Evaluación de la implantación de prácticas seguras con los medicamentos en los Servicios de Medicina Intensiva / Assessment of the implementation of safe medication practices in Intensive Medicine Units

Objetivo Conocer el grado de implantación de las prácticas seguras con los medicamentos en los Servicios de Medicina Intensiva e identificar oportunidades de mejora. Diseño Estudio descriptivo multicéntrico. Ámbito Servicios de Medicina Intensiva. Participantes/procedimiento Cuarenta Servicios de Medicina Intensiva que voluntariamente cumplimentaron el «Cuestionario de autoevaluación de la seguridad del uso de los medicamentos en los Servicios de Medicina Intensiva» entre marzo y septiembre del 2020. El cuestionario contiene 147 ítems de evaluación agrupados en 10 elementos clave. Variables principales de interés Puntuación media y porcentaje medio sobre el valor máximo posible en el cuestionario completo, en los elementos clave y en los ítems de evaluación. Resultados La puntuación media del cuestionario completo en los Servicios de Medicina Intensiva fue de 436,8 (49,2% del valor máximo posible). No se encontraron diferencias según dependencia funcional, tamaño del hospital y tipo de servicio. Los elementos clave referentes a la incorporación de farmacéuticos en estos servicios, así como a la competencia y la formación de los profesionales en prácticas de seguridad, mostraron los valores más bajos (31,2% y 33,2%, respectivamente). Otros tres elementos clave relativos a la accesibilidad a la información sobre los pacientes y los medicamentos; a la estandarización, el almacenamiento y la distribución de los medicamentos, y a los programas de calidad y gestión de riesgos mostraron porcentajes inferiores al 50%. Conclusiones Se han identificado numerosas prácticas seguras efectivas cuyo grado de implantación en los Servicios de Medicina Intensiva es bajo y que es preciso abordar para reducir los errores de medicación en el paciente crítico (AU)

Objective To assess the level of implementation of medication safety practices in Intensive Care Units (ICUs) and to identify opportunities for improvement. Design A descriptive multicenter study was carried out. Setting Intensive Care Units. Participants/procedure A total of 40 ICUs voluntarily completed the “Medication use-system safety self-assessment for Intensive Care Units” between March and September 2020. The survey comprised 147 items for evaluation grouped into 10 key elements. Main variables Calculation was made of the mean scores and mean percentages based on the maximum possible values for the overall survey, for the key elements and for each individual item for evaluation. Results The mean score of the overall questionnaire among the participating ICUs was 436.8 (49.2% of the maximum possible score). No differences were found according to functional dependence, size of the hospital or type of ICU. The key elements referred to the incorporation of clinical pharmacists in these units, as well as the competence and training of the professionals in safety practices yielded the lowest values (31.2% and 33.2%, respectively). Three other key elements related to accessibility to information about patients and medicines; to the standardization, storage and distribution of medicines; and to the quality and risk management programs, yielded percentages below 50%. Conclusions Numerous effective safety medication practices have been identified with a low level of implementation in ICUs. This situation must be addressed in order to reduce medication errors in critically ill patients (AU)

Assessment of the implementation of safe medication practices in Intensive Medicine Units.

OBJECTIVE: To assess the level of implementation of medication safety practices in Intensive Care Units (ICUs) and to identify opportunities for improvement. DESIGN: A descriptive multicenter study was carried out. SETTING: Intensive Care Units. PARTICIPANTS/PROCEDURE: A total of 40 ICUs voluntarily completed the "Medication use-system safety self-assessment for Intensive Care Units" between March and September 2020. The survey comprised 147 items for evaluation grouped into 10 key elements. MAIN VARIABLES: Calculation was made of the mean scores and mean percentages based on the maximum possible values for the overall survey, referred to the key elements and to each individual item for evaluation. RESULTS: The mean score of the overall questionnaire among the participating ICUs was 436.8 (49.2% of the maximum possible score). No differences were found according to functional dependence, size of the hospital or type of ICU. The key elements referred to the incorporation of clinical pharmacists in these Units, as well as the competence and training of the professionals in safety practices yielded the lowest values (31.2% and 33.2%, respectively). Three other key elements related to accessibility to information about patients and medicines; to the standardization, storage and distribution of medicines; and to the quality and risk management programs, yielded percentages <50%. CONCLUSIONS: Numerous effective safety medication practices have been identified with a low level of implementation in ICUs. This situation must be addressed in order to reduce medication errors in critically ill patients.

