La mejora continua y la formación de médicos en la Facultad "Manuel Fajardo" de La Habana / Continuous improvement and physician formation in Manuel Fajardo School of Medical Sciences of Havana

Introducción: El proceso de mejora continua constituye hoy la piedra angular de los esfuerzos para gestionar la calidad en la formación de los profesionales. Objetivo : Evaluar el estado actual de la Facultad "Manuel Fajardo" para el desarrollo del proceso de autoevaluación de la carrera de Medicina con fines de mejora continua. Métodos: El grupo de estudio estuvo integrado por 57 profesores y 143 estudiantes de primero hasta sexto años en el período enero-marzo de 2020. Se seleccionó, para los estudiantes, una muestra estratificada por conglomerado; y para los profesores, una estratificada simple. Además, se realizó una investigación observacional, descriptiva, de corte transversal. Resultados: La calidad del proceso de formación tuvo una percepción diferente entre profesores y estudiantes. Más del 20 por ciento de los encuestados consideró como no satisfactoria la preparación del personal no docente y administrativo, y su incidencia en la formación del profesional; acerca de la organización docente, estos la valoraron en más del 30 por ciento como no satisfactoria. Casi el 30 por ciento de los profesores manifestó como medianamente satisfactoria o insatisfactoria la actividad investigativa y laboral de los estudiantes; y más del 20 por ciento de los estudiantes estimó que había dificultades en la aplicación de las estrategias curriculares. Conclusiones: Se constataron insuficiencias que limitaban el continuo desarrollo del proceso de formación(AU)

Introduction: The continuous improvement process is nowadays the cornerstone of efforts made to manage quality in the training of professionals. Objective: To assess the current state of Manuel Fajardo School of Medical Sciences regarding the development of the self-evaluation process in the medical major for the purpose of continuous improvement. Methods: The study group consisted of 57 professors and 143 students from first to sixth academic years, in the period from January to March 2020. A sample stratified by cluster was selected for the students; while, for teachers, the sample was chosen by simple stratification. In addition, an observational, descriptive and cross-sectional research was carried out. Results: The quality of the training process had a different perception between professors and students. More than 20 percent of the respondents considered as unsatisfactory the preparation of nonteaching and administrative personnel and its impact on professional training. Regarding organization of teaching, more than 30 percent rated it as unsatisfactory. Almost 30 percent of the professors stated that research and work activity of the students was moderately satisfactory or unsatisfactory, while more than 20 percent of the students estimated that there were difficulties in the application of curricular strategies. Conclusions: Insufficiencies were found that limited the continuous development of the training process(AU)

Calidad de atención y mejora continua en el abordaje integral del cáncer de mama: Evaluación de indicadores en una Unidad de Mastología / Quality of care and continous improvement in a comprehensive approach of breast cancer management: evaluation of indicators in a breast center

Introducción: las Unidades de Mastología son organizaciones que tienen por objetivo abordar la patología mamaria de manera multidisciplinaria e integral. A nivel mundial se han implementado programas para evaluar la calidad de atención a través del cumplimiento de indicadores propuestos por Sociedades Científicas u organismos gubernamentales. Algunos de estos han sido propuestos y revisados por la Sociedad Europea de Mastología (EUSOMA). Objetivo: evaluar la calidad de atención de la Unidad de Mastología del Hospital Juan A. Fernández a través del análisis de una serie de indicadores propuestos por EUSOMA como estándares de calidad de atención en centros de patología mamaria. Material y método: estudio descriptivo retrospectivo analizando la base de datos de las pacientes con cáncer de mama estadios 0 a III operadas entre 2015 y 2019. Se analizaron 25 indicadores de procesos propuestos por EUSOMA en 2017. Se registraron las características de la población, y el porcentaje de pacientes en las cuales se cumple la condición de cada uno de los indicadores. Se registró si el indicador alcanza o supera el mínimo estándar, o si alcanza o supera el valor ideal. Resultados: se evaluaron 284 pacientes. Se observó el cumplimiento de la mayoría de los estándares propuestos (18 de 25), alcanzando o superando en el 25% de los indicadores evaluados el valor ideal. Se lograron alcanzar los estándares de calidad de atención relacionados con el diagnóstico clínico y preoperatorio, caracterización anatomopatológica completa en carcinoma invasor, evaluación multidisciplinaria, tratamiento quirúrgico primario en carcinoma invasor e in situ. Se alcanzaron los objetivos tendientes a evitar el sobretratamiento quirúrgico en carcinoma invasor y en cirugía conservadora en carcinoma in situ. En relación a los tratamientos adyuvantes, se alcanzaron los estándares relacionados con radioterapia post cirugía conservadora y post mastectomía, así como también el tratamiento con hormonoterapia y quimioterapia. El seguimiento de los pacientes se realizó en tiempo en tiempo y forma de acuerdo al indicador establecido. Existen 3 indicadores de calidad obligatorios en los que no se alcanzó el estándar mínimo: se observó la necesidad de mejorar la accesibilidad a los tratamientos antiHer2neu en neoadyuvancia, y de reducir los tiempos de espera al inicio del tratamiento. Conclusiones: se observó el cumplimiento de la mayoría de los estándares propuestos. Dado que existen indicadores obligatorios en los que no se alcanzó el estándar mínimo, los esfuerzos primarios deberán centrarse prioritaria e inicialmente en diseñar una planificación que permita alcanzar estos objetivos, así como también mantener en el tiempo los valores positivos ya alcanzados. Se pone de manifiesto la necesidad de implementar políticas a nivel sanitario nacional que permitan mejorar la accesibilidad a medicación oncológica. A su vez, destacamos la importancia de definir indicadores propios con valores ajustados a las características de nuestro país y mantener una evaluación periódica de la calidad de atención a través de los mismos.

