Seguridad del Paciente en Medicina Intensiva. Aspectos bioéticos / Patient Safety in Intensive Care Medicine. Bioethical aspects / Seguretat del Pacient en Medicina Intensiva. Aspectes bioètics

La Seguridad del Paciente se ha convertido en un reto y en una prioridad de todos los sistemas sanitarios. Se ha implantado políticas internacionales con el objetivo de reducir el número de incidentes relacionados con Seguridad del Paciente. Todavía son muchos los pacientes que sufren daños derivados de la atención sanitaria. Además, su impacto se extiende no solo a los familiares y allegados, sino también a los propios profesionales, a las instituciones sanitarias y todo ello con un coste económico y emocional con importantes consecuencias para todos los implicados. La mayoría de estudios realizados han ido dirigidos a conocer la epidemiología de los eventos adversos, a conocer sus causas y sus consecuencias. Se han promovido numerosas prácticas seguras con el objetivo de reducir los riesgos relacionados con la atención sanitaria. Recientemente han cobrado mayor relevancia aspectos relacionados con la actuación posterior a un evento adverso (EA). La gestión del riesgo implica entre otras acciones, la identificación, notificación y el análisis de los EA que señalen los fallos latentes en el sistema y la causa raíz con el objetivo último de establecer acciones de mejora y evitar su recurrencia. De forma paulatina estas estrategias se han ido incorporando en las políticas institucionales y mejorando con ello la cultura de seguridad. Pero todavía existen partes del proceso, que en nuestro ámbito se encuentran en su etapa más inicial, tales como el proceso de información sobre los EA a los pacientes y sus familiares y el soporte a los profesionales tras verse implicados en un EA. Todo ello debe construirse en un marco de confianza y credibilidad

Patient Safety has become a challenge and a priority of all healthcare systems. International policies have been implemented with the aim of reducing the number of incidents related to Patient Safety. There are still many patients who suffer damages derived from health care. In addition, its impact extends not only to family members and relatives, but also to the professionals themselves, to health institutions and all of this at an economic and emotional cost with important consequences for all those involved. Most studies have been directed to know the epidemiology of adverse events (AE), to know their causes and their consequences. Numerous safe practices have been promoted with the aim of reducing the risks related to health care. Recently, aspects related to post-AE performance have become more relevant. Risk management involves, among other actions, the identification, notification and analysis of the AE that point out latent failures in the system and the root cause with the ultimate goal of establishing improvement actions and avoiding their recurrence. Gradually these strategies have been incorporated into institutional policies and thereby improving the safety culture. But there are still parts of the process, which in our area are in their most initial stage, such as the process of informing about AE to patients and their families and the supoort to professionlas after being involved in an AE. All this must be built in a framework of trust and credibility

La seguretat del pacient s'ha convertit en un repte i en una prioritat de tots els sistemes sanitaris. S'han implantat polítiques internacionals amb l'objectiu de reduir el nombre d'incidents relacionats amb la seguretat del pacient. Encara són molts els pacients que sofreixen danys derivats de l'atenció sanitària. A més, el seu impacte s'estén no només als familiars i afins, sinó també als propis professionals, a les institucions sanitàries i tot això amb un cost econòmic i emocional amb importants conseqüències per a tots els implicats. La majoria d'estudis realitzats han anat dirigits a conèixer l'epidemiologia dels esdeveniments adversos, a conèixer les seves causes i les seves conseqüències. S'han promogut nombroses pràctiques segures amb l'objectiu de reduir els riscos relacionats amb l'atenció sanitària. Recentment han cobrat major rellevància els aspectes relacionats amb l'actuació posterior a un EA (esdeveniment advers). La gestió del risc implica entre altres accions, la identificació, notificació i l'anàlisi dels EA que assenyalin les fallades latents en el sistema i la causa arrel de les mateixes amb l'objectiu últim d'establir accions de millora i evitar-ne la recurrència. De forma gradual, aquestes estratègies s'han anat incorporant en les polítiques institucionals millorant amb això la cultura de seguretat. Però encara existeixen parts del procés, que en el nostre àmbit es troben en la seva etapa més inicial, tals com el procés d'informació sobre els EA als pacients i els seus familiars i el suport als professionals després de veure's implicats en un EA. Tot això ha de construir-se en un marc de confiança i credibilitat

Ethical leadership, nursing error and error reporting from the nurses' perspective.

