Soluciones aportadas por Atención Primaria para abordar los riesgos relacionados con la seguridad del paciente / Patient safety risks in primary health care: identification and prevention of adverse events

Objetivo. Conocer si existen estrategias de identificación proactiva de riesgos para la seguridad del paciente, los riesgos potenciales identificados por los profesionales y las soluciones aportadas para evitar su aparición. Material y métodos. Estudio descriptivo retrospectivo de unidades clínicas de Atención Primaria (AP) en proceso de acreditación por la Agencia de Calidad Sanitaria de Andalucía (ACSA). Entre junio de 2010 y junio de 2011 se evaluaron 61 unidades de AP. Se ha analizado si estas unidades utilizaron una metodología para la identificación y priorización de riesgos, los riesgos potenciales identificados y las soluciones aportadas. Los riesgos y soluciones se clasificaron en 8 categorías (medicación, infección, diagnóstico, gestión, accidentes de los pacientes, comunicación, cuidados, equipamiento médico). La información se obtuvo de la aplicación informática que da soporte a los procesos de acreditación (ME_joraC). Resultados. El 47,5% de las unidades utilizaron herramientas para el análisis proactivo de riesgos. Los riesgos potenciales identificados más frecuentemente fueron los relacionados con la medicación (100%) y la infección (89,6%). Las principales soluciones estaban relacionadas con la elaboración de protocolos para la revisión de medicamentos, formación en técnica de higiene de manos, soluciones hidroalcohólicas e intervenciones con polimedicados. Conclusiones. Una proporción importante de los eventos adversos producidos en el medio sanitario son evitables, por lo que es necesario establecer estrategias preventivas. Este estudio pone de manifiesto las soluciones aportadas para evitar que los riesgos potenciales identificados ocurran, así como riesgos para la seguridad del paciente no encontrados en otros estudios (relacionados con el uso de dispositivos médicos/equipamiento) (AU)

Objective. To determine whether there are pro-active strategies for identifying risks to patient safety, the potential risks identified by the professionals, and the solutions to prevent their occurrence. Materials and methods. A descriptive-retrospective study was conducted on Primary Health Care units in the process of accreditation. This work was performed at the Andalusian Agency for Health Care Quality through the analysis of primary healthcare units assessed. A total of 61 Primary healthcare units were assessed between June 2010 to June 2011. The main measurements were methods for identifying and prioritising risks, prioritised risks, and solutions provided by the Primary Health Care units. The risks and solutions were classified into 8 categories (medication, infection, diagnosis, management, patient accidents, communication, care, medical devices/equipment). The data were obtained in our computer application for the accreditation process (Me_joraC). Results. Just under half (47.5%) of the healthcare units used tools for proactive analysis of patient safety risks. The risks identified most often were related to medication (100%), and infection (89.6%). The main solutions identified were related to protocols for medication review, hand hygiene training, alcohol-based hand-wash solutions, and interventions on patients on polypharmacy. Conclusions. A large proportion of adverse events that occur in health care are preventable, thus it is necessary to establish preventive strategies. This study shows the solutions for Primary Health Care units to prevent adverse events, and other patient safety risks not found in other studies (related to the use of medical devices/equipment) (AU)

Medidas para garantizar la confidencialidad de los datos en unidades clínicas en el marco de la acreditación de calidad en Andalucía / Measures to ensure data confidentiality in Clinical Units in order to achieve quality accreditation in Andalusia

Objetivo. Analizar las medidas implantadas en las unidades clínicas para garantizar la confidencialidad de la información sanitaria de los ciudadanos y que han sido validadas como adecuadas por un equipo de evaluadores de la Agencia de Calidad Sanitaria de Andalucía. Material y métodos. Estudio descriptivo retrospectivo de 272 unidades clínicas en proceso de acreditación por la Agencia de Calidad Sanitaria de Andalucía evaluadas entre enero de 2003 y diciembre de 2010. Se han analizado las medidas evaluadas adecuadas para garantizar la confidencialidad, estableciendo categorías tras análisis de los registros de la aplicación que da soporte a los procesos de certificación (ME_joraC). Resultados. Se identificaron espacios de mejora en cuanto a la custodia de los registros clínicos (64,1%) y al control interno de la aplicación de las medidas de seguridad de la información (19,6%). Principalmente, las soluciones implantadas en las unidades clínicas han sido de carácter tecnológico (28,5%). Se aportaron también con frecuencia soluciones relacionadas con la implantación (17,9%) y difusión (22,3%) de protocolos de uso de la historia clínica. Conclusiones. Los procesos de certificación facilitan la identificación de espacios de mejora y la implantación de medidas de garantía de la confidencialidad. Las soluciones tecnológicas que dan respuesta a las necesidades planteadas por la digitalización de los registros clínicos, así como la implantación efectiva de protocolos y la monitorización de la adherencia a estos protocolos mediante autoevaluaciones concentran la mayoría de los esfuerzos por garantizar la confidencialidad. Además, se fomenta la implicación y responsabilidad de los profesionales sobre este tema (AU)