Introduction: Breast Units are organizations that manage Breast Cancer in a comprehensive and multidisciplinary approach. Worlwide, programs have been developed in order to evaluate quality of care through the achievement of certain standards of care that have been proposed by scientific organizations, medical associations or government health departments. Some of these indicators have beeb proposed by the European Society of Breast Cancer Specialist (EUSOMA). Objective: to evaluate quality of care in the Breast Unit at Hospital Juan A Fernández (Buenos Aires, Argentina) through the analysis of a series of indicators described by EUSOMA as standard of care in breast centers. Material and method: we performed a descriptive, retrospective analysis of our database including patients with breast cancer stage 0 to III that wer treated between 2015 and 2019. We studied 25 quality of care process indicators proposed by EUSOMA in 2017. We registered population characteristics and the percentage of patients in which each indicator mínimum requirements were achieved. We also studied whether our results achieved or were beyond the ideal targets for each indicator. Results: a total of 284 patients were evaluated. The mínimum standard of care was achieved in most of the evaluated indicators (18 of 25) and in 25% of these, our results achieved or exce3ded the ideal requirements. The indicators in which the mínimum or ideal standard of care was accomplished were regarding clinical and preoperative diagnosis anatomopathological characterisation in invasive breast cancer, multidisciplinary approach, primary surgical management in invasive and in situ breast cancer, avoidanc of overtreatement in invasive breast cancer and breast conserving therapy in carcinoma in situ. Regarding adjuvant treatment, the standard of care was achieved in radiotherapy after breast conserving surgery and after mastectomy, endocrine therapy and chemotherapy. The follow up timing was according to the indicator. There were 3 mandatory indicators in which the mínimum standards were not achieved and were regarding accesibility to anti Her2neu agents in neoadjuvant setting, and timing form diagnosis to firts treatment. Conclusions: we observed that out Breast Unit achieved most of the quality of care indicators described by EUSOMA. However, there 3 mandatory indicators where the results were below the mínimum. This is why future efforts should be focused on designing and planning new measures that will allow these objectives to be accomplished, as well as maintaining what has already been achived. Our results also show the imperious need to implement national public health pólices that would grant a better accesiblility to oncologic medications. We also analysed the importance of defining our own local quality of care indicators in relation to our health policies and current situation, as well as the importance of a continuous evaluation of quality of care through these indicators.

Study on continuous improvement of clinical application of evidence-based practice program of physical restraint in ICU patients / 中国实用护理杂志

Objective:To understand the current status of the evidence-based practice program of physical restraint in ICU patients and analyze its influencing factors, formulate and implement an action plan for continuous application of the program, so as to improve the knowledge level and evidence-based nursing ability of nurses, promote the improvement of patient outcomes, and strengthen the organization′s evidence-based cultural atmosphere.Methods:This study selected the program application departments of China Japan Friendship Hospital Surgical ICU as the research object, including all nurses, patients, nursing process, department standard system, etc. To understand the status and influencing factors of the project through observation and interview methods. The "Optimized Version of Evidence-based Practice Program of Physical Restraint in ICU Patients" was formulated and implemented, and a before-and-after comparative study method was used to comprehensively evaluate the implementation effect from the level of patients, nurses and organization.Results:The implementation rate of the 7 review standards of the program application department showed a downward trend; the patient restraint rate and restraint duration increased compared with the previous period; after the implementation of the optimized version program, the implementation of each item had been improved; the physical restraint rate decreased from 34.91% (37/106) before optimization to 28.57% (8/28) ( χ 2 value was 0.40, P>0.05), and the time of physical restraint decreased from 60.93 hours before optimization to 48.09 hours after optimization ( Z value was -0.19, P>0.05). Conclusions:The continuous application of the evidence-based practice project of physical restraint in ICU patients was not very optimistic. The continuity of implementation was affected by many factors. The continuous quality improvement of this evidence-based practice project can promote the improvement of the standard of physical restraint of patients, improve the quality of life of patients, promote the improvement of nurses' knowledge level and the improvement of evidence-based nursing ability; at the same time, it created a better organization′s evidence-based cultural atmosphere.

