RESUMEN
Patient safety reporting and learning systems (PSRLS) are tools to promote patient safety culture in healthcare organisations (HCO). Many PRSLS are locally developed. WHO Global Action Plan on Patient Safety 2021-2030 urges governments to deploy policies for healthcare risk management including PSRLS. The Ministry of Health of Catalonia (MHC) faced challenges in addressing quality and patient safety (Q&PS) issues due to disparate information systems. To address these challenges, the MHC developed a territorial PSRLS and embedded it in the Quality and Patient Safety Strategic Plan of Catalonia 2023-2027 (QPSS Plan Cat). METHODS: Four-step process: (1) creation of a governance model, a web platform and reporting forms for a PSRLS in Catalonia (SNiSP Cat); (2) SNiSP Cat roll out; (3) embed SNiSP Cat information in the accreditation model for HCO and the PS scorecard; (4) Development of SNiSP Cat within the QPSS Plan Cat 2023-2027. RESULTS: The SNiSP Cat is in use by 63/64 acute care hospital (ACH), 376/376 primary healthcare teams (PCT) and 17/98 long-term care facilities (LTCF). 1335/109 273 professionals were trained. Until 2022, 127 051 incidents have been migrated and reported (2013-2022). The system has generated three comprehensive risk maps for HCO: one for ACH, including patients' falls, medication, clinical process and procedures; second for PCT, including clinical process and procedures, clinical administration and medication; and a third for LTCF, included patients' falls, medication, digital/analogical documentation. SNiSP Cat provided information to support 53 standards out of 1312 of the ACH accreditation model and 14 standards out of 379 of PCT one. Regarding the MHC patient safety scorecard, 14 indicators out of 147 of ACH and 4 out of 41 of PCT are supported by SNiSP Cat data. CONCLUSIONS: The availability of a territorial PSRLS (SNiSP Cat) allows MHC leads the Q&PS policy with direct information, risk maps and data support to the standards for the Catalan accreditation models and PS scorecard linked to incentivisation, turning the SNiSP Cat into a driven tool to implement the Quality and Patient Safety Strategic Plan of Catalonia 2023-2027.
Asunto(s)
Política de Salud , Liderazgo , Seguridad del Paciente , Gestión de Riesgos , Humanos , Seguridad del Paciente/normas , Seguridad del Paciente/estadística & datos numéricos , España , Gestión de Riesgos/métodos , Gestión de Riesgos/estadística & datos numéricos , Cultura Organizacional , Administración de la Seguridad/métodos , Administración de la Seguridad/normasRESUMEN
PURPOSE: To describe which bacteria can be found on lid margins in patients affected with blepharitis, to show their antibiotic susceptibility pattern, and to evaluate the antibiotic resistance trend of coagulase-negative Staphylococcus through time. MATERIALS AND METHODS: Consecutive cases of 198 eyes affected with blepharitis between 2012 and 2018 were reviewed. A sample was collected by rubbing a swab against the base of the eyelashes of both the eyes of all patients. The samples were inoculated in blood agar and chocolate agar. The susceptibility of the identified bacteria to common antibiotics was tested. In addition, the antibiotic susceptibility pattern of coagulase-negative Staphylococcus detected from year 2016 to 2018 was compared with that of 4 years before. RESULTS: The most common isolated bacterium was coagulase-negative Staphylococcus (89%) and Staphylococcus aureus (28%). Coagulase-negative Staphylococcus showed highest susceptibility to vancomycin (100%), neomycin (94%) and chloramphenicol (91%). Coagulase-negative Staphylococcus and Staphylococcus aureus were the most resistant to penicillin and erythromycin (resistance in 92%, 91% for coagulase-negative Staphylococcus, 86% and 43% of eyes for Staphylococcus aureus). Corynebacterium was resistant to oxacillin and erythromycin. Streptococcus viridans showed resistance to gentamycin and tobramycin. Moraxella was susceptible to most antibiotics. Bacillus was resistant to oxacillin. The antibiotic resistance trend of coagulase-negative Staphylococcus showed that the resistance to rifampicin increased through the years 2012-2018. CONCLUSION: Coagulase-negative Staphylococcus and Staphylococcus aureus were the most isolated bacteria in patients affected by blepharitis in our tertiary eye centre. Both bacteria were resistant to erythromycin. Through the years, it seems that coagulase-negative Staphylococcus gained resistance to penicillin, erythromycin, ciprofloxacin and rifampicin.
