Estrategia de intervención para disminuir la incidencia de extubación no planeada en una unidad pediátrica de cuidados críticos: estudio antes después / Intervention strategy to reduce unplanned extubation incidence in a pediatric intensive care unit: a before-after study

INTRODUCCION: Mejorar la calidad en el cuidado del paciente es un objetivo prioritario en la práctica médica. Estudios recientes centran su atención en reducir los acontecimientos adversos para la mejora continua del cuidado médico. Para ello se deben identificar los potenciales eventos adversos y tratar los factores que contribuyen a generarlos. La extubación no planeada (ENP) representa un acontecimiento adverso frecuente de la ventilación mecánica (VM), 0,11 a 2,4 cada 100 días de VM. Se trata mayormente de un hecho prevenible y susceptible de reducirse con la implementación de estrategias de mejora continua de la calidad.OBJETIVO: Implementar una intervención para disminuir la tasa estandarizada de ENP y evaluar su cumplimiento en una Unidad de Cuidados Intensivos Pediátricos.METODOS: La estrategia consistió en estandarizar procedimientos (fijación de tubo endotraqueal (TET), sedación y destete de VM), desarrollar un programa educativo con evaluación y registrar el evento post-intervención. Se comparó la tasa estandarizada de ENP con dos poblaciones: un grupo pre-intervención (grupo histórico/control) y un grupo post-intervención. Se evaluó el cumplimiento de la estrategia.RESULTADOS: Se capacitó al 80% del personal para la aplicación de la intervención en 8 talleres, cuya evaluación fue muy satisfactoria. El cumplimiento de la estrategia fue de entre el 86 y el 99%. Se incluyó a 136 pacientes en el grupo post-intervención y a 160 en el grupo pre-intervención. No hubo diferencias poblacionales significativas entre los grupos. La tasa estandarizada de ENP fue de 0,41 y 1,28 respectivamente. La diferencia de la tasa entre grupos resultó altamente significativa (p << 0,05).CONCLUSIONES: EN la población de pacientes pediátricos ventilados de la unidad, la implementación y el cumplimiento de la estrategia de prevención de ENP logró disminuir la tasa de incidencia del evento entre los períodos pre y pos intervención en forma significativa.

INTRODUCTION: Improvement of health care quality is a priority objective in medical practice. REcent studies centered their attention in reducing adverse events to achieve better results. Potential adverse events and their provoking factors must be identifies and treated to minimize their occurrence. Unplanned extubation (UEX) is a common adverse event of mechanical ventilation (MV) (from 0.11 to 2.4 per 100 days of MV), most of them avoidable.OBJECTIVE: To put into practice an intervention to reduce the standardized rate of UEX and evaluate its performance in the Pediatric Intensive Care Unit.METHODS: The strategy consisted in standarizing procedures (endotracheal tube setting, sedation and weaning from mechanical ventilation), developing an educational program with evaluation and recording the post-intervention event. The study included a comparison between the standardized rate of UEX in two populations: pre-intervention group (historical control group) and post intervention group. The performance of the strategy was evaluated.RESULTS: 80% of the staff was trained to implement the intervention in 8 workshops, whose evaluation was very satisfactory. Compliance with the planned strategy was between 86 and 99%. 136 patients were included in the post-intervention group and 160 in the pre-intervention group. There were no signficant population differences between the groups. The standardized rate of UEX was 0.41 and 1.28, respectively. The rate difference between groups was highly significant (p <<0,05).CONCLUSIONS: In the pediatric ventilated population patients in the unit, the implementation of a prevention strategy of UEX managed to highly reduce the incidence of the event between pre and post intervention periods.

