDD of neuroleptics in the elderly population. The indicator related to minimising drugs considered inappropriate in the elderly (Beers) was 11.9%. An average of 1.19 safety measures were adopted per Centre. For Criterion 7, 14.44% of professionals had been trained in quality and patient safety. By implementing e-SOAP, Health Centres can know their results in order to implement improvements. In addition, improvements have been set up in the 2010 CAP. Conclusions. With the development of the CAP using the EFQM model as a benchmark, safety indicators have been implemented and monitored systematically in the Health Centres of the Community of Madrid. Best practices that ensure patient safety have been extended and we have begun to evaluate the impact of the health care provided in Primary Care with the measurement of indicators that the scientific evidence reveals affect patient safety(AU)

[Boost for patient safety with the centre agreement program]. / Impulso de la seguridad del paciente a partir del contrato programa de centro.

OBJECTIVE: To identify and define a minimum and standard set of safety objectives in the Centre Agreement Program (CAP) of the Community of Madrid, the introduction of which has led to improved follow-up and an improvement in quality of care and patient safety in Primary Care. MATERIAL AND METHODS: The key element is the Centre Agreement Program developed with the EFQM model as a reference. Methodologically, this project has followed the steps set out in the PDCA cycle., Standardised safety objectives were included in the CAP during the planning phase. Indicators have been monitored by the e-SOAP application. RESULTS: We have identified 12 safety goals and 21 indicators. All the criteria of the model included some safety objectives. We highlight the following results: in the criteria relating to processes, the program cover of patients who were on several medications was 59.22%, a bio-alcohol solution was used in 93% of health facilities, 89% of Health Centres had performed a control and maintenance of vital emergency equipment. As regards communication, 1096 medication errors were notified throughout the Community of Madrid. There were 239 adverse reactions to medication and 1945 safety incidents were reported. In criterion 6, 66.22% of INR determinations were within range. There were 19.46 defined daily doses (DDD) for women of 45-65 years, and 16.9 DDD of neuroleptics in the elderly population. The indicator related to minimising drugs considered inappropriate in the elderly (Beers) was 11.9%. An average of 1.19 safety measures were adopted per Centre. For Criterion 7, 14.44% of professionals had been trained in quality and patient safety. By implementing e-SOAP, Health Centres can know their results in order to implement improvements. In addition, improvements have been set up in the 2010 CAP. CONCLUSIONS: With the development of the CAP using the EFQM model as a benchmark, safety indicators have been implemented and monitored systematically in the Health Centres of the Community of Madrid. Best practices that ensure patient safety have been extended and we have begun to evaluate the impact of the health care provided in Primary Care with the measurement of indicators that the scientific evidence reveals affect patient safety.

Organización y funcionamiento de las consultas de tabaquismo en una comunidad autónoma. Experiencia de la Comunidad de Madrid / Organization and functions of the anti-smoking consultations in a regional community. Experience of the Madrid Community

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[Vaccine coverage against tetanus in the population over 30 years old cared for at a health center]. / Cobertura vacunal frente al tétanos de la población mayor de 30 años at atendida en un centro de salud.

OBJECTIVE: To determine by questionnaire the incidence of effective vaccination against tetanus in the population aged over 30 years attending a health centre. As a secondary objective we wish to determine the patients who sought vaccination after immunoprophylaxis was indicated as a result of incorrect vaccination. RESEARCH DESIGN: Cross section study to determine the incidence of effective vaccination and the number who sought vaccination. LOCATION: Inicial visit patients. "Chopera I" Health Centre, Alcobendas (Madrid). PATIENTS: Stratified sample of 385 patients representative of the population aged over 30 attending the Health Centre. For calculation of number who sought vaccination, 263 patients completed the study. MEASUREMENT AND MAIN RESULTS: Vaccination coverage was 13.24% +/- 3.38% for alpha = 0.05, with statistically significant disfavouring difference in women and older age groups. 66.15% of the patients for whom immunoprophylaxis was indicated sought vaccination. CONCLUSIONS: There is poor vaccination coverage in the over thirties population, especially in women. We note the high percentage of patients who sought vaccination without any risk factor at that time, indicating the fundamental role of the initial visit medical service in immunoprophylaxis.

[Family outbreak of hepatitis B]. / Brote familiar de hepatitis B.

Hepatitis B virus (HBV) causes one of the most widespread infections worldwide. We report a family outbreak where a male with Down's syndrome attending an open institution for mentally retarded individuals probably was the source of the infection. We consider the prevention as the only means to attack the infection with intervention on the transmission mechanisms and immuniprophylaxis. We emphasize eh need of a perfect communication between the several institutions involved in epidemiological surveillance. This might have prevented the present outbreak. Finally, we insist on the importance that the primary care physician could have in the prescription and indication of immunoprophylaxis. To this end, the disappearance of the administrative barriers established by the Secretaría General de Asistencia Sanitaria from the Health Ministry would be needed.