Presence of metallic components in transdermal drug delivery systems and risk of skin burns. / [Artículo traducido] Presencia de partículas metálicas en parches transdérmicos de medicamentos y riesgo de quemaduras.

OBJECTIVE: Skin burns are associated with the presence of metallic components in transdermal drug delivery systems during Magnetic Resonance Imaging, cardioversion or defibrillation procedures. The aim of the study was to review the presence of metallic components in marketed products of transdermal drug delivery systems in Spain. METHOD: For each presentation, the summary of product characteristics was reviewed. If the information was not provided, manufacturers were contacted. RESULTS: We identified 59 marketed products of transdermal drug delivery systems of 12 different active substances. 59.3% of patches contained metallic components or their presence could not be ruled out. Information regarding the need to remove the patch was only included in 8 summaries of product characteristics (13.6%). A table was elaborated and included the following aspects: product, active substance, manufacturer, need to remove the patch before the exposure to magnetic or electric fields and references. CONCLUSION: More than a half of the patches at the time of the study contained metals or their absence could not be confirmed by the manufacturer. However, this information was only included in 13.6% of summaries of product characteristics.

Assessing the implementation of a comprehensive quality management system for cross-sectoral psycho-oncology in Germany.

INTRODUCTION: Quality management in healthcare is essential for safe, effective, and patient-centered services. Quality management systems (QMS) monitor and improve healthcare quality. Integrating QMS is crucial for optimal quality of care, but previous studies show gaps in integration. This study aims to assess program adherence to a QMS in cross-sectoral psycho-oncological care and to develop strategies for better integration, ultimately improving healthcare quality. MATERIALS AND METHODS: The study used a utility analysis to assess the program adherence of a cross-sectoral psycho-oncology care program using a 5-point scale. The evaluation process involved breaking down the program into distinct areas, and used key figures and developed indicators to assess adherence. Descriptive statistics were used. RESULTS: The study conducted a comprehensive assessment of program adherence in a complex care program, analysing 4460 evaluation cases based on 128 quality indicators. The results showed a score of 4.2 out of 5 points (84%), indicating a highly effective implementation of the QMS. Notably, the study observed successful implementation of top-down elements, while encountering more challenges in integrating bottom-up aspects. CONCLUSION: The study demonstrates effective implementation of a comprehensive QMS. Successful integration was observed in areas such as care concept, care management, quality assurance, and IT-based documentation, while challenges remain in quality development and indicators. Active leadership involvement, staff training, data collection, and a learning culture are essential for successful implementation. Future research should assess the impact and cost-effectiveness of QMSs and develop tailored approaches to sustain healthcare professionals' motivation in quality improvement efforts.

Presence of metallic components in transdermal drug delivery systems and risk of skin burns.

OBJECTIVE: Skin burns are associated with the presence of metallic components in transdermal drug delivery systems during Magnetic Resonance Imaging, cardioversion, or defibrillation procedures. The aim of the study was to review the presence of metallic components in marketed products of transdermal drug delivery systems in Spain. METHOD: For each pharmaceutical form, the summary of product characteristics was reviewed. If the information was not provided, manufacturers were contacted. RESULTS: We identified 59 marketed products of transdermal drug delivery systems of 12 different active substances. 59.3% of patches contained metallic components or their presence could not be ruled out. Information regarding the need to remove the patch was only included in 8 summaries of product characteristics (13.6%) A table was elaborated and included the following aspects: product, active substance, manufacturer, need to remove the patch before the exposure to magnetic or electric fields, and references. CONCLUSION: More than a half of the patches at the time of the study contained metals or their absence could not be confirmed by the manufacturer. However, this information was only included in 13.6% of summaries of product characteristics.

Evaluación poblacional del impacto del nivel socioeconómico en los resultados clínicos en pacientes con insuficiencia cardiaca en entornos de atención integrada / Population-based evaluation of the impact of socioeconomic status on clinical outcomes in patients with heart failure in integrated care settings

Introduction and objectives: Low socioeconomic status (SES) is associated with poor outcomes in patients with heart failure (HF). We aimed to examine the influence of SES on health outcomes after a quality of care improvement intervention for the management of HF integrating hospital and primary care resources in a health care area of 209 255 inhabitants.MethodsWe conducted a population-based pragmatic evaluation of the implementation of an integrated HF program by conducting a natural experiment using health care data. We included all individuals consecutively admitted to hospital with at least one ICD-9-CM code for HF as the primary diagnosis and discharged alive in Catalonia between January 1, 2015 and December 31, 2019. We compared outcomes between patients exposed to the new HF program and those in the remaining health care areas, globally and stratified by SES.ResultsA total of 77 554 patients were included in the study. Death occurred in 37 469 (48.3%), clinically-related hospitalization in 41 709 (53.8%) and HF readmission in 29 755 (38.4%). On multivariate analysis, low or very low SES was associated with an increased risk of all-cause death and clinically-related hospitalization (all Ps <.05). The multivariate models showed a significant reduction in the risk of all-cause death (HR, 0.812; 95%CI, 0.723-0.912), clinically-related hospitalization (HR, 0.886; 95%CI, 0.805-0.976) and HF hospitalization (HR, 0.838; 95%CI, 0.745-0.944) in patients exposed to the new HF program compared with patients exposed to the remaining health care areas and this effect was independent of SES.ConclusionsAn intensive transitional HF management program improved clinical outcomes, both overall and across SES strata. (AU)

