Use of the EFQM excellence model to improve hospital pharmacy performance.

BACKGROUND: Quality management systems are widely used to improve the quality and efficiency of healthcare services. However, evidence regarding the value of the European Foundation for Quality Management (EFQM) model in improving the performance of hospital departments is lacking. OBJECTIVE: To describe the value of the EFQM model as a quality framework for improving the performance of a hospital pharmacy department (PD). DESIGN: A case study describing the development of the Enablers' criteria of the model and the results achieved. SETTING: PD in a tertiary-care teaching hospital of the Madrid Public Health Service (Spain). INTERVENTIONS: Four self-assessments were conducted using the questionnaire "Perfil" during the period 2008-2017. A quality improvement plan was developed on the basis of the results of each self-assessment. A balanced scorecard was used to track progress. Improvement in quality management was externally evaluated by the Spanish Management Excellence Club in 2010, 2013, and 2017. MAIN OUTCOME MEASURES: Change in the scores obtained in the external assessments, the quality improvement initiatives implemented for each Enabler's criteria, and the results of key performance indicators. RESULTS: The EFQM was a useful framework for self-assessment and a good system for identifying improvement initiatives. The model progressively improved the services provided for patients, the safety and efficiency of pharmacotherapy, productivity of the PD, and customer and staff satisfaction. The external assessment scores exceeded 300 points in 2010, 400 points in 2013, and 500 points in 2017. Scores for all of the criteria progressively improved, particularly in 'people'. CONCLUSIONS: The EFQM was a practical tool for improvement of PD performance, especially in areas such as strategic planning, people management, and innovation. The main difficulties were the lack of decision-making capacity in relevant areas and benchmarking with other PDs.

Resumption of intercourse, self-reported decline in sexual intercourse and dyspareunia in women by mode of birth: A prospective follow-up study.

AIM: To evaluate the association between mode of birth and the resumption of sexual intercourse, self-reported decline in sexual intercourse and dyspareunia in women at the 6th week and 6th month postpartum. BACKGROUND: Interest in the relationship between mode of birth and postpartum sexual functioning is increasing. However, previous findings are contradictory. DESIGN: Prospective, longitudinal, observational study. METHOD: The participants comprised 552 healthy primiparous women aged 18-45 years who gave birth at a hospital between February 2013 - April 2014. Interviews were performed at the hospital and via telephone at the 6th week and 6th month postpartum. We constructed multivariate logistic regression models to examine the relationship between mode of birth and resumption of intercourse, self-reported decline in sexual intercourse and dyspareunia at the 6th week and 6th month postpartum. RESULTS: At the 6th week postpartum, forceps-assisted birth, combination of episiotomy plus perineal tear and belonging to a higher socio-economic status were related to a higher risk of non-resumption of sexual intercourse, while breastfeeding was related to a higher probability of dyspareunia. At the 6th month postpartum, the likelihood of self-reported decline in sexual intercourse was higher among women who screened positive for postpartum depression and a higher number of breastfeeding women reported a decline in sexual intercourse and dyspareunia. Furthermore, at the 6th month postpartum, women who reported the use of emergency services for a health problem had a higher risk of not having resumed intercourse and of experiencing dyspareunia.

[Detection of adverse events using trigger tools in 2hospital units in Spain]. / Detección de eventos adversos mediante trigger tools en 2unidades de hospitalización de un hospital terciario en España.

INTRODUCTION: Adverse events (AE) related to health care are frequent due to the nature of this activity, and for this reason, it is necessary to develop methods to detect them and prevent their recurrence. One of these methods uses what are called trigger tools, which are markers that allow AE to be identified retrospectively for subsequent analysis. OBJECTIVES: To evaluate the usefulness of a trigger tools system to detect AE related to patient safety in Internal Medicine and General Surgery units of a tertiary referral hospital. As secondary objectives, measurements were made of the rate of AE, its prevalence in admissions, as well as a description of the different types of AE, and to evaluate the time spent using this tool. MATERIAL AND METHODS: A retrospective descriptive study of patients admitted to the units of Internal Medicine and General Surgery and discharged during 2016. Inclusion criteria were hospital stay over 24h and the presence of a complete clinical record of the studied acute episode. Patients admitted to short-stay units were excluded. A verification questionnaire was designed to registry key study variables and associated AE. RESULTS: The study included 118 patients from Internal Medicine and 115 from General Surgery. The presence of at least one trigger was detected in 86 (72.9%) Internal Medicine and 56 (48.7%) General Surgery patients. Of these, 13 (15.1%) were associated with the presence of an AE in Internal Medicine and 34 (60.7%) in General Surgery. The trigger tool system failed to detect 7 AE, 4 of them in Internal Medicine. The median of triggers identified in each patient was 1.5 (IQR p25-p75: 1-2.5) in Internal Medicine and 2 (IQR p25-p75: 1-4) in General Surgery. In total, 262 positive triggers were detected, of which 157 corresponded to Internal Medicine, most of them related to early emergency re-admission after discharge. Most of the identified AEs required re-hospitalisation or extending the length of stay. CONCLUSIONS: Trigger tools systems are useful for the detection and characterisation of AE, which helps to analyse and implement improvement measures.

