Certificación en seguridad del paciente en un Servicio de Medicina Intensiva: nuestra experiencia con la norma UNE 179003:2013 / Patient safety certification in a Department of Intensive Care Medicine: Our experience with standard UNE 179003:2013

Para asegurar que el riesgo asistencial se gestiona de manera efectiva es necesario utilizar métodos sistemáticos y estructurados. La Norma española UNE 179003:2013 ofrece a las organizaciones sanitarias un marco y una forma sistemática de abordar la gestión de la seguridad del paciente desde una perspectiva clínica y organizativa, que contribuye a alcanzar un balance eficiente entre riesgo, resultados en salud y costes. Obtener la certificación con UNE 179003:2013 demuestra el cumplimiento de unas normas y unos procedimientos de trabajo dirigidos a disminuir la incidencia de eventos adversos, y obliga a realizar intervenciones de mejora continua, porque la Norma exige realizar un seguimiento periódico del sistema de gestión de riesgos mediante auditorias regulares. El objetivo de este trabajo es presentar el proceso realizado para obtener la certificación por la Norma UNE 179003:2013 en nuestro Servicio de Medicina Intensiva, proponer un programa de gestión de riesgos del paciente crítico y hacer algunas recomendaciones sobre su implantación

Systematic and structured methods must be used to ensure that healthcare risks are effectively managed. Spanish standard UNE 179003:2013 provides healthcare organizations with a framework and a systematic protocol for managing patient safety from a clinical and organizational perspective. Furthermore, it is useful in securing an efficient balance among health risk, health outcomes and costs. The UNE 179003:2013 certifies that a clinical service complies with rules and operating procedures aimed at reducing the incidence of adverse events. It also requires mandatory continuous improvement, given that the standard entails frequent monitoring of the risk management system through periodic audits. The aims of this paper are to describe the UNE 179003:2013 certification process in an Intensive Care Unit, propose a risk management program for critical patients, and offer some recommendations regarding its implementation

Patient safety certification in a Department of Intensive Care Medicine: our experience with standard UNE 179003:2013.

Systematic and structured methods must be used to ensure that healthcare risks are effectively managed. Spanish standard UNE 179003:2013 provides healthcare organizations with a framework and a systematic protocol for managing patient safety from a clinical and organizational perspective. Furthermore, it is useful in securing an efficient balance among health risk, health outcomes and costs. The UNE 179003:2013 certifies that a clinical service complies with rules and operating procedures aimed at reducing the incidence of adverse events. It also requires mandatory continuous improvement, given that the standard entails frequent monitoring of the risk management system through periodic audits. The aims of this paper are to describe the UNE 179003:2013 certification process in an Intensive Care Unit, propose a risk management program for critical patients, and offer some recommendations regarding its implementation.

Changes in the rate of tubal ligation done after cesarean section.

OBJECTIVE: We studied tubal ligations done after cesarean section in a Spanish hospital during a 20-year period, in order to analyze changes in patient characteristics and indications for cesarean delivery. STUDY DESIGN: We reviewed the clinical records, for the period from 1978 to 1997, of 1996 cases of cesarean section followed by tubal ligation in 108776 births in which the fetus weighed 1000 g or more. RESULTS: During the 20-year period of study, the proportion of cesarean sections relative to vaginal deliveries increased, as did the frequency of cesarean section followed by tubal ligation relative to cesarean and vaginal deliveries. The proportion of women who underwent tubal ligation after a second cesarean section decreased from 60% during 1978-1982 to 5.6% during 1993-1997. The most frequent maternal pathology associated with gestation was previous cesarean section (60.5%), although 50% of the women had no underlying pathology. CONCLUSIONS: In our setting, the rate of cesarean section followed by tubal ligation has been increasing steadily since the early 1980s. The proportion of women who requested tubal sterilization and who had only one living child, or who had had a previous cesarean birth, also increased.

Lipid effects, effectiveness and acceptability of tibolone versus transdermic 17 beta-estradiol for hormonal replacement therapy in women with surgical menopause.

OBJECTIVE: To compare the effectiveness of tibolone and 17 beta-estradiol on climacteric symptoms, lipid and biochemical parameters in women with surgical menopause. METHODS: In a prospective randomised clinical trial group comparative study, the effects on the aforementioned parameters, as well as treatment compliance and side effects were studied with oral tibolone 2.5 mg per day and with transdermic 17 beta-estradiol at 50 microg per day for a period of 12 months. Statistical analysis was carried out using the Fisher-test, analysis of the variance (ANOVA) for the two factors and the Bouferoni test. RESULTS: Lipid metabolism analysis showed lower levels of HDL and triglycerides in the tibolone group. Other biochemical parameters were not affected. Similar reductions in climacteric symptoms were found in both the groups, but the tibolone group revealed a greater improvement in psychological problems and in sexual behaviour. No differences were observed with respect to compliance and side effects. CONCLUSIONS: Tibolone is as effective or more than 17 beta-estradiol in reducing climacteric symptoms, and shows greater triglyceride and total cholesterol improvements. Tibolone is a good alternative to estrogens in women with surgical menopause.

Nuevas líneas de estudio en el aborto habitual. Consejo reproductivo a la abortadora sin causa / New lines of research in recurrent miscarriage. Advice on reproduction to women with unexplained fetal loss

Objetivo: Revisión de las nuevas líneas de estudio en el aborto de repetición sin causa tras un estudio de abortabilidad. Sujetos y método: Revisión de la literatura más reciente sobre el tema. Resultados: La abortadora sin causa necesita una atención individualizada. Conclusiones: Sólo el diagnóstico etiológico permitirán individualizar a cada paciente y someterla al tratamiento específico necesario en cada caso. Mientras esto no suceda sólo se podrá ofrecer tratamientos empíricos, mejoras de sus hábitos de vida y cuidados especiales de seguimiento que disminuyan el grado de ansiedad de estas pacientes (AU)

[Identification of tinnitus. An audiometric study]. / Identificación de los acúfenos. Estudio audiométrico.

We have performed a study in a group of 30 tinnitus patients, males and females, aged between 15 and 50. In order to identify the tinnitus we use a conventional audiometer in its two main parameters (frequency and intensity) with two methods, that are described.

[Nasal mucociliary function after laryngectomy]. / La función mucociliar nasal después de la laringectomía.

We have made a comparative study of nasal mucociliary transport in 46 normal persons and in 31 laryngectomees, with the charcoal powder technique. Nasal mucociliary transport time is significatively increased in laryngectomized patients (p less than 0.000001) and there aren't statistical correlation between the time after laryngectomy and the nasal mucociliary transport time.

[Auditory evoked potentials of the brain stem in the study of tinnitus]. / Los potenciales evocados auditivos de tronco cerebral en el estudio de los acúfenos.

A brain stem evoked response study is carried out, over a group of tinnitus patient. The purpose of this work is to evidence the electrophysiologic indices indicating tinnitus presence. Morphology tracing alterations, variability in the wave latency, also important decreasing in the amplitude of the wave V were found.

The influence of anesthetics and vasoconstrictors on nasal mucociliary transport.

Nasal mucociliary transport time is studied in 38 healthy individuals using the charcoal dust technique, following topical application of a lidocaine solution in 10 cases, tetracaine in 11, and oxymetazoline in 17. The results show that lidocaine does not alter the transit time, whereas tetracaine increases it significantly; in turn, oxymetazoline progressively increases transit time, although this slowing is fully reversible 30 minutes after application.