Estrategia de intervención para disminuir la incidencia de extubación no planeada en una unidad pediátrica de cuidados críticos: estudio antes después / Intervention strategy to reduce unplanned extubation incidence in a pediatric intensive care unit: a before-after study

INTRODUCCION: Mejorar la calidad en el cuidado del paciente es un objetivo prioritario en la práctica médica. Estudios recientes centran su atención en reducir los acontecimientos adversos para la mejora continua del cuidado médico. Para ello se deben identificar los potenciales eventos adversos y tratar los factores que contribuyen a generarlos. La extubación no planeada (ENP) representa un acontecimiento adverso frecuente de la ventilación mecánica (VM), 0,11 a 2,4 cada 100 días de VM. Se trata mayormente de un hecho prevenible y susceptible de reducirse con la implementación de estrategias de mejora continua de la calidad.OBJETIVO: Implementar una intervención para disminuir la tasa estandarizada de ENP y evaluar su cumplimiento en una Unidad de Cuidados Intensivos Pediátricos.METODOS: La estrategia consistió en estandarizar procedimientos (fijación de tubo endotraqueal (TET), sedación y destete de VM), desarrollar un programa educativo con evaluación y registrar el evento post-intervención. Se comparó la tasa estandarizada de ENP con dos poblaciones: un grupo pre-intervención (grupo histórico/control) y un grupo post-intervención. Se evaluó el cumplimiento de la estrategia.RESULTADOS: Se capacitó al 80% del personal para la aplicación de la intervención en 8 talleres, cuya evaluación fue muy satisfactoria. El cumplimiento de la estrategia fue de entre el 86 y el 99%. Se incluyó a 136 pacientes en el grupo post-intervención y a 160 en el grupo pre-intervención. No hubo diferencias poblacionales significativas entre los grupos. La tasa estandarizada de ENP fue de 0,41 y 1,28 respectivamente. La diferencia de la tasa entre grupos resultó altamente significativa (p << 0,05).CONCLUSIONES: EN la población de pacientes pediátricos ventilados de la unidad, la implementación y el cumplimiento de la estrategia de prevención de ENP logró disminuir la tasa de incidencia del evento entre los períodos pre y pos intervención en forma significativa.

INTRODUCTION: Improvement of health care quality is a priority objective in medical practice. REcent studies centered their attention in reducing adverse events to achieve better results. Potential adverse events and their provoking factors must be identifies and treated to minimize their occurrence. Unplanned extubation (UEX) is a common adverse event of mechanical ventilation (MV) (from 0.11 to 2.4 per 100 days of MV), most of them avoidable.OBJECTIVE: To put into practice an intervention to reduce the standardized rate of UEX and evaluate its performance in the Pediatric Intensive Care Unit.METHODS: The strategy consisted in standarizing procedures (endotracheal tube setting, sedation and weaning from mechanical ventilation), developing an educational program with evaluation and recording the post-intervention event. The study included a comparison between the standardized rate of UEX in two populations: pre-intervention group (historical control group) and post intervention group. The performance of the strategy was evaluated.RESULTS: 80% of the staff was trained to implement the intervention in 8 workshops, whose evaluation was very satisfactory. Compliance with the planned strategy was between 86 and 99%. 136 patients were included in the post-intervention group and 160 in the pre-intervention group. There were no signficant population differences between the groups. The standardized rate of UEX was 0.41 and 1.28, respectively. The rate difference between groups was highly significant (p <<0,05).CONCLUSIONS: In the pediatric ventilated population patients in the unit, the implementation of a prevention strategy of UEX managed to highly reduce the incidence of the event between pre and post intervention periods.

Interventions for preventing venous thromboembolism in adults undergoing knee arthroscopy.

