Redefining cyber resilience : Through the risk register lens.

Resilience is deeper than maintaining a company's operations and services in the face of significant disruptions. It is the ability of a business to withstand, pivot and continue to grow in the face of a significant threat. To achieve resilience, companies must have an integrated, end-to-end understanding of how a specific threat magnifies the risks identified on their risk register, and what measures are needed across the enterprise to address the amplification of those risks. This paper details how the need for a holistic approach is especially important for cyber crises, compared with other types of crises, because they tend to have more broad-ranging impacts and complexities, such as: unclear timelines, lack of public empathy, unpredictable human threat actor(s), as well as a broader set of internal and external stakeholders that need to be engaged. Unlike other crises, cyber crises have the potential to magnify most - if not all - of the risks on the risk register. As such, cyber resilience requires ensuring that key stakeholders, whether shareholders, customers, regulators, business partners, employees, etc, stay resolute in their faith in a company and its leadership's ability to navigate the increasingly complex issues related to cyber risks and how these issues are addressed enterprise-wide, not purely seen through the lens of technical or operational resilience. To achieve cyber resilience, organisations must develop and implement programmes that integrate both the technical and the broader business measures needed to limit fallout, demonstrate leadership through cyber crises, and deepen trust regardless of the potential severity of the impact.

Vulnerabilities to disasters in healthcare facilities in the face of the COVID-19 pandemic: a scoping review. / Vulnerabilidades a desastres em estabelecimentos de saúde frente à pandemia de COVID-19: revisão de escopo.

This article maps the structural, nonstructural and functional vulnerabilities of healthcare facilities to the COVID-19 pandemic. It reports on a scoping review guided by JBI recommendations and structured by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The PubMed, CINAHL, LILACS, EMBASE, SciELO, Scopus and Web of Science Repositories and databases were consulted, as was the grey literature. The protocol was registered in the Open Science Framework. The 54 studies included summarised 36 vulnerabilities in three categories in 29 countries. Functional and non-structural vulnerabilities were the most recurrent. Limited material and human resources, service disruption, non-COVID procedures and inadequate training were the items with most impact. COVID-19 exposed nations to the need to strengthen health systems to ensure their resilience in future health crises. Prospective risk management and systematic analysis of health facility vulnerabilities are necessary to ensure greater safety, sustainability and improved standards of preparedness and response to events of this nature.

O objetivo do artigo é mapear as vulnerabilidades estruturais, não-estruturais e funcionais de estabelecimentos de saúde frente à pandemia de COVID-19. Revisão de escopo conduzida mediante recomendações do JBI e estruturada pelos Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Foram consultados repositórios e bases de dados: PubMed, CINAHL, LILACS, EMBASE, SciELO, Scopus e Web of Science, além de literatura cinzenta. O protocolo foi registrado em Open Science Framework, 54 estudos foram incluídos, sumarizando 36 vulnerabilidades entre as três categorias, em 29 países. As vulnerabilidades funcionais e não-estruturais foram as mais recorrentes. Recursos materiais e humanos limitados, interrupção dos serviços e procedimentos não-COVID, além de capacitação profissional insuficiente foram os itens que mais impactaram. A COVID-19 expôs às nações a necessidade de fortalecer os sistemas de saúde para garantir sua resiliência em futuras crises sanitárias. Ações de gestão de risco prospectivas e análise sistematizada de vulnerabilidades dos estabelecimentos de saúde são necessárias para garantir maior segurança, sustentabilidade e melhor padrão de preparação e resposta a futuros eventos dessa natureza.

"Near Miss": A Mixed-Methods Analysis of Medical Student Assignments in Patient Safety.

The purpose of this study is to inform the curriculum for Entrustable Professional Activity 13 through analysis of fourth year medical student patient safety event assignments. From 2016 to 2021, students were asked to identify a patient safety event and indicate if the event required an incident report. Assignments were reviewed and coded based on Joint Commission incident definitions. Qualitative analysis was performed to evaluate incident report justification. There were 473 student assignments included in the analysis. Assignments reported incidents regarding communication, medical judgment, medication errors, and coordination of care. Students indicated only 18.0% (85/473) would warrant an incident report. Justification for not filing an incident report included lack of harm to the patient or that it was previously reported. Students were able to identify system issues but infrequently felt an incident report was required. Justifications for not filing an incident report suggest a need for a curriculum focused on the value of reporting near misses and hazardous conditions.

Risk-based management of international sporting events during the COVID-19 pandemic.

