Traspaso de información en Medicina Intensiva / Handover in Intensive Care

El traspaso de información (TI) es una tarea frecuente y compleja que lleva implícito el traspaso de la responsabilidad del cuidado del paciente. Las deficiencias en este proceso se asocian a importantes brechas en la seguridad clínica e insatisfacción de pacientes y profesionales. Los esfuerzos por estandarizar el TI se han incrementado en los últimos años, dando pie a la aparición de herramientas mnemotécnicas. Globalmente las prácticas locales del TI son heterogéneas y el nivel de formación, bajo. El objetivo de esta revisión es enfatizar la importancia del TI y proporcionar una estructura metodológica que favorezca el TI efectivo en las UCI, reduciendo el riesgo asociado a este proceso. Específicamente, se hace referencia al TI durante los cambios de guardia y los turnos de enfermería, durante el traslado de los pacientes a otras áreas diagnósticas y terapéuticas y en el momento del alta de UCI. También se contemplan las situaciones de urgencia y se señala la potencial participación de pacientes y familiares. Por último, se proponen fórmulas para la medición de la calidad y se mencionan posibles mejoras en este proceso, especialmente en el ámbito de la formación

Handover is a frequent and complex task that also implies the transfer of the responsibility of the care. The deficiencies in this process are associated with important gaps in clinical safety and also in patient and professional dissatisfaction, as well as increasing health cost. Efforts to standardize this process have increased in recent years, appearing numerous mnemonic tools. Despite this, local are heterogeneous and the level of training in this area is low. The purpose of this review is to highlight the importance of IT while providing a methodological structure that favors effective IT in ICU, reducing the risk associated with this process. Specifically, this document refers to the handover that is established during shift changes or nursing shifts, during the transfer of patients to other diagnostic and therapeutic areas, and to discharge from the ICU. Emergency situations and the potential participation of patients and relatives are also considered. Formulas for measuring quality are finally proposed and potential improvements are mentioned especially in the field of training

Handover in Intensive Care. / Traspaso de información en Medicina Intensiva.

Handover is a frequent and complex task that also implies the transfer of the responsibility of the care. The deficiencies in this process are associated with important gaps in clinical safety and also in patient and professional dissatisfaction, as well as increasing health cost. Efforts to standardize this process have increased in recent years, appearing numerous mnemonic tools. Despite this, local are heterogeneous and the level of training in this area is low. The purpose of this review is to highlight the importance of IT while providing a methodological structure that favors effective IT in ICU, reducing the risk associated with this process. Specifically, this document refers to the handover that is established during shift changes or nursing shifts, during the transfer of patients to other diagnostic and therapeutic areas, and to discharge from the ICU. Emergency situations and the potential participation of patients and relatives are also considered. Formulas for measuring quality are finally proposed and potential improvements are mentioned especially in the field of training.

Recomendaciones para el tratamiento de los pacientes críticos de los Grupos de Trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) / Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients

La estandarización de la medicina intensiva puede mejorar el tratamiento del paciente crítico. No obstante, estos programas de estandarización no se han aplicado de forma generalizada en las unidades de cuidados intensivos (UCI). El objetivo de este trabajo es elaborar las recomendaciones para la estandarización del tratamiento de los pacientes críticos. Se seleccionó un panel de expertos de los trece grupos de trabajo (GT) de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), elegido por su experiencia clínica y/o científica para la realización de las recomendaciones. Se analizó la literatura publicada entre 2002 y 2016 sobre diferentes tópicos de los pacientes críticos. En reuniones de cada GT los expertos discutieron las propuestas y sintetizaron las conclusiones, que fueron finalmente aprobadas por los GT después de un amplio proceso de revisión interna realizado entre diciembre de 2015 y diciembre de 2016. Finalmente, se elaboraron un total de 65 recomendaciones, 5 por cada uno de los 13 GT. Estas recomendaciones se basan en la opinión de expertos y en el conocimiento científico y pretenden servir de guía para los intensivistas como una ayuda en el manejo de los pacientes críticos (AU)

The standardization of the Intensive Care Medicine may improve the management of the adult critically ill patient. However, these strategies have not been widely applied in the Intensive Care Units (ICUs). The aim is to elaborate the recommendations for the standardization of the treatment of critical patients. A panel of experts from the thirteen working groups (WG) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2002 to 2016 was extracted. The clinical evidence was discussed and summarised by the experts in the course of a consensus finding of every WG and finally approved by the WGs after an extensive internal review process that was carried out between December 2015 and December 2016. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and are intended as a guide for the intensivists in the management of critical patients (AU)

Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients. / Recomendaciones para el tratamiento de los pacientes críticos de los Grupos de Trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC).

