Contribuições do núcleo interno de regulação para a segurança do paciente / Contributions of the regulatory inner core to patient safety / Aportes del núcleo interno normativo para la seguridad del paciente

Objetivo: identificar as contribuições do Núcleo Interno de Regulação para a segurança do paciente. Método: pesquisa qualitativa desenvolvida entre agosto a outubro de 2020. Foram realizadas entrevistas audiogravadas junto a 13 profissionais que atuavam nas enfermarias, no pronto-socorro, na gestão da qualidade e no Núcleo Interno de Regulação. Os dados foram analisados com o auxílio do software IraMuteq® e as etapas propostas por Creswell. Resultados: os achados revelaram que o Núcleo Interno de Regulação contribui para a segurança do paciente, entornando as metas instituídas: comunicação efetiva; identificação do paciente; redução do risco de infecções associadas aos cuidados em saúde - a pandemia de COVID-19 foi apresentada como um importante dado; segurança para cirurgia, uma vez que agiliza o acesso ao hospital para procedimento cirúrgico; e diminuição de filas de espera. Ainda, contribui para prevenir complicações decorrentes de quedas, pois o paciente pode ser alocado com agilidade num leito seguro. Por fim, o enfermeiro, no seu papel de liderança do serviço e como elo para a gerência do cuidado seguro, também se mostrou importante. Conclusão: embora algumas fragilidades tenham sido detectadas, a contribuição do Núcleo Interno de Regulação se sobressai por fortalecer as metas da segurança do paciente. Em razão disso, reafirma-se a importância de fluxos regulatórios na perspectiva de gestão de leitos hospitalares, assim como os preceitos da segurança do paciente almejada pelos gestores. Não obstante, o enfermeiro atua como elo entre esses dois cenários.(AU)

Objective: to identify the contributions of the Internal Regulation Core to patient safety. Method: qualitative research carried out between August and October 2020. Audio-recorded interviews were carried out with 13 professionals who worked in the wards, in the emergency room, in quality management and in the Internal Regulation Center. Data were analyzed using the IraMuteq® software and the steps proposed by Creswell. Results: the findings revealed that the Internal Regulation Nucleus contributes to patient safety, bypassing the established goals: effective communication; patient identification; reduction in the risk of infections associated with health care - the COVID-19 pandemic was presented as an important fact; safety for surgery, as it speeds up access to the hospital for a surgical procedure; and reduction of queues. It also helps to prevent complications resulting from falls, as the patient can be quickly allocated to a safe bed. Finally, the nurse, in his role as a leader in the service and as a link in the management of safe care, also proved to be important. Conclusion: although some weaknesses were detected, the contribution of the Internal Regulation Center stands out for strengthening patient safety goals. As a result, the importance of regulatory flows from the perspective of hospital bed management is reaffirmed, as well as the precepts of patient safety desired by managers. Nevertheless, the nurse acts as a link between these two scenarios.(AU)

Objetivo: identificar los aportes del Núcleo Interno Normativo para la seguridad del paciente. Método: investigación cualitativa desarrollada de agosto a octubre de 2020. Se realizaron entrevistas audiograbadas a 13 profesionales que trabajaban en las salas, en el servicio de urgencias, en la Gestión de Calidad y en el Núcleo Interno Normativo. Los datos fueron analizados con la ayuda del software IraMuteq® y los pasos propuestos por Creswell. Resultados: los hallazgos revelaron que el Núcleo Interno Normativo contribuye a la seguridad del paciente, desbordando los objetivos establecidos: comunicación eficaz; identificación del paciente; reducción del riesgo de infecciones asociadas a la asistencia sanitaria - la pandemia COVID-19 se presentó como un dato importante; en la seguridad para la cirugía, ya que agiliza el acceso al hospital para procedimientos quirúrgicos y, en la reducción de las colas de espera. También contribuye a la prevención de complicaciones derivadas de caídas, ya que el paciente puede ser ubicado rápidamente en una cama segura. Y, finalmente, el enfermero, en su papel de líder en el servicio, como enlace en la gestión del cuidado seguro, también resultó ser un resultado importante. Conclusión: aunque se detectaron algunas debilidades, se destaca la contribución del Núcleo Interno Normativo en el fortalecimiento de las metas de seguridad del paciente. Como resultado, reafirma la importancia de los flujos normativos desde la perspectiva de la gestión de camas hospitalarias, así como los preceptos de seguridad del paciente deseados por los gestores. Sin embargo, la enfermera actúa como enlace entre estos dos escenarios.(AU)

Interorganizational Communication at Mass Gatherings: Professionals' Perceptions during the Planning and Implementation Stage of Marathon Events.