Mass gatherings include a diverse range of events such as sporting competitions, religious ceremonies, entertainment activities, political rallies and cultural celebrations, which have important implications for population well-being. However, if not managed properly, these events can amplify health risks including those related to communicable diseases, and place undue strain on health systems in host countries and potentially in attendees' home countries, upon their return. The coronavirus disease 2019 (COVID-19) pandemic has provided a unique opportunity to evaluate the risk factors associated with mass gatherings and the effectiveness of applying mitigation measures during infectious disease emergencies. The pandemic has also allowed event organizers and health officials to identify best practices for mass gathering planning in host countries. To guide decisions about whether to hold, postpone, modify or cancel a mass gathering during the COVID-19 pandemic, the World Health Organization and its partners developed normative guidance and derivative tools promoting a risk-based approach to mass gathering planning. This approach involves three steps to guide decision-making around mass gatherings: risk evaluation, risk mitigation and risk communication. The approach was applied in the planning and execution of several mass gathering events, including the Tokyo 2020 and Beijing 2022 Olympic and Paralympic Games. Lessons identified from these large-scale international events offer insights into the planning and implementation of mass gathering events during a pandemic, and the broader impacts of such events on society. These lessons may also further inform and refine planning for future mass gatherings.

Les rassemblements de masse désignent un large éventail d'événements tels que des compétitions sportives, cérémonies religieuses, activités de divertissement, manifestations politiques et fêtes culturelles. Tous ont un impact considérable sur le bien-être de la population. Toutefois, s'ils ne sont pas gérés correctement, ils peuvent augmenter les risques sanitaires, notamment concernant les maladies transmissibles, et exercer une pression excessive sur les systèmes de santé des pays hôtes, voire sur ceux des pays d'origine des participants après leur retour. La pandémie de maladie à coronavirus 2019 (COVID-19) a offert une occasion unique d'évaluer les facteurs de risque associés aux rassemblements de masse, ainsi que l'efficacité des mesures visant à limiter la propagation dans des situations d'urgence liées à des maladies infectieuses. Cette pandémie a également permis aux organisateurs d'événements et responsables de santé d'identifier les bonnes pratiques à appliquer dans les pays hôtes pendant les rassemblements de masse. Afin de guider les décisions relatives au maintien, au report, à la modification ou à l'annulation d'un rassemblement de masse durant la pandémie de COVID-19, l'Organisation mondiale de la Santé et ses partenaires ont mis au point des orientations normatives et des outils dérivés favorisant une approche tenant compte des risques au moment de la planification. Cette approche comprend trois étapes contribuant à la prise de décision: l'évaluation, la réduction et la communication des risques. Elle a été déployée lors de la planification et de l'exécution de nombreux rassemblements de masse, comme les Jeux olympiques et paralympiques de Tokyo 2020 et Beijing 2022. Les leçons tirées de ces événements internationaux à grande échelle fournissent des informations sur leur organisation et leur mise en œuvre en cas de pandémie, ainsi que les impacts de tels événements sur la société. Elles sont en outre susceptibles de faciliter et d'améliorer la planification des futurs rassemblements de masse.

Las concentraciones masivas incluyen una gran variedad de eventos, como competiciones deportivas, ceremonias religiosas, actividades de entretenimiento, mítines políticos y celebraciones culturales, que tienen importantes implicaciones para el bienestar de la población. Sin embargo, si no se gestionan adecuadamente, estos eventos pueden amplificar los riesgos para la salud, incluidos los relacionados con las enfermedades transmisibles, y suponer una carga excesiva para los sistemas sanitarios de los países anfitriones y, potencialmente, de los países de origen de los participantes a su regreso. La pandemia de la enfermedad por coronavirus de 2019 (COVID-19) ha brindado una oportunidad única para evaluar los factores de riesgo asociados a las concentraciones masivas y la eficacia de aplicar medidas de mitigación durante las emergencias por enfermedades infecciosas. La pandemia también ha permitido a los organizadores de eventos y a las autoridades sanitarias identificar las mejores prácticas para la planificación de concentraciones masivas en los países anfitriones. Para orientar las decisiones sobre la celebración, el aplazamiento, la modificación o la cancelación de una concentración masiva durante la pandemia de la COVID-19, la Organización Mundial de la Salud y sus asociados elaboraron orientaciones normativas y herramientas derivadas que promueven un enfoque de la planificación de concentraciones masivas basado en los riesgos. Este enfoque consta de tres pasos para orientar la toma de decisiones en torno a las concentraciones masivas: la evaluación, la mitigación y la comunicación de riesgos. El enfoque se aplicó en la planificación y ejecución de varias concentraciones masivas, incluidos los Juegos Olímpicos y Paralímpicos de Tokio 2020 y Pekín 2022. Las conclusiones extraídas de estos eventos internacionales a gran escala permiten comprender mejor la planificación y ejecución de concentraciones masivas durante una pandemia, así como las repercusiones más generales de estos eventos en la sociedad. Estas lecciones también pueden informar y perfeccionar la planificación de futuras concentraciones masivas.

