Eventos adversos en cirugía / Adverse events in surgery

Objetivo: Analizar los eventos adversos reportados en el Sistema de Notificación de Evento Centinela, Evento Adverso y Cuasifalla ''VENCER II'' del Instituto Mexicano del Seguro Social. Sede: Unidad de Atención Médica Instituto Mexicano del Seguro Social. Diseño: Estudio transversal, retrospectivo, observacional, descriptivo. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas. Material y métodos: Se presenta una revisión de los eventos adversos reportados durante un mes. En esta investigación fueron incluidos dos apartados, eventos adversos relacionados con procedimientos quirúrgicos y procesos infecciosos. Resultados: Total de eventos adversos 78, el grupo de edad más afectado fue de 16 a 45 años (49%), el género predominante fue el femenino con 66%, en el turno en el que ocurrieron con mayor frecuencia fue el matutino con 77%, especialidad de mayor incidencia fue cirugía general con el 51%. En relación al origen, la infección en sitio quirúrgico correspondió al 69%, otras infecciones nosocomiales 1.5% y causas no infecciosas 29.5% (lesión de órgano), la severidad moderada en el 71% de los casos y el personal involucrado con mayor frecuencia fue el médico con el 57%. Conclusión: El sistema prevé retroalimentación permanente, análisis para identificar la causa raíz y las acciones de mejora tendientes a reducir y prevenir los eventos adversos.

Objective: To analyze the adverse events reported to the Notification System of sentinel event, adverse event, and quasi-failure ''VENCER II'' of the Mexican Institute of Social Security (IMSS, for its initials in Spanish). Setting: Medical Care Unit, IMSS Design: Cross-sectional, retrospective, observational, descriptive study. Statistical analysis: Percentages as summary measure for qualitative variables. Material and methods: We present a review of the adverse events reported in one month. In this investigation, we included two types of events: those related to surgical procedures and those to infectious processes. Results: Total of adverse events, 78, the most affected age group was that of 16 to 45 years (49%), the predominating gender was the female with 66%; the shift during which they occurred most frequently was the morning shift with 77%, the specialty with the highest incidence was general surgery with 51%. In regard to origin, infections of the surgical site corresponded to 69%, other nosocomial infections represented 1.5%, and non-infectious cases corresponded to 29.5% (organ lesion); severity was moderate in 71%, and the medical personnel was the most infrequently involved with 57%. Conclusion: The system provides permanent feedback, as well as an analysis to identify the root cause and the improvement actions to reduce and prevent adverse events.

Survey on physicians' knowledge and attitudes towards clinical practice guidelines at the Mexican Institute of Social Security.

OBJECTIVE: A survey was organized to determine the general level of knowledge and attitudes of medical personnel towards clinical practice guidelines (CPG). METHODS: A questionnaire modified from two validated instruments was used. Multi-stratified sampling was applied, and 1782 questionnaires were completed. RESULTS: A total of 80.4% of physicians had regular employment contract, 8.6% managerial post and 9.3% temporary work contract. Average age and working time were 43.7 and 15 years respectively; 64.3% were male. It was reported that 47.9% participated in academic activities, 70.8% belonged to a medical association, 40.3% identified CPG as steps towards arriving at a diagnosis and/or treatment and 14.9% thought that CPG were norms. A total of 10.7% of the physicians believed that guidelines are based on scientific evidence, 10% perceived them as supporting tools, 10.8% had no knowledge of them, 65% said that they used them, 76.7% thought that personal experience was as important as CPG recommendations and 57.4% thought that CPG were necessary for good medical practice. Physicians preferred that CPG be produced by personnel from outside the Mexican Institute of Social Security, or who had followed validity criteria. CONCLUSIONS: The majority of physicians considered CPG to be useful tools. It was evident that few knew where to acquire CPG, and this would lead to their limited use. Findings from this study enabled procuring a broader idea of the level of knowledge and attitudes of Mexican Institute of Social Security physicians towards CPG. This information is relevant when planning strategies for the purpose of sharing and implementing CPG.

[The clinical guidelines of practice project at the Instituto Mexicano del Seguro Social]. / Proyecto para el desarrollo de guías de práctica clínica en el Instituto Mexicano del Seguro Social.

The advance in the knowledge and technology is growing quickly and greater quantity, so it is difficult for the health professional to access to whole information that is generated every day on diagnostic and therapeutic strategies more effective, so the clinic practice guidelines (CPG) is a resource to support the updating of the health professional and support them in making clinical decisions. The CPG is also a better support to the manager of health services in making decisions regarding the strategies that have performed for the patient and less risk to the individual and collective health. They also support the response capacity of the medical units and hospitals and guide the planning of services to the optimization of the resources. This paper summarizes the methodology of a national project for the development of GPC coordinated by the Mexican Social Security Institute with the collaboration of more than 1200 health professionals of the institution in a great effort institutional update and make information accessible to the entire health sector, which also defines the steps to upgrade and maintain the updating of knowledge and technology expressed in them.