BACKGROUND: Knee arthroscopy is a frequent surgical procedure. Arthroscopy procedures are considered minimally invasive. However, some patients will need extended surgical time, suffer injury and immobilization thus increasing the risk for thromboembolic events. Incidence of deep venous thrombosis (DVT) in patients undergoing knee arthroscopy is reported to be from 0.6% to 17.9% depending on the diagnostic method used. Different approaches are available for thromboprophylaxis (mechanical or pharmacological). OBJECTIVES: To assess the effectiveness and safety of thromboprophylaxis to reduce the incidence of DVT in patients undergoing knee arthroscopy. SEARCH STRATEGY: We searched the Cochrane Peripheral Vascular Diseases Group Specialized Register (last searched October 2006) the CENTRAL (last searched Issue 4, 2006), MEDLINE (1966 to 2006), EMBASE (1980 to 2006), and Lilacs (1988 to 2006). We contacted specialists known to be involved in phlebology and interested in post thrombotic syndrome for details of unpublished and ongoing trials. SELECTION CRITERIA: Randomized clinical trials (RCTs) and controlled clinical trials (CCTs), whether blinded or not (i.e. double blinded, single blinded or unblinded) of all type of interventions, whether mechanical or pharmacological, single or in combination, used to prevent DVT in males and females over 18 years old undergoing knee arthroscopy. There was no restriction on language. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Four trials involving 527 predominantly male participants were included. The main weakness of the studies was the lack of correct stratification of the arthroscopic intervention.The relative risk (RR) of thrombotic events was 0.16 (95% confidence interval (CI); 0.05 to 0.52) comparing any type of low molecular weight heparin (LMWH) versus placebo. All thrombotic events but one (pulmonary embolism in the LMWH group) were distal venous thrombosis. Adverse events were most common in the intervention group than in the control group, RR 2.04 (95% CI 1.21 to 3.44). There were 66 episodes of adverse events. The number needed to harm was 20 for any adverse events. AUTHORS' CONCLUSIONS: This meta-analysis suggests that LMWH reduces the incidence of distal DVT diagnosed by sonogram. The clinical benefit of this is uncertain. No strong evidence was found to conclude thromboprophylaxis is effective to prevent thromboembolic events and safe, in people with unknown risk factors for thrombosis, undergoing knee arthroscopy.

[Surveillance of health care errors. An overview of the published data in Argentina]. / Evidencia para mitigar errores en la práctica clínica y sanitaria. Una revisión de la literatura científica argentina.

In the last decades, public health surveillance extended its scope of study to new fields, such as medical errors, in order to improve patient safety. This study was aimed to review all the evidence produced in Argentina about the surveillance of medical errors. An exhaustive literature search was performed. A total of 4656 abstracts were assessed (150 MEDLINE, 145 LILACS, and 4361 hand searched abstracts). Of them, 52 were analysed and 8 were considered relevant for health care error surveillance. Different approaches were used to study medical errors. Some of them have focused on patient safety and others on medical malpractice. There is still a need to improve the surveillance of this type of event. Mainly, the quality reports of study design and surveillance attributes were unclear. A critical appraisal and synthesis of all relevant studies on health care errors may help to understand not only the state of the art, but also to define research priorities.

Evidencia para mitigar errores en la practica clinica y sanitaria: una revision de la literatura cientifica argentina / Surveillance of health care errors: an overview of the published data in Argentina

En las últimas décadas la vigilancia de la salud pública extendió su objeto de estudio hacia el desarrollo de estrategias que mejoren la seguridad del paciente a través de la notificación de los errores en medicina. El objetivo fue analizar las investigaciones publicadas en la Argentina acerca de sistemas diseñados para la vigilancia de los errores en el proceso de atención de los pacientes. Se realizaron búsquedaselectrónicas y una búsqueda manual de literatura. Se revisaron 4656 resúmenes, 150 de MEDLINE, 145 deLILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud) y 4361 de búsqueda manual. De ellos52 estudios fueron incluidos y 8 calificados como relevantes para la vigilancia del error. Los hallazgos mostraron que el enfoque del error en medicina y en particular su notificación es escasa y no está sistematizada. Unaexplicación probable sería el temor de los profesionales por la potencial demanda. La sistematización de la literatura científica es necesaria para acceder de manera eficiente al estado del conocimiento sobre el tema y ladefinición de prioridades en investigación

In the last decades, public health surveillance extended its scope of study to new fields, such as medical errors,in order to improve patient safety. This study was aimed to review all the evidence produced in Argentina aboutthe surveillance of medical errors. An exhaustive literature search was performed. A total of 4656 abstracts were assessed (150 MEDLINE, 145 LILACS, and 4361 hand searched abstracts). Of them, 52 were analysed and 8 were considered relevant for health care error surveillance. Different approaches were used to study medicalerrors. Some of them have focused on patient safety and others on medical malpractice. There is still a need toimprove the surveillance of this type of event. Mainly, the quality reports of study design and surveillance attributeswere unclear. A critical appraisal and synthesis of all relevant studies on health care errors may help to understand not only the state of the art, but also to define research priorities