Application of a Human Factors Systems Approach to Healthcare Control Centres for Managing Patient Flow: A Scoping Review.

Over the past decade, healthcare systems have started to establish control centres to manage patient flow, with a view to removing delays and increasing the quality of care. Such centres-here dubbed Healthcare Capacity Command/Coordination Centres (HCCCs)-are a challenge to design and operate. Broad-ranging surveys of HCCCs have been lacking, and design for their human users is only starting to be addressed. In this review we identified 73 papers describing different kinds of HCCCs, classifying them according to whether they describe virtual or physical control centres, the kinds of situations they handle, and the different levels of Rasmussen's [1] risk management framework that they integrate. Most of the papers (71%) describe physical HCCCs established as control centres, whereas 29% of the papers describe virtual HCCCs staffed by stakeholders in separate locations. Principal functions of the HCCCs described are categorised as business as usual (BAU) (48%), surge management (15%), emergency response (18%), and mass casualty management (19%). The organisation layers that the HCCCs incorporate are classified according to the risk management framework; HCCCs managing BAU involve lower levels of the framework, whereas HCCCs handling the more emergent functions involve all levels. Major challenges confronting HCCCs include the dissemination of information about healthcare system status, and the management of perspectives and goals from different parts of the healthcare system. HCCCs that take the form of physical control centres are just starting to be analysed using human factors principles that will make staff more effective and productive at managing patient flow.

Building resilience: The role of enterprise security risk management in developing a resilient organisation.

Enterprise security risk management (ESRM) has continued to gain global acceptance as a management philosophy for the development and implementation of an enterprise-wide corporate security programme. As organisations continue to rebuild and recover from COVID-19, the value of assessing the resilience of an organisation through regular testing of its response to events has gained prominence. There are opportunities to link the development and implementation of a risk-based approach for designing a security programme, to assessing an organisation's resilience to future events. Organisations can benefit from the complementary approaches of ESRM and organisational resilience once the commonalities are identified and embraced. This paper expands upon the ESRM management approach, linking the concepts of ESRM to the design of a resilient enterprise.

Operational resilience towards a global alignment.

Operational resilience lies between operational risk and business continuity. This paper provides a view on the implementation of the operational resilience framework, and its relationship with operational risk and business continuity. It analyses the similarities and differences between these exercises and how management information from these exercises can be leveraged and aligned. The paper also provides answers to three important questions: (1) What pushed the international regulators to add additional oversight? (2) What benefits and challenges are brought by operational resilience? (3) Why is it important to harmonise operational resilience within the international regulatory landscape?

Strategic dilemmas when managing cyber attacks.

Cyber attacks have a significant business impact, with the potential to escalate into crises if poorly managed. A recurring pattern is strategic dilemmas that cannot be resolved satisfactorily. Some dilemmas are more pronounced, others less so, and therefore often catch decision-makers unprepared, leaving only bad options for decision-making. Something that all dilemmas have in common is that the associated decisions can have a lasting impact on relationships with stakeholders. This paper introduces four recurring dilemmas; shows the typical considerations; lists options for mitigating these dilemmas; and describes the basic requirements for implementing mitigations. The dilemmas and options, in turn, are rooted in the organisation-specific design of: cyber security incident management and response; IT service continuity and disaster recovery management; business continuity management; and crisis management and communication.

Mine the past: How to make better risk-based decisions and improve outcomes with historical threat data.

The impact of every crisis has the potential to cascade throughout an organisation's operations, supply chain and market ecosystem. To properly understand and mitigate this ripple of dynamic risk, business continuity, security and risk management leaders need to know where to focus their attention. Looking at historical threat data provides a clearer picture of the risk landscape, helping leaders better anticipate and plan for the future. To date, however, there have been challenges in this process. As the volume of data about critical events continues to grow at an alarming rate, sifting manually through data puts organisations - and business continuity - in jeopardy. This paper discusses the value of historical threat data and innovations in data-mining technology that can unlock the true power of historical data for informed, strategic decision-making and better outcomes during a crisis.

Management of adverse events in a Moroccan regional hospital: a state of art and perspectives.