Health related quality of life of women at the sixth week and sixth month postpartum by mode of birth.

BACKGROUND: Health-related quality of life of women in the postpartum period may depend on the mode of birth. However, previous findings are contradictory. AIM: To explore health-related quality of life of women at the sixth week and sixth month postpartum by mode of birth. METHODS: We performed a longitudinal prospective study in Spain that included 546 healthy primiparae aged 18 to 45 years who gave birth to a healthy newborn. At the sixth week and sixth month postpartum, we analysed sociodemographic and clinical characteristics and compared health-related quality of life (measured using the SF-36) by mode of birth (normal vaginal, forceps, vacuum-extraction, elective caesarean section, emergency caesarean section). In addition, we analysed the change in health-related quality of life between the two time points for each mode of birth. FINDINGS: We did not find differences in health-related quality of life by mode of birth at the sixth week or sixth month postpartum. At the sixth week postpartum, regardless of the mode of birth, women with postpartum urinary incontinence reported lower health-related quality of life. Between the sixth week and sixth month postpartum, health-related quality of life improved for all modes of birth. CONCLUSION: While mode of birth is not directly associated with health-related quality of life, it does have an indirect relationship in the short term. Women who reported the lowest health-related quality of life were those with postpartum urinary incontinence. Most women with postpartum urinary incontinence were in the forceps group.

Quality of life of mothers at the sixth week and sixth month post partum and type of infant feeding.

INTRODUCTION: there is little scientific evidence on the relationship between maternal quality of life and type of infant feeding. The purpose of this study was to determine if there were differences in mother's quality of life by type of infant feeding. MATERIAL AND METHODS: longitudinal prospective study with 364 women who gave birth at a public hospital at Madrid, Spain, between February and October 2013. To be included, the participants had to be a healthy primigravida aged 18-45 years who gave birth to a healthy newborn with a gestational age between 36 and 42 completed weeks, regardless of birth type. The hospital interviews were performed between 36 and 48 hours post partum in women who had case of vaginal/instrumental births and 60-72 hours post partum for women who had a caesarean birth. Telephone interviews were conducted at the sixth week and sixth month post partum, and included the SF-36 to measure quality of life. SF-36 scores were compared between breast feeding and artificial milk feeding. We also analysed the longitudinal change in SF-36 scores in both groups. RESULTS: at the sixth week post partum, regardless of the infant feeding modality, an increased mental health score was recorded for mothers who reported that their children ate and slept well and for those who did not go to the emergency hospital service because of concern over their baby's health. No significant differences in quality of life were found between the two groups at six months post partum. Between the sixth week and sixth month post partum, quality of life improved significantly in both groups. DISCUSSION: at the sixth week post partum, the proportion of children who ate and slept well and did not have to attend in an emergency hospital service was higher in the breast feeding group. This observation was associated with greater maternal quality of life. This positive indirect relationship between breast feeding and quality of life should be considered an additional maternal health benefit in the short term.

[IMPLEMENTATION OF A QUALITY MANAGEMENT SYSTEM IN A NUTRITION UNIT ACCORDING TO ISO 9001:2008]. / IMPLANTACIÓN DE UN SISTEMA DE GESTIÓN DE CALIDAD EN UNA UNIDAD DE NUTRICIÓN SEGÚN LA NORMA UNE-EN-ISO 9001:2008.

INTRODUCTION: the implementation of quality management systems (QMS) in the health sector has made great progress in recent years, remains a key tool for the management and improvement of services provides to patients. AIM: to describe the process of implementing a quality management system (QMS) according to the standard ISO 9001:2008 in a Nutrition Unit. METHODS: the implementation began in October 2012. Nutrition Unit was supported by Hospital Preventive Medicine and Quality Management Service (PMQM). Initially training sessions on QMS and ISO standards for staff were held. Quality Committee (QC) was established with representation of the medical and nursing staff. Every week, meeting took place among members of the QC and PMQM to define processes, procedures and quality indicators. We carry on a 2 months follow-up of these documents after their validation. RESULTS: a total of 4 processes were identified and documented (Nutritional status assessment, Nutritional treatment, Monitoring of nutritional treatment and Planning and control of oral feeding) and 13 operating procedures in which all the activity of the Unit were described. The interactions among them were defined in the processes map. Each process has associated specific quality indicators for measuring the state of the QMS, and identifying opportunities for improvement. All the documents associated with requirements of ISO 9001:2008 were developed: quality policy, quality objectives, quality manual, documents and records control, internal audit, nonconformities and corrective and preventive actions. The unit was certified by AENOR in April 2013. CONCLUSION: the implementation of a QMS causes a reorganization of the activities of the Unit in order to meet customer's expectations. Documenting these activities ensures a better understanding of the organization, defines the responsibilities of all staff and brings a better management of time and resources. QMS also improves the internal communication and is a motivational element. Explore the satisfaction and expectations of patients can include their view in the design of care processes.

