Identificación de eventos centinela en atención primaria / Identification of sentinel events in primary care

Objetivo. Identificar y describir un listado de eventos centinela (EC) en atención primaria (AP). Metodología. Consenso de expertos estructurado mediante 2 cuestionarios online. Los expertos fueron elegidos por su experiencia en AP y conocimientos en seguridad del paciente. El primer cuestionario valoró la adaptación de los EC hospitalarios del National Quality Forum 2006 al ámbito de AP a través de las respuestas: sí, no, sí con adaptación; en este último caso se permitió una nueva redacción de los mismos y además el cuestionario permitía la incorporación de nuevos EC. El segundo cuestionario incluyó los EC con respuesta positiva (sí, sí con adaptación>55%) para que los expertos eligieran entre redacción original y alternativa y los nuevos EC descritos. Resultados. De los 47 expertos convocados 44 respondieron a ambos cuestionarios. Se identificaron en total 17 EC para AP. Primer cuestionario: de 28 EC hospitalarios 12 se consideraron adaptables para AP; 11 de ellos con redacción alternativa. Treinta y ocho expertos propusieron algún EC nuevo referidos principalmente a: problemas con la medicación/vacunas, retrasos/ausencia en la atención, retraso diagnóstico y problemas con pruebas diagnósticas, resumidos en 5 EC. Segundo formulario: los expertos escogieron en más del 65% la redacción alternativa de los 11 EC adaptados a AP. Los 5 nuevos EC fueron considerados adecuados con respuesta positiva entre 70-85%. Conclusión. Se identificaron 17 EC para AP, lo que disponer de un listado de EC permitirá llevar a cabo una mejor gestión del riesgo sanitario (AU)

Objective. To identify and describe a list of sentinel events (SEs) for Primary Care (PC). Methododology. A structured experts' consensus was obtained by using two online questionnaires. The participants were selected because of their expertise in PC and patient safety. The first questionnaire assessed the suitability of the hospital SEs established in the National Quality Forum 2006 for use in PC via responses of "yes", "no", or "yes but with modification". In the latter case, a re-wording of the SE was requested. Additionally, inclusion of new SEs was also allowed. The second questionnaire included those SEs with positive responses ("yes", "yes with modification"), so that the experts could choose between the original and alternative drafts, and evaluate the newly described SEs. Results. The questionnaires were completed by 44 out of a total of the 47 experts asked to participate, and a total of 17 SEs were identified as suitable for PC. For the first questionnaire, 12 of the 28 hospital SEs were considered adaptable to PC, of which 11 were re-drafts. Thirty-seven experts proposed new SEs. These mainly concerned problems with medication and vaccines, delay, or lack of assistance, diagnostic delays, and problems with diagnostic tests, and were finally summarised in 5 SEs. In the second questionnaire, ≥65% of the experts chose the alternative wording against the original cases for the 11 SEs suitable for PC. The 5 newly included SEs were considered adequate with a positive response of 70-85%. Conclusion. Having a list of SEs available in PC will help to improve the management of health care risks (AU)

[Identification of sentinel events in primary care]. / Identificación de eventos centinela en atención primaria.

OBJECTIVE: To identify and describe a list of sentinel events (SEs) for Primary Care (PC). METHODODOLOGY: A structured experts' consensus was obtained by using two online questionnaires. The participants were selected because of their expertise in PC and patient safety. The first questionnaire assessed the suitability of the hospital SEs established in the National Quality Forum 2006 for use in PC via responses of "yes", "no", or "yes but with modification". In the latter case, a re-wording of the SE was requested. Additionally, inclusion of new SEs was also allowed. The second questionnaire included those SEs with positive responses ("yes", "yes with modification"), so that the experts could choose between the original and alternative drafts, and evaluate the newly described SEs. RESULTS: The questionnaires were completed by 44 out of a total of the 47 experts asked to participate, and a total of 17 SEs were identified as suitable for PC. For the first questionnaire, 12 of the 28 hospital SEs were considered adaptable to PC, of which 11 were re-drafts. Thirty-seven experts proposed new SEs. These mainly concerned problems with medication and vaccines, delay, or lack of assistance, diagnostic delays, and problems with diagnostic tests, and were finally summarised in 5 SEs. In the second questionnaire, ≥65% of the experts chose the alternative wording against the original cases for the 11 SEs suitable for PC. The 5 newly included SEs were considered adequate with a positive response of 70-85%. CONCLUSION: Having a list of SEs available in PC will help to improve the management of health care risks.