Evidencia para mitigar errores en la practica clinica y sanitaria: una revision de la literatura cientifica argentina / Surveillance of health care errors: an overview of the published data in Argentina

En las últimas décadas la vigilancia de la salud pública extendió su objeto de estudio hacia el desarrollo de estrategias que mejoren la seguridad del paciente a través de la notificación de los errores en medicina. El objetivo fue analizar las investigaciones publicadas en la Argentina acerca de sistemas diseñados para la vigilancia de los errores en el proceso de atención de los pacientes. Se realizaron búsquedaselectrónicas y una búsqueda manual de literatura. Se revisaron 4656 resúmenes, 150 de MEDLINE, 145 deLILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud) y 4361 de búsqueda manual. De ellos52 estudios fueron incluidos y 8 calificados como relevantes para la vigilancia del error. Los hallazgos mostraron que el enfoque del error en medicina y en particular su notificación es escasa y no está sistematizada. Unaexplicación probable sería el temor de los profesionales por la potencial demanda. La sistematización de la literatura científica es necesaria para acceder de manera eficiente al estado del conocimiento sobre el tema y ladefinición de prioridades en investigación (AU)

In the last decades, public health surveillance extended its scope of study to new fields, such as medical errors,in order to improve patient safety. This study was aimed to review all the evidence produced in Argentina aboutthe surveillance of medical errors. An exhaustive literature search was performed. A total of 4656 abstracts were assessed (150 MEDLINE, 145 LILACS, and 4361 hand searched abstracts). Of them, 52 were analysed and 8 were considered relevant for health care error surveillance. Different approaches were used to study medicalerrors. Some of them have focused on patient safety and others on medical malpractice. There is still a need toimprove the surveillance of this type of event. Mainly, the quality reports of study design and surveillance attributeswere unclear. A critical appraisal and synthesis of all relevant studies on health care errors may help to understand not only the state of the art, but also to define research priorities (AU)

Evidencia para mitigar errores en la practica clinica y sanitaria: una revision de la literatura cientifica argentina / Surveillance of health care errors: an overview of the published data in Argentina

En las últimas décadas la vigilancia de la salud pública extendió su objeto de estudio hacia el desarrollo de estrategias que mejoren la seguridad del paciente a través de la notificación de los errores en medicina. El objetivo fue analizar las investigaciones publicadas en la Argentina acerca de sistemas diseñados para la vigilancia de los errores en el proceso de atención de los pacientes. Se realizaron búsquedaselectrónicas y una búsqueda manual de literatura. Se revisaron 4656 resúmenes, 150 de MEDLINE, 145 deLILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud) y 4361 de búsqueda manual. De ellos52 estudios fueron incluidos y 8 calificados como relevantes para la vigilancia del error. Los hallazgos mostraron que el enfoque del error en medicina y en particular su notificación es escasa y no está sistematizada. Unaexplicación probable sería el temor de los profesionales por la potencial demanda. La sistematización de la literatura científica es necesaria para acceder de manera eficiente al estado del conocimiento sobre el tema y ladefinición de prioridades en investigación (AU)

In the last decades, public health surveillance extended its scope of study to new fields, such as medical errors,in order to improve patient safety. This study was aimed to review all the evidence produced in Argentina aboutthe surveillance of medical errors. An exhaustive literature search was performed. A total of 4656 abstracts were assessed (150 MEDLINE, 145 LILACS, and 4361 hand searched abstracts). Of them, 52 were analysed and 8 were considered relevant for health care error surveillance. Different approaches were used to study medicalerrors. Some of them have focused on patient safety and others on medical malpractice. There is still a need toimprove the surveillance of this type of event. Mainly, the quality reports of study design and surveillance attributeswere unclear. A critical appraisal and synthesis of all relevant studies on health care errors may help to understand not only the state of the art, but also to define research priorities (AU)