"Near Miss": A Mixed-Methods Analysis of Medical Student Assignments in Patient Safety.

The purpose of this study is to inform the curriculum for Entrustable Professional Activity 13 through analysis of fourth year medical student patient safety event assignments. From 2016 to 2021, students were asked to identify a patient safety event and indicate if the event required an incident report. Assignments were reviewed and coded based on Joint Commission incident definitions. Qualitative analysis was performed to evaluate incident report justification. There were 473 student assignments included in the analysis. Assignments reported incidents regarding communication, medical judgment, medication errors, and coordination of care. Students indicated only 18.0% (85/473) would warrant an incident report. Justification for not filing an incident report included lack of harm to the patient or that it was previously reported. Students were able to identify system issues but infrequently felt an incident report was required. Justifications for not filing an incident report suggest a need for a curriculum focused on the value of reporting near misses and hazardous conditions.

Vulnerabilities to disasters in healthcare facilities in the face of the COVID-19 pandemic: a scoping review. / Vulnerabilidades a desastres em estabelecimentos de saúde frente à pandemia de COVID-19: revisão de escopo.

This article maps the structural, nonstructural and functional vulnerabilities of healthcare facilities to the COVID-19 pandemic. It reports on a scoping review guided by JBI recommendations and structured by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The PubMed, CINAHL, LILACS, EMBASE, SciELO, Scopus and Web of Science Repositories and databases were consulted, as was the grey literature. The protocol was registered in the Open Science Framework. The 54 studies included summarised 36 vulnerabilities in three categories in 29 countries. Functional and non-structural vulnerabilities were the most recurrent. Limited material and human resources, service disruption, non-COVID procedures and inadequate training were the items with most impact. COVID-19 exposed nations to the need to strengthen health systems to ensure their resilience in future health crises. Prospective risk management and systematic analysis of health facility vulnerabilities are necessary to ensure greater safety, sustainability and improved standards of preparedness and response to events of this nature.

O objetivo do artigo é mapear as vulnerabilidades estruturais, não-estruturais e funcionais de estabelecimentos de saúde frente à pandemia de COVID-19. Revisão de escopo conduzida mediante recomendações do JBI e estruturada pelos Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Foram consultados repositórios e bases de dados: PubMed, CINAHL, LILACS, EMBASE, SciELO, Scopus e Web of Science, além de literatura cinzenta. O protocolo foi registrado em Open Science Framework, 54 estudos foram incluídos, sumarizando 36 vulnerabilidades entre as três categorias, em 29 países. As vulnerabilidades funcionais e não-estruturais foram as mais recorrentes. Recursos materiais e humanos limitados, interrupção dos serviços e procedimentos não-COVID, além de capacitação profissional insuficiente foram os itens que mais impactaram. A COVID-19 expôs às nações a necessidade de fortalecer os sistemas de saúde para garantir sua resiliência em futuras crises sanitárias. Ações de gestão de risco prospectivas e análise sistematizada de vulnerabilidades dos estabelecimentos de saúde são necessárias para garantir maior segurança, sustentabilidade e melhor padrão de preparação e resposta a futuros eventos dessa natureza.

Contribuições do núcleo interno de regulação para a segurança do paciente / Contributions of the regulatory inner core to patient safety / Aportes del núcleo interno normativo para la seguridad del paciente