Asunto(s)
Bacterias/aislamiento & purificación , Blefaritis/epidemiología , Infecciones Bacterianas del Ojo/epidemiología , Pestañas/microbiología , Párpados/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Bacterias/efectos de los fármacos , Blefaritis/tratamiento farmacológico , Blefaritis/microbiología , Farmacorresistencia Bacteriana , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/microbiología , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , España , Centros de Atención Terciaria , Adulto JovenRESUMEN
BACKGROUND: Despite their marginal benefit, about 60% of acute lower respiratory tract infections (ALRTIs) are currently treated with antibiotics in Catalonia. This study aims to evaluate the effectiveness and efficiency of a continuous disease-focused intervention (C-reactive protein [CRP]) and an illness-focused intervention (enhancement of communication skills to optimise doctor-patient consultations) on antibiotic prescribing in patients with ALRTIs in Catalan primary care centres. METHODS/DESIGN: A cluster randomised, factorial, controlled trial aimed at including 20 primary care centres (N = 2940 patients) with patients older than 18 years of age presenting for a first consultation with an ALRTI will be included in the study. Primary care centres will be identified on the basis of socioeconomic data and antibiotic consumption. Centres will be randomly assigned according to hierarchical clustering to any of four trial arms: usual care, CRP testing, enhanced communication skills backed up with patient leaflets, or combined interventions. A cost-effectiveness and cost-utility analysis will be performed from the societal and national healthcare system perspectives, and the time horizon of the analysis will be 1 year. Two qualitative studies (pre- and post-clinical trial) aimed to identify the expectations and concerns of patients with ALRTIs and the barriers and facilitators of each intervention arm will be run. Family doctors and nurses assigned to the interventions will participate in a 2-h training workshop before the inception of the trial and will receive a monthly intervention-tailored training module during the year of the trial period. Primary outcomes will be antibiotic use within the first 6 weeks, duration of moderate to severe cough, and the quality-adjusted life-years. Secondary outcomes will be duration of illness and severity of cough measured using a symptom diary, healthcare re-consultations, hospital admissions, and complications. Healthcare costs will be considered and expressed in 2021 euros (year foreseen to finalise the study) of the current year of the analysis. Univariate and multivariate sensitivity analyses will be carried out. DISCUSSION: The ISAAC-CAT project will contribute to evaluate the effectiveness and efficiency of different strategies for more appropriate antibiotic prescribing that are currently out of the scope of the actual clinical guidelines. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03931577.
Asunto(s)
Antibacterianos/uso terapéutico , Tos/tratamiento farmacológico , Pautas de la Práctica en Medicina/economía , Atención Primaria de Salud , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Adulto , Antibacterianos/economía , Comunicación , Análisis Costo-Beneficio , Humanos , Relaciones Médico-Paciente , Investigación Cualitativa , Ensayos Clínicos Controlados Aleatorios como Asunto , EspañaRESUMEN
BACKGROUND: Quality indicators are measured aspects of healthcare, reflecting the performance of a healthcare provider or healthcare system. They have a crucial role in programmes to assess and improve healthcare. Many performance measures for primary care have been developed. Only the Catalan model for patient safety in primary care identifies key domains of patient safety in primary care. OBJECTIVE: To present an international framework for patient safety indicators in primary care. METHODS: Literature review and online Delphi-survey, starting from the Catalan model. RESULTS: A set of 30 topics is presented, identified by an international panel and organized according to the Catalan model for patient safety in primary care. Most topic areas referred to specific clinical processes; additional topics were leadership, people management, partnership and resources. CONCLUSION: The framework can be used to organize indicator development and guide further work in the field.
