Análisis del grado de implantación de las prácticas de prevención de errores de medicación en los hospitales españoles (2022) / Analysis of the degree of implementation of medication error prevention practices in Spanish hospitals (2022)

Objetivo conocer el grado de implantación de las prácticas de prevención de errores de medicación en los hospitales españoles. Método estudio descriptivo multicéntrico del grado de implantación de las prácticas seguras recogidas en el «Cuestionario de autoevaluación de la seguridad del uso de los medicamentos en los hospitales. Versión II». Participaron aquellos hospitales españoles que cumplimentaron este cuestionario entre octubre de 2021 y septiembre de 2022. El cuestionario contiene 265 ítems de evaluación agrupados en 10 elementos clave. Se calculó la puntuación media y el porcentaje medio sobre el valor máximo posible para el cuestionario completo, los elementos clave y los ítems de evaluación. Los resultados se compararon con los del estudio realizado en 2011. Resultados participaron 131 hospitales de 15 comunidades autónomas. La puntuación media del cuestionario completo en los hospitales fue de 898,2 (57,4% del valor máximo posible). No se encontraron diferencias según la dependencia, el tamaño o la finalidad asistencial, ni en el cuestionario completo ni en los elementos clave. Presentaron los valores más bajos los elementos clave VIII, I y VI, sobre competencia y formación de los profesionales en prácticas seguras (45,1%), disponibilidad y accesibilidad de la información esencial sobre los pacientes (48%) y dispositivos para la administración de medicamentos (52,3%). Con respecto a 2011, se encontraron aumentos significativos tanto en el cuestionario completo como en los elementos clave, excepto en el V y VII, referentes a la estandarización, almacenamiento y distribución de medicamentos, y a los factores del entorno y recursos humanos. ...(AU)

Objective To assess the degree of implementation of medication error prevention practices in Spanish hospitals. Method Descriptive multicenter study of the degree of implementation of the safety practices included in the "Medication use-system safety self-assessment for hospitals. Version. II". Spanish hospitals that completed the questionnaire between October/2021 and September/2022 participated. The survey contains 265 items for evaluation grouped into 10 key elements. Mean score and mean percentages based on the maximum possible values for the overall survey, for the key elements and for each individual item of evaluation were calculated. The results were compared with those of the previous 2011 study. Results A total of 131 hospitals from 15 autonomous regions participated in the study. The mean score of the overall questionnaire in all hospitals was 898.2 (57.4% of the maximum possible score). No differences were found according to dependency, size or type of hospital, either in the overall questionnaire or in the key elements. The lowest values were found for key elements 8, 1 and 6, on competence and training of health professionals in safety practices (45.1%), availability and accessibility of essential information on patients (48%), and devices for administering drugs (52.3%). With respect to 2011, significant increases were found both in the overall questionnaire and in the key elements, except 5 and 7, referring to standardization, storage and distribution of medications, and environmental factors and human resources. Several evaluation items on the safe management of high-risk drugs, medication reconciliation, incorporation of clinical pharmacists into the healthcare teams and implementation of technologies that allow full traceability throughout the medication system, showed low percentages. Conclusions.... (AU)

A systematic comparison of hepatobiliary adverse drug reactions in FDA and EMA drug labeling reveals discrepancies.

Drug labeling informs physicians and patients on the safe and effective use of medication. However, recent studies suggested discrepancies in labeling of the same drug between different regulatory agencies. Here, we evaluated the hepatic safety information in labeling for 549 medications approved by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA). Limited discrepancies were found regarding risk for hepatic adverse drug reactions (ADRs) (8.7% in hepatic ADR warnings and 21.3% in contraindication for liver disease), while caution should be exercised over drugs with inconsistencies in contraindications for liver disease and evidence for hepatotoxicity (4.9%). Most discrepancies were attributable to less-severe hepatic events and low-frequency hepatic ADR reports and had limited implication on clinical outcomes.

Organizational Safety Climate and Job Enjoyment in Hospital Surgical Teams With and Without Crew Resource Management Training.