Programa de Evaluación Externa de la Calidad "Prof. Dr. Daniel Mazziotta": una nueva etapa asegurando la mejora continua de la calidad / External Quality Assessment Program "Prof. Dr. Daniel Mazziotta ": a new stage ensuring continuous quality improvement

Las determinaciones de los laboratorios clínicos tienen un papel muy importante en la evaluación, diagnóstico, tratamiento y evolución del estado de salud de las personas. La confiabilidad de sus resultados se logra a través del aseguramiento de la calidad y mejora continua. El Programa de Evaluación Externa de la Calidad "Prof. Dr. Daniel Mazziotta" acompaña a los laboratorios de análisis clínicos desde hace 31 años brindando distintas herramientas para garantizar la calidad analítica. Ofrece los servicios de evaluación externa de la calidad, suministro de material para control de calidad interno para determinaciones en Química Clínica y soluciones para control de instrumental y pruebas de suficiencia. Desde la creación del programa se establecieron objetivos estratégicos a desarrollarse en tres etapas: establecimiento, consolidación y apoyo a la gestión de la calidad. Se genera ahora una nueva etapa, cuyo objetivo final es la acreditación. Como primer paso de este ciclo, se implementó un sistema de gestión de la calidad (SGC) de acuerdo a los requisitos establecidos en la norma argentina IRAM-ISO 9001:2015. En agosto de 2019, el Instituto Argentino de Normalización y Certificación (IRAM), representante en Argentina de la International Organization for Standarization (ISO), certificó que el SGC del programa cumple lo establecido en dicha norma. Su aplicación tiene como objetivo asegurar que los servicios ofrecidos satisfagan las necesidades de los laboratorios clínicos cumpliendo los requisitos legales requeridos y asegurando la mejora continua. El objetivo de este trabajo fue describir las acciones realizadas en la implementación del SGC y la posterior certificación de IRAM-ISO 9001:2015, por el IRAM.

Clinical laboratory determinations have a very important role in the evaluation, diagnosis, treatment and evolution of the health status of people. The reliability of their results is achieved through quality assurance and continuous improvement. The External Quality Assessment Programme Prof. Dr. Daniel Mazziotta has been accompanying clinical analysis laboratories for 31 years offering different tools to ensure analytical quality. It provides the services of external quality assessment, supply of material for internal quality control for determinations in Clinical Chemistry and solutions for instrumental control and sufficiency tests. Since the creation of the program, strategic objectives have been established to be developed in three stages: establishment, consolidation and support for quality management. A new stage is now being generated, whose final objective is accreditation. As a first step of this cycle, a quality management system (QMS) was implemented according to the requirements established in the IRAM Argentina standard-ISO 9001:2015. In August 2019, the Argentine Institute for Standardization and Certification (IRAM), representative in Argentina of the International Organization for Standardization (ISO), certified that the Programme's QMS complies with the provisions of said standard. Its application aims to ensure that the services offered meet the needs of clinical laboratories by fulfilling the legal requirements and ensuring continuous improvement. The objective of this work is to describe the actions carried out in the implementation of the QMS and the subsequent IRAM-ISO 9001: 2015 certification by the IRAM.

As determinações laboratoriais clínicas têm um papel muito importante na avaliação, diagnóstico, tratamento e evolução do estado de saúde das pessoas. A confiabilidade de seus resultados é alcançada através da garantia de qualidade e melhoria contínua. O Programa de Avaliação da Qualidade Externa "Prof. Dr. Daniel Mazziotta" apoia os laboratórios de análises clínicas há 31 anos, oferecendo diferentes ferramentas para garantir a qualidade analítica. Oferece os serviços de: avaliação externa de qualidade, fornecimento de material de controle interno de qualidade para determinações em Química Clínica e soluções para controle instrumental e testes de suficiência. Desde a criação do programa, os objetivos estratégicos foram estabelecidos para serem desenvolvidos em três etapas: estabelecimento, consolidação e suporte para a gestão da qualidade. Uma nova etapa é agora gerada, cujo objetivo final é a Acreditação. Como primeira etapa desse ciclo, um sistema de gestão da qualidade (SGQ) foi implementado de acordo com os requisitos estabelecidos na norma IRAM Argentina - ISO 9001:2015. Em agosto de 2019, o Instituto Argentino de Normalização e Certificação (IRAM), representante na Argentina da Organização Internacional de Normalização (ISO), certificou que o SGC do programa está em conformidade com as disposições da referida norma. Sua aplicação visa garantir que os serviços oferecidos satisfaçam as necessidades dos laboratórios clínicos, atendendo aos requisitos legais exigidos e garantindo a melhoria contínua. O objetivo deste trabalho é descrever as ações realizadas na implementação do SGQ e a subsequente certificação da IRAM-ISO 9001:2015, pela IRAM.