Introducción y objetivos: El nivel socioeconómico (NSE) bajo se asocia con malos resultados en pacientes con insuficiencia cardiaca (IC). Nuestro objetivo es examinar la influencia del NSE en los resultados de salud tras una intervención de mejora de la calidad en el abordaje de la IC en un área de salud integrada de 209.255 habitantes.MétodosSe efectuó una evaluación pragmática poblacional utilizando bases de datos administrativas y sanitarias. Se incluyó a todas las personas consecutivas hospitalizadas con un código CIE-9-CM de IC como diagnóstico principal y dadas de alta vivas en Cataluña entre el 1 de enero de 2015 y el 31 de diciembre de 2019. Se compararon los resultados entre los pacientes expuestos al nuevo programa de IC y los de las demás áreas asistenciales, en general y según su NSE.ResultadosSe incluyó a 77.554 pacientes. Los eventos adversos fueron: muerte en 37.469 (48,3%), hospitalización clínicamente relacionada en 41.709 (53,8%) y reingreso por IC en 29.755 (38,4%). El NSE bajo o muy bajo se asoció con un mayor riesgo de eventos clínicos adversos (p <0,05). Se observó una reducción significativa del riesgo de muerte (HR=0,812; IC95%, 0,723-0,912), hospitalización relacionada con la clínica (HR=0,886; IC95%, 0,805-0,976) y por IC (HR=0,838; IC95%, 0,745-0,944) en los pacientes expuestos al nuevo programa frente a los de las demás áreas sanitarias y este efecto fue independiente del NSE.ConclusionesUn programa de atención transicional para la IC mejoró los resultados clínicos, tanto en general como en todos los estratos de NSE. (AU)

Valoración de un nuevo apósito para úlceras por presión: a propósito de un caso / Assessment for a new dressing for pressure ulcers: regarding a case

El objetivo de este estudio fue valorar la aplicación de un nuevo apósito superabsorbente a propósito de un caso clínico de un paciente con una úlcera por presión (UPP) con alto nivel exudativo, maceración de la piel perilesional, molestias y dolor. El paciente presentaba múltiples comorbilidades, estaba institucionalizado, desorientado, y presentaba una UPP grado IV. Accedió a comenzar un tratamiento con un apósito superabsorbente de nueva implementación en la institución. Se realizó una valoración en conjunto con su enfermera de la residencia según las Necesidades de Virginia Henderson. Según los resultados de dicha valoración se enunció un plan de cuidados con Diagnósticos NANDA, Resultados NOC con sus indicadores e Intervenciones NIC con sus actividades. Se priorizaron cuatro diagnósticos enfermeros: [00032] Patrón respiratorio ineficaz, [00129] Confusión crónica, [00312] Lesión por presión en el adulto y [00132] Dolor agudo. Los resultados NOC enunciados fueron [0402] Estado respiratorio: intercambio gaseoso, [0912] Estado neurológico: consciencia, [1101] Integridad tisular: piel y membranas mucosas, [110123] Necrosis, [1103] Curación de la herida: por segunda intención, [1004] Estado nutricional y [2109] Nivel de malestar. El plan de cuidados fue eficaz en el alcance de la puntuación diana de todos los indicadores excepto el indicador [110115] Lesiones cutáneas, cuya puntuación al alta se mantuvo igual que al ingreso, en 1 “grave”. El nuevo apósito disminuyó el exudado de la úlcera, redujo el tejido necrotizado y mejoró los bordes perilesionales. Esto mejoró a su vez el malestar del paciente al disminuir la frecuencia de cura de tres veces al día a una.(AU)

The objective of this study was to assess the application of a new super absorbent dressing, regarding the clinical case of a patient with one pressure ulcer (PU) with high levels of exudate, maceration of the perilesional skin, discomfort and pain. The patient presented multiple comorbidities; he was institutionalized, disoriented, and presented a Grade IV PU. The patient agreed to initiate treatment with a super absorbent dressing newly implemented at the institution. There was joint assessment with his nurse at the elderly home, according to Virginia Henderson’s Needs. Based on the results of said assessment, a plan of care was stated with NANDA diagnoses, NOC outcomes with their indicators, and NIC interventions with their activities. Four nursing diagnoses were prioritized: [00032] Ineffective breathing pattern, [00129] Chronic confusion, [00312] Pressure lesion in adults, and [00132] Acute pain. The NOC outcomes stated were [0402] Respiratory Status: Gas Exchange, [0912] Neurological status: Consciousness; [1101] Tissue Integrity: Skin and mucous membranes, [110123] Necrosis, [1103] Wound healing: Second intention, [1004] Nutritional status, and [2109] Discomfort level. The plan of care was effective at reaching the target score in all indicators except for [110115] Skin lesions with high score that stays the same than at admission, at 1 “severe”. The new dressing reduced the ulcer exudate and the necrotic tissue, and improved the perilesional edges. At the same time, there was an improvement in discomfort for the patient by reducing the frequency of cures from three times to once a day.(AU)

Population-based evaluation of the impact of socioeconomic status on clinical outcomes in patients with heart failure in integrated care settings.

INTRODUCTION AND OBJECTIVES: Low socioeconomic status (SES) is associated with poor outcomes in patients with heart failure (HF). We aimed to examine the influence of SES on health outcomes after a quality of care improvement intervention for the management of HF integrating hospital and primary care resources in a health care area of 209 255 inhabitants. METHODS: We conducted a population-based pragmatic evaluation of the implementation of an integrated HF program by conducting a natural experiment using health care data. We included all individuals consecutively admitted to hospital with at least one ICD-9-CM code for HF as the primary diagnosis and discharged alive in Catalonia between January 1, 2015 and December 31, 2019. We compared outcomes between patients exposed to the new HF program and those in the remaining health care areas, globally and stratified by SES. RESULTS: A total of 77 554 patients were included in the study. Death occurred in 37 469 (48.3%), clinically-related hospitalization in 41 709 (53.8%) and HF readmission in 29 755 (38.4%). On multivariate analysis, low or very low SES was associated with an increased risk of all-cause death and clinically-related hospitalization (all Ps <.05). The multivariate models showed a significant reduction in the risk of all-cause death (HR, 0.812; 95%CI, 0.723-0.912), clinically-related hospitalization (HR, 0.886; 95%CI, 0.805-0.976) and HF hospitalization (HR, 0.838; 95%CI, 0.745-0.944) in patients exposed to the new HF program compared with patients exposed to the remaining health care areas and this effect was independent of SES. CONCLUSIONS: An intensive transitional HF management program improved clinical outcomes, both overall and across SES strata.

Improving emergency department care of infants with acute bronchiolitis by reducing the use of unrecommended drugs: a quality-of-care initiative in a Spanish autonomous community. / Iniciativa de mejora para reducir el uso de fármacos no recomendados en el manejo de lactantes con bronquiolitis aguda en los servicios de urgencias de una comunidad autónoma.