Assessment of the implementation of safe medication practices in Intensive Medicine Units. / Evaluación de la implantación de prácticas seguras con los medicamentos en los Servicios de Medicina Intensiva.

OBJECTIVE: To assess the level of implementation of medication safety practices in Intensive Care Units (ICUs) and to identify opportunities for improvement. DESIGN: A descriptive multicenter study was carried out. SETTING: Intensive Care Units. PARTICIPANTS/PROCEDURE: A total of 40 ICUs voluntarily completed the "Medication use-system safety self-assessment for Intensive Care Units" between March and September 2020. The survey comprised 147 items for evaluation grouped into 10 key elements. MAIN VARIABLES: Calculation was made of the mean scores and mean percentages based on the maximum possible values for the overall survey, for the key elements and for each individual item for evaluation. RESULTS: The mean score of the overall questionnaire among the participating ICUs was 436.8 (49.2% of the maximum possible score). No differences were found according to functional dependence, size of the hospital or type of ICU. The key elements referred to the incorporation of clinical pharmacists in these units, as well as the competence and training of the professionals in safety practices yielded the lowest values (31.2% and 33.2%, respectively). Three other key elements related to accessibility to information about patients and medicines; to the standardization, storage and distribution of medicines; and to the quality and risk management programs, yielded percentages below 50%. CONCLUSIONS: Numerous effective safety medication practices have been identified with a low level of implementation in ICUs. This situation must be addressed in order to reduce medication errors in critically ill patients.

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.

Estimación de las necesidades de profesionales médicos en los servicios de medicina intensiva / Physician staffing needs in critical care departments

Los servicios de medicina intensiva se asocian a una alta complejidad asistencial y un alto coste monetario. Las recomendaciones sobre el cálculo de las necesidades de intensivistas adolecen de baja evidencia y favorecen un criterio estructural y asistencial (proporción médico/camas), lo que origina modelos reduccionistas. La Sociedad Española de Medicina Intensiva y Unidades Coronarias constituyó una comisión técnica para redactar unas recomendaciones sobre la necesidad de intensivistas en los servicios de medicina intensiva. La comisión técnica definió 5 actividades: 1) asistencial; 2) actividades extra-UCI; 3) seguridad del paciente y gestión clínica; 4) docencia; y 5) investigación. Para cada actividad o categoría se crearon subcomités específicos que definieron criterios para cuantificar el porcentaje que supone cada tarea para los intensivistas por rango profesional. Para las actividades asistenciales dentro y fuera de la UCI, y también para las actividades docentes e investigadoras, se siguió un sistema cuantitativo del número de procedimientos o tareas por tiempos estimados. En relación con las actividades no instrumentales, más difíciles de evaluar en tiempo real, se siguió una matriz de ámbito/productividad, definiendo los porcentajes aproximados de tiempo dedicado por categoría profesional. Se elaboró una hoja de cálculo, modificando un modelo previo, atendiendo la suma de horas estipuladas por contrato. Las competencias exigidas van más allá de la asistencia intra-UCI, y no pueden calcularse bajo criterios estructurales. La metodología sobre 5 actividades, la cuantificación de sus tareas específicas y tiempos y la construcción de una hoja de cálculo generan un instrumento adecuado de gestión (AU)