Study on venous thromboembolism control system based on clinical decision support system / 中华医院管理杂志

Venous thromboembolism ( VTE) is characteristic of high incidence and fatality rate, forming a severe challenge for medical quality management by hospitals and urgently calling for a long-term management mechanism of VTE prevention and treatment. To tackle this problem, the hospital has built a VTE-oriented clinical decision support system, with optimized information platform for the control. The system features automatic scoring of Caprini evaluation model and suggestion of VTE control measures, green ultrasonography channel for VTE high risk patients, and a refined evaluation system. The establishment of an IT control information system has improved VTE awareness and diagnosis level of clinicians. This system can keep track of the risk of VTE occurrence dynamically, significantly improving the number of diagnosed cases and treatment rate, effectively reducing inpatients′ VTE incidence and mortality, and improving quality of care in the end.

Reform and effects on administrative ward rounds at hospitals / 中华医院管理杂志

The study is to establish the administrative ward round system and its effect evaluation system under the modern hospital management conditions, and explore the formation of a standardized, scientific and replicable standard mode of Administrative Ward round. According to the annual ward rounds plan, clinical departments and administrative departments were organized to decide the major issues of a department according to the procedures of " hearing-evaluation-discussion-decision " , and to ensure the implementation of management. Since 2016, administrative ward round has been carried out in 9 departments, and the medical quality and operational efficiency have been improved significantly. The closed-loop administrative ward rounds mode can effectively promote the modernization of hospital management system through the joint decision-making of clinical departments and functional departments.

Construction and consideration of hospital services continuous improvement based on patients ' experience / 中国基层医药

Patients' experience is the feeling of patients in the process of medical perception. This paper expounded the new concept based on the experience of patients with medical services,then reviewed the specific practices of improve services,which including three - dimensional registration service,process intensification,service public commitment, patients choose doctors in medico - technical departments, hospital president in outpatient. Finally,the article proposed that patients' experience should be based on patients' evaluation,have " love" heart, exceed customers' expectation and build patients' experience culture.

Risk management of medical equipment clinical trial / 医疗卫生装备

Objective To propose a set of management methods for minimized risk and continuous improvement of medical equipment clinical trial.Methods The problems were summarized on pre-trial preparation,design and signing of informed consent,insurance-related issues,supervision and quality control,perception of adverse events,and then some countermeas-ures were put forward accordingly.Results A risk management system was established for medical equipment clinical trial whole-course management.Conclusion Planning,recognition and evaluation have to be implemented over all the links of medical equipment clinical trial risk management,and corresponding countermeasures should be carried out for minimized risk and continuous improvement.

Status analysis of 15 quality indicators at clinical laboratorieis of 8029 medical institutions in China / 中华医院管理杂志

Objective To investigate the 15 quality indicators at medical institutions in China , and to explore the model of quality specifications .Methods Online questionnaires were sent to 8029 clinical laboratories ,with the results analyzed by SPSS 20 .The 25th percentile ,50th percentile ,and 75th percentile of the distribution ,according to the level of the hospital ,were regarded as the optimum , appropriate and minimum quality specifications for each quality indicator ,respectively .Results As shown in the median ,sigma values of most indicators were greater than 3 .The defect percentages of test uncovered by internal quality control (IQC)and test uncovered by inter-laboratory comparison were 47.46％ and 85.73％ ,respectively ,both too poor to calculate the sigma values. The turnaround time (TAT )differed greatly among the subjects.The longest time of pre-examination TAt and Intra-laboratory TAT were clinical immunity. The minimum quality specifications for the quality indicators were from 3σ to 6σ.Conclusions Laboratories should strengthen their IQc and inter-laboratory comparison with continuing education training to realize the continuous quality improvement .