OBJECTIVES: To evaluate the impact of a quality-of-care improvement program implemented in emergency departments (EDs) in a Spanish autonomous community with the aim of reducing the use of unrecommended drugs when treating infants for acute bronchiolitis. MATERIAL AND METHODS: Before-after quasi-experimental intervention study. We retrospectively included infants aged 12 months or less who were treated for acute bronchiolitis in 24 Spanish national health system hospital EDs in December during 2 epidemic periods: in 2018, before implementing the program, and in 2019, after implementation. Data collected included epidemiologic information, clinical and care details, and clinical course. The program consisted of providing informative material and training sessions before the epidemic period started. RESULTS: A total of 7717 episodes (4007 in 2018 and 2710 in 2019) were identified. Epidemiologic and clinical characteristics did not differ between the 2 periods. ED use of the following treatments decreased between the 2 periods: salbutamol, from 29.4% (95% CI, 28.8%-30.8%) in 2018 to 10.6% (95% CI, 9.6%-11.6%) in 2019; epinephrine from 6.0% (95% CI, 5.3%-6.8%) to 0.9% (95% CI, 0.7%-1.3%); and hypertonic saline solution fell from 8.2% (95% CI, 7.3%-9.1%) to 2.1% (95% CI, 1.7%-2.6%) (P.001, all comparisons). Prescriptions for salbutamol on discharge fell from 38.7% (95% CI, 36.9%-40.4%) to 10.6% (95% CI, 9.6%-11.6%) (P.001). Admissions and readmissions did not change, and the median time (interquartile range) spent in the ED fell from 81 (44-138) minutes to 66 (37-127) minutes (P.001). CONCLUSION: The quality-of-care improvement initiative was able to decrease the number of unrecommended therapeutic interventions for acute bronchiolitis. However, we identified great variations between EDs, suggesting that training and assessment of impact should continue.

OBJETIVO: Evaluar el impacto de una iniciativa de mejora realizada en los servicios de urgencias (SU) de una comunidad autónoma para reducir el uso de fármacos no recomendados en lactantes con bronquiolitis aguda (BA). METODO: Estudio cuasi-experimental analítico del tipo "antes y después de una intervención". Se incluyeron de forma retrospectiva todas las BA en niños # 12 meses atendidas en los SU de 24 hospitales públicos durante el mes de diciembre de dos periodos epidémicos: 2018 (preintervención) y 2019 (postintervención). Se recogieron variables epidemiológicas, clínicas, asistenciales y evolutivas. La intervención consistió en difundir material informativo y realizar actividades formativas previas al periodo epidémico. RESULTADOS: Se incluyeron 7.717 episodios (2018: 4.007 y 2019: 3.710). No existieron diferencias en las características epidemiológicas y clínicas. El empleo de salbutamol en los SU descendió del 29,4% [intervalo de confianza del 95% (IC 95%): 28,8-30,8] en 2018 al 10,6% (IC 95%: 9,6-11,6) en 2019 (p 0,001), el de adrenalina del 6,0% (IC 95%: 5,3-6,8) al 0,9% (IC 95%: 0,7-1,3) y el de suero salino hipertónico del 8,2% (IC 95%: 7,3-9,1) al 2,1% (IC 95%: 1,7-2,6) (p 0,001). La prescripción al alta de salbutamol se redujo del 38,7% (IC 95%: 36,9-40,4) al 10,6% (IC 95%: 9,6-11,6) (p 0,001). La tasa de ingreso y la tasa de readmisión no cambiaron y la mediana de tiempo de estancia en los SU se redujo 81 minutos [rango intercuartil (RIC) 44-138] a 66 (RIQ: 37-127) (p 0,001). CONCLUSIONES: La iniciativa de mejora ha conseguido disminuir la tasa de intervenciones terapéuticas no indicadas en BA. Sin embargo, existe una gran variabilidad entre los diferentes SU por lo que la estrategia y la medición de su impacto deben mantenerse en el tiempo.

Iniciativa de mejora para reducir el uso de fármacos no recomendados en el manejo de lactantes con bronquiolitis aguda en los servicios de urgencias de una comunidad autónoma / Improving emergency department care of infants with acute bronchiolitis by reducing the use of unrecommended drugs: a quality-of-care initiative in a Spanish autonomous community

Objetivo. Evaluar el impacto de una iniciativa de mejora realizada en los servicios de urgencias (SU) de una comunidad autónoma para reducir el uso de fármacos no recomendados en lactantes con bronquiolitis aguda (BA).Método. Estudio cuasi-experimental analítico del tipo “antes y después de una intervención”. Se incluyeron de forma retrospectiva todas las BA en niños # 12 meses atendidas en los SU de 24 hospitales públicos durante el mes de diciembre de dos periodos epidémicos: 2018 (preintervención) y 2019 (postintervención). Se recogieron variables epidemiológicas, clínicas, asistenciales y evolutivas. La intervención consistió en difundir material informativo y realizar actividades formativas previas al periodo epidémico.Resultados. Se incluyeron 7.717 episodios (2018: 4.007 y 2019: 3.710). No existieron diferencias en las características epidemiológicas y clínicas. El empleo de salbutamol en los SU descendió del 29,4% [intervalo de confianza de 95% (IC 95%): 28,8-30,8] en 2018 al 10,6% (IC 95%: 9,6-11,6) en 2019 (p < 0,001), el de adrenalina del 6,0% (IC 95%: 5,3-6,8) al 0,9% (IC 95%: 0,7-1,3) y el de suero salino hipertónico del 8,2% (IC 95%: 7,3-9,1) al 2,1% (IC 95%: 1,7-2,6) (p < 0,001). La prescripción al alta de salbutamol se redujo del 38,7% (IC 95%: 36,9-40,4) al 10,6% (IC 95%: 9,6-11,6) (p < 0,001). La tasa de ingreso y la tasa de readmisión no cambiaron y la mediana de tiempo de estancia en los SU se redujo 81 minutos [rango intercuartil (RIC) 44-138] a 66 (RIQ: 37-127) (p < 0,001).Conclusiones. La iniciativa de mejora ha conseguido disminuir la tasa de intervenciones terapéuticas no indicadas en BA. Sin embargo, existe una gran variabilidad entre los diferentes SU por lo que la estrategia y la medición de su impacto deben mantenerse en el tiempo. (AU)