Asunto(s)
Seguridad del Paciente , Atención Primaria de Salud , Indicadores de Calidad de la Atención de Salud , Técnica Delphi , Humanos , Modelos TeóricosAsunto(s)
Promoción de la Salud/organización & administración , Seguridad del Paciente , Administración de la Seguridad/organización & administración , Conducta Cooperativa , Implementación de Plan de Salud , Hospitales Privados/organización & administración , Hospitales Públicos/organización & administración , Humanos , Relaciones Interinstitucionales , Participación del Paciente , EspañaRESUMEN
The nationwide Bacteremia Zero (BZ) Project consists in the simultaneous implementation of measures to prevent central venous catheter-related bacteremia (CVC-B) in critically ill patients and in the development of an integral safety plan. The objective is to present the results obtained after the implementation of the BZ project in the ICUs of the Autonomous Community of Catalonia, Spain. All patients admitted to ICUs in Catalonia participating in the ENVIN-HELICS registry between January 2009 and June 2010 were included. Information was provided by 36 (92.3%) of the total possible 39 ICUs. A total of 281 episodes of CVC-B were diagnosed (overall rate of 2.53 episodes per 1000 days of CVC). The rates have varied significantly between ICUs that participated in the project for more or less than 12 months (2.17 vs. 4.27 episodes per 1000 days of CVC, respectively; p<.0001). The implementation of the BZ Project in Catalonia has been associated with a decrease greater than 40% in the CVC-B rates in the ICUs of this community, which is much higher than the initial objective of 4 episodes per 1000 days of CVC).
Asunto(s)
Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/prevención & control , Catéteres Venosos Centrales/efectos adversos , Control de Infecciones/organización & administración , Programas Nacionales de Salud/estadística & datos numéricos , Bacteriemia/epidemiología , Bacteriemia/etiología , Bacteriemia/microbiología , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/microbiología , Cuidados Críticos/estadística & datos numéricos , Fungemia/epidemiología , Fungemia/microbiología , Fungemia/prevención & control , Personal de Salud/educación , Implementación de Plan de Salud , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Programas Nacionales de Salud/organización & administración , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , España/epidemiología , Precauciones UniversalesRESUMEN
The aim of this paper is to discover the aggregated results of a general notification system for incidents related to patient safety implemented in Catalan hospitals from 2010 to 2013. Observational study describing the incidents notified from January 2010 to December 2013 from all hospitals in Catalonia forming part of the project to create operational patient safety management units. The Patient Safety Notification and Learning System (SiNASP) was used. This makes it possible to classify incidents depending on the area where they occur, the type of incident notified, the consequences, the seriousness according to the Severity Assessment Code (SAC) and the profession of the notifying party, as the principal variables. The system was accessed via the Internet (SiNASP portal). Access was voluntary and anonymous or with a name given and later removed. During the study period, notification of a total of 5,948 incidents came from 22-29 hospitals. 5,244 of the incidents were handled by the centres and these are the ones analysed in the study. 64% (3,380) affected patients, 18% (950) created a situation capable of causing an incident and 18% (914) did not affect patients. 26% of incidents that affected patients (864) caused some kind of harm. Most incidents occurred during hospitalisation (54%) and in casualty (15%), followed by the ICU (9%) and the surgical block (8%). The most frequent notifying parties were nurses (71%) followed by doctors (15%) and pharmacists (9%). In terms of severity, most incidents were classified as low-risk (37%) or incidents that did not affect the patient (36%). However, 40 cases (0.76%) of extreme risk should be highlighted. In terms of the types of incident notified, most were due to a medication error (26.8%), followed by falls (16.3%) and patient identification (10.6%). The majority of notifications were incidents that affected patients and, of these, 26% caused harm. In general, they occurred in hospitalisation units and notification was mostly given by nurses. The incident notification system is a tool that complements others for promoting a patient safety culture and defining the risk profile of a health organisation. The opportunity for learning from experience is the reason for the existence of the notification system.