OBJECTIVE: The association between organizational safety climate (OSC) and job enjoyment (JE) for team members in surgical units in 2 hospitals was investigated. The treatment hospital received airline industry-based crew resource management (CRM) training, and the comparison hospital did not. BACKGROUND: Strong OSC has been positively associated with healthy hospital work environments and was expected to also be associated with employee job enjoyment. METHODS: Two hundred sixty-two surgical personnel responded to surveys about OSC and JE. RESULTS: The effects of OSC on JE did not depend on having CRM training. However, OSC and JE scores were higher in the treatment hospital, and the main effect of OSC and JE scores in the treatment hospital was highly significant (P < 0.001), with higher safety climate scores associated with higher JE. CONCLUSIONS: A strong OSC is important to employee job enjoyment. Nurse leaders should promote measures to strengthen the OSC in their surgical services departments.

Health and safety risk perceptions and needs of app-based drivers during COVID-19.

BACKGROUND: App-based drivers face work disruptions and infection risk during a pandemic due to the nature of their work, interactions with the public, and lack of workplace protections. Limited occupational health research has focused on their experiences. METHODS: We surveyed 100 app-based drivers in Seattle, WA to assess risk perceptions, supports, and controls received from the company that employs them, sources of trust, stress, job satisfaction, COVID-19 infection status, and how the pandemic had changed their work hours. Data were summarized descriptively and with simple regression models. We complemented this with qualitative interviews to better understand controls and policies enacted during COVID-19, and barriers and facilitators to their implementation. RESULTS: Drivers expressed very high levels of concern for exposure and infection (86%-97% were "very concerned" for all scenarios). Only 31% of drivers reported receiving an appropriate mask from the company for which they drive. Stress (assessed via PSS-4) was significantly higher in drivers who reported having had COVID-19, and also significantly higher in respondents with lower reported job satisfaction. Informants frequently identified supports such as unemployment benefits and peer outreach among the driver community as ways to ensure that drivers could access available benefits during COVID-19. CONCLUSIONS: App-based drivers received few protections from the company that employed them, and had high fear of exposure and infection at work. There is increased need for health-supportive policies and protections for app-based drivers. The most effective occupational and public health regulations would cover employees who may not have a traditional employer-employee relationship.

Consideration about the society after the COVID-19.

This paper reviews three viewpoints regarding the society after the COVID-19 infection on the concept of safety management. The first is the relationship between With COVID-19 and a zero risk. As a result of coexistence with COVID-19 for more than one year, the Japanese society thought that a zero risk is difficult to accomplish, and some risks will be accepted to maintain social activities. This leads a change in a way of thinking from zero risk to risk-based safety management. The second is the change in the way of working. As a result of having experienced remote work forcibly, it will become the hybrid model that incorporated remote work in a conventional method. Personnel evaluation changes from the seniority system to the job evaluation type, and each person's professional ability will be more focused on. The third is the review of the Japanese society system. In Japan, although the infection level was controlled to some extent by the groupism of the self-restraint of actions by mutual monitoring, there is a limit of managing based on groupism. Moreover, as seen in the delay of vaccine development and the medical care collapse, these problems should be improved by changing Japanese society system.

Reimagining Construction and Renovation of Health Care Facilities During Emergence from a Pandemic.

The built environment has been integral to response to the global pandemic of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In particular, engineering controls to mitigate risk of exposure to SARS-CoV-2 and other newly emergent respiratory pathogens in the future will be important. Anticipating emergence from this pandemic, or at least adaptation given increasing administration of effective vaccines, and the safety of patients, personnel, and others in health care facilities remain the core goals. This article summarizes known risks and highlights prevention strategies for daily care as well as response to emergent infectious diseases and this parapandemic phase.

Examining the Effectiveness of Strategies Developed to Create an Error Reporting Culture.

PURPOSE: This study was conducted to develop strategies for creating an error reporting culture and to assess their effectiveness. DESIGN: This study was planned to explore how to improve patient safety. The study used a quasi-experimental 1-group pre-post design. It examined the culture of reporting through an analysis of employees' attitudes toward medical errors, along with rates of medical error reporting. METHODS: Four different forms were used as data collection tools. The multiple strategies used in this study constituted the research interventions. These strategies were as follows: "Education on Medical Errors and Medical Error Reporting," "Posting Banners and Posters about the Subject," "Using Social Networks and Creating a Facebook Page Titled 'Leaders of Patient Safety'," "Revising the Institution's Incident/Error Reporting System," and "Patient Safety Symposium." Data were evaluated using descriptive statistics and paired sample t test. RESULTS: It was determined that medical error reporting rates increased in the first 6 months after the initiative, and this increase continued in the second 6 months. Medical error reports in the institution where this study was conducted increased by 10 times at the end of the first year. CONCLUSIONS: Multiple strategies applied for creating an error reporting culture and assessing their effectiveness positively affected health professionals' medical error attitudes and increased error reporting rates.