Introducción: la implantación de sistemas de gestión de calidad (SGC) en el sector sanitario ha presentado un gran avance en los últimos años, siendo una herramienta clave para la gestión y la mejora de los servicios ofrecidos a los pacientes. Objetivo: describir el proceso de implantación de un SGC según la Norma ISO 9001:2008 en una unidad de nutrición. Material y métodos: el proceso comenzó en octubre de 2012. Se contó con la asesoría del servicio de medicina preventiva y gestión de calidad (MPGC) del hospital. Al inicio se realizaron sesiones formativas sobre SGC y normas ISO para el personal. Se instauró un comité de calidad (CC) con representación del personal facultativo y de enfermería. Semanalmente, se reunían los miembros del CC y del servicio de MPGC para definir los procesos, los procedimientos y los indicadores de calidad. Antes de validarlos se probaron durante dos meses. Resultados: se identificaron y documentaron un total de 4 procesos (Valoración del estado nutricional, Indicación de tratamiento nutricional, Seguimiento del tratamiento nutricional y Planificación y control de la alimentación oral) y 13 procedimientos operativos donde quedó recogida toda la actividad de la unidad. Las interacciones entre ellos quedaron definidas en el mapa de procesos. En cada uno de los procesos se identificaron indicadores de calidad para medir el estado del SGC y detectar oportunidades de mejora. Se desarrollaron todos los documentos asociados a requerimientos de la Norma ISO 9001:2008: política de calidad, objetivos de calidad, manual de calidad, procedimiento de control de la documentación y registros, de auditoría interna, de no conformidad y de acciones correctivas y preventivas. La unidad obtuvo la certificación de AENOR en abril de 2013. Conclusiones: la implantación de un SGC supone hacer una reflexión sobre las actividades que realiza la unidad con el objetivo de satisfacer las expectativas de los usuarios que demandan nuestros servicios. Documentar dichas actividades asegura un mejor entendimiento de la organización, define las responsabilidades de todo el personal y provoca una mejor gestión del tiempo y los recursos. También mejora la comunicación interna y supone un elemento motivador. Explorar la satisfacción y expectativas de los pacientes permite incluir su punto de vista en el diseño de los procesos asistenciales.

Effectiveness of an electronic tool for medication reconciliation in a general surgery department.

BACKGROUND: Medication reconciliation is a key tool in the prevention of adverse drug events. OBJECTIVE: To assess the impact of an electronic reconciliation tool in decreasing unintended discrepancies between medications prescribed after surgery and the patient's usual treatment. SETTING: General Surgery Department of Gregorio Marañón's University General Hospital, Madrid. METHOD: A pre-post intervention study with no equivalent control group was carried out between June 2009 and December 2010. Patients hospitalized in the General Surgery Department for 24 h or more, and whose prescriptions prior to admission included three or more drugs were included in the study. Patients were interviewed to gather information about their usual treatment drugs. Discrepancies between the latter and the drugs prescribed after surgery were assessed before and after the medication reconciliation electronic tool was implemented. MAIN OUTCOME MEASURE: Proportion of patients with at least one unintended discrepancy. RESULTS: A total of 107 patients in the pre-intervention phase and 84 patients in the post-intervention phase were included. We detected 1,678 discrepancies, 167 were found to be unintended. The number of patients with at least one unintended discrepancy was 43 (40.2 %) in the pre-intervention phase, and 38 (38.1 %) in the post-intervention phase, p = 0.885. The percentage of unintended discrepancies over the total amount of drugs reconciled was lower in the post-intervention phase than in the pre-intervention phase (6.6 vs. 10.6 %), p = 0.002. Regarding unintended discrepancies 79.2 % were grade C severity (the error reached the patient but caused no harm), 13.6 % grade D (the error reached the patient and required monitoring or intervention to preclude harm) and 7.1 % grade E (the error may have contributed to or resulted in temporary harm to the patient and required intervention). CONCLUSION: Implementation of an electronic tool facilitated the process of medication reconciliation in a general surgery unit. The proportion of unintended discrepancies over the total amount of drugs reconciled was reduced after the implementation of the reconciliation programme. However, we could not demonstrate a more significant impact due to some methodological limitations.