Asunto(s)
Seguridad del Paciente , Gestión de Riesgos/organización & administración , Accidentes por Caídas/estadística & datos numéricos , Departamentos de Hospitales/estadística & datos numéricos , Humanos , Internet , Errores Médicos/estadística & datos numéricos , Sistemas de Identificación de Pacientes , Pacientes , Estudios Retrospectivos , Factores de Riesgo , Gestión de Riesgos/estadística & datos numéricos , Índice de Severidad de la Enfermedad , España/epidemiologíaRESUMEN
Since its inception in 2006, the Alliance for Patient Safety in Catalonia has played a major role in promoting and shaping a series of projects related to the strategy of the Ministry of Health, Social Services and Equality, for improving patient safety. One such project was the creation of functional units or committees of safety in hospitals in order to facilitate the management of patient safety. The strategy has been implemented in hospitals in Catalonia which were selected based on criteria of representativeness. The intervention was based on two lines of action, one to develop the model framework and the other for its development. Firstly the strategy for safety management based on EFQM (European Foundation for Quality Management) was defined with the development of standards, targets and indicators to implement security while the second part involved the introduction of tools, methodologies and knowledge to the management support of patient safety and risk prevention. The project was developed in four hospital areas considered higher risk, each assuming six goals for safety management. Some of these targets such as the security control panel or system of adverse event reporting were shared. 23 hospitals joined the project in Catalonia. Despite the different situations in each centre, high compliance was achieved in the development of the objectives. In each of the participating areas the security control panel was developed. Stable structures for safety management were established or strengthened. Training in patient safety played and important role, 1415 professionals participated. Through these kind of projects not only have been introduced programs of proven effectiveness in reducing risks, but they also provide to the facilities a work system that allows autonomy in diagnosis and analysis of the different risk situations or centre specific safety issues.
Asunto(s)
Seguridad del Paciente , Accidentes por Caídas/prevención & control , Servicio de Urgencia en Hospital/normas , Objetivos , Política de Salud , Hospitales Privados/organización & administración , Hospitales Públicos/organización & administración , Humanos , Unidades de Cuidados Intensivos/normas , Errores de Medicación/prevención & control , Modelos Teóricos , Quirófanos/normas , Manejo del Dolor , Indicadores de Calidad de la Atención de Salud , Calidad de la Atención de Salud , Gestión de Riesgos/organización & administración , España , Gestión de la Calidad TotalRESUMEN
Most scoliosis are idiopathic (80%) and occur more frequently in adolescent girls. Plain radiography is the imaging method of choice, both for the initial study and follow-up studies but has the disadvantage of using ionizing radiation. The breasts are exposed to x-ray along these repeated examinations. The authors present a range of recommendations in order to optimize radiographic exam technique for both conventional and digital x-ray settings to prevent unnecessary patients' radiation exposure and to reduce the risk of breast cancer in patients with scoliosis. With analogue systems, leaded breast protectors should always be used, and with any radiographic equipment, analog or digital radiography, the examination should be performed in postero-anterior projection and optimized low-dose techniques. The ALARA (as low as reasonable achievable) rule should always be followed to achieve diagnostic quality images with the lowest feasible dose.
Asunto(s)
Seguridad del Paciente , Traumatismos por Radiación/prevención & control , Escoliosis/diagnóstico por imagen , Adolescente , Mama/efectos de la radiación , Niño , Relación Dosis-Respuesta en la Radiación , Femenino , Humanos , Masculino , Órganos en Riesgo , Ropa de Protección , Mejoramiento de la Calidad , Dosis de Radiación , Protección Radiológica , Intensificación de Imagen Radiográfica/instrumentación , Intensificación de Imagen Radiográfica/métodos , Radiografía/efectos adversos , Radiografía/instrumentación , Radiografía/métodos , Radiometría , Índice de Severidad de la EnfermedadRESUMEN
No disponible
Asunto(s)
Humanos , Promoción de la Salud/organización & administración , Seguridad del Paciente , Administración de la Seguridad/organización & administración , Conducta Cooperativa , España , Participación del Paciente , Relaciones Interinstitucionales , Hospitales Públicos/organización & administración , Hospitales Privados/organización & administración , Implementación de Plan de SaludRESUMEN