Introduction: the risk management system is useful to identify, analyze, and reduce the risk occurrence of adverse events (AEs) in health services. This system suggests useful improvements to patients and to the whole institution and also contributes to the acquisition of a collective and organizational safety culture. This study presented a state of the art of the management of AEs identified in different services of a regional hospital in the north of Morocco. Methods: this is a retrospective cross-sectional exploratory study carried out from 2017 to 2019 using observations and semi-structured interviews, which were recorded, re-transcribed, and analyzed. Data was also collected from audit reports, results of investigations of the nosocomial infection control committee and the risk management commission, AEs declaration sheets, and meetings reports. Results: a number of 83 AEs were recorded, 10 of which were urgent. The reported events were related to care, infection risk, the drugs circuit, and medico-technical events. Two hundred cases of nosocomial infections were also recorded, of which 75 occurred in the intensive care unit and 35 in the maternity service. Surgical site infections were the most frequently reported complication. Adverse events were related to organizational failure, equipment problems, and errors related to professional practices. Conclusion: our findings may guide the improvement of the event management system in order to reduce the occurrence of future incidents. Thus, improving the risk management system requires setting up training strategies for staff on the importance of this system and its mode of operation.

[Interlevel incident management: The experience of a primary care district]. / Gestión de incidencias interniveles. La experiencia de un distrito de atención primaria.

AIM: Determine the prevalence and define the profile of interlevel incidences (ININ) between primary care (PC) and hospital (HC). DESIGN: Multicenter cross-sectional descriptive study. SITE: Primary care. PARTICIPANTS: Professionals from a Health District and its reference hospitals. INTERVENTIONS: ININ are errors in communication between PC and HC professionals derived from administrative, pharmaceutical or clinical procedures not resolved during the formal interlevel communication processes, which requires a coordinated and validated response from the health care directions to not overload the family physician. MAIN MEASUREMENTS: ININ by category, hospital services and health centers, total and validated, relative to the total number of referrals, and the reason for the ININ. RESULTS: We detected 2011 ININs (3.36%) among the 59.859 referrals, although only 1684 were validated (83.7%). Most were administrative (59.5%), followed by pharmaceutical (24.2%), clinical (10.2%) and reverse (6.1%). 41.3% of the clinical ININs were grouped around 5 hospital specialties, and 45.9% in 5 health centers. The main reasons for clinical ININ were non-prescription of the recommended pharmacological treatment in outpatient clinics or on hospital discharge (27.3%), request for referral to another hospital specialist (27.9%), or request to referral in person to patients who had already been referred by teleconsultation (17.8%). CONCLUSIONS: 3.36% of interlevel referrals are accompanied by incidents and 83.7% are validated and processed. It is necessary to develop ININ management tools to guarantee safe healthcare and debureaucratize PC.

Contribuições do núcleo interno de regulação para a segurança do paciente / Contributions of the regulatory inner core to patient safety / Aportes del núcleo interno normativo para la seguridad del paciente

Objetivo: identificar as contribuições do Núcleo Interno de Regulação para a segurança do paciente. Método: pesquisa qualitativa desenvolvida entre agosto a outubro de 2020. Foram realizadas entrevistas audiogravadas junto a 13 profissionais que atuavam nas enfermarias, no pronto-socorro, na gestão da qualidade e no Núcleo Interno de Regulação. Os dados foram analisados com o auxílio do software IraMuteq® e as etapas propostas por Creswell. Resultados: os achados revelaram que o Núcleo Interno de Regulação contribui para a segurança do paciente, entornando as metas instituídas: comunicação efetiva; identificação do paciente; redução do risco de infecções associadas aos cuidados em saúde - a pandemia de COVID-19 foi apresentada como um importante dado; segurança para cirurgia, uma vez que agiliza o acesso ao hospital para procedimento cirúrgico; e diminuição de filas de espera. Ainda, contribui para prevenir complicações decorrentes de quedas, pois o paciente pode ser alocado com agilidade num leito seguro. Por fim, o enfermeiro, no seu papel de liderança do serviço e como elo para a gerência do cuidado seguro, também se mostrou importante. Conclusão: embora algumas fragilidades tenham sido detectadas, a contribuição do Núcleo Interno de Regulação se sobressai por fortalecer as metas da segurança do paciente. Em razão disso, reafirma-se a importância de fluxos regulatórios na perspectiva de gestão de leitos hospitalares, assim como os preceitos da segurança do paciente almejada pelos gestores. Não obstante, o enfermeiro atua como elo entre esses dois cenários.(AU)

