[Impact of the COVID-19 pandemic on patient safety incident and medication error reporting systems]. / Impacto de la pandemia COVID-19 en los sistemas de notificación de incidentes de seguridad del paciente y errores de medicación.

BACKGROUND AND AIM: To determine the impact of the COVID-19 pandemic on the epidemiology of safety incidents (SI) and medication errors (ME) reported to the CISEMadrid notification system in the hospital and primary care settings of the Madrid Health Service (SERMAS). MATERIALS AND METHODS: Observational and descriptive study with a retrospective analysis of data including all CISEMadrid notifications from 01-Jan-2018 to 31-Dec-2020, from 33 hospitals and 262 health care centres of the SERMAS. The two periods in 2020 with the greatest increase in COVID-19 cases were identified to compare incidents reported in the pre-pandemic and pandemic periods. RESULTS: 36,494 incidents were reported. Comparing both periods, an overall decrease in pandemic notifications of 60.7% was observed, being higher in primary care, falling to 33% of previous levels. The reduction in notifications was similar in the peaks and valleys of the waves. The three most frequent SIs in both periods and care settings were: diagnostic tests, medical devices/equipment/clinical furniture and organisational management/citations. In ME, dose failure and inappropriate selection were the most frequent in both settings and periods. There were no relevant differences in patient consequences in both periods. CONCLUSIONS: During the pandemic, patient safety notifications decreased although the most frequent types remained the same, as did their impact on the patient, both in hospitals and in primary care. The safety culture of organisations is a critical aspect for the maintenance of reporting systems.

[EFQM Model in the hospitals of Madrid Regional Health Service: full self-assessment cycle]. / Modelo EFQM en los hospitales del Servicio Madrileño de Salud: ciclo completo de autoevaluación.

AIM: To analyse a complete cycle of self-assessment using the European Foundation for Quality Management (EFQM) Model in the hospitals of the Madrid Health Service as regards the fundamental concepts of excellence (FCE). METHOD: Descriptive study of the EFQM self-assessments of the entire public hospital sector identifying the methodology and the information on strengths, weaknesses, evidence, RADAR matrix (Results, Approach, Deployment, Assessment and Review), and the related FCEs in the enabling criteria and in the prioritised action plans. RESULTS: The self-assessment was carried out in 85% of the hospitals (29/34), 86% of them required specific training (25/29), with a total of 329 teaching hours and 833 people in training. Multidisciplinary working groups were required in 83% of the hospitals (24/29), with 123 groups and 857 people involved. There were 3,686 strengths and 3,197 weaknesses identified: strengths and weaknesses were 78% (2,869) and 74% (2,355), respectively, for the enabling criteria and 22% (817) and 26% (842), respectively, for the results criteria. The mean score was 404 points with a median of 399. The main FCEs were managing with agility, developing organisational capability, sustaining outstanding results, creating a sustainable future, succeeding through the talent of people, and adding value for customers, with harnessing creativity/innovation and leading with vision, inspiration and integrity being placed in lower positions. A total of 113 action plans were identified for all the hospitals. CONCLUSION: A complete EFQM self-assessment cycle of the entire public hospital sector of a Regional Health Service is provided, linking the analysis and action plans with the FCE of the EFQM Model.

[Barriers and challenges of the functional healthcare risk management units in hospitals of Madrid health service]. / Barreras y retos de las unidades funcionales de gestión de riesgos sanitarios en los hospitales del Servicio Madrileño de Salud.

OBJECTIVE: To identify the barriers and challenges for the effective development of risk management units in hospitals of the Madrid Health Service. MATERIAL AND METHODS: Descriptive cross-sectional study aimed at the management teams and members of the functional units of 31 hospitals in the Madrid Health Service. A self-administered questionnaire requesting answers in free text was used, identifying up to five barriers and challenges, and their prioritization by awarding from 1-5 points according to their importance. A discourse analysis was then conducted, grouping common themes and sorting them according to their score. RESULTS: The overall response rate was 94%. The most frequently identified barriers were lack of time (21%), inadequate safety culture (13%), lack of publication of their activities (10%), and lack of training (10%). The most important challenge was developing the training (18%), followed by improving the culture (17%), communication of safety activities (11%), and achieve leadership from the managers of the services (11%). CONCLUSIONS: According to the study conditions, the main identified barrier identified was the lack of available time, and the principal challenge found was promoting a proactive learning culture.

[Assessment of patient safety reporting system in Madrid health services (primary care and hospitals)]. / Evaluación del sistema de información de seguridad del paciente de los centros sanitarios del Servicio Madrileño de Salud (Atención Primaria y Hospitales).

OBJECTIVES: Improve the patient safety reporting system of the Functional Units of Health Risk Management (UFGRS) in Madrid health services, analysing the opinion of the UFGRS about its content, completion and usefulness, detecting the difficulties and identifying the areas for improvement. METHOD: A descriptive study was conducted using a questionnaire addressed to the 45 UFGRS of the Madrid Health Services. RESULTS: The questionnaire, with a scale of 1 to 5, received responses with an average higher than 3.70: contents (3.77); how to complete the form (3.72); clarity of data shown in the report (3.94) and the overall usefulness of the information (3.77). The most significant difficulties found were related to the excess and reiteration of the information requested. As regards areas for improvement, the most notable was the demand for more refining and analysis of the information about safe practices, the execution of two types of format for reporting results in order to facilitate dissemination among the centres and the review of the classification of safety incidents. Knowing the opinion of the Functional Units of the information system may improve the usefulness of the report as far as accessibility, presentation and exchange of information on patient safety is concerned.

[Use of the EFQM red threads in the health public health system]. / Utilización de los ejes transversales del modelo EFQM en el ámbito sanitario público.

OBJECTIVE: To analyse the use of transversal axes (TA) of the EFQM Model in the self- assessment of the service organisations in an Autonomous Community and to describe the self assessment results for the health care system (HCS) as a whole. MATERIAL AND METHODS: Descriptive study divided in two phases: 1) evaluation of the use of the EFQM model in the HCS, and 2) analysis of the methodology using TA. All (37) of the self-assessment reports corresponding to Primary Care and Hospitals in 2007 were analysed. A quantitative analysis was performed on the strengths (S) and areas of improvement (AI) identified, stratifying them according to level of care, centre and EFQM criteria and TA. RESULTS: The use of the EFQM in the HCS reaches 84% of the organizations (32/37), and 94% deploy improvement plans (30/32). A total of 3543 S and 3573 AI were described for the HCS as a whole. From the total identified S, enablers reach 67.66%. Results according to TA the organization management axes are the dominant ones: people, clients, process and communication. Application difficulties derive from the organizations' leadership in quality management, the training strategies for deployment, the innovation character of the model in certain settings and the potential workload generated. CONCLUSIONS: TA are perceived as a feasible work method to gather and synthesize AI. However it requires appropriate training to optimize its use.