Objetivo: identificar as contribuições do Núcleo Interno de Regulação para a segurança do paciente. Método: pesquisa qualitativa desenvolvida entre agosto a outubro de 2020. Foram realizadas entrevistas audiogravadas junto a 13 profissionais que atuavam nas enfermarias, no pronto-socorro, na gestão da qualidade e no Núcleo Interno de Regulação. Os dados foram analisados com o auxílio do software IraMuteq® e as etapas propostas por Creswell. Resultados: os achados revelaram que o Núcleo Interno de Regulação contribui para a segurança do paciente, entornando as metas instituídas: comunicação efetiva; identificação do paciente; redução do risco de infecções associadas aos cuidados em saúde - a pandemia de COVID-19 foi apresentada como um importante dado; segurança para cirurgia, uma vez que agiliza o acesso ao hospital para procedimento cirúrgico; e diminuição de filas de espera. Ainda, contribui para prevenir complicações decorrentes de quedas, pois o paciente pode ser alocado com agilidade num leito seguro. Por fim, o enfermeiro, no seu papel de liderança do serviço e como elo para a gerência do cuidado seguro, também se mostrou importante. Conclusão: embora algumas fragilidades tenham sido detectadas, a contribuição do Núcleo Interno de Regulação se sobressai por fortalecer as metas da segurança do paciente. Em razão disso, reafirma-se a importância de fluxos regulatórios na perspectiva de gestão de leitos hospitalares, assim como os preceitos da segurança do paciente almejada pelos gestores. Não obstante, o enfermeiro atua como elo entre esses dois cenários.(AU)

Objective: to identify the contributions of the Internal Regulation Core to patient safety. Method: qualitative research carried out between August and October 2020. Audio-recorded interviews were carried out with 13 professionals who worked in the wards, in the emergency room, in quality management and in the Internal Regulation Center. Data were analyzed using the IraMuteq® software and the steps proposed by Creswell. Results: the findings revealed that the Internal Regulation Nucleus contributes to patient safety, bypassing the established goals: effective communication; patient identification; reduction in the risk of infections associated with health care - the COVID-19 pandemic was presented as an important fact; safety for surgery, as it speeds up access to the hospital for a surgical procedure; and reduction of queues. It also helps to prevent complications resulting from falls, as the patient can be quickly allocated to a safe bed. Finally, the nurse, in his role as a leader in the service and as a link in the management of safe care, also proved to be important. Conclusion: although some weaknesses were detected, the contribution of the Internal Regulation Center stands out for strengthening patient safety goals. As a result, the importance of regulatory flows from the perspective of hospital bed management is reaffirmed, as well as the precepts of patient safety desired by managers. Nevertheless, the nurse acts as a link between these two scenarios.(AU)

Objetivo: identificar los aportes del Núcleo Interno Normativo para la seguridad del paciente. Método: investigación cualitativa desarrollada de agosto a octubre de 2020. Se realizaron entrevistas audiograbadas a 13 profesionales que trabajaban en las salas, en el servicio de urgencias, en la Gestión de Calidad y en el Núcleo Interno Normativo. Los datos fueron analizados con la ayuda del software IraMuteq® y los pasos propuestos por Creswell. Resultados: los hallazgos revelaron que el Núcleo Interno Normativo contribuye a la seguridad del paciente, desbordando los objetivos establecidos: comunicación eficaz; identificación del paciente; reducción del riesgo de infecciones asociadas a la asistencia sanitaria - la pandemia COVID-19 se presentó como un dato importante; en la seguridad para la cirugía, ya que agiliza el acceso al hospital para procedimientos quirúrgicos y, en la reducción de las colas de espera. También contribuye a la prevención de complicaciones derivadas de caídas, ya que el paciente puede ser ubicado rápidamente en una cama segura. Y, finalmente, el enfermero, en su papel de líder en el servicio, como enlace en la gestión del cuidado seguro, también resultó ser un resultado importante. Conclusión: aunque se detectaron algunas debilidades, se destaca la contribución del Núcleo Interno Normativo en el fortalecimiento de las metas de seguridad del paciente. Como resultado, reafirma la importancia de los flujos normativos desde la perspectiva de la gestión de camas hospitalarias, así como los preceptos de seguridad del paciente deseados por los gestores. Sin embargo, la enfermera actúa como enlace entre estos dos escenarios.(AU)

Evaluación del riesgo biológico en la producción de vacunas inactivadas de uso animal / Biological risk assessment for the production of inactivated vaccines for animal use

