Implementation results of the assessment and management of pain guideline within Best Practice Spotlight Organisations (BPSO®). / Resultados de la implantación de la Guía de valoración y manejo del dolor en Centros Comprometidos con la Excelencia en Cuidados (CCEC®) en España.

AIM: to analyse the progress of implementing the process recommendations of the RNAO Assessment and Management of Pain guideline and health outcomes. METHOD: An observational, longitudinal, retrospective study conducted in 3tertiary-level hospitals in Spain. All patients discharged over the last 5 days of each month from the units selected in the implementation process were included. We evaluated structural data, mean hospital stay, implementation strategy and degree of implementation of the process recommendations of the RNAO guideline over the first 3 years of implementation, and outcomes. A descriptive analysis was performed by calculating means and absolute and relative frequencies in periods: baseline (T0), annual, over the 3first years of implementation (T1, T2 and T3 respectively), and inferential. RESULTS: 8128 patients were included in the study. Hypotheses were contrasted between the different periods. The initial pain assessment in the first 24h following admission or post-surgery increased after the baseline period in all the hospitals, especially those that did not meet the guidelines from the outset. It continued to rise progressively up to 3 years following implementation (reaching 94.6% in hospital 2). By contrast, implementation of the care plan did not exceed 37.5% and 38.5% in hospitals 1 and 3 respectively. With regard to the outcome indicators, the prevalence of pain at 24hours and intense pain generally decreased in the 3hospitals from T0 or T1 to T3, however no conclusive statistically significant differences were obtained. CONCLUSIONS: Implementation of the process recommendations improved from the outset, as did patient outcomes. A decrease in the prevalence and intensity of pain was achieved, although no conclusive data were obtained; all of which leads to better nursing practice with more recording, continuity of care and improved pain management for patients.

[Care plan versus care protocol. Comparative analysis in patients subjected to cardiac catheterism]. / Plan de cuidados frente a protocolo asistencial. Análisis comparativo en pacientes sometidos a cateterismo cardíaco.

The nursing product marks the present and future of the nursing staff. The tools used in the nursing staff should be complete and favor their work. The importance of the cares, during the stay of the patients in the intensive care units, is justified by the obtaining of results and some levels of quality that are adequate for the health care setting. The project aims to know the efficacy of the registered nursing care procedure, care plan or care protocol in an intensive care unit, with a system of computerized clinical records. The resulting information shows a value for the time dedicated to work with the plan greater than that used with the protocol (p = 0.01). In turn, the quality indicators used in both systems are graded as acceptable, although they obtain better results in the care plan. The nursing staff that participate in the study consider that the utility of the care plan in the unit is limited or null for 42.9% and 21.4%, respectively. It should be remembered that the work system in forced in the unit for the nursing care is a care protocol In conclusion, we state that the care plan has better quality in the records than the care protocol, while it requires greater time to fill out the nursing records.

[Nursing records: conventional versus computerized. Critical care unit]. / Registros de enfermería: convencional frente a informatizado. Unidad de cuidados críticos.

In these recent years, electronic clinical data systems have been incorporated into the daily nursing work for the use of records in the hospitalization units. Between 2001 and 2002, the computer program that has presently become the work tool in the Critical Unit I was designed. This project aims to know the opinion of the nursing staff on the use of the computerized record versus the previous pen and paper. The surveys designed were filled out by 90.5% of the unit staff and it was found that for nursing group, the computerized record is a better work system than the pen and paper. Further, the computerized record is characterized by being more complete, by making it possible to better gather the work and by adjusting more reliably to the nursing work. In conclusion, we would say that the perception of nursing after the initiation of the clinical record computerized system is that it has improved versus the pen-paper. The perception of the time aimed at filling out the records is greater, although paradoxically, it generates more time for the patient's care according to the staff opinion. Even so, it is considered to be a good work system.

[Repercussion on the hemodynamic measurements across a Swan-Ganz catheter with the postural changes]. / Repercusión en las mediciones hemodinámicas a través de un Swan-Ganz con los cambios posturales.

AIM: Usually hemodynamic measures are done with the patient in dorsal decubitus and the bedside at 0 degrees. Our aim has been to evaluate the influence that postural changes has in the hemodynamic measures which were carried out with a pulmonary artery catheter, so as called Swan-Ganz. MATERIAL AND METHOD: It's a prospective study. The same patient is control group and study group. There were done tree consecutive measures in each patient. Firstly in dorsal decubitus, then right lateral decubitus and finally in left lateral decubitus. Before doing the measures after change of posture a thirty minutes period was left in order to stabilise the hemodynamical flow. The items of study were, a part of demographic ones, cardiac index, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, pulmonary artery mean pressure, pulmonary artery occlusion pressure, right atrial pressure, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure and heart rate. 28 patients were included in the study. RESULTS: The age average was 62.5 years (27.05-67.05); a 78.6% were male. Who had a NEMS average of 42.4 (39.9-44.9). No difference was found between hemodynamic measures in the different postures. CONCLUSIONS: Postural changes in stable patients have no influence in pressures and other hemodynamic variables measures.