Spleen rupture during labor

Splenic artery aneurysm is a rare condition with a prevalence of less than 1% in the general population and is more common in women; however, it is the third most common cause of intra-abdominal aneurysms and the most common among visceral arterial aneurysms1. This condition was first described by Beussier in 1770; some of the risk factors often described are: fibrodysplasia, portal hypertension, splenomegaly, cirrhosis of the liver, liver transplant, pancreatitis, vasculitis, infectious mononucleosis, and pregnancy1-6.Pregnancy is considered the most important risk factor for the rupture of this aneurysm, but the true prevalence of this event is unknown2. Increased splanchnic and splenic circulation during pregnancy has been indicated as one of the main factors in the development of aneurysms. The modifications in circulation induced by estrogen and progesterone during pregnancy may also contribute to weakening blood vessel walls, especially at the bifurcations. It is speculated that the greater the woman’s parity the greater the risk of development and rupture of the aneurysm, due to the successive stresses to which the vessel wall is submitted3.The importance of an adequate diagnosis and management of this condition, despite its low prevalence, is supported by the high rates of maternal and fetal mortality, 75 and 95%, respectively3.

Metas internacionais de segurança do paciente em hospital universitário / International patient safety goals in a university hospital

Introdução: o Hospital de Clínicas de Porto Alegre (HCPA) deseja conquistar o reconhecimento internacional para a sua qualidade de atendimento através do Programa de Acreditação Internacional da Joint Commission International (JCI). Objetivo: analisar o capítulo de metas de segurança da avaliação diagnóstica no manual de acreditação internacional, e propor planos de ação para correção das não conformidades identificadas na avaliação do Consórcio Brasileiro de Acreditação (CBA). Métodos: para a elaboração desse estudo, analisamos: o Manual da Acreditação Internacional da JCI, o Relatório da Avaliação Diagnóstica realizada pelo CBA na etapa de preparação do HCPA para a Acreditação e o artigo “O HCPA e o Programa de Acreditação Hospitalar Internacional”. Resultados: a primeira meta (Identificação correta dos pacientes) apresenta 5 quesitos – 1 avaliado como não conforme e 4 como parcialmente conformes; a segunda meta (Comunicação efetiva) tem 4 quesitos – 1 não conforme e 3 parcialmente conformes; a terceira meta (Segurança dos medicamentos de alta vigilância) apresenta 2 quesitos – ambos avaliados como não conformes; a quarta meta (Cirurgia segura) tem 4 quesitos – todos avaliados como não conformes; a quinta meta (Higienização das mãos) tem 3 quesitos - 2 conformes e 1 parcialmente conforme; a sexta meta (Queda do paciente) tem 3 quesitos – 1 não conforme e 2 parcialmente conformes. Conclusão: os cuidados referentes à segurança do paciente são um dos setores mais deficitários do HCPA. Enquanto a avaliação geral de todos os quesitos encontrou 55,2% dos padrões avaliados como conforme, 19,5% como parcialmente conforme e 23,6% como não conforme, a avaliação dos quesitos das metas de segurança do paciente encontrou apenas 9,5% avaliados como conforme, 47,6% como parcialmente conforme e 42,9% como não conforme

Background: Hospital de Clínicas de Porto Alegre (HCPA) aims to achieve international recognition for the quality of care provided according to the Joint Commission International (JCI) accreditation program. Aims: to analyze JCI International Patient Safety Goals and propose action plans for correction of noncompliant aspects identified during the evaluation carried out by the Brazilian Consortium for Accreditation (CBA). Methods: the following documents were analyzed for the development of this study: JCI accreditation manuals, CBA Diagnostic Evaluation Report on the preparation stage of HCPA for accreditation, and the article entitled “HCPA and the International Accreditation Program for Hospitals”. Results: goal 1 (identify patients correctly) has 5 items – 1 evaluated as noncompliant and 4 as partially compliant; goal 2 (effective communication) includes 4 items – 1 noncompliant and 3 partially compliant; goal 3 (safety of high-alert medications) has 2 items – both evaluated as noncompliant; goal 4 (surgical safety) has 4 items – all evaluated as noncompliant; goal 5 (hand hygiene) has 3 items – 2 compliant and 1 partially compliant; and goal 6 (patient falls) has 3 items – 1 noncompliant and 2 partially compliant. Conclusion: care related to patient safety is one of the most deficient sectors at HCPA. Overall assessment of items found 55.2% of compliance, 19.5% of items as partially compliant and 23.6% as noncompliant, whereas the assessment of items within the International Patient Safety Goals found only 9.5% of compliance, 47.6% of items as partially compliant and 42.9% as noncompliant