BACKGROUND: Nursing errors endanger patient safety, and error reporting helps identify errors and system vulnerabilities. Nursing managers play a key role in preventing nursing errors by using leadership skills. One of the leadership approaches is ethical leadership. AIM: This study determined the level of ethical leadership from the nurses' perspective and its effect on nursing error and error reporting in teaching hospitals affiliated to Shahid Sadoughi University of Medical Sciences, Yazd, Iran. RESEARCH DESIGN: This was a cross-sectional descriptive study. PARTICIPANTS AND RESEARCH CONTEXT: A total of 171 nurses working in medical-surgical wards were selected through random sampling. Data collection was carried out using "ethical leadership in nursing, nursing errors and error reporting" questionnaires. Data were analyzed with SPSS20 using descriptive and analytical statistics. ETHICAL CONSIDERATIONS: This study was approved by the Ethics Committee for Medical Research. Ethical considerations such as completing informed consent form, ensuring confidentiality of information, explaining research objectives, and voluntary participation were observed in the present study. FINDINGS: The results showed that the level of nursing managers' ethical leadership was moderate from the nurses' point of view. The highest and the lowest levels were related to the power-sharing and task-oriented dimensions, respectively. There was a significant relationship between nursing managers' level of ethical leadership with error rates and error reporting. CONCLUSION: The development of ethical leadership approach in nursing managers reduces error rate and increases error reporting. Programs designed to promote such approach in nursing managers at all levels can help reduce the level of error rate and maintain patient safety.

How Should Gene Editing Be Managed by Risk Managers?

Gene editing, because it is a new technology, presents challenges to health care organizations' risk managers. At this time, little claims data exists upon which to make informed decisions about loss control and to draw upon when developing risk mitigation strategies. This article explores gene editing through the eyes of risk managers and underwriters and concludes that traditional risk management tools must be used to reduce risk until more is known about the frequency and severity of claims.

What Should Clinicians Do to Engage the Public About Gene Editing?

Genome editing holds tremendous promise for preventing, ameliorating, or even curing disease, but a thorough discussion of its bioethical and social implications is necessary to protect humankind against harm, a central tenet of the original Hippocratic Oath. It is therefore essential that medical students, physicians, and all health care workers have a working understanding of what gene editing entails, the controversy surrounding its use, and its far-reaching clinical and ethical implications.

Welfare Checks for Suicide Risk Management: Risks and Benefits.

In clinical practice, welfare checks have become a fairly common aspect of suicide prevention. At the same time, there is almost no guidance in the medical literature to inform clinicians under what circumstances welfare checks should be requested, how best to go about placing those requests, or how to document decision-making around this important subject. Literature searches spanning both PubMed and Google Scholar fail to yield any applicable results. Performed correctly, welfare checks have the potential to be life-saving interventions for persons in suicidal crises. Performed incorrectly, the welfare check may become an overly defensive practice that damages therapeutic relationships, violates patients' rights, and consumes important and limited community resources. The need for thoughtful guidance to assist clinicians in navigating these difficult clinical scenarios is long overdue. This article, the first in a 2-part series, will describe welfare checks and explore their potential risks and benefits.

Responsibility, planning and risk management: moralizing everyday finance through financial education.

The individualization, privatization and marketization of risk management represent a fundamental dimension of the financialization of everyday life. As individuals are required to engage with financial products and services as the main way of protecting themselves from risks and uncertainties, their economic welfare and security are construed as depending largely on their own financial decisions. Within this setting, the concept of financial literacy and accompanying practices of financial education have emerged as a prominent institutional field handling the formulation and communication of the attributes and dispositions that arguably constitute the proper financial actor. This article analyzes financial education programmes currently conducted by state agencies in Israel, examining the notions and principles they articulate when defining and explaining proper financial conduct. The study indicates that moral themes and categories occupy a salient place in the formulation of the character traits that constitute the desired literate financial actor. Notions of individual responsibility, planning ahead and rational risk management are presented not merely as instrumental resources, but as moral imperatives. Through these notions, the programmes moralize a broad array of everyday practices of personal finance such as saving, investing, borrowing and budget management, thereby connecting the sphere of financial matters to the domain of moral virtues. Offering a representation of particular modes of financial conduct as constitutive components of morally virtuous personhood, these practices imbue the financial field as a whole, especially its current generalized logic of individualized and marketized risk management, with moral meanings, hence contributing to the normalization and depoliticization of the financialization of everyday life.

Who is responsible for automated driving? A macro-level insight into automated driving in the United Kingdom using the Risk Management Framework and Social Network Analysis.

To date, vehicle manufacturers have largely been left to their own initiatives when it comes to the design, development and implementation of automated driving features. Whilst this has enabled developments within the field to accelerate at a rapid pace, we are also now beginning to see the negative aspects of automated design (e.g., driver complacency, automation misuse and ethical dilemmas). It is therefore becoming increasingly important to identify systemic aspects that can address some of these Human Factors challenges. This paper applies the principles of the Risk Management Framework to explore the wider systemic issues associated with automated driving in the United Kingdom through the novel application of network metrics. The authors propose a number of recommendations targeted at each level of the Risk Management Framework that seek to shift the power of influence away from vehicle manufacturers and back into the hands of governing bodies.

Toward a Responsibility-Catering Prioritarian Ethical Theory of Risk.

Standard tools used in societal risk management such as probabilistic risk analysis or cost-benefit analysis typically define risks in terms of only probabilities and consequences and assume a utilitarian approach to ethics that aims to maximize expected utility. The philosopher Carl F. Cranor has argued against this view by devising a list of plausible aspects of the acceptability of risks that points towards a non-consequentialist ethical theory of societal risk management. This paper revisits Cranor's list to argue that the alternative ethical theory responsibility-catering prioritarianism can accommodate the aspects identified by Cranor and that the elements in the list can be used to inform the details of how to view risks within this theory. An approach towards operationalizing the theory is proposed based on a prioritarian social welfare function that operates on responsibility-adjusted utilities. A responsibility-catering prioritarian ethical approach towards managing risks is a promising alternative to standard tools such as cost-benefit analysis.