Gestión de los costos de la calidad en la Droguería de Holguín / Management of quality costs in the Drugstore of Holguín

Introducción: la gestión de los costos de la calidad, como destreza gerencial, constituye hoy la herramienta más poderosa para gestionar la calidad a través de resultados económicos satisfactorios y la búsqueda de oportunidades de mejora continua. Inmersa en la búsqueda de la mejora continua se encuentra la Droguería de Holguín, pero carece de un sistema de gestión de costos de la calidad. Objetivo: gestionar los costos de la calidad con enfoque de procesos, sistema, gestión y mejora continua en la Droguería de Holguín. Métodos: se desarrolló un procedimiento para la implementación de un sistema de gestión de costos de la calidad. El procedimiento fue validado por expertos y en su diseño combina el enfoque de sistema, gestión, mejora continua y procesos, a través de un software, herramientas para el control de su gestión y el benchmarking. Resultados: como resultado del procesamiento de los datos, se obtuvo que la entidad se encuentra en la zona de proyectos de mejora y el mayor impacto en los costos de la calidad es provocado por las cero coberturas y las devoluciones en venta. Conclusiones: por medio de la aplicación del procedimiento en la Droguería de Holguín, se pudo medir objetivamente en términos económicos el desempeño de la calidad en cada uno de los procesos identificados, la eficiencia del sistema de gestión de la calidad y el trazado acciones para la mejora continua de los costos de la calidad.

Introduction: managing the costs of quality, as managerial skills, is today the most powerful tool to manage quality through satisfactory economic results and the search for opportunities for continuous improvement. The Holguín Drugstore is immersed in the search for continuous improvement, but lacks a cost management system for quality. Objective: to manage the quality costs with a focus on processes, system, management and continuous improvement at Holguin Drugstore. Methods: a procedure was developed for the implementation of a management system of quality costs. The procedure was validated by experts and in its design combines the system approach, management and processes, all this through a software and tools to control the managerial administration and benchmarking. Results: as a result of the data processing it was found that the entity is located in the area of improvement projects and that the biggest impact in the quality costs is caused by the zero coverings and the refunds in sale. Conclusions: through the application of the procedure in the Holguin Drugstore, was possible to objectively measure, on economic terms, the performance of quality in each of the identified processes, the efficiency of the quality management system and the design of actions for continuous improvement of the costs of quality.

Marco de referencia de la aplicación de manufactura esbelta en la industria / A framework for the implementation of lean manufacturing in the industry

RESUMEN: 21. Actualmente las empresas que aplican las herramientas de Manufactura Esbelta cometen el error de implementarlas de manera aislada para cubrir las necesidades de mejora a un corto plazo, por lo que obtienen beneficios limitados. Se presenta una revisión de litera tura relacionada con la implementación de herramientas de Manufactura Esbelta en la Industria, tales como Takt Time, 5's, Ocho desperdicios "mudas", Control Visual, Células de Manufactura, a prueba de errores (Poka-Yoke), Nivelación de la producción (Heijunka), Automatización inteligente (Jidoka), Mejora continua (Kaizen), Kanban, Cambios rápidos de modelo (SMED), Mantenimiento total de la producción (TPM), Justo a tiempo (JIT) y Mapeo del flujo de valor (VSM), analizando su aplicación tanto individual como en conjunto. Se visualiza que las 5'S, el VSM, Kaizen, Kanban y TPM son las más utilizadas en el ramo Manufacturero con un 9,46%, 8.1%, 6,75%, 5,4% y 4,05% respectivamente, y SMED con un 4,05% y JET con un 6,76% en el sector Automotriz; caso contrario, las Células de Manufactura, Heijunka y Andon son las menos utilizadas (en 1,35%).

ABSTRACT: 26. Currently the industries that apply Len Manufacturing tools commit the mistake of implement them in insolation to meet short-term improvement needs, so that, they obtain limited benefits. A literature review present is related with the implementation of Lean Manufacturing tools in the industry, such as Takt Time, 5's, Eight wastes "mudas", Visual Control, Manufacturing Cells, mistake proof ing (Poka-Yoke), Leveling production (Heijunka), Intelligent automa tion (Jidoka), Continuous improvement (Kaizen), Kanban, Quick changeover of model (SMED), Total productive maintenance (TPM), Just in time (JIT) and Value stream map (VSM), analyzing their application both individual and in assemblage. It is visualized that the 5's, the VSM, Kaizen, Kanban and TPM are the most utilized tools in the Manufacturing branch with 9.46%, 8.1%, 6.75%, 5.4% and 4.05% respectively, and SMED with 4.05% and JIT with 6.76% in the Automotive sector, otherwise, the Manufacturing Cells, Heijunka and Andon are the least used in 1.35%.