INTRODUCTION: Mass gatherings (MGs) often bring together professionals and organizations that collaborate irregularly or have never engaged in joint working. They involve interaction and communication among multiple and diverse services, which can often prove challenging. Planning such an event is of paramount importance for its success, and interorganizational communication ranks among its most important aspects. Nonetheless, there is limited empirical evidence to support interagency communication in MGs. OBJECTIVE: This study used the 2017 Athens Marathon (Athens, Greece) as the empirical setting to examine how interorganizational communication was perceived among the multiple public health and safety professionals during the planning and implementation phase of the event. METHODS: Data comprised 15 semi-structured in-depth interviews with key informants, direct observations of meetings and the event itself, and documentary analysis. Open coding and thematic analysis were used to analyze the data. RESULTS: Findings indicated three key components of interorganizational communication in such an event: (1) shared situational awareness; (2) interorganizational understanding; and (3) implementing liaison officers. CONCLUSION: This study outlined the factors that influenced interorganizational communication before and during a MG. Practical implications arising from this study may inform the way organizers of marathons and other mass sporting events can engage in effective interorganizational communication.

Engagement in local and collaborative wildfire risk mitigation planning across the western U.S.-Evaluating participation and diversity in Community Wildfire Protection Plans.

Since their introduction two decades ago, Community Wildfire Protection Plans (CWPPs) have become a common planning tool for improving community preparedness and risk mitigation in fire-prone regions, and for strengthening coordination among federal and state land management agencies, local government, and residents. While CWPPs have been the focus of case studies, there are limited large-scale studies to understand the extent of, and factors responsible for, variation in stakeholder participation-a core element of the CWPP model. This article describes the scale and scope of participation in CWPPs across the western United States. We provide a detailed account of participants in over 1,000 CWPPs in 11 states and examine how levels of participation and stakeholder diversity vary as a function of factors related to planning process, planning context, and the broader geographic context in which plans were developed. We find that CWPPs vary substantially both by count and diversity of participants and that the former varies as a function of the geographic scale of the plan, while the latter varies largely as a function of the diversity of landowners within the jurisdiction. More than half of participants represented local interests, indicating a high degree of local engagement in hazard mitigation. Surprisingly, plan participation and diversity were unrelated to wildfire hazard. These findings suggest that CWPPs have been largely successful in their intent to engage diverse stakeholders in preparing for and mitigating wildfire risk, but that important challenges remain. We discuss the implications of this work and examine how the planning process and context for CWPPs may be changing.

Addressing Occupational Fatigue in Nurses: A User-Centered Design Approach for Fatigue Risk Management.

OBJECTIVE: To understand hospital nurses' current fatigue risk management (FRM), identify design goals and principles, and obtain feedback on FRM design concepts. BACKGROUND: FRM systems can address fatigue and associated risks, yet they are not widely implemented in hospital nursing. This may be due to a lack of contextually appropriate FRM tools. METHODS: A user-centered design approach was used, including interviews with 21 hospital nursing stakeholders. FINDINGS: Nurses described integrated fatigue monitoring and management activities to pursue balance between work demands and capacity to meet those demands as individual nurses, within the unit, across the hospital, and over time. Seven principles were identified and applied to 2 initial design concepts for tools to support FRM. Participants' feedback on designs was positive. CONCLUSIONS: This study advances the science and practice for FRM in nursing. The design principles and concepts from this study can be used to facilitate implementation of FRM systems in hospitals.

Learning from incidents in medically assisted reproduction: the Notify Library as a learning tool.

