[Nursing service certification. Norm UNE-EN-ISO 9001-2008]. / Certificación de los servicios enfermeros. Norma UNE-EN-ISO 9001-2008.

OBJECTIVE: To certify the nursing services using a quality management system, taking an international standard as a reference, and based on a continuous improvement process. MATERIAL AND METHOD: The standard was revised, and the Quality Management System documentation was updated, consisting of a Quality Manual and 7 control procedures. All the existing procedures were coded in accordance with the documentation control process. Each operational procedure was associated with a set of indicators which permitted to know the results obtained, analyze the deviations and to implement further improvements. RESULTS: The system was implemented successfully. Twenty-eight care procedures and eleven procedures concerning techniques were incorporated into the management system. Thirty indicators were established that allowed the whole process to be monitored. All patients were assigned to a nurse in their clinical notes and all of them had a personalized Care Plan according to planning methodology using North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) international rankings. The incidence of falls, as well as the incidence of chronic skin wounds, was low, taking into account the characteristics of the patient and the duration of the stay (mean=35.87 days). The safety indicators had a high level of compliance, with 90% of patients clearly identified and 100% with hygiene protocol. The confidence rating given to the nurses was 91%. CONCLUSION: The certification enabled the quality of the service to be improved using a structured process, analyzing the results, dealing with non-conformities and introducing improvements.

Certificación de los servicios enfermeros. Norma UNE-EN-ISO 9001-2008 / Nursing service certification. Norm UNE-EN-ISO 9001-2008

Objetivo: Certificar los servicios enfermeros mediante un sistema de gestión de calidad, tomando como referencia una norma internacional basada en un enfoque por procesos y en la mejora continua. Material y método: La norma fue revisada, actualizando la documentación del control del sistema de gestión, formado por el Manual de calidad y 7 procedimientos de control. Se codificaron todos los procedimientos existentes de acuerdo al proceso de control de la documentación. Cada proceso operativo tuvo asociado un conjunto de indicadores que permitieron conocer los resultados obtenidos, analizar las desviaciones e implantar mejoras. Resultados: El sistema se implantó satisfactoriamente. Se incorporaron al sistema de gestión 28 procedimientos de cuidados y 11 relativos a técnicas. Se establecieron 30 indicadores que permitieron monitorizar el proceso. El 100% de los pacientes tuvo asignada una enfermera en la historia clínica y todos contaron con un plan de cuidados personalizado acorde con la metodología de planificación y utilizando clasificaciones internacionales de la North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC) y Nursing Outcomes Classification (NOC). La incidencia de caídas y de heridas cutáneas crónicas (HCC) fue baja, atendiendo a las características de los pacientes y a la duración de la estancia (X = 35,8 días). Los indicadores de seguridad tuvieron un alto grado de cumplimiento (90% el de identificación inequívoca del paciente y 100% el protocolo de higiene). La valoración sobre la confianza que proporcionaban las enfermeras fue del 91%. Conclusión: La certificación permitió mejorar la calidad del servicio de manera estructurada, analizando resultados, tratando las no conformidades e introduciendo mejoras (AU)

Objective: To certify the nursing services using a quality management system, taking an international standard as a reference, and based on a continuous improvement process. Material and method: The standard was revised, and the Quality Management System documentation was updated, consisting of a Quality Manual and 7 control procedures. All the existing procedures were coded in accordance with the documentation control process. Each operational procedure was associated with a set of indicators which permitted to know the results obtained, analyze the deviations and to implement further improvements. Results: The system was implemented successfully. Twenty-eight care procedures and eleven procedures concerning techniques were incorporated into the management system. Thirty indicators were established that allowed the whole process to be monitored. All patients were assigned to a nurse in their clinical notes and all of them had a personalized Care Plan according to planning methodology using North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) international rankings. The incidence of falls, as well as the incidence of chronic skin wounds, was low, taking into account the characteristics of the patient and the duration of the stay (mean = 35.87 days). The safety indicators had a high level of compliance, with 90% of patients clearly identified and 100% with hygiene protocol. The confidence rating given to the nurses was 91%. Conclusion: The certification enabled the quality of the service to be improved using a structured process, analyzing the results, dealing with non-conformities and introducing improvements (AU)

