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1.
J Surg Res ; 257: 221-226, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32858323

RESUMO

BACKGROUND: The Accreditation Council for Graduate Medical Education has defined six core competencies (CCs) that every successful physician should possess. However, the assessment of CC achievement among trainees is difficult. This project was designed to prospectively evaluate the impact of resident identification of CC as a component of morbidity review on error identification and standard of care (SOC) assessments. The platform was assessed for its reliability as a measure of resident critical analysis of complication causality across postgraduate year (PGY). MATERIALS AND METHODS: A total of 1945 general surgery cases with complications were assessed for error identification and SOC management between January 1, 2016, and December 31, 2018. CC identification was additionally assessed between January 1, 2019, and December 31, 2019, and included 708 general surgery cases. Data were evaluated for error assessments and overall SOC management. PGY4 and 5 residents were compared for number of cases and complications reviewed, severity, error causation, and CC relevance. RESULTS: Study groups were equivalent by Clavien-Dindo scores. Error identification significantly increased in all categories: diagnostic (P < 0.001), technical (P < 0.05), judgment (P < 0.001), system (P < 0.001), and communication (P < 0.001). Overall SOC assessments validated by a supervising surgical quality officer were unchanged. An increased exposure to cases with severe complications, error causation, and CC relevance was noted across PGY. CONCLUSIONS: The addition of CC assessment into morbidity review appears to improve the critical thinking of evaluating residents by increasing the identification of management errors. Used as an element of prospective self-assessment, teaching residents to identify CC principles in cases with complications may assist in learner progression toward clinical competence and critical thinking.


Assuntos
Educação Baseada em Competências/métodos , Cirurgia Geral/educação , Complicações Pós-Operatórias/prevenção & controle , Autoavaliação , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Competência Clínica , Seguimentos , Humanos , Internato e Residência , Erros Médicos/efeitos adversos , Erros Médicos/prevenção & controle , Dano ao Paciente/prevenção & controle , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Cirurgiões/psicologia , Procedimentos Cirúrgicos Operatórios/educação
2.
Rev. medica electron ; 42(6): 2487-2498, nov.-dic. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1150032

RESUMO

RESUMEN Introducción: el control de daños en Ortopedia es aplazar la reparación definitiva de lesiones traumáticas, con el objetivo de la recuperación fisiológica deteriorada por lesiones y/o complicaciones que pueden poner en peligro la vida, realizando entonces procedimientos quirúrgicos sencillos, como una estabilización quirúrgica externa de las fracturas. Objetivo: determinar el comportamiento del control de daños ortopédicos en politraumatizados pediátricos. Materiales y método: se realizó un estudio observacional, descriptivo, prospectivo, de corte transversal, de enero del 2015 a diciembre del 2018. El universo estuvo constituido por 22 pacientes menores de 19 años de edad, politraumatizados en el período; la muestra por 15 pacientes, a los que se les aplicó control de daños ortopédicos, según criterios de selección. Resultados: se aplicó control de daños ortopédicos a 15 infantes. El más afectado fue el sexo masculino con el 73,3 %. Prevalecieron los traumatismos de los miembros inferiores con el 58,3 % y las fracturas cerradas con un 53,8 %. La osteomielitis crónica fue la complicación que predominó, en el 20 % de la muestra. En el 73,3 % de los casos se evaluó como satisfactoria la aplicación del control de daños ortopédicos en los politraumatizados. Conclusiones: a la totalidad de los traumatizados se le aplicó control de daños ortopédicos. Predominó el sexo masculino y el grupo de edad de 9 -14 años. Los miembros inferiores aportan la mayor cantidad con el fémur y la tibia. El control de daños ortopédicos se evaluó satisfactoriamente en la mayoría de los pacientes estudiados (AU).