Departments of Critical Care Medicine are characterized by high medical assistance costs and great complexity. Published recommendations on determining the needs of medical staff in the DCCM are based on low levels of evidence and attribute excessive significance to the structural/welfare approach (physician-to-beds ratio), thus generating incomplete and minimalistic information. The Spanish Society of Intensive Care Medicine and Coronary Units established a Technical Committee of experts, the purpose of which was to draft recommendations regarding requirements for medical professionals in the ICU. The Technical Committee defined the following categories: 1) Patient care-related aspects; 2) Activities outside the ICU; 3) Patient safety and clinical management aspects; 4) Teaching; and 5) Research. A subcommittee was established with experts pertaining to each activity category, defining criteria for quantifying the percentage time of the intensivists dedicated to each task, and taking into account occupational category. A quantitative method was applied, the parameters of which were the number of procedures or tasks and the respective estimated indicative times for patient care-related activities within or outside the context of the DCCM, as well as for teaching and research activities. Regarding non-instrumental activities, which are more difficult to evaluate in real time, a matrix of range versus productivity was applied, defining approximate percentages according to occupational category. All activities and indicative times were tabulated, and a spreadsheet was created that modified a previously designed model in order to perform calculations according to the total sum of hours worked and the hours stipulated in the respective work contract. The competencies needed and the tasks which a Department of Critical Care Medicine professional must perform far exceed those of a purely patient care-related character, and cannot be quantified using structural criteria. The method for describing the 5 types of activity, the quantification of specific tasks, the respective times needed for each task, and the generation of a spreadsheet led to the creation of a management instrument (AU)

Physician staffing needs in critical care departments. / Estimación de las necesidades de profesionales médicos en los servicios de medicina intensiva.

Departments of Critical Care Medicine are characterized by high medical assistance costs and great complexity. Published recommendations on determining the needs of medical staff in the DCCM are based on low levels of evidence and attribute excessive significance to the structural/welfare approach (physician-to-beds ratio), thus generating incomplete and minimalistic information. The Spanish Society of Intensive Care Medicine and Coronary Units established a Technical Committee of experts, the purpose of which was to draft recommendations regarding requirements for medical professionals in the ICU. The Technical Committee defined the following categories: 1) Patient care-related aspects; 2) Activities outside the ICU; 3) Patient safety and clinical management aspects; 4) Teaching; and 5) Research. A subcommittee was established with experts pertaining to each activity category, defining criteria for quantifying the percentage time of the intensivists dedicated to each task, and taking into account occupational category. A quantitative method was applied, the parameters of which were the number of procedures or tasks and the respective estimated indicative times for patient care-related activities within or outside the context of the DCCM, as well as for teaching and research activities. Regarding non-instrumental activities, which are more difficult to evaluate in real time, a matrix of range versus productivity was applied, defining approximate percentages according to occupational category. All activities and indicative times were tabulated, and a spreadsheet was created that modified a previously designed model in order to perform calculations according to the total sum of hours worked and the hours stipulated in the respective work contract. The competencies needed and the tasks which a Department of Critical Care Medicine professional must perform far exceed those of a purely patient care-related character, and cannot be quantified using structural criteria. The method for describing the 5 types of activity, the quantification of specific tasks, the respective times needed for each task, and the generation of a spreadsheet led to the creation of a management instrument.

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.

Gestión de riesgos en un servicio de Medicina Intensiva: conciliación de la medicación / Risk management at an Intensive Care Department: conciliation of medication

Objetivo: Explicar el proceso de implantación de la conciliación de la medicación como medida dentro de un plan de gestión de riesgos en un servicio de Medicina Intensiva. Método: Para la realización del plan de gestión de riesgos se creó un equipo de trabajo multidisciplinar. Se realizaron reuniones de trabajo durante los meses de enero a diciembre de 2011. El desarrollo del plan de gestión de riesgos se realizó en fases sucesivas: identificación de los riesgos potenciales, análisis y evaluación, tratamiento, despliegue, implementación, seguimiento y revisión. Resultados: Se identificaron un total de 17 riesgos potenciales, de los cuales se analizaron y trataron aquellos con mayor puntuación otorgada por el grupo de trabajo, entre ellos los errores de conciliación. Para el tratamiento de este riesgo se propuso como medida la conciliación de la medicación donde el farmacéutico se responsabilizó de su implementación. Asimismo, se responsabilizó del proceso de seguimiento y revisión de esta medida, para asegurar su eficacia, mediante el diseño de indicadores que permitiesen una monitorización periódica. Conclusiones: La implantación de un plan de gestión de riesgos clínicos es promover la reducción de errores y, consecuentemente, apostar por una mejora en la seguridad del paciente. La integración del farmacéutico en los servicios de Medicina Intensiva contribuye a la consecución de este objetivo, y por ello debemos aceptar nuestra responsabilidad en la implantación de medidas que vayan en esta línea como puede ser la conciliación de la medicación (AU)

