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1.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31806153

RESUMO

OBJECTIVE: The main objective of our study is to determine if the implementation of an HIT protocol modifies the annual rate of incidents related to patient safety. The secondary objectives are, firstly, to classify the identified events, secondly to analyze the factors that are associated with the presence of said adverse events and finally to analyze the degree of monitoring of the protocol. MATERIAL AND METHODS: Retrospective descriptive analysis that included patients admitted to the Intensive Care Unit who required HIT between 2009 and 2018. A multidisciplinary protocol was developed and the incidents were classified according to the severity and type of events. RESULTS: We included 1662 transfers. The total number of transfers with incidents was 153 (9.2%) in which 189 incidents were registered, of which 17 (9%) were described as adverse events (AD), while 172 (91%) were classified as Incidents without Damage (IsD). The clinical incidents were the most frequent (70.37%). In the multivariate analysis we found as associated factors cardiac arrhythmias (OR: 2.88 [IQR 2.01-4.12]), history of stroke (OR 1.72 [IQR 1.06-2.78]) and anemia (OR 1.55 [IQR 1.02-2.37]) The rate of safety-related incidents was less over time as adherence to protocol compliance increased. CONCLUSIONS: The implementation of a critical patient transport protocol and its application through checklists allows to reduce both the incidence of adverse events in these patients and of Incidents without Damage.

2.
Rev. esp. anestesiol. reanim ; 65(9): 486-494, nov. 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-177197

RESUMO

Introducción: La norma UNE 179003:2013 exige el cumplimiento de normas que permiten reducir los riesgos de los pacientes frente a eventos adversos. Métodos: Presentamos el procedimiento elaborado para la certificación en la norma UNE 179003:2010 del Bloque Quirúrgico, Unidad de Cuidados Intensivos de Anestesia y Unidad de Recuperación Postanestésica (URPA) en base a un sistema de gestión de riesgos basado en el análisis proactivo mediante la realización de AMFE con la descripción de causas, consecuencias, ponderación del riesgo y medidas específicas que minimicen los riesgos. Además, presentamos el análisis de los eventos adversos declarados (análisis reactivo) en el sistema de notificación SENSAR y las medidas implementadas durante 8 años. Resultados: Se ha obtenido la certificación UNE 179003:2010 en julio del 2012 y la recertificación en julio del 2015. Se han establecido 66 riesgos potenciales que se han ponderado a través de un índice de probabilidad del riesgo (IPR) y se han implementado medidas que han permitido reducir dicho IPR a la mitad. También se refleja el análisis de 1.114 eventos declarados en el sistema SENSAR durante los últimos 8 años que ha permitido la implantación de 2.681 medidas, de las cuales el 98,4% están completamente implantadas. Conclusión: La aplicación de la metodología para la gestión del riesgo nos ha permitido en primer lugar mejorar la seguridad en nuestro ámbito de actuación reduciendo el riesgo al que están sometidos nuestros pacientes y, en segundo lugar, la certificación en la norma UNE 179003


Introduction: The UNE 179003:2013 standard requires compliance with protocols to reduce the risks of patients from adverse events. Methods: A description is presented of the procedure used in the Hospital Povisa to achieve UNE 179003:2010 certification for the intensive care unit, surgical division, and post-anaesthesia recovery unit (PARU). This was based on a risk management system, focusing on pro-active analysis using failure modes and effects analysis (FMEA) with the description of causes, consequences, risk weighting, and specific risk-minimising measures. A description is also presented of the analysis of reported adverse events (reactive analysis) in the Safety in Anesthesia and Resuscitation (SENSAR) notification system and the measures implemented over an eight-year period. Results: The UNE 179003:2010 certification was obtained in July 2012, and the re-certification was achieved in July 2015. A total of 66 potential risks were established, which were weighted using a risk probability index (RPI), and measures were implemented that reduced this RPI by half. It also reflects the analysis of 1114 events declared in the SENSAR system over the past eight years, allowing for the introduction of 2681 measures, of which 98.4% are fully implemented. Conclusion: The application of the risk management methodology allowed (a) to improve safety in the area of action by reducing the risk to which the patients are subject, and (b) to gain certification in the UNE 179003 standard


Assuntos
Humanos , Anestesia/normas , Cuidados Críticos/normas , Medidas de Segurança/normas , Segurança do Paciente/normas , Certificação , Comportamento de Redução do Risco , Melhoria de Qualidade/normas
3.
Rev. esp. anestesiol. reanim ; 65(9): 504-513, nov. 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-177199

