Identificación inequívoca de pacientes ingresados en hospitales del Sistema Nacional de Salud / Unique patient identification in hospitals in the National Health Service

En las organizaciones sanitarias actuales, la identificación de los pacientes comporta riesgos de los que pueden derivarse desde diagnósticos erróneos hasta la realización de pruebas o intervenciones quirúrgicas, o la administración de medicamentos o hemoderivados, a pacientes equivocados. Los organismos que velan por la seguridad de los pacientes propugnan la instauración de métodos que aseguren la identificación inequí- voca como una de las acciones clave en las estrategias de mejora de la seguridad. Las políticas de identificación deben garantizar la identificación de todos los pacientes mediante métodos inequívocos de implantación universal. A los profesionales nos compete confirmar la identidad del paciente, mediante los documentos apropiados, siempre que se realice un procedimiento diagnóstico o terapéutico que suponga riesgos para él. En este trabajo se revisan las bases para una identificación inequívoca de los pacientes y se exponen las experiencias de 5 comunidades autónomas implicadas en el desarrollo de las estrategias de mejora de la seguridad de los pacientes promovidas por la Agencia de Calidad del Ministerio de Sanidad y Consumo (AU)

Currently, patient misidentification in healthcare organizations is a risk that can lead to diagnostic errors, performing of surgical procedures, and administration of medicines or hemoderivates to wrong patients. The organizations that deal with patient safety promote methods that guarantee unique identifications within the strategies for improving safety in healthcare. Identification policies are obligatory to ensure the accuracy of the identification in all patients using universally implemented unique methods, and healthcare workers have the responsibility of verifying patient identification with appropriate documents when a diagnostic or therapeutic procedure is planned. In this paper we review the bases for an unmistakable unique identification and present the experiences of five regional health services that develop the policies promoted in Spain by the Quality Agency of the Ministry of Health and Consumer Affairs (AU)

[Unique patient identification in hospitals in the National Health Service]. / Identificación inequívoca de pacientes ingresados en hospitales del Sistema Nacional de Salud.

Currently, patient misidentification in healthcare organizations is a risk that can lead to diagnostic errors, performing of surgical procedures, and administration of medicines or hemoderivates to wrong patients. The organizations that deal with patient safety promote methods that guarantee unique identifications within the strategies for improving safety in healthcare. Identification policies are obligatory to ensure the accuracy of the identification in all patients using universally implemented unique methods, and healthcare workers have the responsibility of verifying patient identification with appropriate documents when a diagnostic or therapeutic procedure is planned. In this paper we review the bases for an unmistakable unique identification and present the experiences of five regional health services that develop the policies promoted in Spain by the Quality Agency of the Ministry of Health and Consumer Affairs.

[Evaluation of the effectiveness of metabolic self-control through direct dispensation of diagnostic strips to type 2 diabetic patients]. / Evaluación de la efectividad en el autocontrol metabólico mediante la dispensación directa de tiras diagnósticas a los diabéticos tipo 2.

OBJECTIVE: To perform an evaluation of the effectiveness of diagnostic strips in metabolic control by type 2 diabetics. DESIGN: A crossover, observational study. SETTING: Primary Health Care. PATIENTS: A sample of 400 histories at a Primary Care Centre (PCC), representative of Diabetes 2 patients who used reactive strips directly dispensed at PCCs as a method of home self-analysis of their disease, was evaluated. They were monitored in 1995 and 1996 in the seven health districts in the Primary Care region of Tortosa. MEASUREMENTS AND MAIN RESULTS: The use of reactive strips was considered effective if the data recorded in the PCC histories satisfied the criteria for acceptable metabolic control, as defined by the GEDAPS, for the previous year of monitoring, or for at least three months if the period of use of the strips was under a year. Mean annual cost and consumption per diabetic, and the evolution of these over the study period, were calculated. CONCLUSIONS: Direct dispensing of reactive strips led to an important annual increase in cost (+46.59%) and consumption (+89.25%), but acceptable effectiveness was not demonstrated (1.10%).

[Costs of accidental punctures in hospital health personnel]. / Costes de las inoculaciones accidentales en personal sanitario de un hospital.

OBJECTIVES: The aim of this study was to calculate the average cost of each hepatitis B, C and HIV follow-up carried out in the health personnel that have suffered an exposure to blood and body fluids and to estimate the cost for each of the different types of sources as well as to identify the items that account for the main part of the cost. METHODS: A cost analysis was carried out. The post-exposure programme was modelled in a decision tree combining probabilities (percentage of each type of source in dependence of its positivity for the three viruses and immunization state of the health personnel against hepatitis B) and monetary costs (pesetas from 1994). Costs included: salaries, laboratory, chemist, energy, cleaning, telephone, medical and office equipment, amortization and lost productivity. A sensitivity analysis was carried out with the real fulfillment of the programme. RESULTS: The average cost was 39,564 ptas. (29,750 ptas. applying the sensitivity analysis), with a range from 86,864 ptas. (source positive for the three viruses and injured subject not immunized) to 23,074 ptas. (source negative for the three viruses). If the source was hepatitis B positive, the average cost was 86,093 ptas. when the injured subject was not immunized and 53,232 ptas. if he was immunized. Serologic tests account for the main part of the cost (range from 72.8% to 87.7%). CONCLUSIONS: High cost suggests an appropriate risk evaluation in order to avoid unnecessary follow-ups. The model used allows to know the cost of each potentially avoided episode and it could be used for any hospital in order to make an economical evaluation of new preventive devices.

[Minimizing the costs of prescription of anti-infective drugs in two areas of primary health care]. / Un estudio de minimización de costes en la prescripción de antiinfecciosos en dos areas de atención primaria.

BACKGROUND: Pharmaceutical costs are the main cost item in basic health care. The need to contain health care expenditure has led to the search for alternatives in this area, one of which would be to foster a prescription policy which uses the cheapest presentation for each active principle. The aim of this study was to evaluate the amount which would be saved by prescribing the cheapest alternative from a selection of anti-infective drugs. METHODS: Pharmacy prescriptions in two different health areas were analyzed using the database on turnover of pharmaceutical products for 1995. Single principle drugs with anti-infective action were selected, and for each active principle and presentation the most economic alternative was sought using the records provided by the Ministry of Health and a cost minimisation analysis was undertaken. The cost of applying this prescription policy was not considered. RESULTS: Total pharmaceutical expenditure in the areas was pesetas 8.547 bn in 1995. Expenditure on selected anti-infective drugs was pesetas 522 million (6.1% of the total). The overall saving estimated was 7.63% (pesetas 39,901,778). This saving was centred on the following subgroups: penicillins, quinolones, cephalosporins and macrolides. Of potential savings identified, 75% would be achieved by prescribing the cheaper alternative of 2 active principles: amoxacillin and cyprofloxacine. CONCLUSIONS: The study shows the possibility of containing expenditure in our area and offers a basis for action in this direction. It would be advisable to increase information and training for prescribers and dispensers in order to stimulate the use of the most economical alternative of each medicament prescribed, especially in cases in which there are significant margins to be saved.