ABSTRAC Introduction: the control of damages in Orthopedics is to postpone the definitive repair of traumatic lesions, with the objective of the physiologic recovery deteriorated by lesions and/or complications that can put in danger the life, carrying out simple surgical procedures, like an external surgical stabilization of the fractures at that time. . Objective: to determine the behavior of the orthopedic damage control in pediatric politraumatized patients. Material and method: a cross-sectional, prospective, descriptive, observational study was carried out from January 2015 to December 2018. The universe was formed by 22 patients younger than 19 years politraumatized in the period and the sample formed 15 patients; they underwent orthopedic damage control, according to the selection criteria. Results: the orthopedic damage control, was applied to 15 children. Male sex was the most affected one. Trauma in the lower limbs with 58.3 % and closed fractures with 53.8 prevailed. The predominating complication was chronic poliomyelitis in 20 % of the sample. The orthopedic damage control in politraumatized patients was assessed as successful in 73.3 % of the cases. Conclusions: the orthopedic damage control was applied to the total of traumatized patients. The male sex and the 9-14 years-old age group predominated. Lower limbs contributed with the biggest quantity of trauma, in femur and tibia. The orthopedic damage control was assessed as successful in most of studied patients (AU).


Assuntos
Humanos , Masculino , Feminino , Traumatismo Múltiplo/prevenção & controle , Criança , Dano ao Paciente/prevenção & controle , Ortopedia/métodos , Procedimentos Cirúrgicos Menores/métodos , Ferimentos e Lesões/prevenção & controle , Procedimentos Ortopédicos/métodos , Fraturas Fechadas/diagnóstico , Fraturas Expostas/diagnóstico
3.
Rev. enferm. UERJ ; 28: e48578, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1116102

RESUMO

Objetivo: conhecer a experiência dos pais como estratégia de avaliação da qualidade da assistência de enfermagem. Método: pesquisa descritiva com abordagem qualitativa, desenvolvida na Unidade Neonatal de um Hospital do sul do Brasil. A coleta de dados foi realizada através de entrevistas, utilizando a técnica do incidente crítico (TIC), com 18 pais que estavam com seus filhos internados por 20 dias ou mais e que tinham previsão e plano de alta hospitalar. Após, os dados foram submetidos à análise de conteúdo. Resultados: a análise revelou fragilidades no cuidado prestado pela equipe de enfermagem em relação à administração de medicamentos, ao uso de equipamentos, à monitorização e ao posicionamento dos bebês, aos cuidados com a pele e à higiene de mãos. Conclusão: a experiência dos pais revelou elementos que integram a avaliação da assistência em enfermagem, destacando-os como pilares para a segurança do paciente.


Objective: to learn the parents' experience as a strategy for assessing the quality of nursing care. Method: in this qualitative, descriptive study at the Neonatal Unit of a hospital in southern Brazil, data were collected by critical incident (CI) interviews of 18 parents whose children had been hospitalized for 20 days or more, and whose discharge was scheduled and planned for. The data subsequently underwent content analysis. Results: data analysis revealed weaknesses in the care provided by the nursing staff as regards administration of medication, use of equipment, monitoring and positioning of babies, skin care and hand hygiene. Conclusion: The parents' experience revealed elements that enter into evaluation of nursing care, revealing parents to be mainstays of patient safety.


Objetivo: conocer la experiencia de los padres como estrategia para evaluar la calidad de la atención de enfermería. Método: en este estudio cualitativo y descriptivo en la Unidad Neonatal de un hospital en el sur de Brasil, los datos fueron recolectados por entrevistas de incidentes críticos (IC) de 18 padres cuyos hijos habían estado hospitalizados durante 20 días o más, y cuyo alta fue programada y planificada para. Los datos posteriormente se sometieron a análisis de contenido. Resultados: el análisis de datos reveló debilidades en la atención brindada por el personal de enfermería en lo que respecta a la administración de medicamentos, uso de equipos, monitoreo y posicionamiento de bebés, cuidado de la piel e higiene de manos. Conclusión: la experiencia de los padres reveló elementos que entran en la evaluación de la atención de enfermería, revelando que los padres son pilares de la seguridad del paciente.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Adulto , Pais , Qualidade da Assistência à Saúde , Unidades de Terapia Intensiva Neonatal/normas , Segurança do Paciente , Equipe de Enfermagem/normas , Análise e Desempenho de Tarefas , Brasil , Terapia Intensiva Neonatal , Pesquisa Qualitativa , Dano ao Paciente/prevenção & controle
4.
Gac. sanit. (Barc., Ed. impr.) ; 34(5): 500-513, sept.-oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198874