El proyecto nacional Bacteriemia Zero (BZ) consiste en la aplicación simultánea de un paquete de medidas para la prevención de bacteriemias relacionadas con catéteres venosos centrales (B-CVC) en los pacientes críticos y en el desarrollo de un plan integral en seguridad. El objetivo es presentar los resultados de la aplicación del proyecto BZ en las unidades de cuidados intensivos (UCI) de la comunidad autónoma de Catalunya. Se han incluido todos los pacientes ingresados en las UCI participantes de Catalunya en el registro ENVINHELICS desde enero de 2009 hasta junio de 2010. Han aportado información 36 UCI (92,3%) de las 39 posibles. Se han diagnosticado 281 episodios de B-CVC (tasa global de 2,53 episodios por 1.000 días de CVC). Las tasas han variado significativamente entre las UCI que han participado más o menos de 12 meses en el proyecto (2,17 frente a 4,27 episodios por 1.000 días de CVC, respectivamente; p < 0,0001). La aplicación del proyecto BZ en Catalunya ha disminuido la tasa de las B-CVC en las UCI de esta comunidad en más del 40%, mejorando el objetivo inicial de 4 episodios por 1.000 días de CVC (AU)
The nationwide Bacteremia Zero (BZ) Project consists in the simultaneous implementation of measures to prevent central venous catheter-related bacteremia (CVC-B) in critically ill patients and in the development of an integral safety plan. The objective is to present the results obtained after the implementation of the BZ project in the ICUs of the Autonomous Community of Catalonia, Spain. All patients admitted to ICUs in Catalonia participating in the ENVIN-HELICS registry between January 2009 and June 2010 were included. Information was provided by 36 (92.3%) of the total possible 39 ICUs. A total of 281 episodes of CVC-B were diagnosed (overall rate of 2.53 episodes per 1000 days of CVC). The rates have varied significantly between ICUs that participated in the project for more or less than 12 months (2.17 vs. 4.27 episodes per 1000 days of CVC, respectively; p<.0001). The implementation of the BZ Project in Catalonia has been associated with a decrease greater than 40% in the CVC-B rates in the ICUs of this community, which is much higher than the initial objective of 4 episodes per 1000 days of CVC) (AU)
Asunto(s)
Humanos , Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/prevención & control , Catéteres Venosos Centrales/efectos adversos , Control de Infecciones/organización & administración , Programas Nacionales de Salud/organización & administración , Programas Nacionales de Salud/estadística & datos numéricos , Fungemia/epidemiología , Fungemia/microbiología , Fungemia/prevención & control , Unidades de Cuidados Intensivos/estadística & datos numéricos , Bacteriemia/epidemiología , Bacteriemia/etiología , Bacteriemia/microbiología , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/microbiología , Personal de Salud/educación , Implementación de Plan de Salud , Ensayo Clínico , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , España/epidemiología , Precauciones Universales , Cuidados Críticos/estadística & datos numéricosRESUMEN
Desde su creación en 2006, la Alianza para la Seguridad del Paciente ha tenido en Cataluña un papel muy destacado para impulsar y dar forma a una serie de proyectos relacionados con la estrategia del Ministerio de Sanidad, Servicios Sociales e Igualdad para la mejora de la seguridad del paciente. Uno de estos ha sido el proyecto de creación de unidades funcionales o comisiones de seguridad en los hospitales con el objetivo de facilitar la gestión de la seguridad del paciente. La estrategia se planteó en un determinado número de hospitales de Cataluña seleccionados en función de criterios de representatividad. La intervención se basó en 2 líneas de actuación: una, para enmarcar el modelo y otra, para su desarrollo. En el primer caso se definió la estrategia de gestión de la seguridad basada en el modelo EFQM (European Foundation for Quality Management) con la elaboración de estándares, objetivos e indicadores de seguridad que se proponía implementar, mientras que la segunda línea supuso la introducción de herramientas, metodologías y conocimientos como soporte a la gestión de la seguridad del paciente y a la prevención de riesgos. El proyecto se desarrolló en las 4 áreas del hospital consideradas de mayor riesgo, asumiendo cada una de ellas 6 objetivos de gestión de la seguridad. Algunos de estos objetivos, como el cuadro de mando o el sistema de notificación de eventos adversos, fueron compartidos por las 4 áreas. Se adhirieron al proyecto 23 hospitales de Cataluña. A pesar de las diferentes situaciones de cada centro se alcanzó un alto cumplimiento en el desarrollo de los objetivos. Se elaboró el cuadro de mando de seguridad en cada una de las áreas participantes. Se crearon o reforzaron estructuras estables para la gestión de la seguridad. La formación en seguridad del paciente, que tuvo un papel prioritario, llegó a 1.415 profesionales. A través de este tipo de proyectos no solo se introducen y desarrollan programas de efectividad contrastada en la reducción de riesgos, sino que se dota a los centros de una sistemática de trabajo que les permite la autonomía en el diagnóstico y análisis de las diferentes situaciones de riesgo o problemas de seguridad propios de cada centro (AU)