The standardization of the Intensive Care Medicine may improve the management of the adult critically ill patient. However, these strategies have not been widely applied in the Intensive Care Units (ICUs). The aim is to elaborate the recommendations for the standardization of the treatment of critical patients. A panel of experts from the thirteen working groups (WG) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2002 to 2016 was extracted. The clinical evidence was discussed and summarised by the experts in the course of a consensus finding of every WG and finally approved by the WGs after an extensive internal review process that was carried out between December 2015 and December 2016. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and are intended as a guide for the intensivists in the management of critical patients.

Análisis de los factores contribuyentes en incidentes relacionados con la seguridad del paciente en Medicina Intensiva / Analysis of contributing factors associated to related patients safety incidents in Intensive Care Medicine

OBJETIVO: Analizar los factores contribuyentes (FC) que intervienen en la aparición de incidentes relacionados con la seguridad del paciente crítico. DISEÑO: Análisis post hoc del estudio SYREC. ÁMBITO: Un total de 79 servicios de Medicina Intensiva. PACIENTES: Un total de 1.017 pacientes, de los que se incluyeron 591 en los que se notificó al menos un incidente. Variables de interés principales FC categorizados según una adaptación del modelo propuesto por la National Patient Safety Agency del Reino Unido. Tipo, clase y gravedad de los incidentes relacionados con la seguridad del paciente. RESULTADOS: Se notificaron 2.965 FC (1.729 se comunicaron en incidentes sin daño y 1.236 en eventos adversos). El grupo de FC más frecuente fue el relacionado con el paciente. Los FC relacionados con el profesional se notificaron más en los incidentes sin daño. En cambio, los relacionados con la tarea se comunicaron más en los eventos adversos. Se declararon FC en todas las clases de incidentes. La mayoría de FC se notificaron en los incidentes menos graves aunque los FC relacionados con el paciente se asociaron a incidentes de mayor gravedad. Los incidentes que se asociaron a los FC relacionados con el profesional se consideraron evitables y los FC relacionados con el paciente, inevitables. CONCLUSIONES: Los FC relacionados con el paciente fueron los más frecuentes y se relacionaron con los incidentes más graves y considerados inevitables. Los relacionados con el profesional se notificaron en las categorías menos graves y se consideraron evitables. La identificación de FC fue más frecuente en los incidentes sin daño

OBJECTIVE: To explore contributing factors (CF) associated to related critical patients safety incidents. Design: SYREC study pos hoc analysis. SETTING: A total of 79 Intensive Care Departments were involved. PATIENTS: The study sample consisted of 1.017 patients; 591 were affected by one or more incidents. MAIN VARIABLES: The CF were categorized according to a proposed model by the National Patient Safety Agency from United Kingdom that was modified. Type, class and severity of the incidents was analyzed. RESULTS: A total 2,965 CF were reported (1,729 were associated to near miss and 1,236 to adverse events). The CF group more frequently reported were related patients factors. Individual factors were reported more frequently in near miss and task related CF in adverse events. CF were reported in all classes of incidents. The majority of CF were reported in the incidents classified such as less serious, even though CF patients factors were associated to serious incidents. Individual factors were considered like avoidable and patients factors as unavoidable. CONCLUSIONS: The CF group more frequently reported were patient factors and was associated to more severe and unavoidable incidents. By contrast, individual factors were associated to less severe and avoidable incidents. In general, CF most frequently reported were associated to near miss

Analysis of contributing factors associated to related patients safety incidents in Intensive Care Medicine.

OBJECTIVE: To explore contributing factors (CF) associated to related critical patients safety incidents. DESIGN: SYREC study pos hoc analysis. SETTING: A total of 79 Intensive Care Departments were involved. PATIENTS: The study sample consisted of 1.017 patients; 591 were affected by one or more incidents. MAIN VARIABLES: The CF were categorized according to a proposed model by the National Patient Safety Agency from United Kingdom that was modified. Type, class and severity of the incidents was analyzed. RESULTS: A total 2,965 CF were reported (1,729 were associated to near miss and 1,236 to adverse events). The CF group more frequently reported were related patients factors. Individual factors were reported more frequently in near miss and task related CF in adverse events. CF were reported in all classes of incidents. The majority of CF were reported in the incidents classified such as less serious, even thought CF patients factors were associated to serious incidents. Individual factors were considered like avoidable and patients factors as unavoidable. CONCLUSIONS: The CF group more frequently reported were patient factors and was associated to more severe and unavoidable incidents. By contrast, individual factors were associated to less severe and avoidable incidents. In general, CF most frequently reported were associated to near miss.