Objective. To evaluate the impact of a quality-of-care improvement program implemented in emergency departments (EDs) in a Spanish autonomous community with the aim of reducing the use of unrecommended drugs when treating infants for acute bronchiolitis. Methods. Before-after quasi-experimental intervention study. We retrospectively included infants aged 12 months or less who were treated for acute bronchiolitis in 24 Spanish national health system hospital EDs in December during 2 epidemic periods: in 2018, before implementing the program, and in 2019, after implementation. Data collected included epidemiologic information, clinical and care details, and clinical course. The program consisted of providing informative material and training sessions before the epidemic period started. Results. A total of 7717 episodes (4007 in 2018 and 2710 in 2019) were identified. Epidemiologic and clinical characteristics did not differ between the 2 periods. ED use of the following treatments decreased between the 2 periods: salbutamol, from 29.4% (95% CI, 28.8%-30.8%) in 2018 to 10.6% (95% CI, 9.6%-11.6%) in 2019; epinephrine from 6.0% (95% CI, 5.3%-6.8%) to 0.9% (95% CI, 0.7%-1.3%); and hypertonic saline solution fell from 8.2% (95% CI, 7.3%-9.1%) to 2.1% (95% CI, 1.7%-2.6%) (P<.001, all comparisons). Prescriptions for salbutamol on discharge fell from 38.7% (95% CI, 36.9%-40.4%) to 10.6% (95% CI, 9.6%-11.6%) (P<.001). Admissions and readmissions did not change, and the median time (interquartile range) spent in the ED fell from 81 (44-138) minutes to 66 (37-127) minutes (P<.001). Conclusions. The quality-of-care improvement initiative was able to decrease the number of unrecommended therapeutic interventions for acute bronchiolitis. However, we identified great variations between EDs, suggesting that training and assessment of impact should continue. (AU)

Trombosis venosa de retina. Auditoría de un programa de atención especializada / Retinal vein occlusion. Audit of a specialized care program

Background and objectives Retinal vein occlusion (RVO) is the second most frequent cause of retinal vascular disease and is related to classic cardiovascular risk factors. A specific program was designed to detect and treat risk factors in patients with RVO. The aim of this study is to audit the results of this program. Patients and methods The program consisted of a multidisciplinary clinical evaluation by the Ophthalmology and Internal Medicine Departments. All patients with RVO were screened, at minimum, for hypertension, diabetes, dyslipidemia, smoking, overweight, and antiphospholipid syndrome. New risk factors or poor control of known risk factors were expected to be found in at least one-third of the patients. Among them, therapeutic measures were expected to be taken in at least two-thirds. A dissociated automated search of the data of all patients who entered the program between April 2021 and April 2022 was performed. Results Fifty-six patients were included for analysis. Of these, 39 (69.6%) had at least one new or poorly controlled risk factor and 43 (76.8%) had their treatment modified in some way. Antiphospholipid syndrome was detected in five (8.9%). Only one patient had low-risk hereditary thrombophilia. After an exhaustive examination, no risk factors were found in 11 patients. Conclusion This specific program has been effective in detecting new or poorly controlled risk factors and improving their treatment (AU)

Antecedentes y objetivo La trombosis venosa de retina (TVR) es la segunda causa más frecuente de enfermedad vascular de la retina y se relaciona con factores de riesgo cardiovascular clásicos. Se diseñó un programa específico para detección y tratamiento de factores de riesgo en pacientes con TVR. El objetivo de este estudio es auditar los resultados de dicho programa. Pacientes y métodos El programa consistió en una evaluación clínica multidisciplinar por parte de Oftalmología y Medicina Interna. A todos los pacientes con TVR se les realizó cribado, al menos, de hipertensión arterial, diabetes, dislipidemia, tabaquismo, sobrepeso y síndrome antifosfolípido. Se esperó encontrar nuevos factores de riesgo o pobre control de los ya conocidos en, al menos, un tercio de los pacientes. Entre ellos, se esperó tomar alguna medida terapéutica en, al menos, dos tercios. Se llevó a cabo una búsqueda automatizada disociada de los datos de todos los pacientes que entraron en el programa entre abril de 2021 y abril de 2022. Resultados Cincuenta y seis pacientes se incluyeron para el análisis. De ellos, 39 (69,6%) tenían al menos un factor de riesgo nuevo o mal controlado, y 43 (76,8%) vieron modificado en algún modo su tratamiento. Se detectó síndrome antifosfolípido en 5 (8,9%). Solo un paciente tenía una trombofilia hereditaria de bajo riesgo. Tras un examen exhaustivo no se encontró factor de riesgo alguno en 11 pacientes. Conclusión Este programa específico ha sido efectivo para detectar factores de riesgo nuevos o mal controlados y mejorar su tratamiento (AU)

Retinal vein occlusion. Audit of a specialized care program.

BACKGROUND AND OBJECTIVES: Retinal vein occlusion (RVO) is the second most frequent cause of retinal vascular disease and is related to classic cardiovascular risk factors. A specific program was designed to detect and treat risk factors in patients with RVO. The aim of this study is to audit the results of this program. PATIENTS AND METHODS: The program consisted of a multidisciplinary clinical evaluation by the Ophthalmology and Internal Medicine Departments. All patients with RVO were screened, at minimum, for hypertension, diabetes, dyslipidemia, smoking, overweight, and antiphospholipid syndrome. New risk factors or poor control of known risk factors were expected to be found in at least one-third of the patients. Among them, therapeutic measures were expected to be taken in at least two-thirds. A dissociated automated search of the data of all patients who entered the program between April 2021 and April 2022 was performed. RESULTS: Fifty-six patients were included for analysis. Of these, 39 (69.6%) had at least one new or poorly controlled risk factor and 43 (76.8%) had their treatment modified in some way. Antiphospholipid syndrome was detected in five (8.9%). Only one patient had low-risk hereditary thrombophilia. After an exhaustive examination, no risk factors were found in 11 patients. CONCLUSION: This specific program has been effective in detecting new or poorly controlled risk factors and improving their treatment.