Potencial de recuperação de recicláveis em um condomínio residencial de grande porte de São Caetano do Sul / Recovery potencial of recyclables at a large residential condominium in São Caetano do Sul

RESUMO Este trabalho tem como objetivo avaliar o potencial de recuperação de resíduos recicláveis de um condomínio residencial vertical de grande porte localizado no município de São Caetano do Sul (SP). Foi realizado o diagnóstico da gestão de resíduos e da infraestrutura do condomínio, bem como foram feitas entrevistas com o Conselho Diretivo do condomínio e com o instituto responsável pela triagem dos resíduos, e aplicados questionários aos moradores. O principal desafio foi a frequência e a adequabilidade na comunicação interna e sensibilização, tanto de residentes como dos funcionários domésticos. Entre os aspectos favoráveis, identificou-se a comodidade para descarte dos recicláveis para os moradores; e condições favoráveis para a comercialização dos recicláveis, como presença de local adequado para armazenamento de recicláveis segregados, elevado volume de recicláveis gerados e mercado favorável na região para a comercialização dos materiais. Foi verificado que são recuperados 13,7% da totalidade de recicláveis presentes nos resíduos domiciliares. Conforme o presente estudo, verificou-se ainda que a coleta seletiva de resíduos sólidos domiciliares em condomínios é vulnerável, dado à falta de consistência de ações efetivas de divulgação e mobilização, bem como de decisões da administração local.

ABSTRACT This paper aims at evaluating the potential recovery of recyclable materials at a large vertical residential condominium located in the municipality of São Caetano do Sul, state of São Paulo, Brazil. A survey on the waste management and the building facilities was conducted. Interviews with the governing board of the condominium and with the institute responsible for segregating recyclables were carried out, together with questionnaires applied to residents. The main challenge during this survey was the frequency and quality of internal communication for information and awareness, including both residents and respective domestic staff. As positive aspects, the convenience for disposal of recyclables by the residents; favorable conditions for the recyclables market, and presence of suitable location for storing segregated recyclables at the condominium were identified. It was found that the recovered materials were 13.7% of all recyclables present in domestic waste. This study showed that the selective collection of solid waste in residential condominiums is vulnerable owing to the lack of effective promoting and mobilization actions, as well lack of local administration decisions.

Continuous Improvement of Automated Pharmacies in Hospitals / 现代医院

Objective To adjust the layout of secondary medicine shelves in hospital pharmacy for outpatient services and optimize the varieties of automated equipment to improve working process and promote human-machine cooperation.Methods This article discussed the adjustment of the layout of secondary medicine shelves in hospital pharmacy for outpatient services and the optimization of varieties of automated equipment for storing by analyzing actual problems in automated system and clinical drug uses and the requirements of the automated equipment for drug storage respectively to improve working process and to adapt to the operation of outpatient pharmacy automated system.Results Dispensing efficiency of outpatient pharmacy automated system was improved, patients′ waiting time was significantly shortened, and the workload of pharmacists was decreased.Conclusion Optimization of hospital pharmacy drug delivery system and its operation can obviously improve work efficiency, shorten patients′ waiting time and reduce dispensing error, thus ensuring the safety of medication.

Analysis of the Application Effects of High-alert Medications Management Review and Evaluation System Based on Tracer Methodology / 中国药房

OBJECTIVE:To explore the application and feasibility of tracer methodology in the continuous improvement of high-alert medications management in the hospital,and to improve the quality of high-alert medications management and ensure the safety of clinical medication. METHODS:According to the theory and requirements of tracer methodology,a series of interven-tions were applied to the management of high-alert medications in our hospital. The comparisons on the mastery of high-alert medi-cations knowledge,review and evaluation results and the incidence of adverse events were conducted before and after applying trac-er methodology,so as to evaluate the improvement effect of tracer methodology on high-alert medications management. RESULTS:After implementing intervention measures such as the reduction of high-alert medications list and medical staff training about high-alert medications,compared to before management,medical staffs had improved the knowledge level of high-alert medica-tions (the average awareness rate increased from 69.6% to 88.5%);the review and evaluation results had been improved signifi-cantly (the proportion of the terms with qualified level evaluation results or above increased from 66.67% to 88.89%);the inci-dence of adverse events was reduced(from 0.321% to 0.139%). CONCLUSIONS:The tracer methodology has a significant effect on the management of high-alert medications in our hospital. It is feasible and can be widely used in the management of high-alert medications in the hospitals.

Estudio de los factores de calidad educativa en diferentes instituciones educativas de cúcuta

El objetivo de esta investigación es analizar los factores de calidad educativa en algunas escuelas de Cúcuta. Se trata de un estudio cualitativo de tipo descriptivo no experimental transeccional en el que participaron docentes y directivos docentes de 29 instituciones educativas públicas. Para la recolección de la información, se diseñó una matriz de evaluación de la calidad educativa según la literatura dispuesta y la selección de variables implementadas en otros modelos específicos de evaluación de la calidad educativa. Además, se realizaron jornadas pedagógicas con 10 instituciones educativas en las que participaron directivos docentes y docentes, y el registro de las contribuciones de los docentes permitió complementar la información contenida en el instrumento diligenciado. Los hallazgos demuestran que las instituciones educativas evaluadas se han focalizado en aspectos administrativos y técnicos y en la formulación de documentos e informes, pero han dejado a un lado temas importantes, como la praxis y reflexión pedagógica, la escritura y la lectura, la formación ciudadana, el currículo, el proceso de enseñanza-aprendizaje y las prácticas innovadoras y científicas. En consecuencia, se invita a replantear la visión de calidad en la educación para que se supere la visión que reduce la escuela a informes y documentos, trasladándose a la práctica pedagógica y lo que ello implica.