Using Participatory Design to Mitigate Hospital Patient Falls.

Participatory design can involve, empower, and facilitate those stake-holders (health care providers, nurses, professional development experts, patients, and patients' families) who can positively impact patient falls through the design process. Participatory design can help participants identify effective solutions to prevent patient falls and solve other health care problems. This article guides professional development specialists on how to use participatory design to solve health care problems with a focus on fall reduction. [J Contin Educ Nurs. 2021;52(8):359-361.].

Patient safety management systems and activities related to promoting voluntary in-hospital reporting and mandatory national-level reporting for patient safety issues: A cross-sectional study.

Both voluntary in-hospital reporting and mandatory national-level reporting systems for patient safety issues need to work well to develop a patient safety learning system that is effective in preventing the recurrence of adverse events. Some of the hospital systems and activities may increase voluntary in-hospital reporting and mandatory national-level reporting. This study aimed to identify the hospital systems and activities that increase voluntary in-hospital reporting and mandatory national-level reporting for patient safety issues. An anonymous mail survey of hospitals in Japan was conducted in 2017. The hospitals were selected by stratified random sampling according to number of beds. The survey examined the annual number of reported events in the voluntary in-hospital reporting system for patient safety and experience of reporting unexpected patient deaths possibly due to medical interventions to the mandatory national-level reporting system in the last 2 years. The relationship of the answer to the questions with the patient safety management systems and activities at each hospital was analyzed. The response rate was 18.8% (603/3,215). The number of in-hospital reports per bed was positively related to identifying events by referring complaints or questions of patients or family members, using root cause analysis for analyzing reported events, and developing manuals or case studies based on reported events, and negatively related to the unification and standardization of medical devices and equipment. The experience with mandatory national-level reporting of serious adverse events was positively related to identifying problematic cases by a person in charge of patient safety management from the in-hospital reporting system of complications and accidental symptoms. Enhanced feedback for reporters may promote voluntary in-hospital reporting of minor cases with low litigation risks. Developing an in-hospital mechanism that examines all serious complications and accidental symptoms may promote mandatory national-level reporting of serious adverse events with high litigation risks.

The management of the new and emerging musculoskeletal and psychosocial risks by EU-28 enterprises.

INTRODUCTION: Although the strategic framework of the European Union in the field of Health and Safety at Work 2014-2020 considers as one of its main challenges to improve the prevention of diseases related to NERs (New and Emerging Risks) (European Commission, 2014) there are still not many studies in the literature related to them. METHOD: An exploratory study was carried out in order to get a picture of the NERs management in the UE-28 countries. The sample was extracted from the ESENER-2 datasets. ESENER-1 was carried out in 2009 and ESENER- 2 in 2014. This survey explores managers' and workers representatives' opinions on health and safety management. It surveyed over 49,000 enterprises in 36 countries. RESULTS: The results obtained confirm that there are significant differences between the EU-28 countries in terms of the identification and the management of NERs. Conclusions NERs are becoming an increasingly studied phenomenon due to the changes that are taking place in the labour market: the percentage of temporary workers is increasing, the demands to the workers due to the globalization of the market are more complex and all this with an aging working force. Pratical A pplications It would be necessary to rethink the management of OHS, so that managers are aware that the combination of musculoskeletal and psychosocial risks should have a global approach in order to reduce accident and disability rates.

Perioperative patient safety management activities: A modified theory of planned behavior.