Objective: to identify the contributions of the Internal Regulation Core to patient safety. Method: qualitative research carried out between August and October 2020. Audio-recorded interviews were carried out with 13 professionals who worked in the wards, in the emergency room, in quality management and in the Internal Regulation Center. Data were analyzed using the IraMuteq® software and the steps proposed by Creswell. Results: the findings revealed that the Internal Regulation Nucleus contributes to patient safety, bypassing the established goals: effective communication; patient identification; reduction in the risk of infections associated with health care - the COVID-19 pandemic was presented as an important fact; safety for surgery, as it speeds up access to the hospital for a surgical procedure; and reduction of queues. It also helps to prevent complications resulting from falls, as the patient can be quickly allocated to a safe bed. Finally, the nurse, in his role as a leader in the service and as a link in the management of safe care, also proved to be important. Conclusion: although some weaknesses were detected, the contribution of the Internal Regulation Center stands out for strengthening patient safety goals. As a result, the importance of regulatory flows from the perspective of hospital bed management is reaffirmed, as well as the precepts of patient safety desired by managers. Nevertheless, the nurse acts as a link between these two scenarios.(AU)

Objetivo: identificar los aportes del Núcleo Interno Normativo para la seguridad del paciente. Método: investigación cualitativa desarrollada de agosto a octubre de 2020. Se realizaron entrevistas audiograbadas a 13 profesionales que trabajaban en las salas, en el servicio de urgencias, en la Gestión de Calidad y en el Núcleo Interno Normativo. Los datos fueron analizados con la ayuda del software IraMuteq® y los pasos propuestos por Creswell. Resultados: los hallazgos revelaron que el Núcleo Interno Normativo contribuye a la seguridad del paciente, desbordando los objetivos establecidos: comunicación eficaz; identificación del paciente; reducción del riesgo de infecciones asociadas a la asistencia sanitaria - la pandemia COVID-19 se presentó como un dato importante; en la seguridad para la cirugía, ya que agiliza el acceso al hospital para procedimientos quirúrgicos y, en la reducción de las colas de espera. También contribuye a la prevención de complicaciones derivadas de caídas, ya que el paciente puede ser ubicado rápidamente en una cama segura. Y, finalmente, el enfermero, en su papel de líder en el servicio, como enlace en la gestión del cuidado seguro, también resultó ser un resultado importante. Conclusión: aunque se detectaron algunas debilidades, se destaca la contribución del Núcleo Interno Normativo en el fortalecimiento de las metas de seguridad del paciente. Como resultado, reafirma la importancia de los flujos normativos desde la perspectiva de la gestión de camas hospitalarias, así como los preceptos de seguridad del paciente deseados por los gestores. Sin embargo, la enfermera actúa como enlace entre estos dos escenarios.(AU)

Evaluación del riesgo biológico en la producción de vacunas inactivadas de uso animal / Biological risk assessment for the production of inactivated vaccines for animal use

La vacunación continúa siendo una de las vías más sostenibles y utilizadas en el control de enfermedades infectocontagiosas en medicina veterinaria, dado por su mayor factibilidad económica y por el problema que representa el residuo de antibióticos en productos animales de consumo humano. El surgimiento de vacunas de nuevas generaciones ha motivado la instrumentación de medidas de bioseguridad y la necesidad de realizar estudios de evaluaciones de los riesgos que acometemos en la obtención y producción de vacunas, existiendo puntos críticos importantes en el proceso de obtención de las mismas. El área de vacunas inactivadas que se encuentra ubicada en la Empresa Productora de Vacunas Virales y Bacterianas UP-7, perteneciente al grupo empresarial LABIOFAM de La Habana, Cuba, se encarga de la producción y control de la calidad de las vacunas y los medios diagnósticos. Las inspecciones previas realizadas a dicha área mostraron, en el personal involucrado, desconocimiento y baja percepción del riesgo biológico existente en los procesos productivos que allí se llevan a cabo, lo que sugirió la realización de la presente investigación. Se identificaron y caracterizaron los peligros y se realizó una evaluación del riesgo, utilizando una matriz de estimación del riesgo; mediante un método cualitativo de posibilidad de ocurrencia del peligro y se evaluó de bajo, moderado o alto. Se identificaron las vulnerabilidades presentes empleando para ello una lista de chequeo, detectándose, entre otras, aquellas relacionadas con el diseño del área, con el tratamiento de los desechos y la organización de la bioseguridad, lo que confirmó puntos críticos dentro del proceso productivo con riesgo alto y moderado(AU)