Objective. To analyse the measures introduced by Health Care Units to ensure the confidentiality of health information on patients that been validated as adequate by an assessment team of the Agency for Healthcare Quality in Andalusia (Spain). Material and methods. A retrospective study was conducted on Health Care Units accredited by the Agency for Healthcare Quality in Andalusia. A total of 272 Health Care Units were evaluated between January 2003 and December 2010. We analysed the measures that were assessed as adequate to ensure the confidentiality of data by this team, establishing categories after analysing records of the application that supports the certification process (ME_joraC). Results. Using on- site surveys, areas of improvement were found in the safeguarding of medical records (64.1%) and the internal control of implementing the information security measure (19.6%). The measures introduced into the Health Care Services were mainly technological actions (28.5%), which were related to the increasing presence of electronic history. It also frequently provided solutions related to implementation (17.9%) and dissemination (22.3%) protocols for use of medical records. Conclusions. Accreditation processes help to identify areas for improvement and the introduction of procedures for ensure confidentiality of data in the healthcare system. Technological solutions that respond to the needs created by the computerisation of medical records, and the effective implementation of protocols and monitoring the adherence to these protocols using self-assessment, strengthen the efforts to ensure confidentiality. Furthermore, it promotes the involvement and responsibility of the professionals on this topic (AU)

[Measures to ensure data confidentiality in Clinical Units in order to achieve quality accreditation in Andalusia]. / Medidas para garantizar la confidencialidad de los datos en unidades clínicas en el marco de la acreditación de calidad en Andalucía.

OBJECTIVE: To analyse the measures introduced by Health Care Units to ensure the confidentiality of health information on patients that been validated as adequate by an assessment team of the Agency for Healthcare Quality in Andalusia (Spain). MATERIAL AND METHODS: A retrospective study was conducted on Health Care Units accredited by the Agency for Healthcare Quality in Andalusia. A total of 272 Health Care Units were evaluated between January 2003 and December 2010. We analysed the measures that were assessed as adequate to ensure the confidentiality of data by this team, establishing categories after analysing records of the application that supports the certification process (ME_joraC). RESULTS: Using on- site surveys, areas of improvement were found in the safeguarding of medical records (64.1%) and the internal control of implementing the information security measure (19.6%). The measures introduced into the Health Care Services were mainly technological actions (28.5%), which were related to the increasing presence of electronic history. It also frequently provided solutions related to implementation (17.9%) and dissemination (22.3%) protocols for use of medical records. CONCLUSIONS: Accreditation processes help to identify areas for improvement and the introduction of procedures for ensure confidentiality of data in the healthcare system. Technological solutions that respond to the needs created by the computerisation of medical records, and the effective implementation of protocols and monitoring the adherence to these protocols using self-assessment, strengthen the efforts to ensure confidentiality. Furthermore, it promotes the involvement and responsibility of the professionals on this topic.

[Patient safety risks in Primary Health Care: identification and prevention of adverse events]. / Soluciones aportadas por Atención Primaria para abordar los riesgos relacionados con la seguridad del paciente.

OBJECTIVE: To determine whether there are pro-active strategies for identifying risks to patient safety, the potential risks identified by the professionals, and the solutions to prevent their occurrence. MATERIALS AND METHODS: A descriptive-retrospective study was conducted on Primary Health Care units in the process of accreditation. This work was performed at the Andalusian Agency for Health Care Quality through the analysis of primary healthcare units assessed. A total of 61 Primary healthcare units were assessed between June 2010 to June 2011. The main measurements were methods for identifying and prioritising risks, prioritised risks, and solutions provided by the Primary Health Care units. The risks and solutions were classified into 8 categories (medication, infection, diagnosis, management, patient accidents, communication, care, medical devices/equipment). The data were obtained in our computer application for the accreditation process (Me_joraC). RESULTS: Just under half (47.5%) of the healthcare units used tools for proactive analysis of patient safety risks. The risks identified most often were related to medication (100%), and infection (89.6%). The main solutions identified were related to protocols for medication review, hand hygiene training, alcohol-based hand-wash solutions, and interventions on patients on polypharmacy. CONCLUSIONS: A large proportion of adverse events that occur in health care are preventable, thus it is necessary to establish preventive strategies. This study shows the solutions for Primary Health Care units to prevent adverse events, and other patient safety risks not found in other studies (related to the use of medical devices/equipment).