Quality improvement in the implementation science paradigm in professional programs: scoping review / Mejora de la calidad en el paradigma de la ciencia de la implementación en programas profesionales: revisión del alcance / Melhoria de qualidade no paradigma da ciência da implementação em programas profissionais: revisão de escopo

ABSTRACT Objective: To map knowledge regarding Quality Improvement in the implementation science paradigm in graduate nursing education in professional programs. Method: This is a scoping review, conducted from October to December 2021, following the assumptions established by the Joanna Briggs Institute and the PRISMA-ScR protocol. Results: 18 studies were selected. Being, 7 articles (38.8%) about the implementation strategies and development of Quality Improvement projects for graduate nursing students. The included studies emphasize Quality Improvement as a methodological strategy capable of capturing a problem in practice, to be solved without losing scientific rigor, and emphasize the importance of obtaining Quality Improvement skills in professional programs. Conclusion: Implementation science and Quality Improvement projects advance professional programs to improve and develop quality health care.

RESUMEN Objetivo: Mapear el conocimiento sobre Mejora de la Calidad en el paradigma de la ciencia de la implementación, en la formación de posgrado en enfermería en programas profesionales. Método: Se trata de una revisión de alcance, realizada de octubre a diciembre de 2021, siguiendo los supuestos establecidos por el Instituto Joanna Briggs y el protocolo PRISMA-ScR. Resultados: Se seleccionaron 18 estudios. Siendo, 7 artículos (38,8%) sobre las estrategias de implementación y desarrollo de proyectos de Mejora de la Calidad para estudiantes de posgrado en enfermería. Los estudios incluidos enfatizan la Mejora de la Calidad como una estrategia metodológica capaz de capturar un problema en la práctica, para ser resuelto sin perder el rigor científico, y resaltan la importancia de obtener habilidades de Mejora de la Calidad en los programas profesionales. Conclusión: La ciencia de la implementación y los proyectos de mejora de la calidad avanzan en los programas profesionales para mejorar y desarrollar una atención médica de calidad.

RESUMO Objetivo: Mapear o conhecimento referente a Melhoria de Qualidade no paradigma da ciência da implementação na educação de pós-graduação em enfermagem de programas profissionais. Método: Trata-se de revisão de escopo, realizada de outubro a dezembro de 2021, seguindo os pressupostos estabelecidos pelo Joanna Briggs Institute e pelo protocolo PRISMA-ScR. Resultados: Foram selecionados 18 estudos. Sendo, 7 artigos (38,8 %) sobre as estratégias de implementação e de desenvolvimento de projetos de Melhoria de Qualidade para estudantes de pós-graduação em enfermagem.Os estudos incluídos fazem ênfase à Melhoria de Qualidade como estratégia metodológica capaz de captar uma problemática da prática, a ser resolvida sem perder o rigor científico e destaca a importância de obter habilidades de Melhoria de Qualidade nos programas profissionais. Conclusão: A ciência da implementação e os projetos de Melhoria da Qualidade avançam nos programas profissionais, para aprimorar e desenvolver os cuidados de saúde com qualidade.

Process of implementing thirst management in surgical burned patients, based on knowledge translation / Proceso de implementación del manejo de la sed en pacientes quirúrgicos con quemaduras, sobre la base de knowledge translation / Processo de implantação do manejo da sede no paciente queimado cirúrgico embasado no knowledge translation

ABSTRACT Objective: to report the path taken to implement the Thirst Management Model using the Knowledge Translation Evidence-based Practice for Improving Quality intervention in a Burn unit. Method: an experience report on the implementation, which took place in two stages: Preparation; and Implementation/Change, both requiring a sequence of steps. Results: the implementation was performed in four cycles of the PDSA improvement tool. All had the same indicator collected, with increasing goals to be attained. Considering the barriers identified, multiple combined Knowledge Translation strategies were used, namely: posters; theoretical and practical training sessions, individual or in group; videos; dynamics; music; logo development for implementation visibility; audit and feedback; and didactic and illustrated clinical protocols. Conclusion: the report of the entire implementation process using the Evidence-based Practice for Improving Quality intervention, pointing out its weaknesses and strengths, proves to be useful, necessary and innovative. This study may assist in future evidence-based implementations that choose to use multifaceted interventions.

RESUMEN Objetivo: informar el camino recorrido para implementar el Modelo de Manejo de la Sed recurriendo a la intervención Knowledge Translation llamada Evidence-based Practice for Improving Quality (Práctica Basada en Evidencia para Mejorar la Calidad) en una unidad especializada en Quemaduras. Método: informe de experiencia sobre la implementación, que tuvo lugar en dos etapas: Preparación e Implantación/cambio, ambas obedeciendo una secuencia de pasos para su realización. Resultados: la implementación se realizó en cuatro ciclos de la herramienta de mejoras PDSA. En todos los ciclos se recolectó el mismo indicador, con metas crecientes por alcanzar. Considerando las barreras identificadas, se utilizaron múltiples estrategias combinadas de Knowledge Translation, a saber: posters; sesiones de capacitación teóricas y prácticas, individuales o en grupo, videos, dinámicas, música, desarrollo de un logotipo para conferir visibilidad a la implementación; auditoría y feedback; y protocolos clínicos didácticos e ilustrados. Conclusión: el informe de la totalidad del proceso de implementación recurriendo a la intervención Evidence-based Practice for Improving Quality, incluso señalando sus debilidades y puntos fuertes, demuestra que es útil, necesaria e innovadora. Este estudio pode auxiliar futuras implementaciones de evidencias que decidan utilizar intervenciones multifacéticas.