Since its inception in 2006, the Alliance for Patient Safety in Catalonia has played a major role in promoting and shaping a series of projects related to the strategy of the Ministry of Health, Social Services and Equality, for improving patient safety. One such project was the creation of functional units or committees of safety in hospitals in order to facilitate the management of patient safety. The strategy has been implemented in hospitals in Catalonia which were selected based on criteria of representativeness. The intervention was based on two lines of action, one to develop the model framework and the other for its development. Firstly the strategy for safety management based on EFQM (European Foundation for Quality Management) was defined with the development of standards, targets and indicators to implement security while the second part involved the introduction of tools, methodologies and knowledge to the management support of patient safety and risk prevention. The project was developed in four hospital areas considered higher risk, each assuming six goals for safety management. Some of these targets such as the security control panel or system of adverse event reporting were shared. 23 hospitals joined the project in Catalonia. Despite the different situations in each centre, high compliance was achieved in the development of the objectives. In each of the participating areas the security control panel was developed. Stable structures for safety management were established or strengthened. Training in patient safety played and important role, 1415 professionals participated. Through these kind of projects not only have been introduced programs of proven effectiveness in reducing risks, but they also provide to the facilities a work system that allows autonomy in diagnosis and analysis of the different risk situations or centre specific safety issues (AU)
Asunto(s)
Humanos , Seguridad del Paciente , Unidades de Cuidados Intensivos/normas , Errores de Medicación/prevención & control , Modelos Teóricos , Quirófanos/normas , Manejo del Dolor , Gestión de Riesgos/organización & administración , Gestión de la Calidad Total , Accidentes por Caídas/prevención & control , Servicio de Urgencia en Hospital/normas , Objetivos , Política de Salud , Hospitales Privados/organización & administración , Hospitales Públicos/organización & administración , Indicadores de Calidad de la Atención de Salud , Calidad de la Atención de Salud , EspañaRESUMEN
El objetivo de este artículo es describir los resultados agregados de un sistema de notificación genérico de incidentes relacionados con la seguridad del paciente, implantado en los hospitales catalanes desde 2010 a 2013. Se trata de un estudio observacional, descriptivo de los incidentes notificados desde enero de 2010 a diciembre de 2013, de todos los hospitales de Cataluña adheridos al proyecto de creación de unidades funcionales de gestión de la seguridad del paciente. Se utilizó el Sistema de Notificación y Aprendizaje para la Seguridad del Paciente (SiNASP), que permite clasificar los incidentes en función del área donde se producen, el tipo de incidente notificado, las consecuencias, la gravedad según el Severity Assessment Code (SAC) y la profesión del notificante como principales variables. El acceso al sistema se realizó a través de internet (portal SiNASP), fue voluntario y anónimo o nominativo con posterior anonimización. Durante el período de estudio notificaron entre 22 y 29 hospitales, con un total de 5.948 incidentes, de los cuales 5.244 fueron gestionados por los centros y son los que se analizan en el estudio. Un 64% (3.380) llegó al paciente, un 18% (950) creó una situación con capacidad de causar un incidente y un 18% (914) no llegó al paciente. De los incidentes que llegaron al paciente, un 26% (864) ocasionó algún daño. La mayoría de incidentes ocurrió en hospitalización (54%) y urgencias (15%), seguidos de UCI (9%) y bloque quirúrgico (8%). Los que más notificaron fueron los enfermeros (71%), seguidos de los médicos (15%) y de los farmacéuticos (9%). Atendiendo a la gravedad, la mayoría fueron clasificados de riesgo bajo (37%) o que el incidente no llegó al paciente (36%). No obstante destacan 40 casos (0,76%) de riesgo extremo. En relación con el tipo de incidente notificado, la mayoría fue por error en la medicación (26,8%), seguido por caídas (16,3%) e identificación del paciente (10,6%). La mayoría de las notificaciones fueron incidentes que llegaron al paciente y de ellos, un 26% ocasionó daño. En general ocurrieron en las unidades de hospitalización y fueron los enfermeros los que más notificaron. El sistema de notificación de incidentes es una herramienta complementaria a otras para promocionar una cultura de seguridad del paciente y definir el perfil de riesgos de una organización sanitaria. La oportunidad para aprender de la propia experiencia es la razón de ser del sistema de notificación (AU)
