Using Explicit Thresholds were valuable for judging Benefits and Harms in partially contextualized GRADE Guidelines.

OBJECTIVES: Guideline panels must assess the magnitude of health benefits and harms to develop sensible recommendations. However, they rarely use explicit thresholds. In this paper we report on the piloting and the use thresholds for benefits and harms. STUDY DESIGN AND SETTING: We piloted the use of thresholds in a Chilean COVID-19 living guideline. For each of the critical outcomes, we asked panelists to suggest values of the thresholds for large, moderate, small, or trivial or no effect. We collected this information through a survey and an on-line discussion. RESULTS: Twelve panelists decided on thresholds for three critical outcomes (mortality, need for mechanical ventilation and serious adverse events). For all outcomes, an absolute risk reduction was considered larger with more than 50 events, moderate with less than 50 events, small with less than 25 events, and trivial with less than 10 events. Having these a priori thresholds in place significantly impacted on the development of recommendations. CONCLUSION: Explicit thresholds were a valuable addition to the judgment of the certainty in the evidence, to decide the direction and strength of the recommendation and to evaluate the need for update. We believe this is a line of research worth perusing.

Development of a safe drug administration assessment instrument for nursing students.

OBJECTIVE: to determine the content and face validity of a safe drug administration assessment instrument for nursing students. METHOD: quantitative, descriptive study. The literature on medication errors made by students was analyzed, and an instrument was developed using the Architecture of Integrated Information Systems and the Work Breakdown Structure. Face validity was analyzed using the nominal technique, with experts in education, management, research and/or clinical practice. RESULTS: nine experts participated in the validation process, which resulted in an instrument containing 8 sub-processes and 58 items, adjusted to the simulation environment and to clinical practice. CONCLUSION: the instrument may be used for the evaluation of safe drug administration by nursing students, especially in a simulation environment.

Development of a safe drug administration assessment instrument for nursing students / Elaboração de um roteiro de avaliação de administração segura de medicamentos em estudantes de enfermagem / Elaboración de una pauta de evaluación de administración segura de medicamentos en estudiantes de enfermería

Objective: to determine the content and face validity of a safe drug administration assessment instrument for nursing students. Method: quantitative, descriptive study. The literature on medication errors made by students was analyzed, and an instrument was developed using the Architecture of Integrated Information Systems and the Work Breakdown Structure. Face validity was analyzed using the nominal technique, with experts in education, management, research and/or clinical practice. Results: nine experts participated in the validation process, which resulted in an instrument containing 8 sub-processes and 58 items, adjusted to the simulation environment and to clinical practice. Conclusion: the instrument may be used for the evaluation of safe drug administration by nursing students, especially in a simulation environment.

Objetivo: determinar a validade de face e conteúdo de um roteiro de avaliação de administração segura de medicamentos em estudantes de enfermagem. Método: estudo quantitativo, descritivo. Analisou-se a literatura relativa a erros de medicação em estudantes e elaborou-se um roteiro utilizando a metodologia Arquitetura Integrada de Sistema de Informação e a Estrutura de Decomposição do Trabalho. Analisou-se a validade de face utilizando a técnica nominal com especialistas em educação, gestão, pesquisa e/ou prática clínica. Resultados: nove especialistas participaram de todo o processo de validação, do qual se obteve um roteiro com 8 subprocessos e 58 itens, ajustados ao ambiente de simulação e prática clínica. Conclusão: o roteiro se encontra em condições de ser testado na avaliação da administração segura de medicamentos em estudantes de enfermagem, principalmente em ambiente de simulação.