RESUMO Objetivo: Relatar o caminho percorrido para a implantação do Modelo de Manejo da Sede com o uso da intervenção de Knowledge Translation Evidence-based Practice for Improving Quality (Prática Baseada em Evidência para a Melhoria do Processo de Qualidade) em uma unidade de queimados. Método: Relato de experiência sobre a implantação que ocorreu em duas etapas: Preparação e Implantação/ mudança, ambas obedecendo uma sequência de passos para sua realização. Resultados: A implementação foi realizada em quatro ciclos da ferramenta de melhoria PDSA. Todos tiveram o mesmo indicador coletado, com metas crescentes a serem alcançadas. Considerando as barreiras identificadas, utilizaram-se múltiplas estratégias combinadas de Knowledge Translation: cartazes, capacitações teóricas e práticas, individuais ou em grupo, vídeos, dinâmicas, músicas, desenvolvimento de logo para visibilidade da implantação, auditoria e feedback, protocolos clínicos didáticos e ilustrados. Conclusão: O relato de todo o processo de implantação com o uso da intervenção Evidence-based Practice for Improving Quality, apontando suas fragilidades e fortalezas, mostra-se útil, necessária e inovador. Este estudo pode auxiliar futuras implantações de evidências que escolham utilizar intervenções multifacetadas.

Impacto del mapa de riesgos como estrategia de monitorización y mejora de seguridad del paciente en urgencias / Impact of risk mapping as a strategy for monitoring and improving patient safety in paediatric emergency care

Objetivo: Diseñar un Mapa de Riesgos (MR) como herramienta para identificar y gestionar los riesgos en Urgencias Pediátricas y analizar el impacto de las acciones de mejora desarrolladas a partir de los riesgos identificados, en el nivel de riesgo para la Seguridad del Paciente (SP).Metodología: Un grupo de trabajo multidisciplinar revisó todo el proceso asistencial aplicando la herramienta Análisis Modal Fallos y Efectos (AMFE). Fases del proyecto: 1ª) MR 2017 y planificación acciones de mejora. 2ª) Desarrollo e implantación de acciones de mejora. 3ª) MR 2019. 4ª) Análisis: evolución del MR e impacto de las acciones de mejora. Resultados: En el MR 2017 se identificaron 106 modos de fallo (MF) (54,7% riesgo alto o muy alto). Se aplicaron criterios de priorización para seleccionar las acciones de mejora que debían planificarse. Se planificaron 19 acciones de mejora, con responsables y plazos, que permitían abordar 46 MF prioritarios. Se implantaron el 100%. En el MR 2019 se identificaron 110 MF (48,2% riesgo alto) y se objetivó una reducción global del nivel de riesgo del 20%. Analizando los 46 MF prioritarios que se habían abordado mediante las 19 acciones de mejora planificadas, se comprobó que el 60% habían pasado de nivel de riesgo alto a medio y que se había reducido el nivel de riesgo tanto a nivel global (-27,8%) como desglosado por procesos. Conclusión: El AMFE es una herramienta útil para identificar riesgos, analizar el impacto de las estrategias de mejora y monitorizar el nivel de riesgo de un servicio clínico complejo. Las acciones de mejora desarrolladas han logrado reducir el nivel de riesgo de nuestros procesos, mejorando la SP. (AU)

Objective: To design a risk map (RM) as a tool for identifying and managing risks in the paediatric emergency department and to assess the impact of the improvement actions developed based on the identified risks in terms of the level of risk to patient safety. Methodology: A multidisciplinary working group reviewed the entire care process by applying the Failure Mode and Effects Analysis (FMEA) tool. Project phases: 1) RM 2017 and planning of improvement actions; 2) Development and implementation of improvement actions; 3) RM 2019; 4) Analysis: evolution of the RM and impact of improvement actions. Results: A total of 106 failure modes (FMs) were identified in the 2017 RM (54.7% high- or very high risk). We applied prioritization criteria to select the improvement actions to plan. Nineteen improvement actions were planned, with assigned responsible parties and deadlines, to address 46 priority FMs. One hundred percent were implemented. In the 2019 RM, we identified 110 FMs (48.2% high risk) and found an overall reduction of the risk level of 20%. Analysing the 46 priority FMs that had been addressed by the 19 planned improvement actions, we found that 60% had changed from high to medium risk level and that the risk level had decreased, both overall (–27.8%) and by process. Conclusión: The FMEA is a useful tool to identify risks, analyse the impact of improvement strategies and monitor the risk level of a complex clinical care department. The improvement actions developed succeeded in reducing the level of risk in the processes in our unit, improving patient safety. (AU)

Resultados de aplicar un protocolo de seguridad al paciente traqueotomizado procedente de una unidad de cuidados críticos / Results of applying a safety protocol of the patient with tracheotomy from a critical care unit

Introducción y objetivo: El incremento de traqueotomías en las unidades de cuidados críticos aumenta notablemente la morbimortalidad en la sala general. Para revertirlo, hemos implementado un programa de seguimiento multidisciplinar basado en la formación, la estandarización de los cuidados y la adopción de nuevas estrategias. Metodología: Estudio de cohorte prospectivo y observacional del seguimiento de 150 pacientes en un hospital universitario de tercer nivel, que carece de unidad de cuidados intermedios. Registramos y analizamos las variables clínicas, epidemiológicas y la evolución tras la aplicación del programa. Resultados: La edad media de los pacientes fue de 61 años, 67% varones y el 42% neurocríticos. 71% con traqueotomía percutánea. La mortalidad general fue del 17% y la de los pacientes con accidente cerebrovascular del 6,3%. Hubo un 8% de reingresos en la unidad de críticos. Detectamos un 23% de complicaciones de escasa gravedad. Se decanuló durante el ingreso a un 43% de pacientes y el 38% volvió a su domicilio, siendo dados de alta un 55% con alimentación oral. El tiempo medio de estancia en la unidad de críticos fue de 34 días y de 70 días la media de ingreso hospitalario. Conclusiones: Este trabajo describe los resultados obtenidos tras aplicar un protocolo de seguimiento multidisciplinar en la sala de hospitalización, del paciente traqueotomizado que procede de las UCC. La finalidad de este seguimiento es mejorar la seguridad de estos pacientes, a fin de disminuir su morbimortalidad. Las aplicación de nuevas estrategias permitirá su evaluación en relación con los datos obtenidos de este estudio. (AU)