La vacunación continúa siendo una de las vías más sostenibles y utilizadas en el control de enfermedades infectocontagiosas en medicina veterinaria, dado por su mayor factibilidad económica y por el problema que representa el residuo de antibióticos en productos animales de consumo humano. El surgimiento de vacunas de nuevas generaciones ha motivado la instrumentación de medidas de bioseguridad y la necesidad de realizar estudios de evaluaciones de los riesgos que acometemos en la obtención y producción de vacunas, existiendo puntos críticos importantes en el proceso de obtención de las mismas. El área de vacunas inactivadas que se encuentra ubicada en la Empresa Productora de Vacunas Virales y Bacterianas UP-7, perteneciente al grupo empresarial LABIOFAM de La Habana, Cuba, se encarga de la producción y control de la calidad de las vacunas y los medios diagnósticos. Las inspecciones previas realizadas a dicha área mostraron, en el personal involucrado, desconocimiento y baja percepción del riesgo biológico existente en los procesos productivos que allí se llevan a cabo, lo que sugirió la realización de la presente investigación. Se identificaron y caracterizaron los peligros y se realizó una evaluación del riesgo, utilizando una matriz de estimación del riesgo; mediante un método cualitativo de posibilidad de ocurrencia del peligro y se evaluó de bajo, moderado o alto. Se identificaron las vulnerabilidades presentes empleando para ello una lista de chequeo, detectándose, entre otras, aquellas relacionadas con el diseño del área, con el tratamiento de los desechos y la organización de la bioseguridad, lo que confirmó puntos críticos dentro del proceso productivo con riesgo alto y moderado(AU)

Vaccination continues being one of the most sustainable and used ways in the control of infectious and contagious diseases in veterinary medicine because of both its greater economic feasibility and thwarting animal products from having antibiotics residues, a big-time issue for human ingestion. The appearance of new generation vaccines has motivated the application of biosafety measures and the need to carry out studies of risk assessments that we undertake to obtaining and producing vaccines, being important critical points in the process of acquiring them. The inactivated vaccines' area is located in the UP-7 Viral and Bacterial Vaccine Production Company, belonging to LABIOFAM business group in Havana, Cuba; this area is responsible for vaccines, diagnostic means production and quality control. Previous checkups carried out showed that the personnel involved had lack of knowledge and low perception of the existing biological risk in the productive processes carried out there; leading to suggest the investigation. Hazards were identified and characterized and a risk assessment was carried out, using a qualitative estimate risk matrix. Such hazards were assessed as low, moderate or high. Vulnerabilities were identified using a checklist to this purpose, detecting those related to area design, treatment of waste and the biosafety organization, which established the existence of critical points within the production process with high and moderate risk(AU)

Violence against trainees: urgent ethical challenges for medical educators and academic leaders in perinatal medicine.

Objectives Violence against medical trainees confronts medical educators and academic leaders in perinatal medicine with urgent ethical challenges. Despite their evident importance, these ethical challenges have not received sufficient attention. The purpose of this paper is to provide an ethical framework to respond to these ethical challenges. Methods We used an existing critical appraisal tool to conduct a scholarly review, to identify publications on the ethical challenges of violence against trainees. We conducted web searches to identify reports of violence against trainees in Mexico. Drawing on professional ethics in perinatal medicine, we describe an ethical framework that is unique in the literature on violence against trainees in its appeal to the professional virtue of self-sacrifice and its justified limits. Results Our search identified no previous publications that address the ethical challenges of violence against trainees. We identified reports of violence and their limitations. The ethical framework is based on the professional virtue of self-sacrifice in professional ethics in perinatal medicine. This virtue creates the ethical obligation of trainees to accept reasonable risks of life and health but not unreasonable risks. Society has the ethical obligation to protect trainees from these unreasonable risks. Medical educators should protect personal safety. Academic leaders should develop and implement policies to provide such protection. Institutions of government should provide effective law enforcement and fair trials of those accused of violence against trainees. International societies should promulgate ethics statements that can be applied to violence against trainees. By protecting trainees, medical educators and academic leaders in perinatology will also protect pregnant, fetal, and neonatal patients. Conclusions This paper is the first to provide an ethical framework, based on the professional virtue of self-sacrifice and its justified limits, to guide medical educators and academic leaders in perinatal medicine who confront ethical challenges of violence against their trainees.