Biovigilance is the systematic monitoring of serious adverse reactions and events (SARE) that ensures the quality and safety of tissues and cells for human application in medically assisted reproduction (MAR). The Notify Library is an open access database launched by the World Health Organization and supported by the Italian National Transplant Centre (CNT) that has collected information on documented adverse occurrences in transplantation, transfusion and MAR. It is not a SARE register, but rather a collection of SARE types identified primarily by review of published articles and case reports from national or regional vigilance programmes. The Notify Library includes many well-documented records of adverse occurrences in MAR treatment, representing a useful tool for MAR operators in the evaluation of the risks associated with the clinical application of reproductive tissues and cells. It is updated with new records when a new type of incident is reported for the first time. All incident types described might have teaching value during the risk management carried out by a MAR centre. Sharing lessons learned from these incidents represents an important didactic opportunity that can help MAR centres to improve their processes and to achieve higher standards of quality and safety.

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.

The Impact of the COVID-19 2020 Pandemic on Hospital Length of Stay Following Fragility Hip Fracture Surgery.

BACKGROUND: Hip fractures in elderly patients are a major cause of morbidity and mortality. Variability in length of hospital stay (LOS) was evident in this population. The coronavirus disease-2019 (COVID-19) pandemic led to prompt discharge of effected patients in order to reduce contagion risk. LOS and discharge destination in COVID-19 negative patients has not been studied. OBJECTIVES: To evaluate the LOS and discharge destination during the COVID-19 outbreak and compare it with a similar cohort in preceding years. METHODS: A retrospective study was conducted comparing a total of 182 consecutive fragility hip fracture patients operated on during the first COVID-19 outbreak to patients operated on in 2 preceding years. Data regarding demographic, co-morbidities, surgical management, hospitalization, as well as surgical and medical complications were retrieved from electronic charts. RESULTS: During the pandemic 67 fragility hip fracture patients were admitted (COVID group); 55 and 60 patients were admitted during the same time periods in 2017 and 2018, respectively (control groups). All groups were of similar age and gender. Patients in the COVID group had significantly shorter LOS (7.2 ± 3.3 vs. 8.9 ± 4.9 days, P = 0.008) and waiting time for a rehabilitation facility (7.2 ± 3.1 vs. 9.3 ± 4.9 days, P = 0.003), but greater prevalence of delirium (17.9% vs. 7% of patients, P = 0.028). In hospital mortality did not differ among groups. CONCLUSIONS: LOS and time to rehabilitation were significantly shorter in the COVID group. Delirium was more common in this group, possibly due to negative effects of social distancing.

Myocarditis and Pericarditis After COVID-19 mRNA Vaccination: Practical Considerations for Care Providers.

The mRNA vaccines against COVID-19 infection have been effective in reducing the number of symptomatic cases worldwide. With widespread uptake, case series of vaccine-related myocarditis/pericarditis have been reported, particularly in adolescents and young adults. Men tend to be affected with greater frequency, and symptom onset is usually within 1 week after vaccination. Clinical course appears to be mild in most cases. On the basis of the available evidence, we highlight a clinical framework to guide providers on how to assess, investigate, diagnose, and report suspected and confirmed cases. In any patient with highly suggestive symptoms temporally related to COVID-19 mRNA vaccination, standardized workup includes serum troponin measurement and polymerase chain reaction testing for COVID-19 infection, routine additional lab work, and a 12-lead electrocardiogram. Echocardiography is recommended as the imaging modality of choice for patients with unexplained troponin elevation and/or pathologic electrocardiogram changes. Cardiovascular specialist consultation and hospitalization should be considered on the basis of the results of standard investigations. Treatment is largely supportive, and myocarditis/pericarditis that is diagnosed according to defined clinical criteria should be reported to public health authorities in every jurisdiction. Finally, we recommend COVID-19 vaccination in all individuals in accordance with the Health Canada and National Advisory Committee on Immunization guidelines. In patients with suspected myocarditis/pericarditis after the first dose of an mRNA vaccine, deferral of a second dose is recommended until additional reports become available.

Mitigation of in-hospital risk of coronavirus disease 2019: Experience from a haematology-oncology and stem cell transplant setting.