Vaccination continues being one of the most sustainable and used ways in the control of infectious and contagious diseases in veterinary medicine because of both its greater economic feasibility and thwarting animal products from having antibiotics residues, a big-time issue for human ingestion. The appearance of new generation vaccines has motivated the application of biosafety measures and the need to carry out studies of risk assessments that we undertake to obtaining and producing vaccines, being important critical points in the process of acquiring them. The inactivated vaccines' area is located in the UP-7 Viral and Bacterial Vaccine Production Company, belonging to LABIOFAM business group in Havana, Cuba; this area is responsible for vaccines, diagnostic means production and quality control. Previous checkups carried out showed that the personnel involved had lack of knowledge and low perception of the existing biological risk in the productive processes carried out there; leading to suggest the investigation. Hazards were identified and characterized and a risk assessment was carried out, using a qualitative estimate risk matrix. Such hazards were assessed as low, moderate or high. Vulnerabilities were identified using a checklist to this purpose, detecting those related to area design, treatment of waste and the biosafety organization, which established the existence of critical points within the production process with high and moderate risk(AU)

Capacitación del manejo clínico de casos de infección por coronavirus COVID-19 / Training in the clinical management of cases of coronavirus infection COVID-19

Fecha de actualización: 22 de mayo 2020. Actualizar a los profesionales de pediatría, Medicina Interna, Gineco obstetricia, personal de enfermería, de laboratorio y el comité de gestión de riesgo en el manejo clínico de casos del nuevo coronavirus COVID-19.

Comunicação efetiva para a segurança do paciente: nota de transferência e Modified Early Warning Score / Comunicación efectiva para la seguridad del paciente: nota de transferencia y Modified Early Warning Score / Effective communication for patient safety: transfer note and Modified Early Warning Score

Resumo OBJETIVO Analisar o registro da Nota de Transferência (NT) e a emissão do Modified Early Warning Score (MEWS) realizados pelo enfermeiro em pacientes adultos transferidos do Serviço de Emergência como estratégia de comunicação efetiva para a segurança do paciente. MÉTODO Estudo transversal retrospectivo desenvolvido em um hospital de ensino no Sul do Brasil que avaliou 8028 prontuários eletrônicos no ano de 2017. Procedeu-se a análise descritiva. RESULTADOS A realização da NT atingiu a meta institucional de 95% nos meses de janeiro e fevereiro, ficando abaixo da meta nos demais meses. A mensuração do MEWS foi realizada em 85,6% (n=6.870) dos prontuários. Destes pacientes, 96,8% (n=6.652) possuíam MEWS não alterado. CONCLUSÃO A NT e o MEWS estão inseridos no trabalho do enfermeiro, no entanto, são necessárias ações com vistas a qualificar a segurança do paciente, melhorando a comunicação efetiva e, por conseguinte, diminuindo a possibilidade de ocorrências de eventos adversos.

Resumen OBJETIVO Analizar el registro, realizado por el enfermero, la Nota de Transferencia (NT) y la emisión del Modified Early Warning Score (MEWS) en pacientes adultos transferidos del Servicio de Emergencia como estrategia de comunicación efectiva para la seguridad del paciente. MÉTODO Estudio transversal retrospectivo desarrollado en un hospital de enseñanza en el sur de Brasil que evaluó 8028 históricos electrónicos en el año 2017. Se llevó a cabo el análisis descriptivo. RESULTADOS La realización de la NT alcanzó la meta institucional del 95% en los meses de enero y febrero, quedando por debajo de la meta en los demás meses. La medición del MEWS se realizó en el 85,6% (n = 6.870) de los históricos. De estos pacientes, el 96,8% (n = 6.652) poseía MEWS no alterado. CONCLUSIÓN La NT y el MEWS están insertos en el trabajo del enfermero, sin embargo es necesario acciones con miras a calificar la seguridad del paciente, para mejor la comunicación efectiva y, por consiguiente, disminuir la posibilidad de ocurrencia de eventos adversos.

Abstract OBJECTIVE To analyze the registry of the Transfer Note (NT) and the emission of the Modified Early Warning Score (MEWS) performed by the nurse in adult patients transferred from the Emergency Service as an effective communication strategy for patient safety. METHOD A cross-sectional retrospective study developed at a teaching hospital in the South of Brazil that evaluated 8028 electronic medical records in the year 2017. A descriptive analysis was performed. RESULTS NT reached the institutional target of 95% in January and February, falling below the target in other months. The MEWS measurement was performed in 85.6% (n = 6,870) of the medical records. Of these patients, 96.8% (n = 6,652) had unchanged MEWS. CONCLUSION NT and MEWS are inserted in the work of the nurse, however, actions are needed to qualify patient safety, improving effective communication and therefore reducing the possibility of occurrence of adverse events.