The objective of this research is to analyze educational quality factors in some schools in the municipality of Cúcuta. It is a qualitative study of descriptive-non-experimental-transectional type in which it participates in teachers and teaching directors of 29 public educational institutions. For the collection of information, a matrix of evaluation of the educational quality was designed based on the available literature and the selection of variables implemented in other specific models of evaluation of the educational quality. In addition, pedagogical sessions were held with ten educational institutions in which they participated in manager-teachers and teachers, and the registration of teachers' contributions allowed supplementing the information contained in the completed instrument. The findings show that the educational institutions evaluated have focused on administrative and technical aspects and the formulation of documents and reports, but also important themes such as praxis and pedagogical reflection, writing and reading, citizenship training, curriculum, teaching-learning process and innovative and scientific practices. Consequently, it is invited to rethink the visión of quality in education so as to overeóme the vision that reduces the school to reports and documents, moving it to pedagogical practice and what it implies.

Application and analysis of PDCA in medical equipment maintenance / 中国医学装备

Objective:To explore effective ways to improve the medical quality and safety management level of medical equipment.Methods: Using the PDCA management tool in the daily maintenance of medical equipment, the management of medical equipment is more reasonable. Results:During 2 years’ PDCA plan implementation, fault total cases in 32 sets of hemodialysis equipment were 461, and annual average cases were 230.5. In comparison with the total number of 441 fault cases of 28 units in the previous 1 years, the failure rate is greatly decreased. The mis-operation caused by fault is also greatly reduced. The circuit and water failures were annually 16.5 times and 197 times, and they were greatly reduced compared to 25 times and 324 times in the previous year.Conclusion: It can effectively improve the medical quality and safety management level of medical equipment by using the PDCA management tool in the daily maintenance of medical equipment, and also in the tertiary general hospital accreditation standards provisions to clear quality and safety indicators and records of continuous improvement effect of the department of medical equipment. Therefore, In the medical equipment maintenance work, it can carry out the new trend of PDCA and medical equipment management.

Application of the Whole Course Case Tracking Method in Continuous Improvement of the Nursing Quality in Outpatient Operation Unit / 中国医科大学学报

Objective to investigate the application of the whole course case tracking method in continuous improvement of nursing quality of out-patient operation unit. Methods Administration frames were established for this project,such as monitoring group and executive group. the medi-cal treatment procedure and patients′experience were followed by referees. the results were quantified for statistical analysis. the problems were rec-ognized by priorities and rectification was correspondingly performed. Afterward,another group of patients were traced to evaluate the results of the rectification. We focus on those items of lower scores and undertook rectifications accordingly. Particularly,we optimized signs in outpatient unit, made pamphlets to clarify the procedures,and were cautious to provide more easy-to-understand informs. Results By the second round evaluate, these scores were effectively improved. Especially,the item of“clear informed consent”was statistically significant(P = 0.003). Meanwhile,the team of outpatient operation unit became more cohesion,with enhanced service consciousness,and was initiative to improve the work. Conclusion the whole course case tracking method is feasible for short-range medical service evaluation such as outpatient surgery. the evaluation results clarify the direction for quality improvement,thus set the starting point of quality management aiming at continuously improvement of the patients′ experi-ence and quality of nursing service.

Grade review and the development of hospital information system / 中国医学装备

Objective:To adapt to the new review requirements of third level of first-class hospital, passed the hospital informationization evaluation successfully, to promote the continuous development of hospital informatization.Methods: Analysis standard from the section level and hospital level One by one, find out the gap, implement of rectification from the written materials, application of information system and the function point, server and network hardware.Results:The hospital pay high attention to and strongly support as well as the efforts of all staff of our department, through the review of hospital informationization disposable.Conclusion:The hospital informationization construction only carries on, there is no complete, must improve continually, make unremitting efforts to improve hospital management and service level.