Impacto de las nuevas guías para el manejo de recién nacidos de riesgo de sepsis precoz por estreptococo del grupo / Impact of the new guidelines for management of newborns at risk of early sepsis due to Group B streptococcus

Introducción y objetivos: Las recomendaciones para la prevención de la sepsis neonatal precoz por estreptococo del grupo B (EGB) de los Centers for Disease Control and Prevention han sido revisadas en el año 2010. El objetivo de este estudio es conocer su impacto sobre los hijos de madres colonizadas por EGB en cuanto a realización de pruebas complementarias y número de ingresos. Material y métodos: Estudio de cohortes retrospectivo de recién nacidos de madres colonizadas por EGB, con edad de gestación igual o superior a 36 semanas, nacidos en el segundo semestre de 2010 y 2012, antes y después de la implantación del nuevo protocolo. Se compara la frecuencia de realización de estudios complementarios e ingresos hospitalarios entre ambos periodos. Resultados: Ambas cohortes (152 casos en 2010 y 130 en 2012) fueron homogéneas en cuanto a tasas de colonización materna, control obstétrico, sexo, edad gestacional, tiempo prolongado de bolsa rota, presencia de corioamnionitis e indicación y administración de profilaxis antibiótica materna. No hubo ningún caso de sepsis precoz por EGB en ninguno de los dos periodos. El nuevo protocolo evitó la solicitud de estudios complementarios en un 88 % (Pfe= 0,88. IC: 0,39-0,96) y el número de ingresos un 48% (Pfe= 0,481. IC: -0,648-0,864). Conclusiones: La aplicación del nuevo protocolo ha disminuido significativamente el número de pruebas complementarias solicitadas y el número de ingresos sin que se observe un aumento del número de casos de sepsis precoz por EGB

Background: Guidelines for prevention of perinatal infection Group B Streptococcus (GBS) has been revised in 2010 and new early-onset sepsis (EOS) algorithms have been applied. Aim: To know the impact of this new algorithm on ECO evaluations, admissions and EOS-GBS cases detection. Methods: A retrospective cohort study was performed, including neonates born at > 36 week's, with positive maternal detection of GBS, in two periods of time: from July to December 2010 (previous to new EOS algorithm) and from July to December 2012. The following data was compared: evaluations and admissions. Statistical were performed using the Student t test for quantitative variables and chi square test for categorical. Preventable fraction exposed (Pfe) was used to quantify the impact of new algorithm. Results: One hundred and fifty-two neonates were included in 2010 and 130 in 2012. No significant differences were found in terms of sex, GBS positive mothers, obstetric care, gestational age, chorioamnionitis, indication and maternal antibiotic administration. There were no cases of neonatal GBS infection in both periods. In 2012 a decrease of 88% in blood EOS evaluation was obtained (Pfe= 0.88, IC: 0.39-0.96). The number of admissions for suspected early GBS sepsis was reduced by 48.1%. (Pfe= 0.481. IC: -0.648-0.864) Conclusions. Implementation of the new EOS algorithm resulted in a decrease of EOS evaluations, and the number of admissions for suspected sepsis

Oblicuidad pélvica o contractura congénita en abducción de la cadera: una entidad poco conocida / Congenital pelvic obliquity or congenital hip’s abduction contracture: a little known entity

La oblicuidad pélvica congénita es una patología frecuente en el lactante y poco conocida por los pediatras. Se presentan cuatro casos de oblicuidad pélvica simple en lactantes mujeres. Se describen los hallazgos clínicos y radiológicos en el momento del diagnóstico, la actitud terapéutica y la evolución de cada uno de ellos. Los pediatras de Atención Primaria debemos estar atentos a los antecedentes, signos acompañantes y al diagnóstico de esta entidad, así como tener formación en la exploración de la cadera para detectar clínicamente una inestabilidad, preferentemente en la cadera aducta (opuesta a la contracturada). Es importante la interrelación entre Pediatría, Radiología Infantil, Traumatología Infantil y Rehabilitación (AU)

Congenital pelvic obliquity is frequent, although pediatricians are not used to diagnose it. We report four female infants with simple pelvic obliquity. We describe clinical and radiologic findings, their treatment and outcome. Primary care pediatricians must be alert looking for pelvic obliquity in infants. We need to improve our abilities in hip exploration, to detect instability in the adduct hip (in the opposite of the contractured hip). Is very important to work together: pediatricians, radiologist, orthopedist and rehabilitation physician (AU)

Reducción del riesgo de complicaciones relacionadas con los catéteres venosos centrales: una propuesta para mejorar la seguridad del paciente / Reduction of the risk of complications related to central venous catheters: a proposal for improving patient safety

Objetivo: Implementar medidas eficaces para disminuir la bacteriemia relacionada con catéter venoso central. Material y método: Se revisó la técnica de inserción y el material necesario, elaborando instrucciones y material gráfico de ayuda. Calculamos la prevalencia de inserción de los catéteres venosos centrales (CVC). Se han analizado todas las listas de verificación realizadas entre 2010 y 2012 en un año y los datos de una encuesta autocumplimentada y anónima para valorar los conocimientos del mantenimiento de la vía central, evaluando el resultado conforme a las nuevas instrucciones. Se elaboró la «Instrucción de seguridad para la prevención de la bacteriemia relacionada con el catéter en pacientes hospitalizados», se organizó un kit de inserción y se formó a 58 médicos y 168 enfermeras. Se revisó a 687 pacientes, encontrando un 6,7% de portadores de un CVC. Resultados: El 21,7% de los pacientes tenían cumplimentada la lista de verificación y un 39,4% necesitó más de un intento. En cuanto a los cuidados, falló el registro de fechas de cambios de apósito y de sistemas de infusión. Conclusiones: Se ha conseguido una máxima difusión del material elaborado. Se deben reforzar aquellos procedimientos donde se han producido un mayor porcentaje de errores (AU)