Una aproximación al benchmarking de indicadores de cuidados. Aprendiendo para mejorar la seguridad del paciente / An approach to care indicators benchmarking. Learning to improve patient safety

La mejora de la seguridad clínica puede alcanzarse mediante la promoción de una cultura de seguridad, formación y aprendizaje a través del benchmarking. El objetivo fue identificar áreas de mejora tras analizar indicadores relacionados con la seguridad de 2 hospitales públicos del área noroeste de la Comunidad de Madrid. Material y métodos. Estudio descriptivo realizado en 2011 en el Hospital Universitario Puerta de Hierro Majadahonda (HUPHM) y en el Hospital de Guadarrama (HG). Las variables fueron 40 indicadores sobre cuidados de enfermería relacionados con la seguridad; 19 habían sido definidos en el Proyecto SENECA como estándares de calidad de cuidados para mejorar la seguridad en los hospitales. Para la recogida de datos se utilizó la historia clínica, los informes de evaluación del Servicio Madrileño de Salud, los procedimientos de cuidados y la observación directa. Resultados. De 40 indicadores 22 eran de estructura (procedimientos), el HUPHM disponía del 86% y el HG del 95%. Hubo 14 indicadores de proceso (formación y cumplimiento de protocolos) con resultados similares en los 2 hospitales, excepto en los informes de continuidad de cuidados y formación en higiene de manos. Los 4 indicadores de resultado (incidencia, y prevalencia de úlceras por presión, caídas y dolor) mostraron resultados dispares. Conclusiones. Analizar indicadores permitió identificar acciones de mejora en cada hospital, elaborar conjuntamente un decálogo de seguridad en los cuidados y un protocolo de prevención y tratamiento de heridas crónicas, instaurar la evaluación sistemática del dolor y la realización de informes de continuidad de cuidados a los pacientes derivados del HUPHM al HG (AU)

Improvements in clinical safety can be achieved by promoting a safety culture, professional training, and learning through benchmarking. The aim of this study was to identify areas for improvement after analysing the safety indicators in two public Hospitals in North-West Madrid Region. Material and methods. Descriptive study performed during 2011 in Hospital Universitario Puerta de Hierro Majadahonda (HUPHM) and Hospital de Guadarrama (HG). The variables under study were 40 indicators on nursing care related to patient safety. Nineteen of them were defined in the SENECA project as care quality standards in order to improve patient safety in the hospitals. The data collected were clinical history, Madrid Health Service assessment reports, care procedures, and direct observation. Results. Within the 40 indicators: 22 of them were structured (procedures), HUPHM had 86%, and HG 95% 14 process indicators (training and protocols compliance) with similar results in both hospitals, apart from the care continuity reports and training in hand hygiene. The 4 results indicators (pressure ulcer, falls and pain) showed different results. Conclusions. The analysis of the indicators allowed the following actions to be taken: to identify improvements to be made in each hospital, to develop joint safety recommendations in nursing care protocols in prevention and treatment of chronic wound, to establish systematic pain assessments, and to prepare continuity care reports on all patients transferred from HUPHM to HG (AU)

[An approach to care indicators benchmarking. Learning to improve patient safety]. / Una aproximación al benchmarking de indicadores de cuidados. Aprendiendo para mejorar la seguridad del paciente.