RESUMO

OBJETIVO: 1) Determinar la percepción de seguridad que tienen los/las profesionales sanitarios/as y no sanitarios/as en un hospital universitario; 2) describir el clima de seguridad con sus fortalezas y debilidades; y 3) evaluar las dimensiones valoradas negativamente y establecer áreas de mejoras. MÉTODO: Estudio transversal y descriptivo realizado en el Hospital Universitario San Juan de Alicante en el que se recogen los resultados de la valoración del nivel de cultura de seguridad utilizando como instrumento de medición la encuesta Hospital Survey on Patient Safety Culture de la Agency for Healthcare Research and Quality adaptada al español. RESULTADOS: La tasa de respuesta fue del 35,36%. El colectivo con mayor participación fue el médico (32,3%), y el servicio más implicado, el de urgencias (9%). El 86,4% tuvo contacto con el paciente. El 50% de los/las trabajadores/as calificó el clima de seguridad entre 6 y 8 puntos. El 82,8% no notificó ningún evento adverso en el último año. Los profesionales con mayor cultura de seguridad fueron los farmacéuticos, y los que tuvieron peor cultura, los celadores. No se identificó ninguna fortaleza de manera global. Hubo dos dimensiones que se comportaron como una debilidad: la 9 (dotación de personal) y la 10 (apoyo de la gerencia a la seguridad del paciente). CONCLUSIONES: La percepción sobre seguridad del paciente es buena, aunque mejorable. No se han identificado fortalezas. Las debilidades identificadas son dotación de personal, apoyo de la gerencia a la seguridad del paciente, cambios de turno y transición entre servicios, y percepción de seguridad


OBJECTIVE: 1) To determine the perception of safety of health professionals and non-health professionals in a university hospital; 2) describe the climate of safety with its strengths and weaknesses; 3) evaluate the negatively valued dimensions and establish areas of improvement. METHOD: A cross-sectional and descriptive study carried out at the San Juan University Hospital in Alicante, where the results of the assessment of the safety culture level are collected using Hospital Survey On Patient Safety survey of the Agency for Healthcare Research and Quality adapted to Spanish language. RESULTS: The response rate was 35.36%. The group with the greatest participation was the physician (32.3%) and the service most involved, urgencies (9%). 86.4% had contact with the patient. 50% of workers rated the safety climate between 6 and 8 points. 82.8% did not report any adverse events in the last year. The professionals with the greatest security culture were the pharmacists and with the worst culture, the guards. No strength was identified globally. There were two dimensions that behaved like a weakness: 9 (staffing) and 10 (management support for patient safety). CONCLUSIONS: The patient's perception of safety is good, although it can be improved. No strengths have been identified. The weaknesses identified are staffing, management support for patient safety, handoffs and transitions, and safety perception


Assuntos
Humanos , Gestão da Segurança/organização & administração , Segurança do Paciente/estatística & dados numéricos , Ameaças/prevenção & controle , Dano ao Paciente/prevenção & controle , Cultura Organizacional , Hospitais Universitários/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Estudos Transversais , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Melhoria de Qualidade/tendências , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos
7.
J Nurs Adm ; 50(6): 349-354, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32427664

RESUMO

BACKGROUND: Speaking up is using one's voice to alert those in authority of concerns. Failure to speak up leads to moral distress; speaking up leads to moral courage. OBJECTIVE: The purpose of this study was to explore the influences of organizational culture, personal culture, and workforce generation on speaking-up behaviors among RNs. METHODS: We distributed a cross-sectional electronic survey to several thousand RNs, resulting in 303 usable surveys. RESULTS: Organizational culture was a strong predictor of speaking-up behaviors; speaking up partially mediated the relationship between organizational culture and moral distress but was not a mediator between organizational culture and moral courage. Workforce generation did not explain speaking up. CONCLUSIONS: The role of organizational culture supports efforts toward healthy work environments. Because not speaking up is related to moral distress, efforts must be escalated to empower nurses to use their voices.