Objective: To adopt effective measures for reducing bacteremia related to central venous catheters (CVCs). Material and methods: A review was made of the insertion technique and required material, developing instructions and graphic support. The prevalence of CVC insertion was calculated. An analysis was made of all the yearly checklists between 2010 and 2012, along with the data drawn from an anonymous self-administered questionnaire, to assess knowledge of maintenance of central catheterization, and evaluating performance on the basis of the new instructions provided. «Safety instructions for the prevention of catheter-related bacteremia in hospitalized patients» were developed, an insertion kit was produced, and 58 physicians and 168 nurses were trained. A total of 687 patients were reviewed, of which 6.7% were seen to carry a CVC. Results: The checklist was found to be completed in 21.7% of the patients, and 39.4% required more than one catheterization attempt. Regarding care-related aspects, there were deficiencies in the registry of the dates on which the dressings and infusion systems were replaced. Conclusions: Maximum diffusion of the developed material was achieved. Reinforcement is required of those procedures in which a greater percentage of errors were detected (AU)

Predictores de la satisfacción de los pacientes con la alimentación de un hospital público de Madrid / Predictors of patient satisfaction with the food services in a public hospital in Madrid

Objetivo. Conocer el nivel de satisfacción de los pacientes con la alimentación recibida durante su ingreso y qué factores la predicen. Material y métodos. Estudio transversal realizado en el Hospital Clínico San Carlos entre mayo y septiembre de 2010 mediante una encuesta autocumplimentada tras el alta hospitalaria tanto en pacientes con dieta basal como terapéutica. Se recogieron variables sociodemográficas, satisfacción global con la alimentación y con diferentes aspectos y tipos de alimentos. Se realizó un análisis descriptivo y multivariable, siendo la variable dependiente la satisfacción global mediante regresión logística binaria. Resultados. Se obtuvieron 549 encuestas (tasa de respuesta del 29%), de las cuales el 60,7% habían recibido dieta terapéutica. La edad mediana fue de 68 años y el 55,4% eran hombres. El 75% manifestaron estar satisfechos o muy satisfechos. Las variables que influyeron de forma significativa en la satisfacción con la alimentación fueron la condimentación, la temperatura, y la satisfacción con los pescados y sopas/cremas. Conclusiones. A pesar de un elevado nivel de satisfacción con la alimentación existen oportunidades de mejora. Se han identificado algunos factores sobre los cuales podría ser más rentable actuar(AU)

Objective. To describe patients satisfaction with the food services during hospitalisation, and to determine the predictors. Methodology. A cross-sectional study was conducted in the “Clínico San Carlos” Hospital, between May and September 2010. A self-completion questionnaire was given to patients with both regular and therapeutic diets after their hospital discharge. We included socio-demographic variables, overall satisfaction, and satisfaction regarding different aspects and types of food. Descriptive and multivariable analyses were performed, with the overall satisfaction with food as the dependent variable using binary logistic regression. Results. A total of 549 questionnaires were returned (rate 29%), of which 60.7% received a therapeutic diet. 55.4% were men, and the median age was 68 years. Three-quarters (75%) were satisfied or very satisfied. Statistically significant variables associated with patient satisfaction with the food services received were the meal's taste and temperature, as well as being satisfied with the fish and soups on the menu. Conclusions. Despite the high level of satisfaction with food services, there is scope for improvement. We have identified some of the aspects on which action would be more beneficial(AU)

[Predictors of patient satisfaction with the food services in a public hospital in Madrid]. / Predictores de la satisfacción de los pacientes con la alimentación de un hospital público de Madrid.

OBJECTIVE: To describe patients satisfaction with the food services during hospitalisation, and to determine the predictors. METHODOLOGY: A cross-sectional study was conducted in the "Clínico San Carlos" Hospital, between May and September 2010. A self-completion questionnaire was given to patients with both regular and therapeutic diets after their hospital discharge. We included socio-demographic variables, overall satisfaction, and satisfaction regarding different aspects and types of food. Descriptive and multivariable analyses were performed, with the overall satisfaction with food as the dependent variable using binary logistic regression. RESULTS: A total of 549 questionnaires were returned (rate 29%), of which 60.7% received a therapeutic diet. 55.4% were men, and the median age was 68 years. Three-quarters (75%) were satisfied or very satisfied. Statistically significant variables associated with patient satisfaction with the food services received were the meal's taste and temperature, as well as being satisfied with the fish and soups on the menu. CONCLUSIONS: Despite the high level of satisfaction with food services, there is scope for improvement. We have identified some of the aspects on which action would be more beneficial.