Notificação de eventos adversos: caracterização dos eventos ocorridos em um complexo hospitalar / Notificación de eventos adversos: caracterización de los eventos ocurridos en un complejo hospitalario / Notifications of adverse events: characterization of the events that occurred in a hospital complex

Resumo OBJETIVO Analisar as notificações de incidentes relacionados à segurança do paciente. MÉTODOS Estudo transversal com abordagem quantitativa, baseado nos dados do Gerenciamento de Risco de um complexo hospitalar, localizado no noroeste paulista, de agosto/2015 a julho/2016. RESULTADOS Foram analisadas 4.691 notificações. O enfermeiro foi a categoria profissional que mais notificou (71%), seguido do médico (8%). O período mais frequente em que ocorreram as notificações foi o diurno. Houve diferença significativa da proporção de notificações entre os dias da semana. As notificações foram classificadas por motivo, com destaque para os medicamentos (17%), seguido de lesões de pele (15%) e flebite (14%). A maior frequência de notificações ocorreu nas unidades de Internação. Quanto à gravidade 344 eventos ocasionaram dano ao paciente, sendo a maioria de intensidade leve (65%). CONCLUSÃO As notificações espontâneas são uma importante fonte de informações e evidenciam a magnitude do problema relacionado aos incidentes em saúde.

Resumen OBJETIVO Analizar las notificaciones de incidentes relacionados con la seguridad del paciente. MÉTODOS Estudio transversal con abordaje cuantitativo, basado en los datos del Gestión de Riesgos de un complejo hospitalario, ubicado em el noroeste paulista, de agosto de 2015 a julio de 2016. RESULTADOS Se analizaron 4.691 notificaciones. El enfermero fue la categoría profesional que más notificó (71%), seguido del médico (8%). El período más frecuente en que ocurrieron las notificaciones fue el diurno. Hubo una diferencia significativa de la proporción de notificaciones entre los días de la semana. Las notificaciones se clasificaron por motivo, con destaque para los medicamentos (17%), seguido de lesiones de piel (15%), flebitis (14%). La mayor frecuencia de notificaciones ocurrió en las unidades de Internación. En cuanto a la gravedad 344 eventos ocasionaron daño al paciente, siendo la mayoría de intensidad leve (65%). CONCLUSIÓN Las notificaciones espontáneas son una importante fuente de información, y evidencia la magnitud del problema relacionado con los incidentes en salud.

Abstract OBJECTIVE Analyze incident notifications related to the patient's safety. METHOD Cross-sectional study with quantitative approach, based on data from the risk Management of a hospital complex, located in northwest São Paulo, from August 2015 to July 2016. RESULTS 4,691 notifications were analyzed. Nurses were the professionals who notified the most (71%), followed by physicians (8%). The most frequent period in which the notifications occurred was the daytime. There was significant difference in the proportion of notifications between the days of the week. The notifications were classified by reason and the most prevalent were those related to medication (17%), followed by skin lesions (15%), and phlebitis (14%). The highest frequency of notifications occurred in the hospitalization units. In relation to severity, 344 events caused damage to the patient, most of which were of mild intensity (65%). CONCLUSION Spontaneous notifications are an important source of information, and highlight the magnitude of the problem related to health incidents.

Estructura de plan de continuidad operativa bajo el enfoque de la gestión de riesgo de desastres en empresas de saneamiento de agua / Structure of business continuity plan under the approach of disaster risk management in public water companies

Resumen: En el marco del Sistema Nacional de Gestión de Riesgos de Desastres, el Estado Peruano ha establecido la necesidad de desarrollar la Gestión de la Continuidad Operativa en todos los niveles de gobierno. A partir de ello, nace la obligación que las entidades públicas deban elaborar Planes de Continuidad Operativa; sin embargo, no se cuenta con referencias documentarias ni técnicas que permitan servir de información de entrada para dichos planes. Actualmente, existe abundante normativa técnicas e investigaciones que desarrollan la continuidad operativa (continuidad de negocio) bajo el enfoque de las tecnologías de la información. La presente investigación consistió en la revisión de documentación normativa, técnica y de benchmark (modelos empresariales) con el propósito de diseñar la estructura modelo que debería comprender un Plan de Continuidad Operativa. Dicha estructura modelo fue implementada en una empresa de ser vicios de saneamiento, permitiéndole abordar las amenazas de riesgo operativo en los macroprocesos y procesos de Nivel 1 considerados como prioritarios.