The aim of this paper is to discover the aggregated results of a general notification system for incidents related to patient safety implemented in Catalan hospitals from 2010 to 2013. Observational study describing the incidents notified from January 2010 to December 2013 from all hospitals in Catalonia forming part of the project to create operational patient safety management units. The Patient Safety Notification and Learning System (SiNASP) was used. This makes it possible to classify incidents depending on the area where they occur, the type of incident notified, the consequences, the seriousness according to the Severity Assessment Code (SAC) and the profession of the notifying party, as the principal variables. The system was accessed via the Internet (SiNASP portal). Access was voluntary and anonymous or with a name given and later removed. During the study period, notification of a total of 5,948 incidents came from 22-29 hospitals. 5,244 of the incidents were handled by the centres and these are the ones analysed in the study. 64% (3,380) affected patients, 18% (950) created a situation capable of causing an incident and 18% (914) did not affect patients. 26% of incidents that affected patients (864) caused some kind of harm. Most incidents occurred during hospitalisation (54%) and in casualty (15%), followed by the ICU (9%) and the surgical block (8%). The most frequent notifying parties were nurses (71%) followed by doctors (15%) and pharmacists (9%). In terms of severity, most incidents were classified as low-risk (37%) or incidents that did not affect the patient (36%). However, 40 cases (0.76%) of extreme risk should be highlighted. In terms of the types of incident notified, most were due to a medication error (26.8%), followed by falls (16.3%) and patient identification (10.6%). The majority of notifications were incidents that affected patients and, of these, 26% caused harm. In general, they occurred in hospitalisation units and notification was mostly given by nurses. The incident notification system is a tool that complements others for promoting a patient safety culture and defining the risk profile of a health organisation. The opportunity for learning from experience is the reason for the existence of the notification system (AU)
Asunto(s)
Humanos , Seguridad del Paciente , Gestión de Riesgos/organización & administración , Gestión de Riesgos/estadística & datos numéricos , Accidentes por Caídas/estadística & datos numéricos , Departamentos de Hospitales/estadística & datos numéricos , Internet , Errores Médicos/estadística & datos numéricos , Sistemas de Identificación de Pacientes , Pacientes , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , España/epidemiologíaRESUMEN
La mayoría de las escoliosis son idiopáticas (80%) y ocurren más frecuentemente en adolescentes y en el sexo femenino. La radiografía simple es el método de imagen de elección, tanto en el estudio inicial como en el seguimiento evolutivo, pero tiene el inconveniente de utilizar radiaciones ionizantes. Las mamas quedan en el campo de exposición durante estos estudios repetidos. Los autores presentan una serie de recomendaciones para optimizar la técnica de las exploraciones y los equipos radiográficos, tanto analógicos como digitales, para evitar dosis de irradiación innecesarias a los pacientes y reducir el riesgo de cáncer de mama en los pacientes con escoliosis. Cuando se utilizan equipos analógicos siempre debe utilizarse protector mamario plomado y, en todos los equipos, sean analógicos o digitales, hay que realizar la radiografía en proyección posteroanterior y con técnicas optimizadas de baja dosis. Hay que seguir siempre el principio ALARA (as low as reasonable achievable) para obtener imágenes diagnósticas de calidad con la dosis lo más baja posible (AU)
Most scoliosis are idiopathic (80%) and occur more frequently in adolescent girls. Plain radiography is the imaging method of choice, both for the initial study and follow-up studies but has the disadvantage of using ionizing radiation. The breasts are exposed to x-ray along these repeated examinations. The authors present a range of recommendations in order to optimize radiographic exam technique for both conventional and digital x-ray settings to prevent unnecessary patients' radiation exposure and to reduce the risk of breast cancer in patients with scoliosis. With analogue systems, leaded breast protectors should always be used, and with any radiographic equipment, analog or digital radiography, the examination should be performed in postero-anterior projection and optimized low-dose techniques. The ALARA (as low as reasonable achievable) rule should always be followed to achieve diagnostic quality images with the lowest feasible dose (AU)