Background: . Coronavirus disease 2019 (Covid-19) was first described in December 2019 and has evolved into an ongoing global pandemic. Cancer patients on chemotherapy are immunocompromised and are at the highest risk of Covid-19-related complications. We describe our experience with the management of haematology-oncology and stem cell transplant (SCT) patients receiving curative chemotherapy in a hospital with a high influx of Covid-19 patients. Methods: . We did a prospective observational study at a 99-bedded cancer centre of a tertiary care teaching hospital from April 2020 to September 2020. Preventive measures taken were categorized as follows: (i) staff: screening, mandatory use of personal protective equipment (PPE), risk stratification of potential exposure and testing and isolation as needed; (ii) patients: mandatory viral polymerase chain reaction testing, segregation of positive and untested patients and testing of family members; and (iii) environment: mandatory regular cleaning, visitor restriction, telemedicine services and reassignment of priority to clinic visits. Treatment of the underlying conditions was continued with added precautions. Results: . A total of 54 patients were included in the analysis, including 48 with haematological malignancies and 6 for stem cell therapy. Preventive measures were universally applied, and chemotherapy with a curative intent was initiated as per protocol. Three patients were detected to have Covid-19 infection before admission and one after the institution of chemotherapy. Nine patients died after the first cycle of chemotherapy, 2 due to severe Covid-19-related illness and 7 due to complications of chemotherapy or disease progression. Conclusions: . In the wake of the Covid-19 pandemic, treatment for haematological malignancies must continue while balancing the risk of Covid-19 infections. Our report emphasizes the effectiveness of measures such as hand hygiene, social isolation, patient segregation, use of masks and PPE and universal pre-treatment testing for Covid-19 in reducing the risk of infection in a high-risk clinical setting.

Coercive pressure as a moderator of organizational structure and risk management: Empirical evidence from Malaysian construction industry.

INTRODUCTION: The construction industry in Malaysia has been bedevilled by myriads of risk issues that have hampered its smooth operations in recent times. This paper is an empirical assessment that aims to examine the effect of coercive pressure on the relationship between organizational structure and construction risk management among construction industry in Malaysia. METHOD: Based on the proposed model, a quantitative method was employed to obtain data from G7 construction industry operating within the peninsular Malaysia. Out of the 180 copies of questionnaire, 165 copies were properly filled, returned, and used for the analysis. PLS-SEM was used to analyze the obtained data. RESULTS: The findings of the study affirmed that specialization, centralization, and management of risk by the construction industry had positive correlation. CONCLUSIONS: As anticipated, coercive pressure had positive moderating correlation with both formalization and the management of risk by the construction industry. Similarly, it was also found that in the course of carrying out construction activities, coercive pressure made significant interactive influence on formalization, specialization, and centralization. Practical Applications: Coercive pressure reduced the frequency of accidents among workers in the process of carrying out construction works.

[Occupational health nurse: prevention of workplace risks in a multidisciplinary team]. / L'infirmier de santé au travail : prévention et sécurité en équipe pluridisciplinaire.

The presence of nurses within occupational health care teams is now mandatory. Their role, centred on prevention, health protection and employees' safety, is practised under the authority and in close collaboration with the occupational health doctor, within a multidisciplinary team. Over recent years, their scope of practice has been expanded to include the individual monitoring of employees' health. It could be further expanded in future.

Transnasal endoscopic skull base surgery in the COVID-19 era: Recommendations for increasing the safety of the method.

Transnasal endoscopic skull base surgery (eSBS) has been adopted in recent years, in great part to replace the extended procedures required by external approaches. Though sometimes perceived as "minimally invasive", eSBS still necessitates extensive manipulations within the nose/paranasal sinuses. Furthermore, exposure of susceptible cerebral structures to light and heat emanated by the telescope should be considered to comprehensively evaluate the safety of the method. While the number of studies specifically targeting eSBS safety still remains scarce, the problem has recently expanded with the SARS-CoV-2 pandemic, which also has implications for the safety of the surgical personnel. It must be stressed that eSBS may directly expose the surgeon to potentially high volumes of virus-contaminated aerosol. Thus, the anxiety of both the patient and the surgeon must be taken into account. Consequently, safety requirements must follow the highest standards. This paper summarizes current knowledge on SARS-CoV-2 biology and the peculiarities of human immunology in respect of the host-virus relationship, taking into account the latest information concerning the SARS-CoV-2 worrisome affinity for the nervous system. Based on this information, a workflow proposal is offered for consideration. This could be useful not only for the duration of the pandemic, but also during the unpredictable timeline involving our coexistence with the virus. Recommendations include technical modifications to the operating theatre, personal protective equipment, standards of testing for SARS-CoV-2 infection, prophylactic pretreatment with interferon, anti-IL6 treatment and, last but not least, psychological support for the patient.

Medication incident recovery and prevention utilising an Australian community pharmacy incident reporting system: the QUMwatch study.