Audits in real time for safety in critical care: Definition and pilot study / Análisis aleatorios de seguridad en medicina intensiva: definición y estudio piloto

Adverse events significantly impact upon mortality rates and healthcare costs. Purpose To design a checklist of safety measures based on relevant scientific literature, apply random checklist measures to critically ill patients in real time (safety audits), and determine its utility and feasibility. Methods A list of safety measures based on scientific literature was drawn up by investigators. Subsequently, a group of selected experts evaluated these measures using the Delphi methodology. Audits were carried out on 14 days over a period of one month. Each day, 50% of the measures were randomly selected and measured in 50% of the randomized patients. Utility was assessed by measuring the changes in clinical performance after audits, using the variable improvement proportion related to audits. Feasibility was determined by the successful completion of auditing on each of the days on which audits were attempted. Results The final verified checklist comprised 37 measures distributed into 10 blocks. The improvement proportion related to audits was reported in 83.78% of the measures. This proportion was over 25% in the following measures: assessment of the alveolar pressure limit, checking of mechanical ventilation alarms, checking of monitor alarms, correct prescription of the daily treatment orders, daily evaluation of the need for catheters, enteral nutrition monitoring, assessment of semi-recumbent position, and checking that patient clinical information is properly organized in the clinical history. Feasibility: rounds were completed on the 14 proposed days. Conclusions Audits in real time are a useful and feasible tool for modifying clinical actions and minimizing errors

Los eventos adversos impactan significativamente en la mortalidad y costes sanitarios. Objetivos Elaborar un listado de verificación de medidas de seguridad basadas en la literatura científica más relevante, aplicarlo en tiempo real y aleatoriamente (rondas de seguridad) y determinar su utilidad y factibilidad. Diseño Los investigadores desarrollaron un listado de medidas de seguridad basado en la literatura científica. Posteriormente, mediante el método Delphi un grupo de expertos consensuaron las medidas. Las auditorías fueron realizadas en 14 días durante un mes. Cada día se seleccionaron aleatoriamente el 50% de las variables y se midieron en el 50% de los pacientes. La utilidad se determinó midiendo las modificaciones en la actuación clínica usando la variable «proporción de mejora relacionada con las auditorías». La factibilidad fue determinada por la capacidad de realizar los análisis cada día que fueron previstos. Resultados El listado de verificación estuvo formado por 37 medidas distribuidas en 10 bloques. En el 83,78% de las medidas se produjeron modificaciones después de las rondas. La proporción de mejora relacionada con las rondas fue superior al 25% en las siguientes medidas: evaluación del límite de presión alveolar, revisión de las alarmas de la ventilación mecánica, revisión de las alarmas del monitor, prescripción correcta de las órdenes de tratamiento, evaluación diaria de la necesidad de catéteres, monitorización de la nutrición enteral, posición semiincorporada e información clínica del paciente. Factibilidad: las rondas fueron completadas los 14 días que se propusieron. Conclusiones Las rondas de seguridad aleatorizadas son una herramienta útil y factible para modificar actuaciones clínicas minimizando los errores

Audits in real time for safety in critical care: definition and pilot study.

UNLABELLED: Adverse events significantly impact upon mortality rates and healthcare costs. PURPOSE: To design a checklist of safety measures based on relevant scientific literature, apply random checklist measures to critically ill patients in real time (safety audits), and determine its utility and feasibility. METHODS: A list of safety measures based on scientific literature was drawn up by investigators. Subsequently, a group of selected experts evaluated these measures using the Delphi methodology. Audits were carried out on 14 days over a period of one month. Each day, 50% of the measures were randomly selected and measured in 50% of the randomized patients. Utility was assessed by measuring the changes in clinical performance after audits, using the variable improvement proportion related to audits. Feasibility was determined by the successful completion of auditing on each of the days on which audits were attempted. RESULTS: The final verified checklist comprised 37 measures distributed into 10 blocks. The improvement proportion related to audits was reported in 83.78% of the measures. This proportion was over 25% in the following measures: assessment of the alveolar pressure limit, checking of mechanical ventilation alarms, checking of monitor alarms, correct prescription of the daily treatment orders, daily evaluation of the need for catheters, enteral nutrition monitoring, assessment of semi-recumbent position, and checking that patient clinical information is properly organized in the clinical history. Feasibility: rounds were completed on the 14 proposed days. CONCLUSIONS: Audits in real time are a useful and feasible tool for modifying clinical actions and minimizing errors.