Abstract: According to the National Disaster Risk Management System, the Peruvian State has established the need to develop the Business Continuity Management at all levels of government. From this, the obligation that the public entities must elaborate Business Continuity Plans is born; however, there are no documentary references or techniques that can serve as input information for these plans. Currently, there are abundant technical regulations and investiga tions that develop business continuity under the focus of informa tion technologies. The present investigation consisted in the revision of normative, technical and benchmark documentation with the purpose of design ing the model structure that should comprise an Operational Continuity Plan. This model structure was implemented in a public water company, allowing it to address the operational risk threats in the macro processes and processes Level 1.

Implementación de la gestión de riesgo en los procesos misionales de la Sección de Dermatología de la Universidad de Antioquia (Medellín, Colombia) siguiendo las directrices de la norma ISO 9001: 2015 / Implementation of Risk Management in the Mission Processes of the Dermatology Section of the Universidad de Antioquia (Medellín, Colombia) Following the ISO 9001: 2015 Guidelines / Implementação de gestão de risco em processos missionais da Seção de Dermatologia da Universidade de Antioquia (Medellín, Colômbia) seguindo diretrizes da norma ISO 9001: 2015

Resumen La gestión de riesgos en los servicios de atención en salud es un proceso que considera la planeación y aplicación de estrategias orientadas a controlar posibles efectos adversos que surjan durante la atención a los usuarios, la calidad en el servicio y la seguridad del paciente. En el presente artículo se reporta el desarrollo del sistema de gestión del riesgo de los procesos misionales de la Sección de Dermatología de la Universidad de Antioquia, así como los principales resultados obtenidos a la fecha y la manera como el Sistema de Gestión de Calidad bajo la norma ISO 9001 sirvió de complemento y apoyo al sistema de gestión del riesgo implementado. Se identificaron cinco riesgos inherentes para el Laboratorio de Dermatopatología, seis para Otros Procesos Dermatológicos y ocho para la Unidad de Fotodermatología, los cuales fueron analizados y evaluados, luego de lo cual se implementaron los controles pertinentes.

Abstract Risk management in health care services is a process that takes into account the planning and implementation of strategies aimed at controlling possible adverse effects that arise during the attention to users, quality of service, and patient safety. This article reports on the development of the risk management system for the mission processes of the Dermatology Section of the Universidad de Antioquia, as well as on the main results obtained to date and the way in which the Quality Management System (under the ISO 9001 standard) worked as a complement and support to the implemented risk management system. Five inherent risks were identified for the Dermatopathology Laboratory, six for Other Dermatological Procedures, and eight for the Photodermatology Unit, all of which were analyzed and evaluated; the relevant controls were implemented afterwards.

Resumo A gestão de riscos nos serviços de atenção em saúde é um processo que considera o planejamento e aplicação de estratégias orientadas a controlar possíveis efeitos adversos que surgirem durante o atendimento a utentes, a qualidade no serviço e a segurança do paciente. No presente artigo relata-se o desenvolvimento do sistema de gestão de riscos dos processos missionais da Seção de Dermatologia da Universidade de Antioquia, bem como os principais resultados obtidos a hoje e a maneira como o Sistema de Gestão de Qualidade sob a norma ISO 9001 serviu de complemento e apoio ao sistema de gestão do risco implementado. Cinco riscos inerentes ao Laboratório de Dermatopatologia foram identificados, seis para outros Processos Dermatológicos e oito para a Unidade de Fotodermatologia, os quais foram analisados e avaliados, após disso implementaram-se os controles pertinentes.

Determinar el riesgo médico-legal de la historia clínica mediante la aplicación de un Score / DETERMINATION OF THE THE MEDICO-LEGAL RISK IN THE CLINICAL HISTORY WITH THE APPLICATION OF A SCORE

El objetivo de este trabajo es identificar aquellas variables previamente definidas -indicios que podrían ser elevados al rango de prueba- en las propias historias clínicas confeccionadas, y establecer preventivamente un score de riesgo médicolegal, por lo que un profesional o una institución entonces, podrán así determinar y categorizar entonces el riesgo médicolegal en el propio documento médico

The objective of this paper is to identify some previously defined variables ­ legal indications that could be raised to the legal proof ­ at the medical reports themselves, and to establish preventively a medical legal risk score, so that a professional or an Institution can then determine and categorize the medical-legal risk in the medical document itself