Capacitación del manejo clínico de casos de infección por coronavirus COVID-19 / Training in the clinical management of cases of coronavirus infection COVID-19

Fecha de actualización: 22 de mayo 2020. Actualizar a los profesionales de pediatría, Medicina Interna, Gineco obstetricia, personal de enfermería, de laboratorio y el comité de gestión de riesgo en el manejo clínico de casos del nuevo coronavirus COVID-19.

Transfusion-associated circulatory overload risk mitigation: survey on hospital policies for compliance with AABB Standard 5.9.17.

BACKGROUND: AABB Standards for Blood Banks and Transfusion Services require accredited institutions to have a policy for handling requests for blood components on patients clinically identified as being at high risk for transfusion-associated circulatory overload (TACO; Standard 5.19.7, 31st edition). This survey elucidated how AABB accredited hospital transfusion services/blood banks around the world are complying with this Standard. METHODS: A link to a Web-based survey in English was e-mailed under the auspice of the AABB to each AABB accredited hospital transfusion service/blood bank (n = 851) asking for details on how their institution is complying with this Standard and for general information on any TACO risk mitigation strategies in place. RESULTS: Of the 290 responses received (34% response rate), 282 met the criteria for analysis. There were 174 of 282 (62%) respondents who indicated that their institution has a formal policy for complying with the Standard, and 108 of 282 (38%) who indicated that their institution does not have a formal policy. A diverse range of policies and practices were in place at the institutions with and without a formal policy ranging from writing advice/recommendations in the charts of patients at increased risk of TACO, promulgating policies from the transfusion service/blood bank or institution itself that would reduce the risk, or using decision support tools to provide education about reducing the risk of TACO. CONCLUSIONS: Many but not all AABB accredited institutions have policies to comply with the TACO risk mitigation Standard. However, the vast majority conduct activities that could mitigate risk for TACO.

Notifications of adverse events: characterization of the events that occurred in a hospital complex. / Notificação de eventos adversos: caracterização dos eventos ocorridos em um complexo hospitalar.

OBJECTIVE: Analyze incident notifications related to the patient's safety. METHOD: Cross-sectional study with quantitative approach, based on data from the risk Management of a hospital complex, located in northwest São Paulo, from August 2015 to July 2016. RESULTS: 4,691 notifications were analyzed. Nurses were the professionals who notified the most (71%), followed by physicians (8%). The most frequent period in which the notifications occurred was the daytime. There was significant difference in the proportion of notifications between the days of the week. The notifications were classified by reason and the most prevalent were those related to medication (17%), followed by skin lesions (15%), and phlebitis (14%). The highest frequency of notifications occurred in the hospitalization units. In relation to severity, 344 events caused damage to the patient, most of which were of mild intensity (65%). CONCLUSION: Spontaneous notifications are an important source of information, and highlight the magnitude of the problem related to health incidents.

Effective communication for patient safety: transfer note and Modified Early Warning Score. / Comunicação efetiva para a segurança do paciente: nota de transferência e Modified Early Warning Score.

OBJECTIVE: To analyze the registry of the Transfer Note (NT) and the emission of the Modified Early Warning Score (MEWS) performed by the nurse in adult patients transferred from the Emergency Service as an effective communication strategy for patient safety. METHOD: A cross-sectional retrospective study developed at a teaching hospital in the South of Brazil that evaluated 8028 electronic medical records in the year 2017. A descriptive analysis was performed. RESULTS: NT reached the institutional target of 95% in January and February, falling below the target in other months. The MEWS measurement was performed in 85.6% (n = 6,870) of the medical records. Of these patients, 96.8% (n = 6,652) had unchanged MEWS. CONCLUSION: NT and MEWS are inserted in the work of the nurse, however, actions are needed to qualify patient safety, improving effective communication and therefore reducing the possibility of occurrence of adverse events.