Introduction and objective: Increasing the number of tracheostomies in critical care units significantly increases morbimortality in the wards. To reverse this, we have implemented a multidis-ciplinary follow-up program based on training, standardization of care and the adoption of new strategies. Methodology: Prospective and observational cohort study of the follow-up of 150 patients in a third-level university hospital that does not have a step-down unit. We record and analyze the clinical and epide-miological variables and the evolution after the application of the program. Results: The average age was 61 years old, 67 % male, and 41 % neurocritical care patients. Percutaneous tracheostomy in 71 % of all tracheostomies. Global mortality was 17 % and that of patients with stroke was 6.3 %. Readmission to critical care units was 8 %. Low-severity complications were detected in 23 % of patients. The decannulation process was completed during admission in 43 % of patients, 38 % in all discharged from hospital, 55 % of them with oral feeding now of discharge. Average stay in critical care unit was 34 days and hospital length of stay was 70 days. Conclusions: This work describes the results obtained after applying a multidisciplinary follow-up protocol in the wards, of the tracheotomized patient who comes from the critical care units. The purpose of this follow-up is to improve the safety of these patients, to reduce their morbimortality. The application of new strategies will allow their evaluation in relation to the data obtained from this study. (AU)

Impact of risk mapping as a strategy for monitoring and improving patient safety in paediatric emergency care.

OBJECTIVE: To design a risk map (RM) as a tool for identifying and managing risks in the paediatric emergency department and to assess the impact of the improvement actions developed based on the identified risks in terms of the level of risk to patient safety. METHODOLOGY: A multidisciplinary working group reviewed the entire care process by applying the Failure Mode and Effects Analysis (FMEA) tool. Project phases: (1) RM 2017 and planning of improvement actions; (2) Development and implementation of improvement actions; (3) RM 2019; (4) Analysis: evolution of the RM and impact of improvement actions. RESULTS: A total of 106 failure modes (FMs) were identified in the 2017 RM (54.7% high- or very high risk). We applied prioritization criteria to select the improvement actions to plan. Nineteen improvement actions were planned, with assigned responsible parties and deadlines, to address 46 priority FMs. One hundred percent were implemented. In the 2019 RM, we identified 110 FMs (48.2% high risk) and found an overall reduction of the risk level of 20%. Analysing the 46 priority FMs that had been addressed by the 19 planned improvement actions, we found that 60% had changed from high to medium risk level and that the risk level had decreased, both overall (-27.8%) and by process. CONCLUSION: The FMEA is a useful tool to identify risks, analyse the impact of improvement strategies and monitor the risk level of a complex clinical care department. The improvement actions developed succeeded in reducing the level of risk in the processes in our unit, improving patient safety.

Decrease in the use of bronchodilators in the management of bronchiolitis after applying improvement initiatives.

INTRODUCTION: In the treatment of patients with acute bronchiolitis there is great variability in clinical practice. Treatments whose efficacy has not been demonstrated are frequently used despite the recommendations contained in the Clinical Practice Guidelines. MATERIAL AND METHODS: A quality improvement strategy is implemented in the care of patients with acute bronchiolitis in the Emergency Department, which is maintained for five years and is periodically updated to be increasingly restrictive regarding the use of bronchodilators. To evaluate the impact of the intervention, a retrospective study of the rates of prescription of bronchodilators in children diagnosed with acute bronchiolitis in the month of December of four epidemic periods (2012, 2014, 2016 and 2018) was carried out. RESULTS: 1767 children are included. There were no differences regarding age, respiratory rate, oxygen saturation or the estimated severity in each of the study seasons. The use of salbutamol in the Emergency Department decreased from 51.2% (95% CI: 46.6-55.8%) in 2012 to 7.8% (95% CI: 5.7%-10.5%) in 2018 (P < .001) and epinephrine prescription rates fell from 12.9% (95% CI: 10.1%-16.3%) to 0.2% (95% CI: 0-1.1%) (P < .001). At the same time, there was a decrease in the median time of attendance in the Emergency Department and in the admission rate without changing the readmission rate in 72 h. CONCLUSIONS: The systematic and continuous deployment over time of actions aimed at reducing the use of salbutamol and epinephrine in the treatment of bronchiolitis, prior to the epidemic period, seems an effective strategy to reduce the use of bronchodilators in the Emergency Department.

Descenso del uso de broncodilatadores en el manejo de la bronquiolitis tras aplicar iniciativas de mejora / Decrease in the use of bronchodilators in the management of bronchiolitis after applying improvement initiatives

Introducción: En el tratamiento de los pacientes con bronquiolitis aguda existe una gran variabilidad de la práctica clínica y con frecuencia se utilizan de forma indiscriminada tratamientos cuya eficacia no está demostrada a pesar de las recomendaciones recogidas en las guías de práctica clínica. Material y métodos: Se implementó una estrategia de mejora de la calidad en la atención a los pacientes con bronquiolitis aguda en el Servicio de Urgencias que se mantuvo durante 5 años y se actualizó periódicamente para ser cada vez más restrictiva respecto al uso de tratamientos broncodilatadores. Para evaluar el impacto de la intervención se realizó un estudio descriptivo retrospectivo de las tasas de prescripción de broncodilatadores en los niños diagnosticados de bronquiolitis aguda en el mes de diciembre de 4 periodos epidémicos (2012, 2014, 2016 y 2018). Resultados: Se incluyó a 1.767 niños. No existieron diferencias respecto a edad, frecuencia respiratoria, saturación de oxígeno ni gravedad en cada una de las temporadas a estudio. El empleo de salbutamol en Urgencias descendió del 51,2% (IC del 95%: 46,6-55,8%) en 2012 al 7,8% (IC del 95%: 5,7-10,5%) en 2018 (p <0,001) y el de adrenalina del 12,9% (IC del 95%: 10,1-16,3%) al 0,2% (IC del 95%: 0-1,1%) (p <0,001). Se produjo a su vez un descenso en la mediana de tiempo de asistencia en Urgencias y en la tasa de ingreso sin que se modificase la tasa de readmisión en 72 h. Conclusiones: El despliegue sistemático y continuado en el tiempo de acciones dirigidas a la reducción del uso de fármacos en el tratamiento de la bronquiolitis, previo al periodo epidémico, parece una estrategia eficaz para reducir el uso de broncodilatadores en urgencias. (AU)

