El audit como herramienta de mejora continua en el Plan de Atención al Ictus de Aragón / Auditing as a tool for ongoing improvement in the Stroke Care Plan of the Region of Aragón

Introducción. El Plan de Atención al Ictus de Aragón (PAIA) se creó en 2008 en el marco de la Estrategia Nacional en Ictus del Sistema Nacional de Salud. La monitorización de la atención hospitalaria al ictus mediante auditorías periódicas se definió como una de sus líneas de trabajo. Objetivo. Determinar la calidad del proceso asistencial hospitalario prestado al paciente con ictus en Aragón mediante el uso de indicadores de calidad. Materiales y métodos. Se realizaron tres audits (en los años 2008, 2010 y 2012) siguiendo la misma metodología, basada en la revisión retrospectiva de una muestra representativa de ingresos por ictus en cada uno de los hospitales generales del Servicio Aragonés de Salud. Se recogió información sobre 48 indicadores seleccionados según su evidencia científica o relevancia clínica. Resultados. Se estudiaron 1.011 casos (331 en el primer audit, y 340 en el segundo y en el tercero). Treinta y un indicadores presentaron una mejoría significativa (entre ellos destacan los indicadores de calidad de la historia clínica, de evaluación neurológica, las medidas preventivas iniciales y, con especial relevancia, la realización de test de deglución), dos sufrieron empeoramiento (relacionados con el tratamiento rehabilitador) y 15 no registraron variaciones significativas. Conclusiones. La implantación del PAIA ha supuesto una mejoría notable en la mayoría de los indicadores de calidad evaluados, reflejo de una mejora continua en la atención hospitalaria del ictus. La generalización progresiva de la atención especializada y la creación de las áreas de ictus son algunos de los factores determinantes (AU)

Introduction. The Aragón Stroke Care Plan (PAIA) was created in 2008 within the framework of the Spanish National Health System. Monitoring hospital care of strokes by means of periodic audits was defined as one of its lines of work. Aim. To determine the quality of the hospital care process for stroke patients in Aragón by using quality indicators. Materials and methods. Three audits were carried out (in the years 2008, 2010 and 2012) following the same methodology, based on the retrospective review of a representative sample of admissions due to stroke in each of the general hospitals belonging to the Aragonese Health Service. Information was collected on 48 indicators selected according to their scientific evidence or clinical relevance. Results. Altogether 1011 cases were studied (331 in the first audit, and 340 in the second and the third). Thirty-one indicators showed a significant improvement (some of the most notable being the indicators of quality of the medical record, neurological assessment, initial preventive measures and, especially relevant, performing the swallowing test), two underwent a decline in their condition (related with rehabilitation treatment) and 15 did not register any significant variation. Conclusions. The implementation of the PAIA has given rise to a notable improvement in most of the quality indicators evaluated, which reflects an ongoing improvement in hospital stroke care. The progressive generalisation of specialised care and the creation of stroke units are some of the determining factors (AU)

Prevention of DNA contamination during forensic medical examinations in a clinical forensic medical service: A best practice implementation project.

BACKGROUND: Contamination of forensic specimens can have significant and detrimental effects on cases presented in court. In 2010 a wrongful conviction in Australia resulted in an inquiry with 25 recommendations to minimize the risk of DNA contamination of forensic specimens. DNA decontamination practices in a clinical forensic medical service currently attempt to comply with these recommendations. Evaluation of these practices has not been undertaken. OBJECTIVES: The aim of this project was to audit the current DNA decontamination practices of forensic medical and nursing examiners in the forensic medical examination process and implement changes based on the audit findings. A re-audit following implementation would be undertaken to identify change and inform further research. METHODS: The Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice were used as the audit tool in this project. A baseline audit was conducted; analysis of this audit process was then undertaken. Following education and awareness training targeted at clinicians, a re-audit was completed. RESULTS: There were a total of 24 audit criteria; the baseline audit reflected 20 of these criteria had 100% compliance. The remaining 4 audit criteria demonstrated compliance between 65% and 90%. Education and awareness training resulted in improved compliance in 2 of the 4 audit criteria, with the remaining 2 having unchanged compliance. CONCLUSIONS: The findings demonstrated that education and raising awareness can improve clinical practice; however there are also external factors outside the control of the clinicians that influence compliance with best practice.

Managing Haemophilia for Life: 5th Haemophilia Global Summit.

The 5th Haemophilia Global Summit was held in Barcelona, Spain, in September 2014. The programme was designed by an independent Scientific Steering Committee of haemophilia experts and explored issues relevant to the practical management of haemophilia, as well as key opportunities and challenges for care in the future. The topics outlined in this supplement were selected by the Scientific Steering Committee for their relevance to improving haemophilia care globally. In this supplement from the meeting, Gerry Dolan explores pharmacokinetics and dynamics in haemophilia, and Gerry Dolan and Ian Jennings jointly address the role of the laboratory in haemophilia care. The potential benefits of low-dose prophylaxis regimens for people with haemophilia in the developing world are reviewed by Jerzy Windyga, and the question of whether 'Future haemophilia research should be undertaken in the developing world' is debated by Jerzy Windyga and Cedric Hermans. Management strategies for ankle arthropathy are discussed by Sébastien Lobet and E. Carlos Rodríguez-Merchán, and the use of ultrasound for the early detection of haemophilic arthropathy is addressed by Matteo Nicola Dario Di Minno and Víctor Jiménez-Yuste. Finally, the role of patients in the future of haemophilia care is reviewed by Brian O'Mahony.

Audit of the use of intravenous immunoglobulin for antibody deficiencies in a Clinical Immunology Unit

No disponible

Identifying best practice principles of audit in health care.

Audit is recognised as a crucial component of improving the quality of patient care. Examples include giving patients safe, reliable and dignified care, enhancing their experiences and satisfaction by encouraging them to self-direct their recovery, and reducing the length of stay in hospital, readmission rates and delayed discharge. This article describes clinical audit, the stages involved in the process and the support required to achieve strategic objectives.

Ethical dilemmas of a large national multi-centre study in Australia: time for some consistency.

AIMS AND OBJECTIVES: To examine the impact and obstacles that individual Institutional Research Ethics Committee (IRECs) had on a large-scale national multi-centre clinical audit called the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study. BACKGROUND: Multi-centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects. METHODS: The National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes study used an investigator-developed questionnaire concerning a clinical audit for heart failure programmes throughout Australia. Ethical guidelines developed by the National governing body of health and medical research in Australia classified the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study as a low risk clinical audit not requiring ethical approval by IREC. RESULTS: Fifteen of 27 IRECs stipulated that the research proposal undergo full ethical review. None of the IRECs acknowledged: national quality assurance guidelines and recommendations nor ethics approval from other IRECs. Twelve of the 15 IRECs used different ethics application forms. Variability in the type of amendments was prolific. Lack of uniformity in ethical review processes resulted in a six- to eight-month delay in commencing the national study. CONCLUSIONS: Development of a national ethics application form with full ethical review by the first IREC and compulsory expedited review by subsequent IRECs would resolve issues raised in this paper. IRECs must change their ethics approval processes to one that enhances facilitation of multi-centre research which is now normative process for health services. RELEVANCE TO CLINICAL PRACTICE: The findings of this study highlight inconsistent ethical requirements between different IRECs. Also highlighted are the obstacles and delays that IRECs create when undertaking multi-centre clinical audits. However, in our clinical practice it is vital that clinical audits are undertaken for evaluation purposes. The findings of this study raise awareness of inconsistent ethical processes and highlight the need for expedient ethical review for clinical audits.