Proposition of a Shared and Value-Oriented Work Structure for Hospital-Based Health Technology Assessment and Enterprise Risk Management Processes.

BACKGROUND: Healthcare organizations have invested efforts on hospital-based health technology assessment (HB-HTA) and enterprise risk management (ERM) processes for novel systems to obtain more accurate data on which to base strategic decisions. This study proposes to analyze how HB-HTA and ERM processes can share personal resources and skills to achieve principles with value-oriented results. METHODS: Literature on ERM and HB-HTA and data from interviews with healthcare managers compose the research data sources, which were submitted to a qualitative data analysis. It was oriented to identify the association between ERM and HB-HTA application in hospitals and the common principles between both processes, in addition to proposing the capability to share personal resources between both teams in a matrix. RESULTS: The common principles and personal background suggested for HB-HTA and ERM teams allowed the build of a matrix identifying how both teams can work in an integrated manner being more effective and value-oriented. The shared resource matrix reports how each professional (with a specific background) may interact with each activity associated to HB-HTA or ERM implementation guidelines. CONCLUSIONS: The identification of common principles and capabilities between ERM and HB-HTA suggested advances with the literature from both research areas. The opportunity to share personal resources also contributes to the implementation of those processes in hospitals with less financial resources, approaching its own management to be more efficient with the care chain.

[Evacuation of critical care areas due to an initial outbreak of fire in a second level hospital]. / Evacuación de áreas críticas por conato de incendio en un hospital de segundo nivel.

In this letter to the editor, it is exposed an initial outbreak of fire that affected a secondary care center in Córdova, Veracruz, Mexico, and, most of all, the lack of a hospital fire evacuation plan in the presence of a fire event.

En la presente carta al editor, se expone un conato de incendio ocurrido en un hospital de segundo nivel de atención en Córdova, Veracruz, México, y, sobre todo, la carencia de un plan hospitalario de evacuación ante un evento de este tipo.

Comunicação efetiva para a segurança do paciente: nota de transferência e Modified Early Warning Score / Comunicación efectiva para la seguridad del paciente: nota de transferencia y Modified Early Warning Score / Effective communication for patient safety: transfer note and Modified Early Warning Score

Resumo OBJETIVO Analisar o registro da Nota de Transferência (NT) e a emissão do Modified Early Warning Score (MEWS) realizados pelo enfermeiro em pacientes adultos transferidos do Serviço de Emergência como estratégia de comunicação efetiva para a segurança do paciente. MÉTODO Estudo transversal retrospectivo desenvolvido em um hospital de ensino no Sul do Brasil que avaliou 8028 prontuários eletrônicos no ano de 2017. Procedeu-se a análise descritiva. RESULTADOS A realização da NT atingiu a meta institucional de 95% nos meses de janeiro e fevereiro, ficando abaixo da meta nos demais meses. A mensuração do MEWS foi realizada em 85,6% (n=6.870) dos prontuários. Destes pacientes, 96,8% (n=6.652) possuíam MEWS não alterado. CONCLUSÃO A NT e o MEWS estão inseridos no trabalho do enfermeiro, no entanto, são necessárias ações com vistas a qualificar a segurança do paciente, melhorando a comunicação efetiva e, por conseguinte, diminuindo a possibilidade de ocorrências de eventos adversos.

Resumen OBJETIVO Analizar el registro, realizado por el enfermero, la Nota de Transferencia (NT) y la emisión del Modified Early Warning Score (MEWS) en pacientes adultos transferidos del Servicio de Emergencia como estrategia de comunicación efectiva para la seguridad del paciente. MÉTODO Estudio transversal retrospectivo desarrollado en un hospital de enseñanza en el sur de Brasil que evaluó 8028 históricos electrónicos en el año 2017. Se llevó a cabo el análisis descriptivo. RESULTADOS La realización de la NT alcanzó la meta institucional del 95% en los meses de enero y febrero, quedando por debajo de la meta en los demás meses. La medición del MEWS se realizó en el 85,6% (n = 6.870) de los históricos. De estos pacientes, el 96,8% (n = 6.652) poseía MEWS no alterado. CONCLUSIÓN La NT y el MEWS están insertos en el trabajo del enfermero, sin embargo es necesario acciones con miras a calificar la seguridad del paciente, para mejor la comunicación efectiva y, por consiguiente, disminuir la posibilidad de ocurrencia de eventos adversos.