UNLABELLED: Improvements in clinical safety can be achieved by promoting a safety culture, professional training, and learning through benchmarking. The aim of this study was to identify areas for improvement after analysing the safety indicators in two public Hospitals in North-West Madrid Region. MATERIAL AND METHODS: Descriptive study performed during 2011 in Hospital Universitario Puerta de Hierro Majadahonda (HUPHM) and Hospital de Guadarrama (HG). The variables under study were 40 indicators on nursing care related to patient safety. Nineteen of them were defined in the SENECA project as care quality standards in order to improve patient safety in the hospitals. The data collected were clinical history, Madrid Health Service assessment reports, care procedures, and direct observation RESULTS: Within the 40 indicators: 22 of them were structured (procedures), HUPHM had 86%, and HG 95% 14 process indicators (training and protocols compliance) with similar results in both hospitals, apart from the care continuity reports and training in hand hygiene. The 4 results indicators (pressure ulcer, falls and pain) showed different results. CONCLUSIONS: The analysis of the indicators allowed the following actions to be taken: to identify improvements to be made in each hospital, to develop joint safety recommendations in nursing care protocols in prevention and treatment of chronic wound, to establish systematic pain assessments, and to prepare continuity care reports on all patients transferred from HUPHM to HG.

El quién, cómo y dónde de la formación continuada de un área de salud / The who, how and where of continuing education in a health area

Introducción. El objetivo de nuestro estudio es describir el Plan de Formación Continuada de nuestra área en 2009 y el perfil académico de nuestros profesionales. Material y métodos. Estudio descriptivo transversal realizado en el Área 9 de Atención Primaria de Madrid. Las variables analizadas se obtuvieron del sistema de información del Plan de Formación Continuada 2009 y de una encuesta estructurada autocumplimentada diseñada por el grupo investigador. Se incluyeron los profesionales que solicitaron alguna actividad formativa en 2009 y los que contestaron la encuesta. La medida de asociación se calculó a través del test ji cuadrado. La magnitud del efecto se expresó a través de la razón de prevalencias (IC 95%). Resultados. Se gestionaron 1.557 inscripciones. El 94,9% de los profesionales del área han realizado al menos una actividad formativa. El 37,6% de las inscripciones se realizaron por enfermeras, 15,7% auxiliares administrativos y 15,4% médicos. El 61,7% (IC 95%; 59,2-64,1) recibieron el certificado. La mediana del número de participantes por curso fue 16 (rango intercuartílico [RI]=9-22,7) y del coste 500 € (RI=250-1.287,5). Por áreas temáticas, el 60% se forman en práctica asistencial y más del 50% realizan la formación en la institución. Hay diferencias significativas entre las profesiones en cuanto a experiencia docente (p=0,01) y pertenencia a grupo o sociedad (p<0,001). Conclusiones. Casi todos nuestros profesionales han realizado alguna actividad formativa, aunque un porcentaje considerable no llega a recibir certificado. Mayoritariamente se forman en práctica asistencial y a través de la organización sanitaria. Las enfermeras se inscriben más y reciben más la certificación (AU)

Introduction. The aim of our study is to describe the 2009 Continuing Education Plan in our area and the academic profile of our professionals. Material and methods Descriptive cross-sectional study performed in Primary Care Area 9 Madrid. The variables analysed were obtained from the information system of Continuing Education Plan 2009 and a self-completed structured questionnaire designed by the research team. We included professionals who applied for some education activity in 2009 and those who filled in the questionnaire. The measure of association was calculated by the chi-squared test. The magnitude of the effect was expressed as the prevalence ratio (95%). Results. A total of 1557 registrations were handled, and 94.9% of professionals had attended at least one training activity. Nurses accounted for 37.6% of registrations, followed by administrative assistants, 15.7% and physicians 15.4%. A continuing education certificate was received by 61.7% of the professionals (95% CI, 59.2-64.1). The median number of participants per course was 16 (RI=9 to 22.7) and cost 500 € (IR=250 to 1287.5). As regards the training location, 60% took place in the clinical practice and more than 50% reported training in the institution. There were significant differences between professions in terms of teaching experience (P=.01) and group or society membership (P<.001). Conclusions. Almost all of our professionals had completed a training activity, although a considerable percentage failed to receive a certificate. Most took place in clinical practice and through the health care organization. Nurses are enrolling more and received more certificates (AU)