Empowering Engineering Students in Ethical Risk Management: An Experimental Study.

The complexity of industrial reality, the plurality of legitimate perspectives on risks and the role of emotions in decision-making raise important ethical issues in risk management that are usually overlooked in engineering. Using a questionnaire answered by 200 engineering students from a major engineering school in Canada, the purpose of this study was to assess how their training has influenced their perceptions toward these issues. While our results challenge the stereotypical portrait of the engineer, they also suggest that the current engineering education might fail to empower engineers to engage in ethical risk management. We therefore propose an active-learning method to help in this matter. Carried out through workshops with 34 students in chemical engineering, the effectiveness of this method has been evaluated using group interviews and questionnaires. Our results suggest that such an approach is effective, at least in the short run, to motivate students to engage in ethical risk management and to trigger reflectivity on what it means to be an engineer today.

Borderline personality disorder and the ethics of risk management: The action/consequence model.

Patients with borderline personality disorder are frequent users of inpatient mental health units, with inpatient crisis intervention often used based on the risk of suicide. However, this can present an ethical dilemma for nursing and medical staff, with these clinician responses shifting between the moral principles of beneficence and non-maleficence, dependent on the outcomes of the actions of containing or tolerating risk. This article examines the use of crisis intervention through moral duties, intentions and consequences, culminating in an action/consequence model of risk management, used to explore potential outcomes. This model may be useful in measuring adherence and violation of the principles of beneficence and non-maleficence and therefore an aid to clinical decision making.

Big Data in Genomics: ethical challenges and risks / 'Big Data' en genómica: retos y riesgos éticos / 'Big Data' en genòmica: reptes i riscos ètics

Genomic information is a class of Big Data in expanding use thanks to technological developments. Here, we review three categories of ethical risks and challenges associated with genomic information: privacy issues, the management of incidental findings, and challenges in data storage and sharing. First, we need to implement strong mechanisms to protect privacy, but genomic data faces specific risks and we need to acknowledge the possibility of re-identification. Proper usage of genomic information has to be regulated, including recommendations on incidental finding management. Also, clear policies for data sharing and explicit efforts to promote central repositories of genomic data should be established. However, technology and new applications of genetic information will develop fast and we should anticipate potential new risks

La información genómica es un tipo de 'Big Data' de uso creciente debido a mejoras tecnológicas. En este trabajo, revisamos tres grupos de retos y riesgos éticos asociados con esta información: riesgos de privacidad, gestión de los hallazgos incidentales y retos en el almacenamiento y compartición de datos. En primer lugar, debemos establecer mecanismos sólidos para proteger la privacidad, pero los datos genómicos presentan riesgos específicos y debemos admitir la posibilidad de reidentificación. Hay que regular el uso adecuado de la información genómica incluyendo recomendaciones para la gestión de los hallazgos incidentales. También hay que establecer políticas claras para compartir datos y fomentar el uso de repositorios de datos genómicos. No obstante, debemos esperar desarrollos rápidos en la tecnología y nuevas aplicaciones de la información genética, y debemos anticiparnos a los futuros riesgos potenciales

La informació genòmica és un tipus de 'Big Data' d’ús creixent a causa de millores tecnològiques. En aquest treball, revisem tres grups de reptes i riscos ètics associats amb aquesta informació: riscos de privadesa, gestió de les troballes incidentals i reptes en l'emmagatzematge i compartició de dades. En primer lloc, hem d’establir mecanismes sòlids per protegir la privadesa, però les dades genòmiques presenten riscos específics i hem d'admetre la possibilitat de reidentificació. Cal regular l'ús adequat de la informació genòmica incloent-hi recomanacions per a la gestió de les troballes incidentals. També cal establir polítiques clares per compartir dades i fomentar l'ús de repositoris de dades genòmiques. No obstant això, hem d'esperar desenvolupaments ràpids a la tecnologia i noves aplicacions de la informació genètica, i hem d'anticipar-nos als riscos potencials futurs

Nuevos perfiles jurídicos del acto médico: responsabilidad derivada del screening genético / No disponible

El screening de enfermedades genéticas en donantes viene enmarcado dentro del proceso de selección y evaluación de los donantes de células reproductoras en procesos de técnicas de reproducción asistida, derivado de la necesidad reconocida por todas las sociedades científicas relacionadas con la donación de gametos, de realizar una historia clínica al donante que recoja sus antecedentes personales y familiares. El presente trabajo analiza las obligaciones legales y la responsabilidad derivada del mismo

The screening of genetic diseases in donors is framed within the process of selection and evaluation of donors of reproductive cells in processes of assisted reproduction techniques, derived from the need recognized by all scientific societies related to gamete donation, making a donor medical history to collect their personal and family history. This paper analyzes the legal obligations and liability arising the refrom