Objective: To explain the implementation process of conciliation of medication as one measure included in the risk management program at an Intensive Care department. Method: A multidisciplinary team was put together to work on a risk management program. Work meetings were held from January to December of 2011. The development of the risk management program was done in sequential stages; identification of potential risks; analysis and assessment, management, set-up, implementation, follow-up, and reassessment. Results: In total, 17 potential risks were identified, of which those with the highest scores given by the working group were analyzed and managed. Conciliation of medication was included. For managing this particular risk, conciliation of medication was proposed as an improvement measure, for which the pharmacist was in charge of its implementation. Besides, he also was in charge of the follow-up and reassessment process to assure its efficacy by designing indicators allowing periodic monitoring Conclusions: The implementation of a clinical risks management program aims at reducing the errors and consequently improving the patient's safety. The inclusion of the pharmacist in the Intensive Care units contributes to achieving this goal and therefore we should accept our duties in the implementation of this kind of measures, such as conciliation of medication (AU)

[Risk management at an Intensive Care Department: conciliation of medication]. / Gestión de riesgos en un servicio de Medicina Intensiva: conciliación de la medicación.

OBJECTIVE: To explain the implementation process of conciliation of medication as one measure included in the risk management program at an Intensive Care department. METHOD: A multidisciplinary team was put together to work on a risk management program. Work meetings were held from January to December of 2011. The development of the risk management program was done in sequential stages; identification of potential risks; analysis and assessment, management, set-up, implementation, follow-up, and reassessment. RESULTS: In total, 17 potential risks were identified, of which those with the highest scores given by the working group were analyzed and managed. Conciliation of medication was included. For managing this particular risk, conciliation of medication was proposed as an improvement measure, for which the pharmacist was in charge of its implementation. Besides, he also was in charge of the follow-up and reassessment process to assure its efficacy by designing indicators allowing periodic monitoring. CONCLUSIONS: The implementation of a clinical risks management program aims at reducing the errors and consequently improving the patient's safety. The inclusion of the pharmacist in the Intensive Care units contributes to achieving this goal and therefore we should accept our duties in the implementation of this kind of measures, such as conciliation of medication.

Objetivo: Explicar el proceso de implantación de la conciliación de la medicación como medida dentro de un plan de gestión de riesgos en un servicio de Medicina Intensiva. Método: Para la realización del plan de gestión de riesgos se creó un equipo de trabajo multidisciplinar. Se realizaron reuniones de trabajo durante los meses de enero a diciembre de 2011. El desarrollo del plan de gestión de riesgos se realizó en fases sucesivas: identificación de los riesgos potenciales, análisis y evaluación, tratamiento, despliegue, implementación, seguimiento y revisión. Resultados: Se identificaron un total de 17 riesgos potenciales, de los cuales se analizaron y trataron aquellos con mayor puntuación otorgada por el grupo de trabajo, entre ellos los errores de conciliación. Para el tratamiento de este riesgo se propuso como medida la conciliación de la medicación donde el farmacéutico se responsabilizó de su implementación. Asimismo, se responsabilizó del proceso de seguimiento y revisión de esta medida, para asegurar su eficacia, mediante el diseño de indicadores que permitiesen una monitorización periódica. Conclusiones: La implantación de un plan de gestión de riesgos clínicos es promover la reducción de errores y, consecuentemente, apostar por una mejora en la seguridad del paciente. La integración del farmacéutico en los servicios de Medicina Intensiva contribuye a la consecución de este objetivo, y por ello debemos aceptar nuestra responsabilidad en la implantación de medidas que vayan en esta línea como puede ser la conciliación de la medicación.

Intoxicación por metanol: rapidez en el inicio del tratamiento específico / Methanol poisoning: speed in the initiation of specific treatment

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