Introduction: In the treatment of patients with acute bronchiolitis there is great variability in clinical practice. Treatments whose efficacy has not been demonstrated are frequently used despite the recommendations contained in the Clinical Practice Guidelines. Material and methods: A quality improvement strategy is implemented in the care of patients with acute bronchiolitis in the Emergency Department, which is maintained for five years and is periodically updated to be increasingly restrictive regarding the use of bronchodilators. To evaluate the impact of the intervention, a retrospective study of the rates of prescription of bronchodilators in children diagnosed with acute bronchiolitis in the month of December of four epidemic periods (2012, 2014, 2016 and 2018) was carried out. Results: 1767 children are included. There were no differences regarding age, respiratory rate, oxygen saturation or the estimated severity in each of the study seasons. The use of salbutamol in the Emergency Department decreased from 51.2% (95% CI: 46.6%–55.8%) in 2012 to 7.8% (95% CI: 5.7%–10.5%) in 2018 (P<.001) and epinephrine prescription rates fell from 12.9% (95% CI: 10.1%–16.3%) to 0.2% (95% CI: 0–1.1%) (P<.001). At the same time, there was a decrease in the median time of attendance in the Emergency Department and in the admission rate without changing the readmission rate in 72h. Conclusions: The systematic and continuous deployment over time of actions aimed at reducing the use of salbutamol and epinephrine in the treatment of bronchiolitis, prior to the epidemic period, seems an effective strategy to reduce the use of bronchodilators in the Emergency Department. (AU)

Effects of an specific methodology (I Pass the Baton) on quality of handoff information among Nurses: A comparative study.

AIM: The aim of this study was to investigate the effect of applying I Pass the Baton (IPB) on the quality of handoff among nurses. METHOD: The present study was a quasi-experimental study. All nurses of the internal wards of Sanandaj educational hospitals, Kurdistan Province, Iran were selected by census method and randomly assigned to intervention (n=34) and control (n=31) groups. Handoff quality was measured by self-report and observation methods. The intervention included a face-to-face training session, training on how to use the IPB, inserting the IPB chart into the patient file, training leaflet, and installing a poster in the ward. The Situation, Background, Assessment, Recommendation (SBAR) was used according to routine practice in the control group. Descriptive and inferential tests were applied to analyze the data using SPSS-16. RESULTS: The mean score of handoff quality was 82.61±12.77 and 107.11±7.97 before and after the intervention in the intervention group (p<0.05) and 89.00±0.34 and 85.64±19.19 before and after the intervention in the control group, respectively (p=0.91). There was a statistically significant difference between the two groups after the intervention (p<0.05). Implementation of the training program and the IPB tool improved the handoff quality in terms of interaction and support, patient involvement, information quality, and efficiency. CONCLUSIONS: The IPB has various indicators of patient participation and includes the criteria needed for patient evaluation. Therefore, it can be used to handoff a wide range of patients in the internal ward.

Avanzando en la sistematización del benchmarking en servicios de salud pública / Improving the systematization of benchmarking in public health services

La mejora continua de la gestión debería ser una aspiración para todas las organizaciones del sector público. Los elementos de comparación externa obenchmarkingidentifican buenas prácticas en organizaciones similares. En servicios de salud pública, obtener indicadores de este tipo no es fácil. Los objetivos de este trabajo son describir el proceso seguido para llevar a cabo un ejercicio debenchmarkingen una organización de salud pública, y compartir sus frutos. Para ello, se identificaron organizaciones para compararlas, y se buscaron en sus páginas web informes o memorias con indicadores de las actividades o resultados de los servicios de salud pública. Se identificaron limitaciones y condicionantes de los indicadores de las diferentes organizaciones, así como maneras de mejorar su capacidad de comparación. Finalmente, se propone un conjunto de 19 indicadores como núcleo inicial de comparación orientado a la gestión de calidad. (AU)

Continuous management improvement should be an aspiration for all public sector organizations. External comparison or benchmarking identifies good practices in similar organizations. For public health services, it is not easy to obtain such indicators. The objectives of this paper are to describe the process of conducting a benchmarking exercise for a public health agency, and to share its results. For this purpose, agencies that may be compared were identified, and their websites were searched for annual reports or other documents with indicators of the activities or results of public health services. Limitations and contextual aspects of the indicators of the different organizations were identified, as well as ways to improve their comparability. Finally, a set of 19 indicators is proposed, as an initial core for quality management comparisons. (AU)

[Interprofessional team training with in situ simulation to improve the quality of cardiopulmonary resuscitation]. / Entrenamiento de equipos interprofesionales con simulación in situ para mejorar la calidad de la reanimación cardiopulmonar.

INTRODUCTION: In situ simulation facilitates training in clinical settings under similar emotional pressure that occurs in real life situations. The objective of the present study was to assess the feasibility, implementation, facilitators self-confidence and teaching challenges of a training program of cardiopulmonary resuscitation through an in situ simulation plan. METHOD: A training program was designed for the facilitators. The number of professionals trained and in situ simulations performed were recorded, as well as the logistical challenges. An ad hoc survey was designed to assess facilitators self-confidence and educational challenge which were classified using the debriefing assessment for simulation in healthcare©. RESULTS: During a period of 3 years, 95 trained facilitators implemented 378 in situ simulations that allowed to train 1281 nursing professionals working at inpatient units. Integration of in situ simulations with daily activities and availability of facilitators were the main logistical challenges. Stablishing and maintaining a stimulating learning environment and structuring the debriefing in an organized way were the main educational challenges. CONCLUSIONS: In situ simulation helps to train the coordination of nursing teams taking care of patients in cardiorespiratory arrest and to identify the risks that may affect patient safety. Identifying the educational challenges during the implementation of in situ simulation facilitates the design of specific educational and monitoring strategies.