RESUMO

Objetivo: Describir las complicaciones que aparecen durante la anestesia/sedación en el ámbito de la endoscopia digestiva, comparando también procedimientos programados frente a urgentes. Métodos: Se diseñó un protocolo de pacientes y pruebas en los que siempre debe estar presente un anestesiólogo. Estos incluyen a pacientes ASA 3 y 4, pruebas complejas como polipectomías, colangiopancreatografía retrógrada endoscópica o ecoendoscopia, necesidad de sedación profunda o alteraciones anatómicas que dificulten el manejo de la vía aérea. Se analizó la seguridad con base a las complicaciones que se recogen a partir de los datos recogidos de forma automática directamente desde los monitores, tanto durante la sedación como en la unidad de recuperación. Se analizan los factores de riesgo asociados a las complicaciones cardiorrespiratorias, la eficacia en función de las pruebas completadas y el grado de satisfacción global a través de una entrevista empleando una escala de satisfacción. Resultados: Se estudió a 3.746 pacientes durante 7 años. La incidencia de complicaciones importantes durante la prueba fue baja, destacando las complicaciones hemodinámicas y respiratorias. Así encontramos una incidencia de hipoxemia del 3% en endoscopia programada frente al 5,7% en pruebas urgentes (p <0,05). También la hipotensión presenta diferencias significativas entre la sedación programada y urgente (6,4% vs. 18,8%, p <0,001). En nuestro estudio, no se ha suspendido ninguna prueba por mala tolerancia del paciente, y el grado de satisfacción es alto en más del 99% de los casos. Conclusión: La participación del anestesiólogo en la sedación para endoscopia digestiva ha demostrado en este estudio excelentes resultados en cuanto a seguridad y eficacia, principalmente en los pacientes más graves y pruebas complejas, y un alto grado de satisfacción


Objective: To describe the anaesthesia/sedation complications during gastrointestinal endoscopy, as well as comparing scheduled procedures versus urgent procedures. Methods: A protocol was developed to define the anaesthesia/sedation in gastrointestinal endoscopy, where the anaesthetist should always be present. These include ASA 3 and 4 patients, complex tests such as polypectomies, endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound, deep sedation, or patients with probable difficult airway management. An analysis was made of the safety based on the complications recorded from the data directly collected automatically from the monitors, both during the sedation and in the recovery unit. An analysis was also performed on the risk factors associated with cardiorespiratory complications, the effectiveness based on the completed tests and the overall level of satisfaction through an interview using a satisfaction scale. Results: The study included a total of 3746 patients over a 7 year-period. The incidence of major complications was low, especially haemodynamic and respiratory complications. An incidence of hypoxaemia of 3% was found in scheduled endoscopy versus 5.7% in urgent endoscopy (P<.05). The rate of hypotension was also low, with significant differences between scheduled and urgent endoscopy (6.4% vs. 18.8%, P<.001). In present study, no test had to be suspended due to poor patient tolerance, and the satisfaction was high in more than 99% of cases. Conclusion: The participation of the anaesthetist in sedation for gastrointestinal endoscopy has shown excellent results in this study, in terms of safety and efficacy, mainly in the most serious patients and complex tests, as well as a high level of satisfaction


Assuntos
Humanos , Endoscopia do Sistema Digestório/métodos , Sedação Profunda/efeitos adversos , Eficiência , Anestesia/efeitos adversos , Estudos Prospectivos , Fatores de Risco , Hipotensão/epidemiologia , Satisfação do Paciente/estatística & dados numéricos , Obesidade/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia
5.
Rev Esp Anestesiol Reanim ; 65(9): 486-494, 2018 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30153990

RESUMO

INTRODUCTION: The UNE 179003:2013 standard requires compliance with protocols to reduce the risks of patients from adverse events. METHODS: A description is presented of the procedure used in the Hospital Povisa to achieve UNE 179003:2010 certification for the intensive care unit, surgical division, and post-anaesthesia recovery unit (PARU). This was based on a risk management system, focusing on pro-active analysis using failure modes and effects analysis (FMEA) with the description of causes, consequences, risk weighting, and specific risk-minimising measures. A description is also presented of the analysis of reported adverse events (reactive analysis) in the Safety in Anesthesia and Resuscitation (SENSAR) notification system and the measures implemented over an eight-year period. RESULTS: The UNE 179003:2010 certification was obtained in July 2012, and the re-certification was achieved in July 2015. A total of 66 potential risks were established, which were weighted using a risk probability index (RPI), and measures were implemented that reduced this RPI by half. It also reflects the analysis of 1114 events declared in the SENSAR system over the past eight years, allowing for the introduction of 2681 measures, of which 98.4% are fully implemented. CONCLUSION: The application of the risk management methodology allowed (a) to improve safety in the area of action by reducing the risk to which the patients are subject, and (b) to gain certification in the UNE 179003 standard.


