Improving patient safety by detecting obstetric care-related adverse events: application of a new screening guide.

PURPOSE: Determining the magnitude and importance of patient safety-related incidents and the effectiveness of measures to improve patient safety (PS) are high-priority goals in efforts to improve the quality of obstetric care. The aim of this study was to evaluate the usefulness of the MRF1-OBST screening guide in detecting adverse events in women who received obstetric care. METHODS: This retrospective cohort study included 244 women who were hospitalized for delivery. All medical records were reviewed with the MRF1-OBST screening guide to identify adverse events and incidents. This tool is a modified form of the MRF1 screening guide regularly used in epidemiological studies of PS, to which we added items developed specifically for obstetric care. We calculated the positive predictive value and compared the ability of the MRF1 and MRF1-OBST guides to detect incidents related to PS in Obstetrics. RESULTS: The MRF1-OBST guide did not identify any additional complications during hospitalization or incidents related to PS that were not also identified by the MRF1 guide. CONCLUSIONS: The MRF1-OBST guide did not improve the detection of obstetric AE. The modified version of the guide required more work to use as a screening aid than the original MRF1 instrument. Efforts to improve the detection of incidents related to PS in obstetrics require complementary tools to be developed for information analysis.

[Clinical safety paediatric patients]. / Seguridad clínica de los pacientes durante la hospitalización en pediatría.

OBJECTIVE: To describe the incidence and types of adverse events in children and how they can be prevented. MATERIAL AND METHODS: Analysis of paediatric hospitalisations in the ENEAS Study, the Asturias Study on hospitalisation -related adverse events (EAPAS) and the Aragon Study of the Adverse Effects related to the hospitalisation, which involved a retrospective medical record review of a population-based, representative sample of all paediatric hospital discharges. Adverse events were defined as an injury caused by medical management, rather than by disease processes. RESULTS: We were able to identify 24 paediatric patients suffering 29 AEs directly associated with medical care. Compared to non-elderly adult patients, infants and adolescents suffered lower rates of adverse events. Of these, 65.5% (19 AE) were considered as preventable. Adverse events occurred in 3.61% of paediatric hospitalisations. Adverse events rates were 3.8% in infants (0-1.5 years), 4.0% in children 1.5-6 years of age, and 2.6% in children 7-16 years of age, compared with a rate of 6.4% in non-elderly adults. Medication related (37.9%) events were the most common types of adverse event. CONCLUSIONS: The epidemiology of adverse events in children is different to that in adults. To reduce the adverse events that occur in hospitalized children, knowledge of AE epidemiology in paediatric patients will help in the development of prevention strategies to avoid or to minimise them.

[Evolution of the adverse effects prevalence related to healthcare in hospitals of the Valencia community]. / Evolución de la prevalencia de eventos adversos relacionados con la asistencia en hospitales de la Comunidad Valenciana.

OBJECTIVE: Improvement of knowledge on patient safety by a study of the number, importance and impact of Adverse Events (AEs), analysing the patient and healthcare characteristics associated with their occurrence. MATERIAL AND METHODS: Cross-sectional study of prevalence carried out for one week every year in the years 2005-2008 in hospitals of the Comunidad Valenciana. RESULTS: AE prevalence in participating hospitals remained constant at around 6 % during the four years of study. The mean age and sex distribution were also constant. The predominant causal factors of AEs were nosocomial infection, procedures and medicines, in that order, although we did observe an increase in AEs due to nosocomial infection during the period of study. With regard to severity, we observed a decrease in the percentage of serious AEs (31.5 % in 2005 vs.17.8 % in 2008), as well as an increase in the proportion of avoidable AEs from 50.8 % to 63.2 % in 2008. CONCLUSIONS: The results of the study demonstrate the need for a cultural change among professionals that will stimulate the promotion of a proactive culture for patient safety, and allows us to anticipate a social problem of increasing repercussions. Knowledge of EA epidemiology will help in the development of prevention strategies to avoid or to minimise them.

[How to identify adverse events in emergency services? A guide agreed for the screening]. / ¿Cómo identificar los efectos adversos en urgencias? Una guía consensuada para el cribado.