Mejoras aplicadas al proceso de distribución de medicamentos en la Droguería La Habana / Improvements in the drug distribution process in Droguería La Habana

INTRODUCCIÓN: en la actualidad, el plan para erradicar las faltas, evaluar la distribución y el consumo de medicamentos, así como para actividades relacionadas con los fármacos, se controla periódica y sistemáticamente por la más alta dirección del partido y el gobierno del país a fin de analizar la situación existente y adoptar decisiones conjuntas. La Droguería La Habana lleva a cabo el análisis y planificación del consumo de medicamentos en la ciudad y asume las pérdidas por concepto de vencimiento de los medicamentos año tras año. OBJETIVO: establecer acciones de mejora continua en el proceso de distribución de medicamentos en la Droguería La Habana, para la disminución de vencimientos de los medicamentos. MÉTODOS: se revisaron todos los dictámenes técnicos elaborados por concepto de vencimiento, por el grupo profesional de la Droguería La Habana, cuya fecha de vencimiento del medicamento coincidió con el período de estudio, que comprendió enero 2008-diciembre 2009. Los indicadores analizados fueron: cantidad de medicamentos vencidos por laboratorios y años, causas del vencimiento e importe económico que representó. Se determinaron las causas del vencimiento de medicamentos durante el proceso de distribución, combinando el trabajo en equipo con la tormenta de ideas; además considerando los aspectos regulatorios vigentes y las no conformidades detectadas en auditorías internas. El orden de prioridad de las acciones de mejora se determinó al aplicar la herramienta de gestión de la calidad: selección ponderada. Para la confirmación del mejoramiento se analizaron los mismos indicadores establecidos en el diagnóstico, para el período enero de 2010-octubre de 2011. RESULTADOS: en el diagnóstico se detectaron 102 renglones afectados, del total de medicamentos que conformó el Cuadro Básico. Se vencieron 92 530 medicamentos, para un importe económico de $264 365,80. Se propusieron seis factores críticos para el éxito y cuatro opciones de mejoras. Una vez implementadas las acciones de mejora, se disminuyó significativamente la cantidad de medicamentos vencidos (31 724 unidades), con un nivel de afectación de 44 renglones; lo que representó el 5,07 por ciento del total de medicamentos que conformó el Cuadro Básico, lo cual confirmó el progreso alcanzado en la actividad. CONCLUSIONES: la eficacia de las acciones implementadas para la mejora del proceso de distribución de medicamentos, se evidencia con la reducción de medicamentos con riesgo de vencimiento, el mejor aprovechamiento de las existencias, el mejor funcionamiento de la Comisión de Vencimiento, la capacitación del personal de las áreas involucradas; lo que reduce la contribución de los laboratorios al vencimiento de medicamentos en la etapa de seguimiento(AU)

INTRODUCTION: the present plan for eradication of failures, evaluation of distribution and consumption of drugs and the pharmaceutical-related activities are systematically controlled by the highest governmental and party authorities with the objective of analyzing the existing situation and of making joint decisions. Droguería La Habana is making analysis and planning the drug consumption in the capital and is taking responsibility on the losses caused by drug expiration year after year. OBJECTIVE: to set actions to improve the drug distribution process on a continuous basis in Droguería La Habana, so that the expiration of drugs be reduced. METHODS: the professional group of Droguería La Habana revised all the technical reports on drug expiration whose expiration date coincided with the study period from January 2008 to December 2009. The analysis indicators were number of drugs that had expired per laboratory and year, causes of expiration and economic cost. The causes of expiration were determined during the distribution process by combining the teamwork with the brainstorm and taking the present regulatory aspects and the non-conformity claims detected in the internal auditing. The order of priority for the improvement actions was determined by the quality management tool called weighed selection. For confirmation of improvement, the same indicators set in the diagnosis were considered for the January 2010-October 2011 period. RESULTS: the diagnosis detected 102 affected items out of the total number of drugs included in the Basic Drug Program. The expired drugs amounted to 92 530 for an economic cost of $ 264 365.80. Six critical factors for success and four improvement options were then put forward. Once the improvement actions were implemented, the number of expired drugs significantly lowered (31 724 units) representing 44 items for 5.07 percent of the total number of drugs included in the Basic Drug Program. This confirmed the advances attained in this activity. CONCLUSIONS: effectiveness of actions that were implemented to improve the drug distribution process is seen in the reduction of drugs at risk of expiration; the best utilization of stocks, better functioning of the drug expiration commission, the training of staff in the involved areas, all of which decreases the contribution of labs to the expiration of drugs in the follow-up phase(AU)

Practice and insights of building the quality management system at the hospital / 中华医院管理杂志

Quality management covers every corner of hospital services,which upholds full-process quality management,continuous quality improvement and smooth management with patients at the center.By means of building a 3-tier quality management framework at the hospital,development of quality management criteria,appraisal indicators and documentation and use of quality management tools,quality management defects were identified from a third-party perspective.This effort has significantly improved quality of care at the hospital,and elevated the management execution and general service quality of the hospital.