Objetivo: determinar la validez de aspecto y contenido de una pauta de evaluación de administración segura de medicamentos en estudiantes de enfermería. Método: estudio cuantitativo, descriptivo. Se analizó la literatura respecto a errores de medicación en estudiantes y se creó una pauta utilizando la metodología Arquitectura Integrada de Sistema de Información y la Estructura de Descomposición del Trabajo. Se analizó la validez de aspecto utilizando la técnica nominal con personas expertas en educación, gestión, investigación y/o práctica clínica. Resultados: Nueve personas expertas participaron durante todo el proceso de validación, se obtuvo una pauta con 8 subprocesos y 58 ítems, ajustados al ambiente de simulación y práctica clínica. Conclusión: La pauta se encuentra en condiciones de ser probada en la evaluación de la administración segura de medicamentos en estudiantes de enfermería, especialmente en el ambiente de simulación.

Simulación clínica y seguridad del paciente: integración en el currículo de enfermería / Clinical simulation and patient safety: integration into the nursing curriculum

OBJETIVOS: Presentar la experiencia de la creación, desarrollo y resultados de un currículo de enfermería que integra la simulación clínica y la seguridad del paciente con sus desafíos y alcances después de cuatro generaciones egresadas. DESCRIPCIÓN DE LA EXPERIENCIA: La Escuela de Enfermería de la Universidad Finis Terrae es resultado de una solicitud directa de las autoridades de la institución en un momento en que el país requería el aumento de la oferta de los profesionales de enfermería. Esta parte con un proyecto que a través de su desarrollo y puesta en marcha requiere varios ajustes en términos programáticos. El proyecto tiene en consideración desde su generación la integración de la simulación y pone en el centro del desarrollo a la seguridad. Para esto, se trabajó en nuevos instrumentos que establecieron la forma de implementar el proceso educativo, generando un modelo propio de docencia basada en simulación, sumado al establecimiento de puntos de control que permitieran aplicar el modelo de mejora continua. A través de su desarrollo, se configuran elementos sellos que diferencian al estudiante de enfermería en el medio nacional. En la actualidad nos mantenemos trabajando en el cumplimiento de estándares internacionales, revisando periódicamente las estrategias implementadas y la forma de hacer docencia en beneficio de nuestros estudiantes. Nos planteamos como desafíos la generación de trabajo interprofesional, el fortalecimiento del cuerpo docente y la generación de investigaciones que evidencien los beneficios de tener un currículo para la seguridad basado en simulación considerando nuestra realidad local. CONCLUSIONES: La integración de la simulación y seguridad del paciente en el currículo de la carrera de enfermería es un desafío que requiere implementar procesos innovadores, movilizando recursos de todo tipo para el logro del objetivo. Fortalecer el liderazgo, el juicio clínico y la calidad de los profesionales enfermeros merece este tipo de cambios. Creemos que cambios como este en la educación de enfermería permitirán alcanzar mejores resultados de salud a nivel mundial.

AIMS: To present the experience of creation, development and results of a nursing curriculum that integrates clinical simulation and patient safety with its challenges and achievements after four generations of graduates. EXPERIENCE DESCRIPTION: The School of Nursing at the Finis Terrae University is the result of a direct request from the authorities of the institution at a time when the country required an increase in the supply of nursing professionals. It started with a project that in the course of its development and implementation require several adjustments in programmatic terms. From its beginning, the project takes into consideration the integration of simulation and sets security at the heart of development. For this, we worked on new instruments that established how to implement the educational process, generating a model of teaching based on simulation, together with the establishment of control points that allowed the application of the model of continuous improvement. Through its development, seals are configured that differentiate the nursing student in the national environment. We are currently working to comply with international standards, periodically reviewing the implemented strategies and the way we teach for the benefit of our students. We consider as challenges the generation of interprofessional work, the strengthening of the teaching staff, and the generation of research, that demonstrate the benefits of having a curriculum for security based on simulation considering our local reality. CONCLUSIONS: The integration of simulation and patient safety in the nursing career curriculum is a challenge that requires the implementation of innovative processes, mobilizing resources of all kinds to achieve the goal. Strengthening leadership, clinical judgment and quality of nursing professionals deserve this kind of change. We believe changes like this in nursing education will enable us to achieve better health outcomes worldwide.