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Adolescente , Niño , Femenino , Humanos , Masculino , Traumatismos por Radiación/prevención & control , Seguridad del Paciente , Escoliosis , Mama/efectos de la radiación , Relación Dosis-Respuesta en la Radiación , Órganos en Riesgo , Ropa de Protección , Mejoramiento de la Calidad , Dosis de Radiación , Intensificación de Imagen Radiográfica/instrumentación , Intensificación de Imagen Radiográfica/métodos , Radiografía/efectos adversos , Radiografía/instrumentación , Radiografía/métodos , Radiometría , Índice de Severidad de la EnfermedadRESUMEN
INTRODUCTION: A system for monitoring the use of aphaeresis in the treatment of ulcerative colitis (UC), named system for monitoring aphaeresis in ulcerative colitis (SiMAC), was designed in 2006 in the Basque Country. In the present study, the opinion of the clinicians who participated in SiMAC was evaluated, in order to identify the barriers and gather suggestions that could improve implementation of this kind of system. METHODS: A mixed questionnaire was designed, in order to gather clinicians' assessments of the SiMAC monitoring system. RESULTS: The response rate was 73.9% (17/23). The data from 40.96% (159/388) of patients with UC treated with aphaeresis was recorded. The main reasons for not including the data from all treated patients were a lack of required data or not meeting the study inclusion criteria. Positive aspects of the SiMAC were identified, as the simplicity of data collection and its systematic, multi-center approach. The negative aspects mentioned were the use of a local computer application and the lack of time for health professionals to enter data. DISCUSSION: The use of monitoring systems helps to formalize the introduction of technologies of little-known effectiveness; involve clinicians and medical societies in coming to agreement and obtaining information about the safety, effectiveness or efficiency of new technologies; and provide relevant information to healthcare administrations for making decisions about the introduction of new technologies into healthcare practice. In order for a monitoring system to work, the process must be straightforward. A minimum set of key variables that are easy to collect must be selected, and an effort made to involve a range of stakeholders, especially institutions and scientific societies, to support the work group.
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Humanos , Costos de la Atención en Salud , Enfermedad Coronaria/tratamiento farmacológico , Enfermedad Coronaria/cirugía , Stents/economía , Sistemas de Liberación de Medicamentos/economía , Enfermedad Coronaria/economía , Análisis Costo-Eficiencia , EspañaRESUMEN
INTRODUCTION AND OBJECTIVES: Antiproliferative drug-coated stents are a possible solution for post-angioplasty coronary restenosis. Here we analyze their efficacy, effectiveness and safety, and estimate the economic impact of their use in Spain. MATERIAL AND METHOD: Systematic review (meta-analysis) of the scientific evidence available up to January 2004, and analysis of hospital costs within a 1-year time horizon. RESULTS: We identified 12 published studies (5 clinical series and 7 RCTs) comparing coated stents (sirolimus or paclitaxel) with conventional stents in patient with de novo single lesions < 30 mm in 2.5-3.5 mm vessels. In nearly all cases the rates of angiographic restenosis and major adverse cardiac events were lower in the coated stent group after 6-12 months. Meta-analysis showed a 69% decrease in revascularization rate (RR=0.31; 95%CI, 0.19-0.51). For every 1000 patients with de novo lesions, the use of a coated stent involved an additional average cost of Euro 818718. The estimated neutral price of a new stent was Euro 1448 at a market price per unit of Euro 2000. CONCLUSIONS: At 12-month follow-up, sirolimus- or paclitaxel-eluting stents were effective and safe in patients with de novo lesions and low or medium risk of restenosis. At current market prices, the widespread use of these stents would involve an increase in health care expenditure for the different sensitivity scenarios we evaluated. More studies are needed to specify the type of patients and lesions likely to obtain the greatest clinical benefit.
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Reestenosis Coronaria/prevención & control , Estenosis Coronaria/terapia , Sistemas de Liberación de Medicamentos/instrumentación , Implantes de Medicamentos , Stents , Angioplastia Coronaria con Balón , Análisis Costo-Beneficio , Sistemas de Liberación de Medicamentos/economía , Implantes de Medicamentos/economía , Humanos , Paclitaxel/administración & dosificación , Sirolimus/administración & dosificación , España , Stents/economíaRESUMEN
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Humanos , Estudios Epidemiológicos , Diseño de Investigaciones Epidemiológicas , Recolección de Datos/métodos , 28573 , Distribución Aleatoria , Placebos , Estudios de Casos y Controles , Método Doble Ciego , Método Simple Ciego , Ensayos Clínicos Controlados Aleatorios como Asunto/métodosRESUMEN
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