OBJECTIVE: Since a third of adverse events (AE) occur outside hospital, the Emergency Services are a suitable place to look at their incidence. We considered designing a screening guide, adapted to the conditions of the emergency services, to identify AE. MATERIAL AND METHODS: A qualitative technique was applied (nominal group) in which 14 professionals participated. They analysed which factors of intrinsic risk, extrinsic risk, and alert conditions, were suitable for a screening guide of AE in emergency services. The session was chaired by a specialist in these types of techniques. RESULTS: Consensus was high in that the most frequent AE in emergencies were those related to medicines, diagnostic tests and with the correct identification of the reason for emergency. With respect to screening guide, the group proposed adding alcohol abuse, patient social problems, cognitive deterioration, basal autonomy and disability. In relation to extrinsic risk factors, they pointed to the need of including defibrillation, spinal tap or drainage implantation. With respect to the alert conditions form, the professionals agreed in that all the criteria seemed correct and suitable, except for that related to damage relation childbirth or amniocentesis. CONCLUSIONS: By using this technique we have managed to validate materials already recognized, and widely used in our country. The screening guide was considered useful, with slight modifications in some risk factors and alert conditions. The professionals agreed that the MRF2 modular questionnaire is appropriate for the characterisation of AE in emergencies.

[Perceptions of clinical safety after hospital discharge]. / Percepción de seguridad clínica tras el alta hospitalaria.

OBJECTIVE: Patient perception of clinical safety has been scantly studied. This study describes the frequency of clinical errors from a patient point of view, their perception of safety and its relationship with the information received. MATERIAL AND METHODS: Descriptive study based on a postal survey to 336 surgical patients, 20 days after the discharge from the hospital (the corrected rate of response is 75.58%, the error is 5.7% for a confidence level of 95%). RESULTS: In the responses, 13.05% (95% CI, 9.16-16.95%) reported suffering a clinical error. Of these, 10.5% had severe complications. This experience decreases the perception of safety in future treatments (p = 0.0001). The risk of being a victim of a medical error with serious consequences is high was considered by 11.9% (95% CI, 7.2-16.6%) of the patients, although less than suffering from a traffic accident, a robbery or a serious illness. A higher frequency in the media related to medical mistakes, decreases the perception of safety (p < .001). The patients who positively value the information received regarding the treatment and who can formulate questions to ask the doctor are those who report less errors (p < .001). CONCLUSIONS: A total of 1.37% of surgical patients report mistakes with severe consequences, whereas 12% believe that the risk of a mistake with serious consequences is high. Distrust increases after an error. Improving communication with the patient helps to reduce mistakes, which strengthens the role of programs to increase safety that encourage more active patient involvement.

[Management by integrated care processes]. / La gestión por procesos asistenciales integrados.

Processes management has a positive effect in both reducing the variability of clinical practice, and increasing therapeutic effectiveness and patients' satisfaction. In this article the different types of processes and the methods used to identify and define processes and subprocesses are described. The management by processes requires to combine information of patients' needs and expectations, and the recent evidence, describing the activities' sequence that the professionals would realize in order to obtain a positive outcome. Defining quality criteria of clinical practice and monitoring if standards are achieved are critical to obtain other of its characteristic: continuous improvement (PDCA cycle). The introduction of total quality ideas in the healthcare organizations in recent years has yielded the dissemination of the advantages of management processes in health care sector.

Absenteeism as a symptom of occupational ill-health in hospitals and its repercussion on quality assurance.

The purpose of the present study was to evaluate the importance of absenteeism due to illness in the hospital organization. A measurement of absenteeism due to illness among hospital professionals of the National Health System in the Alicante province (Spain) during the years 1988, 1989 and 1990 was carried out, as well as its repercussion on quality assurance in health care. The absenteeism index (frequency) was 5.39, 6.38 and 6.79 in 1988, 1989 and 1990, respectively. The extent of absenteeism (duration) in 1988 was 19.7 days per worker, and was 24.23 in 1989 and 26.45 in 1990. Hospitals with more than 400 beds presented during these periods poor absenteeism self-control. Maintenance personnel, nurses, administrative personnel and graduates had, in this order, the highest scores of days lost. We show that the dimension of Intrinsic Job Satisfaction, Extrinsic Job Satisfaction and Job Monotony are interrelated with absenteeism.