Abstract OBJECTIVE To analyze the registry of the Transfer Note (NT) and the emission of the Modified Early Warning Score (MEWS) performed by the nurse in adult patients transferred from the Emergency Service as an effective communication strategy for patient safety. METHOD A cross-sectional retrospective study developed at a teaching hospital in the South of Brazil that evaluated 8028 electronic medical records in the year 2017. A descriptive analysis was performed. RESULTS NT reached the institutional target of 95% in January and February, falling below the target in other months. The MEWS measurement was performed in 85.6% (n = 6,870) of the medical records. Of these patients, 96.8% (n = 6,652) had unchanged MEWS. CONCLUSION NT and MEWS are inserted in the work of the nurse, however, actions are needed to qualify patient safety, improving effective communication and therefore reducing the possibility of occurrence of adverse events.

Notificação de eventos adversos: caracterização dos eventos ocorridos em um complexo hospitalar / Notificación de eventos adversos: caracterización de los eventos ocurridos en un complejo hospitalario / Notifications of adverse events: characterization of the events that occurred in a hospital complex

Resumo OBJETIVO Analisar as notificações de incidentes relacionados à segurança do paciente. MÉTODOS Estudo transversal com abordagem quantitativa, baseado nos dados do Gerenciamento de Risco de um complexo hospitalar, localizado no noroeste paulista, de agosto/2015 a julho/2016. RESULTADOS Foram analisadas 4.691 notificações. O enfermeiro foi a categoria profissional que mais notificou (71%), seguido do médico (8%). O período mais frequente em que ocorreram as notificações foi o diurno. Houve diferença significativa da proporção de notificações entre os dias da semana. As notificações foram classificadas por motivo, com destaque para os medicamentos (17%), seguido de lesões de pele (15%) e flebite (14%). A maior frequência de notificações ocorreu nas unidades de Internação. Quanto à gravidade 344 eventos ocasionaram dano ao paciente, sendo a maioria de intensidade leve (65%). CONCLUSÃO As notificações espontâneas são uma importante fonte de informações e evidenciam a magnitude do problema relacionado aos incidentes em saúde.

Resumen OBJETIVO Analizar las notificaciones de incidentes relacionados con la seguridad del paciente. MÉTODOS Estudio transversal con abordaje cuantitativo, basado en los datos del Gestión de Riesgos de un complejo hospitalario, ubicado em el noroeste paulista, de agosto de 2015 a julio de 2016. RESULTADOS Se analizaron 4.691 notificaciones. El enfermero fue la categoría profesional que más notificó (71%), seguido del médico (8%). El período más frecuente en que ocurrieron las notificaciones fue el diurno. Hubo una diferencia significativa de la proporción de notificaciones entre los días de la semana. Las notificaciones se clasificaron por motivo, con destaque para los medicamentos (17%), seguido de lesiones de piel (15%), flebitis (14%). La mayor frecuencia de notificaciones ocurrió en las unidades de Internación. En cuanto a la gravedad 344 eventos ocasionaron daño al paciente, siendo la mayoría de intensidad leve (65%). CONCLUSIÓN Las notificaciones espontáneas son una importante fuente de información, y evidencia la magnitud del problema relacionado con los incidentes en salud.