Puntos críticos en la conservación y caducidad de medicamentos. Mejoras implantadas por unidades clínicas en procesos de acreditación / Critical points in the storage and expiry of drugs. Improvements implemented by healthcare units in the accreditation process

Objetivo. Conocer los puntos críticos encontrados en las unidades clínicas y las áreas de mejora implantadas en el marco de la acreditación, en relación con la conservación y caducidad de medicamentos y productos sanitarios, con el fin de generar conocimiento y que las unidades implanten estrategias para disponer de medicamentos eficaces y seguros. Material y métodos. Estudio descriptivo retrospectivo. Los puntos críticos se han obtenido de una muestra constituida por 64 unidades evaluadas por la Agencia de Calidad Sanitaria de Andalucía que no cumplieron el estándar relacionado con la correcta conservación y caducidad de medicamentos y productos sanitarios, analizando la información extraída por los evaluadores durante las visitas de evaluación realizadas. Las áreas de mejora analizadas corresponden a las implantadas por 48 unidades. Toda la información analizada se obtuvo de la aplicación informática que da soporte a los procesos de acreditación. Resultados. En el 32,98% de las unidades evaluadas se detectaron puntos críticos (medicamentos caducados y/o mal conservados), principalmente por la ausencia de responsabilidades, falta de registros de control de temperaturas y procedimientos; 48 unidades clínicas implantaron 241 áreas de mejora en este sentido, lo que les permitió la obtención de la acreditación. Conclusiones. Los principales puntos críticos encontrados son fácilmente abordables por otras unidades, al tratarse de incidencias de tipo organizativo, siendo evitables mediante la asignación de responsabilidades, la elaboración y difusión de procedimientos, así como mediante el control de la cadena de frío(AU)

Objective. Measures for controlling the expiry date and storage conditions of the drugs is a standard used in the accreditation program. The present paper has two principal aims: to identify the critical points in the clinical units evaluated, and to find out the different actions for improvement introduced in these areas. Materials and methods. A descriptive-retrospective study was used. For analysing the critical points, the units that did not achieve the referred standard (n=64) during the accreditation process were selected. All the information analysed on the units (n=48) that had introduced improvements was obtained from the computer application that supports the accreditation processes. Results. The critical points (drug expiry date and storage conditions, were found in 32.98% of the units evaluated. These were mainly due to associated with lack of responsibility, absence of refrigeration control records and standard procedures. The 241 improvement actions made in the 48 units analysed were recorded in the computer program. The deficiencies were resolved, which enabled them to achieve accreditation. Conclusions. The actions introduced to resolve the critical points regarding drug storage and expiry in clinical units, can be easily implemented by other healthcare units in order to achieve accreditation(AU)

[Critical points in the storage and expiry of drugs. Improvements implemented by healthcare units in the accreditation process]. / Puntos críticos en la conservación y caducidad de medicamentos. Mejoras implantadas por unidades clínicas en procesos de acreditación.

OBJECTIVE: Measures for controlling the expiry date and storage conditions of the drugs is a standard used in the accreditation program. The present paper has two principal aims: to identify the critical points in the clinical units evaluated, and to find out the different actions for improvement introduced in these areas. MATERIALS AND METHODS: A descriptive-retrospective study was used. For analysing the critical points, the units that did not achieve the referred standard (n=64) during the accreditation process were selected. All the information analysed on the units (n=48) that had introduced improvements was obtained from the computer application that supports the accreditation processes. RESULTS: The critical points (drug expiry date and storage conditions, were found in 32.98% of the units evaluated. These were mainly due to associated with lack of responsibility, absence of refrigeration control records and standard procedures. The 241 improvement actions made in the 48 units analysed were recorded in the computer program. The deficiencies were resolved, which enabled them to achieve accreditation. CONCLUSIONS: The actions introduced to resolve the critical points regarding drug storage and expiry in clinical units, can be easily implemented by other healthcare units in order to achieve accreditation.

[Geographic isolation in the geriatric population of a rural town]. / Aislamiento geográfico en la población geriátrica de un municipio rural.

OBJECTIVE: To estimate the prevalence and characteristics of geographic isolation in the elder people from Alora (Málaga). DESIGN: A transversal observational study. SETTING: Town of Alora. PATIENTS OR OTHER PARTICIPANTS: Elder people of both sexes, who lives habitually in Alora and born in 1927 or before. Home interview in a 153 individuals random sample proceeding from actual census during june to september 1992. MEASUREMENTS AND MAIN RESULTS: We found 25 individuals with the isolation conditions being the 16.34% (IC 95%: 10.48-22.20). In the 24% of them (IC 95%: 11.5-43.4) we found dependence of other person for two and more basic functions in the current life. Half of them this deficits are cover by the couple, the rest depends on their sons. We didn't found significative differences in none variables with the urban group. CONCLUSIONS: The geographic isolation affect to an important proportion of elder people in rural areas and must be used in the designs of care elderly programs.