[Benchmarking in patient identification: An opportunity to learn]. / Benchmarking en la identificación de pacientes: una oportunidad para aprender.

OBJECTIVE: To perform a benchmarking on the safe identification of hospital patients involved in "Club de las tres C" (Calidez, Calidad y Cuidados) in order to prepare a common procedure for this process. MATERIAL AND METHODS: A descriptive study was conducted on the patient identification process in palliative care and stroke units in 5medium-stay hospitals. The following steps were carried out: Data collection from each hospital; organisation and data analysis, and preparation of a common procedure for this process. RESULTS: The data obtained for the safe identification of all stroke patients were: hospital 1 (93%), hospital 2 (93.1%), hospital 3 (100%), and hospital 5 (93.4%), and for the palliative care process: hospital 1 (93%), hospital 2 (92.3%), hospital 3 (92%), hospital 4 (98.3%), and hospital 5 (85.2%). CONCLUSIONS: The aim of the study has been accomplished successfully. Benchmarking activities have been developed and knowledge on the patient identification process has been shared. All hospitals had good results. The hospital 3 was best in the ictus identification process. The benchmarking identification is difficult, but, a useful common procedure that collects the best practices has been identified among the 5 hospitals.

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.

Abordaje multidisciplinar de las caídas en un hospital de media estancia / A multidisciplinary approach to falls in a medium-stay hospital

ObjetivoAbordar el problema de las caídas en un hospital de media estancia, identificando a los pacientes de mayor riesgo y las circunstancias más habituales en las que se producen.Pacientes y métodosEstudio descriptivo de todos los pacientes ingresados en el Hospital Guadarrama durante el año 2007 (n=920). Se recogieron en una base de datos incluida en la historia informatizada del paciente: el STRATIFY al ingreso, la situación cognitiva y funcional, Unidad de Hospitalización, registro de las caídas y circunstancias en las que se produjeron. Se realizó el estudio descriptivo y análisis multivariante con el programa SPSS 16.ResultadosDurante el periodo de estudio se produjeron 144 caídas. La incidencia de caídas/ingreso fue de 14,3%, siendo la Unidad de Recuperación funcional la que mas caídas registra con un 22,01%, siendo los pacientes con ictus, con un 31%, el grupo de pacientes que más caídas sufrieron. El turno de la mañana ha sido el que mas caídas ha registrado, el 51%. El mayor número de caídas se produjeron desde la silla (44%). Un 34% de los pacientes habían sufrido caídas anteriores. Cuando se realizó el análisis de regresión logística, las variables que permanecieron con asociación estadísticamente significativa con caídas fueron: el índice de Barthel al ingreso (Exp β 2,5, IC del 95%: 1,5–4,2; p<0,01) y la escala de STRATIFY al ingreso (Exp β 1,67, IC del 95%: 1,05–2,66; p=0,02).ConclusionesLos pacientes crónicos con mayor deterioro funcional son más propensos a sufrir caídas. En cuanto a la actividad en el momento de la caída, podemos observar que el mayor porcentaje de pacientes sufren la caída al tratar de levantarse(AU)

ObjectiveTo approach the problem of the falls in an average stay hospital; identifying the patients of greater risk; and find out the circumstances in which the falls occurred.Patients and methodsA descriptive study of all the patients who entered the Guadarrama Hospital (Madrid) during year 2007 (n=920). On admission, all patients were assessed using the Stratify falls risk scale, their cognitive and functional situation, unit of hospitalisation, record of falls and circumstances under which the falls occurred. The descriptive study and multivariate analysis was performed using the SPSS 16 statistics program.ResultsDuring the period of study 144 falls took place. There was a falls/admission incidence of 14.30%. The highest number of falls (22.1%) occurred in the Functional Recovery Unit (FRU) and patients with stroke being the group that suffered most falls (31%). Most falls were registered during the morning shift, with 51%. The greatest number of falls occurred from a chair (44%) and 66% of the patients had mobility limitations. A total of 34% of the patients had fallen previously. When the logistic regression analysis was made, the variables that remained with statistically significant association with falls, were: the Barthel index on admission (Exp β 2.5, 95%CI; 1.5–4.2; P<0,01) and the STRATIFY scale on admission (Exp β 1.67, 95%CI; 1.05–2.66; P=0.02)ConclusionsThe chronic patients with greater functional deterioration are more prone to suffer falls. With respect to patient activity at the time of the fall, we can observe that most of them were seated and tried to stand up(AU)

[A multidisciplinary approach to falls in a medium-stay hospital]. / Abordaje multidisciplinar de las caídas en un hospital de media estancia.

OBJECTIVE: To approach the problem of the falls in an average stay hospital; identifying the patients of greater risk; and find out the circumstances in which the falls occurred. PATIENTS AND METHODS: A descriptive study of all the patients who entered the Guadarrama Hospital (Madrid) during year 2007 (n = 920). On admission, all patients were assessed using the Stratify falls risk scale, their cognitive and functional situation, unit of hospitalisation, record of falls and circumstances under which the falls occurred. The descriptive study and multivariate analysis was performed using the SPSS 16 statistics program. RESULTS: During the period of study 144 falls took place. There was a falls/admission incidence of 14.30%. The highest number of falls (22.1%) occurred in the Functional Recovery Unit (FRU) and patients with stroke being the group that suffered most falls (31%). Most falls were registered during the morning shift, with 51%. The greatest number of falls occurred from a chair (44%) and 66% of the patients had mobility limitations. A total of 34% of the patients had fallen previously. When the logistic regression analysis was made, the variables that remained with statistically significant association with falls, were: the Barthel index on admission (Exp beta 2.5, 95%CI; 1.5-4.2; P < 0,01) and the STRATIFY scale on admission (Exp beta 1.67, 95%CI; 1.05-2.66; P = 0.02) CONCLUSIONS: The chronic patients with greater functional deterioration are more prone to suffer falls. With respect to patient activity at the time of the fall, we can observe that most of them were seated and tried to stand up.