Does Skilled Nursing Facility Trigger Tool used with Global Trigger Tool increase its value for adverse events evaluation?

OBJECTIVE: To assess the additional value in the evaluation of incidents and adverse events by adding the IHI Skilled Nursing Facility Trigger Tool (SNFTT) to the Institute for Healthcare Improvement's Global Trigger Tool (GTT) in an acute geriatric hospital. MATERIAL AND METHODS: A one-year retrospective study reviewing 240 electronic clinical records using the general GTT, either alone or combined with SNFTT. MAIN OUTCOME MEASURES: Number of triggers and identified adverse events (AEs), categories of severity and preventability of AEs, GTT incidence rates, and the number needed to alert (NNA). RESULTS: One hundred and thirty-seven AEs were identified in 107 patients (57.1 AEs per 100 admissions). Of these, 127 (92.7%) occurred 3 or more days after admissions; 49.6% of the harm events were preventable. The NNA for GTT plus SNFTT was 8.6. No significant difference was found using the general GTT alone versus the general GTT plus SNFTT in terms of the main outcome measures. Eleven categories of triggers were better identified when using GTT plus SNFTT because with GTT alone they were allocated to a category of "Other": 9 from the care module (C15) and 2 from the medication module (M13). CONCLUSIONS: The study demonstrates that adding the SNFTT to the GTT did not increase its effectiveness as regards the evaluation of AEs. However, some triggers are better described in SNFTT and now have now been added into the general GTT method in our hospital.

[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.

[Compliance with the surgical safety checklist and surgical events detected by the Global Trigger Tool]. / Cumplimiento del listado de verificación quirúrgica y los eventos quirúrgicos detectados mediante la herramienta del Global Trigger Tool.

INTRODUCTION: The implementing of the WHO Surgical Safety Checklist (SSC) has helped to improve patient safety. The aim of this study was to assess the level of compliance of the SSC, and incorporating the non-compliances as «triggers¼ in the Global Trigger Tool (GTT). SETTING: Acute Geriatric Hospital (200 beds). Retrospective study, study period: 2011-2014. The SSC formulary and the methodology of the GTT were used for the analysis of electronic medical records and the compliance with the SSC. The NCCP MERP categories were used to assess the severity of the harm. RESULTS: Out of all the electronic medical records (EMR), a total of 227 (23.6%) discharged patients (1.7% of interventions in the four year study period) were analysed. All (100%) of the EMR included the SSC, with 94.4% of the items being completed, and 28.2% of SSC had all items completed in the 3 phases of the process. Surgical adverse events decreased from 16.3% in 2011 to 9.4% in 2014 (P=.2838, not significant), and compliance with all items of SSC was increased from 18.6% to 39.1% (P=.0246, significant). CONCLUSIONS: The GTT systematises and evaluates, at low cost, the triggers and incidents/ AEs found in the EMR in order to assess the compliance with the SSC and consider non-compliance of SSC as «triggers¼ for further analysis. This strategy has never been referred to in the GTT or in the SCC formulary.

Errores en el uso de antimicrobianos: la epidemia silenciosa para la seguridad de pacientes / Antimicrobial drugs errors: the silent epidemic in patient safety

Introducción. Los errores en el uso de medicamentossuponen una de las primeras causas de sucesos adversos enlos hospitales. El objetivo ha sido evaluar los errores en eluso de antimicrobianos producidos en una unidad de nuestrohospital en el bienio 2005-2006.Métodos. Se recogieron todos los errores mediante elformulario de notificación voluntaria IR2 del Servicio Nacionalde Salud inglés y se clasificaron los mismos en funcióndel tipo de proceso, tipos de errores, sus causas y factorescontribuyentes, así como la severidad de los mismos.También se analizaron los posibles errores teóricos y los costesasociados.Resultados. Los errores en el uso de antimicrobianos seprodujeron en un 1,3% de los pacientes ingresados (0,84 casospor cada 1.000 órdenes médicas). Por tipo de proceso loserrores más frecuentes fueron debidos a la administración(32,4%) y la dispensación (44,1%). Por tipo de error: medicamentoerróneo (32,4%), la causa-raíz principal fueron losfactores humanos (58,8 %) y como factor contribuyente elmal diseño de tareas (55,9 %). En un 5,9 % se catalogaroncomo sucesos severos, especialmente el grupo de los betalactámicos,y como vía, la endovenosa (50%).Conclusiones. Los sucesos adversos relacionados con eluso de antimicrobianos, muy frecuentes y a veces severos,suponen una epidemia silenciosa al no ser detectados si nose utiliza la metodología específica de seguridad de pacientes.Suponen unos costes nada desdeñables para un hospital (AU)

Introduction. Prescribed drugs and the mistakes inthe administration to patient is the first cause of adverseevents in the hospitals. The aim of this study has been toevaluate antimicrobial drug mistakes in one of our hospitalwards in a two year period 2005 and 2006.Methods. All the errors were reported through theNational Health Service IR2 form (England) on a voluntarybasis and classified by means of process, type oferrors, their causes and contributory factors, as well asthe severity. We analyzed the economic costs.Results. A 1.3% of the inpatients had an antimicrobialerror in the administration to the patient (0.84 by1,000 prescribing orders). Classified by processes, the administration(32.4%) and dispensation (44.1%) were themost frequent errors. By type of error: the erroneous medication(32.4%), the main root cause the human factors(58.8 %) and the contribution factor due to design oftasks (55.9 %). The 5.9% of errors were severe events,mainly in the group of the betalactamic drugs, andmainly by parenteral administration (50%).Conclusions. Antimicrobial drug errors, frequentand sometimes severe, suppose a silent epidemic notbeing detected without the patient safety methodology.They represent a high cost for a hospital (AU)