Abstract OBJECTIVE Analyze incident notifications related to the patient's safety. METHOD Cross-sectional study with quantitative approach, based on data from the risk Management of a hospital complex, located in northwest São Paulo, from August 2015 to July 2016. RESULTS 4,691 notifications were analyzed. Nurses were the professionals who notified the most (71%), followed by physicians (8%). The most frequent period in which the notifications occurred was the daytime. There was significant difference in the proportion of notifications between the days of the week. The notifications were classified by reason and the most prevalent were those related to medication (17%), followed by skin lesions (15%), and phlebitis (14%). The highest frequency of notifications occurred in the hospitalization units. In relation to severity, 344 events caused damage to the patient, most of which were of mild intensity (65%). CONCLUSION Spontaneous notifications are an important source of information, and highlight the magnitude of the problem related to health incidents.

Estructura de plan de continuidad operativa bajo el enfoque de la gestión de riesgo de desastres en empresas de saneamiento de agua / Structure of business continuity plan under the approach of disaster risk management in public water companies

Resumen: En el marco del Sistema Nacional de Gestión de Riesgos de Desastres, el Estado Peruano ha establecido la necesidad de desarrollar la Gestión de la Continuidad Operativa en todos los niveles de gobierno. A partir de ello, nace la obligación que las entidades públicas deban elaborar Planes de Continuidad Operativa; sin embargo, no se cuenta con referencias documentarias ni técnicas que permitan servir de información de entrada para dichos planes. Actualmente, existe abundante normativa técnicas e investigaciones que desarrollan la continuidad operativa (continuidad de negocio) bajo el enfoque de las tecnologías de la información. La presente investigación consistió en la revisión de documentación normativa, técnica y de benchmark (modelos empresariales) con el propósito de diseñar la estructura modelo que debería comprender un Plan de Continuidad Operativa. Dicha estructura modelo fue implementada en una empresa de ser vicios de saneamiento, permitiéndole abordar las amenazas de riesgo operativo en los macroprocesos y procesos de Nivel 1 considerados como prioritarios.

Abstract: According to the National Disaster Risk Management System, the Peruvian State has established the need to develop the Business Continuity Management at all levels of government. From this, the obligation that the public entities must elaborate Business Continuity Plans is born; however, there are no documentary references or techniques that can serve as input information for these plans. Currently, there are abundant technical regulations and investiga tions that develop business continuity under the focus of informa tion technologies. The present investigation consisted in the revision of normative, technical and benchmark documentation with the purpose of design ing the model structure that should comprise an Operational Continuity Plan. This model structure was implemented in a public water company, allowing it to address the operational risk threats in the macro processes and processes Level 1.

ERM for Health Care Organizations: An Economic Enterprise Risk Management Innovation Program (E2RMhealth care).

BACKGROUND: In recent years, health care organizations have looked to enterprise risk management (ERM) for novel systems to obtain more accurate data on which to base risk strategies. OBJECTIVE: This study proposes a conceptual ERM framework specifically designed for health care organizations. METHODS: We explore how hospitals in the United States and Brazil are structuring and implementing ERM processes within their management structure. This study incorporates interviews with 15 chief risk officers (8 from the United States and 7 from Brazil) with qualitative data analysis using NVivo (QSR International software). RESULTS: The interviews confirm that adopting ERM for health care organizations has gained momentum and become a priority, and that the demand for risk economic assessment orientation is common among health care risk managers. CONCLUSION: We propose an ERM model for health care (Economic Enterprise Risk Management in Health Care) divided into four maturity levels and complemented by an implementation timeline. The model is accompanied by guidelines to orient the gradual implementation of ERM, including orientation to perform risk economic assessment.

Implementación de la gestión de riesgo en los procesos misionales de la Sección de Dermatología de la Universidad de Antioquia (Medellín, Colombia) siguiendo las directrices de la norma ISO 9001: 2015 / Implementation of Risk Management in the Mission Processes of the Dermatology Section of the Universidad de Antioquia (Medellín, Colombia) Following the ISO 9001: 2015 Guidelines / Implementação de gestão de risco em processos missionais da Seção de Dermatologia da Universidade de Antioquia (Medellín, Colômbia) seguindo diretrizes da norma ISO 9001: 2015