PURPOSE: To identify factors in community pharmacy that facilitate error recovery from medication incidents (MIs) and explore medication safety prevention strategies from the pharmacist perspective. METHODS: Thirty community pharmacies in Sydney, Australia, participated in a 30-month prospective incident reporting program of MIs classified in the Advanced Incident Management System (AIMS) and the analysis triangulated with case studies. The main outcome measures were the relative frequencies and patterns in MI detection, minimisation, restorative actions and prevention recommendations of community pharmacists. RESULTS: Participants reported 1013 incidents with 831 recovered near misses and 165 purported patient harm. MIs were mainly initiated at the prescribing (68.2%) and dispensing (22.6%) stages, and most were resolved at the pharmacy (76.9%). Detection was efficient within the first 24 h in 54.6% of MIs, but 26.1% required one month or longer; 37.2% occurred after the patient consumed the medicine. The combination of specific actions/attributes (85.5%), appropriate interventions (81.6%) and effective communication (77.7%) minimised MIs. An array of remedial actions were conducted by participants including notification, referral, advice, modification of medication regimen, risk management and documentation corrections. Recommended prevention strategies involved espousal of medication safety culture (97.8%), better application of policies/procedures (84.6%) and improvements in healthcare providers' education (79.9%). CONCLUSION: Incident reporting provided insights on the human and organisational factors involved in the recovery of MIs in community pharmacy. Optimising existing safeguards and redesigning certain structures and processes may enhance the resilience of the medication use system in primary care.

Lessons Learned from Rwanda: Innovative Strategies for Prevention and Containment of COVID-19.

Introduction: Rwanda has made significant advancements in medical and economic development over the last 20 years and has emerged as a leader in healthcare in the East African region. The COVID-19 pandemic, which reached Rwanda in March 2020, presented new and unique challenges for infectious disease control. The objective of this paper is to characterize Rwanda's domestic response to the first year of the COVID-19 pandemic and highlight effective strategies so that other countries, including high and middle-income countries, can learn from its innovative initiatives. Methods: Government publications describing Rwanda's healthcare capacity were first consulted to obtain the country's baseline context. Next, official government and healthcare system communications, including case counts, prevention and screening protocols, treatment facility practices, and behavioral guidelines for the public, were read thoroughly to understand the course of the pandemic in Rwanda and the specific measures in the response. Results: As of 31 December 2020, Rwanda has recorded 8,383 cumulative COVID-19 cases, 6,542 recoveries, and 92 deaths since the first case on 14 March 2020. The Ministry of Health, Rwanda Biomedical Centre, and the Epidemic and Surveillance Response division have collaborated on preparative measures since the pandemic began in January 2020. The formation of a Joint Task Force in early March led to the Coronavirus National Preparedness and Response Plan, an extensive six-month plan that established a national incident management system and detailed four phases of a comprehensive national response. Notable strategies have included disseminating public information through drones, robots for screening and inpatient care, and official communications through social media platforms to combat misinformation and mobilize a cohesive response from the population. Conclusion: Rwanda's government and healthcare system has responded to the COVID-19 pandemic with innovative interventions to prevent and contain the virus. Importantly, the response has utilized adaptive and innovative technology and robust risk communication and community engagement to deliver an effective response to the COVID-19 pandemic.

ESSD Commentary on Dysphagia Management During COVID Pandemia.

Since the World Health Organization declared the COVID-19 pandemic a Global Public Health Emergency, experts in swallowing are seeking guidance on service delivery and clinical procedures. The European Society for Swallowing Disorders provides considerations to support experts in swallowing disorders in clinical practice. During the COVID-19 pandemic, assessment and treatment of patients with oropharyngeal dysphagia should be provided, while at the same time balancing risk of oropharyngeal complications with that of infection of patients and healthcare professionals involved in their management. Elective, non-urgent assessment may be temporarily postponed and patients are triaged to decide whether dysphagia assessment is necessary; instrumental assessment of swallowing is performed only if processing of the instruments can be guaranteed and clinical assessment has not provided enough diagnostic information for treatment prescription. Assessment and management of oropharyngeal dysphagia is a high-risk situation as it must be considered an aerosol-generating procedure. Personal protective equipment (PPE) should be used. Telepractice is encouraged and compensatory treatments are recommended.