Patient safety is an important healthcare issue worldwide, and patient accidents in the operating room can lead to serious problems. Accordingly, we investigated the explanatory ability of a modified theory of planned behavior to improve patient safety activities in the operating room. Questionnaires were distributed to perioperative nurses working in 12 large hospitals in Korea. The modified theory of planned behavior data from a total of 330 nurses were analyzed. The conceptual model was based on the theory of planned behavior data, with two additional organizational factors-job factors and safety management system. Individual factors included attitude, subjective norms, perceived behavioral control, behavioral intention, and patient safety management activities. Results indicated that job factors were negatively associated with perceived behavioral control. The patient safety management system was positively associated with attitude, subjective norm, and perceived behavioral control. Attitude, subjective norm, and perceived behavioral control were positively associated with behavioral intention. Behavioral intention was positively associated with patient safety management activities. The modified theory of planned behavior effectively explained patient safety management activities in the operating room. Both organizations and individuals are required to improve patient safety management activities.

Advocacy for School Nurses and Student Health and Safety: Highlighting National and State Efforts.

Annually, the National Association of School Nurses (NASN) sets advocacy goals. The goals include legislative and policy priorities. The COVID-19 pandemic brought attention to the need to heighten advocacy efforts, specifically to provide for additional school nurses and supplies necessary to meet the challenge of safely returning students to school. While advocating at the national level, NASN also encouraged advocacy at the state and local levels. This article provides a brief summary of NASN's advocacy efforts as well as providing examples from two different state associations demonstrating the importance of collaboration in advocacy efforts in areas related to the pandemic and in general areas related to school nursing.

X-ray management in electrophysiology: a survey of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC).

AIMS: Radiation use in medicine has significantly increased over the last decade, and cardiologists are among the specialists most responsible for X-ray exposure. The present study investigates a broad range of aspects, from specific European Union directives to general practical principles, related to radiation management among a national cohort of cardiologists. METHODS AND RESULTS: A voluntary 31-question survey was run on the Italian Arrhythmology and Pacing Society (AIAC) website. From June 2019 to January 2020, 125 cardiologists, routinely performing interventional electrophysiology, participated in the survey. Eighty-seven (70.2%) participants are aware of the recent European Directive (Euratom 2013/59), although only 35 (28.2%) declare to have read the document in detail. Ninety-six (77.4%) participants register the dose delivered to the patient in each procedure, in 66.1% of the cases both as fluoroscopy time and dose area product. Years of exposition (P = 0.009) and working in centers performing pediatric procedures (P = 0.021) related to greater degree of X-ray equipment optimization. The majority of participants (72, 58.1%) did not recently attend radioprotection courses. The latter is related to increased awareness of techniques to reduce radiation exposure (96% vs. 81%, P = 0.022), registration of the delivered dose in each procedure (92% vs. 67%, P = 0.009), and X-ray equipment optimization (50% vs. 36%, P = 0.006). CONCLUSION: Italian interventional cardiologists show an acceptable level of radiation awareness and knowledge of updated European directives. However, there is clear space for improvement. Comparison to other health professionals, both at national and international levels, is needed to pursue proper X-ray management and protect public health.

Evaluations of Healthcare Providers' Perceived Support From Personal, Hospital, and System Resources: Implications for Well-Being and Management in Healthcare in Montreal, Quebec, During COVID-19.

Increased stressful experiences are pervasive among healthcare providers (HCPs) during the COVID-19 pandemic. Identifying resources that help mitigate stress is critical to maintaining HCPs' well-being. However, to our knowledge, no instrument has systematically examined how different levels of resources help HCPs cope with stress during COVID-19. This cross-sectional study involved 119 HCPs (64 nurses and 55 physicians) and evaluated the perceived availability, utilization, and helpfulness of a list of personal, hospital, and healthcare system resources. Participants also reported on their level of burnout, psychological distress, and intentions to quit. Results revealed that HCPs perceived the most useful personal resource to be family support; the most useful hospital resources were a safe environment, personal protective equipment, and support from colleagues; the most useful system resources were job protection, and clear communication and information about COVID. Moreover, HCPs who perceived having more available hospital resources also reported lower levels of psychological distress symptoms, burnout, and intentions to quit. Finally, although training and counseling services were perceived as useful to reduce stress, training was not perceived as widely available, and counseling services, though reported as being available, were underutilized. This instrument helps identify resources that support HCPs, providing implications for healthcare management.

Reintroduction of elective cardiac interventions in the era of COVID-19: the Barts experience.