Assuntos
Serviço Hospitalar de Anestesia/normas , Certificação , Cuidados Críticos/normas , Unidades de Terapia Intensiva/normas , Segurança do Paciente/normas , Melhoria de Qualidade , Gestão de Riscos/normas , Centro Cirúrgico Hospitalar/normas , Humanos , Espanha , Fatores de Tempo
6.
Rev Esp Anestesiol Reanim ; 65(9): 504-513, 2018 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30055768

RESUMO

OBJECTIVE: To describe the anaesthesia/sedation complications during gastrointestinal endoscopy, as well as comparing scheduled procedures versus urgent procedures. METHODS: A protocol was developed to define the anaesthesia/sedation in gastrointestinal endoscopy, where the anaesthetist should always be present. These include ASA 3 and 4 patients, complex tests such as polypectomies, endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound, deep sedation, or patients with probable difficult airway management. An analysis was made of the safety based on the complications recorded from the data directly collected automatically from the monitors, both during the sedation and in the recovery unit. An analysis was also performed on the risk factors associated with cardiorespiratory complications, the effectiveness based on the completed tests and the overall level of satisfaction through an interview using a satisfaction scale. RESULTS: The study included a total of 3746 patients over a 7 year-period. The incidence of major complications was low, especially haemodynamic and respiratory complications. An incidence of hypoxaemia of 3% was found in scheduled endoscopy versus 5.7% in urgent endoscopy (P<.05). The rate of hypotension was also low, with significant differences between scheduled and urgent endoscopy (6.4% vs. 18.8%, P<.001). In present study, no test had to be suspended due to poor patient tolerance, and the satisfaction was high in more than 99% of cases. CONCLUSION: The participation of the anaesthetist in sedation for gastrointestinal endoscopy has shown excellent results in this study, in terms of safety and efficacy, mainly in the most serious patients and complex tests, as well as a high level of satisfaction.


Assuntos
Anestesiologia , Sedação Profunda/efeitos adversos , Endoscopia Gastrointestinal , Satisfação do Paciente , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
13.
Cir. mayor ambul ; 8(2): 87-91, mayo-ago. 2003. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-84853

RESUMO

OBJETIVOS: El objetivo principal del estudio fue comparar bupivacaina hiperbara intratecal a dosis estándares (10 mg) con dosis menores (4mg), analizando intra y postoperatoriamente los niveles sensitivos y motores, su regresión, efectos secundarios, el tiempo de recuperación y la estancia media en la unidad de CMA.MATERIAL Y MÉTODOS: Realizamos un estudio prospectivo en 114 pacientes intervenidos ambulatoriamente de cirugía perineal con anestesia raquídea, que se dividieron, según la dosis administrada, en grupo control (10 mg) y grupo estudio (4mgr). Se monitorizaron de forma habitual, midiéndose el comienzo y progresión del nivel sensorial mediante pinchazo, el grado de bloqueo motor siguiendo la escala de Bromage, los efectos secundarios aparecidos y la idoneidad de la técnica para realizar la cirugía. Posteriormente fueron conducidos a la unidad de recuperación analizándose las mismas variables y el tiempo de estancia media. RESULTADOS: Se obtuvieron intraoperatoriamente niveles sensitivos > a L4, con un grado de bloqueo motor más intenso en el grupo control con respecto al grupo estudio, siendo las condiciones para realizar la cirugía adecuadas en ambos grupos; los efectos secundarios fueron menos intensos y frecuentes en el grupo estudio. Postope-ratoriamente la regresión de los niveles era más lenta en el grupo control, necesitando más tiempo para deambular correctamente y cumplir criterios de alta, con lo que prolonga el tiempo de estancia media CONCLUSIONES: Con dosis inferiores a las utilizadas habitualmente, obtenemos condiciones quirúrgicas adecuadas, con efectos secundarios y tiempo de estancia media menores (AU)


To compare intrathecal hyperbaric bupivacaine with 10mgs. versus 4mgs. during the peri-operative period (..) (AU)


Assuntos
Humanos , Procedimentos Cirúrgicos Ambulatórios , Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Períneo/cirurgia , Estudos de Casos e Controles , Estudos Prospectivos
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