Resumen La gestión de riesgos en los servicios de atención en salud es un proceso que considera la planeación y aplicación de estrategias orientadas a controlar posibles efectos adversos que surjan durante la atención a los usuarios, la calidad en el servicio y la seguridad del paciente. En el presente artículo se reporta el desarrollo del sistema de gestión del riesgo de los procesos misionales de la Sección de Dermatología de la Universidad de Antioquia, así como los principales resultados obtenidos a la fecha y la manera como el Sistema de Gestión de Calidad bajo la norma ISO 9001 sirvió de complemento y apoyo al sistema de gestión del riesgo implementado. Se identificaron cinco riesgos inherentes para el Laboratorio de Dermatopatología, seis para Otros Procesos Dermatológicos y ocho para la Unidad de Fotodermatología, los cuales fueron analizados y evaluados, luego de lo cual se implementaron los controles pertinentes.

Abstract Risk management in health care services is a process that takes into account the planning and implementation of strategies aimed at controlling possible adverse effects that arise during the attention to users, quality of service, and patient safety. This article reports on the development of the risk management system for the mission processes of the Dermatology Section of the Universidad de Antioquia, as well as on the main results obtained to date and the way in which the Quality Management System (under the ISO 9001 standard) worked as a complement and support to the implemented risk management system. Five inherent risks were identified for the Dermatopathology Laboratory, six for Other Dermatological Procedures, and eight for the Photodermatology Unit, all of which were analyzed and evaluated; the relevant controls were implemented afterwards.

Resumo A gestão de riscos nos serviços de atenção em saúde é um processo que considera o planejamento e aplicação de estratégias orientadas a controlar possíveis efeitos adversos que surgirem durante o atendimento a utentes, a qualidade no serviço e a segurança do paciente. No presente artigo relata-se o desenvolvimento do sistema de gestão de riscos dos processos missionais da Seção de Dermatologia da Universidade de Antioquia, bem como os principais resultados obtidos a hoje e a maneira como o Sistema de Gestão de Qualidade sob a norma ISO 9001 serviu de complemento e apoio ao sistema de gestão do risco implementado. Cinco riscos inerentes ao Laboratório de Dermatopatologia foram identificados, seis para outros Processos Dermatológicos e oito para a Unidade de Fotodermatologia, os quais foram analisados e avaliados, após disso implementaram-se os controles pertinentes.

[Model for a risk-focused approach to health inspection, surveillance, and control in Colombia]. / Modelo para la inspección, vigilancia y control sanitario con enfoque de riesgos en Colombia.

Colombian Ministry of Health Resolution 1229 of 2013 established that health inspection, surveillance, and control (IVC, Spanish acronym) should be based on a risk-focused approach. In 2014 Colombia´s National Food and Drugs Surveillance Institute (INVIMA) designed and implemented a risk-based health surveillance model called IVC-SOA. This model measures the risks of drugs, medical devices, food, and cosmetics by taking into account three factors: severity of the product (S), occurrence of product failure (O), and the potentially affected population (A) - hence its name, SOA. The model incorporates 40 variables and statistical methods that make it possible to create a risk profile for each entity surveyed, and thus to generate a ranking to determine which should be inspected. The objective of this report is to describe the methodology and results obtained following the design and implementation of the IVC-SOA model created by the regulatory agency in Colombia, and its impact on health surveillance effectiveness.

Changes in nursing practice to improve patient safety. / Mudanças na prática de enfermagem para melhorar a segurança do paciente.

OBJECTIVE: To identify changes in nursing practice to improve the quality of care and patient safety. METHOD: A case study conducted at an inpatient unit with professionals from the patient safety centre and a nursing team, totalling 31 participants. Data were collected from May to December 2015 through interviews, observations recorded in a field journal, and documentary analysis, followed by content analysis. RESULTS: The changes observed in the nursing practice included the identification of care and physical risks, especially the risk of falls and pressure injury, with the use of personal forms and the Braden scale; notification of adverse events; adoption of protocols; effective communication with permanent education and multiprofessional meetings. CONCLUSIONS: Changes were observed in the nursing practice, chiefly focused on risk management.