BACKGROUND: The response to COVID-19 has required cancellation of all but the most urgent procedures; there is therefore a need for the reintroduction of a safe elective pathway. METHODS: This was a study of a pilot pathway performed at Barts Heart Centre for the admission of patients requiring elective coronary and structural procedures during the COVID-19 pandemic (April-June 2020). All patients on coronary and structural waiting lists were screened for procedural indications, urgency and adverse features for COVID-19 prognosis and discussed at dedicated multidisciplinary teams. Dedicated admission pathways involving preadmission isolation, additional consent, COVID-19 PCR testing and dedicated clean areas were used. RESULTS: 143 patients (101 coronary and 42 structural) underwent procedures (coronary angiography, percutaneous coronary intervention, transcatheter aortic valve intervention and MitralClip) during the study period. The average age was 68.2; 74% were male; and over 93% had one or more moderate COVID-19 risk factors. All patients were COVID-19 PCR negative on admission with (8.1%) COVID-19 antibody positive (swab negative). All procedures were performed successfully with low rates of procedural complications (9.8%). At 2-week follow-up, no patients had symptoms or confirmed COVID-19 infection with significant improvements in quality if life and symptoms. CONCLUSION: We demonstrated that patients undergoing coronary and structural procedures can be safely admitted during the COVID-19 pandemic, with no patients contracting COVID-19 during their admission. Reassuringly, patients reflective of typical practice, that is, those at moderate or higher risk, were treated successfully. This pilot provides important information applicable to other settings, specialties and areas to reintroduce services safely.

Clima organizativo en una Unidad de Cuidados Intensivos: percepción del equipo de enfermería / The Organizational Climate of an Intensive Care Unit: perceptions from the nursing team / Clima Organizacional em uma Unidade de Terapia Intensiva: percepções da equipe de enfermagem

OBJETIVO: Medir el clima organizacional del equipo de enfermería en la unidad de cuidados intensivos. MÉTODO: Este es un estudio transversal, con enfoque cuantitativo, desarrollado en una unidad de cuidados intensivos de un hospital universitario en el noreste de Brasil. La recolección de datos se realizó en 2016, con la participación de 30 profesionales de enfermería. Se realizó el análisis de datos a partir de estadística descriptiva y análisis de datos bivariados. RESULTADOS: Se encontró que los profesionales de enfermería perciben un clima organizacional bajo en el sector en que trabajan y el desarrollo profesional y los beneficios fueron el factor considerado más bajo entre los trabajadores. El análisis bivariado infiere significativamente que los profesionales que tienen hijos tienen una baja percepción del clima organizacional. CONCLUSIÓN: La percepción del clima organizacional del equipo de enfermería investigado es baja

OBJECTIVE: To measure the organizational climate of the nursing team in the intensive care unit. METHOD: This is a cross-sectional study, with a quantitative approach, developed in the intensive care unit of a university hospital in the Northeast of Brazil. Data collection was carried out in 2016, with the participation of 30 nursing professionals. Data analysis was carried out using descriptive statistics and a bivariate analysis of data. RESULTS: It was found that nursing professionals perceive a low organizational climate score in the sector they work. The professional Development and the benefits were considered the lowest factor by the workers. The bivariate analysis significantly infers that the professionals who have children have a low perception of the organizational climate. CONCLUSION: The nursing team investigated is perceives the score of the organizational climate to be low

OBJETIVO: Mensurar o clima organizacional da equipe enfermagem na unidade de terapia intensiva. MÉTODO: trata-se de um estudo transversal, de abordagem quantitativa, desenvolvida em uma unidade de terapia intensiva em um hospital universitário no nordeste do Brasil. A coleta de dados foi realizada em 2016, com a participação de 30 profissionais de enfermagem. A análise dos dados se deu por estatística descritiva e análise bivariada dos dados. RESULTADOS: Verificou-se que os profissionais de enfermagem percebem um baixo clima organizacional no setor que atuam e o Desenvolvimento profissional e benefícios foi o fator considerado mais baixo entre os trabalhadores. A análise bivariada infere de maneira significativa que os profissionais que possuem filhos têm uma baixa percepção do clima organizacional. CONCLUSÃO: A percepção do clima organizacional da equipe de enfermagem investigada é baixa