Assuntos
Princípios Morais , Recursos Humanos de Enfermagem/estatística & dados numéricos , Cultura Organizacional , Dano ao Paciente/prevenção & controle , Estudos Transversais , Feminino , Humanos , Masculino , Recursos Humanos de Enfermagem/psicologia , Gestão da Segurança , Inquéritos e Questionários
9.
BMC Fam Pract ; 21(1): 20, 2020 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996137

RESUMO

BACKGROUND: Patient safety issues in primary health care and in emergency departments have not been as thoroughly explored as patient safety issues in the hospital setting. Knowledge is particularly sparse regarding which patients have a higher risk of harm in these settings. The objective was to evaluate which patient-related factors were associated with risk of harm in patients with reports of safety incidents. METHODS: A case-control study performed in primary health care and emergency departments in Sweden. In total, 4536 patients (cases) and 44,949 controls were included in this study. Cases included patients with reported preventable harm in primary health care and emergency departments from January 1st, 2011 until December 31st, 2016. RESULTS: Psychiatric disease, including all psychiatric diagnoses regardless of severity, nearly doubled the risk of being a reported case of preventable harm (odds ratio, 1.96; p < 0.001). Adjusted for income and education there was still an increased risk (odds ratio, 1.69; p < 0.001). The preventable harm in this group was to 46% diagnostic errors of somatic disease. CONCLUSION: Patients with psychiatric illness are at higher risk of preventable harm in primary care and the emergency department. Therefore, this group needs extra attention to prevent harm.


Assuntos
Erros de Diagnóstico/estatística & dados numéricos , Serviço Hospitalar de Emergência , Transtornos Mentais/epidemiologia , Dano ao Paciente/estatística & dados numéricos , Atenção Primária à Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Escolaridade , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Humanos , Renda/estatística & dados numéricos , Lactente , Recém-Nascido , Masculino , Erros de Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Dano ao Paciente/prevenção & controle , Fatores de Risco , Suicídio/estatística & dados numéricos , Suécia/epidemiologia , Adulto Jovem
11.
Rev. Rol enferm ; 43(1,supl): 507-513, ene. 2020. graf
Artigo em Português | IBECS | ID: ibc-193427

RESUMO

Background: Due to the disturbing data that have been published, health security has gained special notoriety. The involvement of manager nurses is a fundamental condition to ensure high hospital safety standards. These are responsible for promoting a safety culture in teams and for promoting safe environments. Objective: To know what areas manager nurses consider as priority in the safety of clients and nurses in a hospital service. Methodology: A phenomenological qualitative study carried out through a semistructured interview to 14 manager nurses of a hospital in the central region of Portugal, chosen by convenience. Content analysis was carried out using Atlas.ti software and Bardin methodology. Results and Discussion: We identified 11 priority areas in client safety that reflect concern about adverse events with higher incidence rates and their causes described as more significant. The 12 priority areas in occupational safety are in line with the known occupational hazards and the most frequent workplace accidents. There are 5 categories that show a relationship between nurses 'and clients' safety. Conclusion: For those interviewed, customer and professional safety are equally important and interrelated. It is understood that health security is complex and multidimensional and does not only imply client safety, this may be dependent on the safety of the nurse and vice versa. They also demonstrated knowledge of the main safety problems described in the literature


No disponible


Assuntos
Humanos , Administração dos Cuidados ao Paciente/organização & administração , Gestão da Segurança/organização & administração , Gestão da Qualidade , Dano ao Paciente/prevenção & controle , Dano ao Paciente/enfermagem , Gestão de Riscos/organização & administração , Medição de Risco/métodos , Pesquisa Qualitativa
13.
Int J Nurs Educ Scholarsh ; 16(1)2019 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-31760379

RESUMO

Despite extensive research and technological advancements, errors related to medication administration continue to rise annually. The body of evidence surrounding medication errors has focused largely on licensed practicing nurses. Nursing students can offer a unique perspective regarding medication administration as their foundation for professional psychomotor skills and cognitive abilities are developed. The purpose of this study was to explore the variables related to medication errors made by pre-licensure nursing students. Data were collected from 2013-2015 in a pre-licensure program. Students completed a post-error survey available in Google Forms. One hundred thirteen responses to the error report were completed. By exploring the factors related to medication errors among nursing students, teaching and learning strategies forming the foundations of medication administration can improve professional nursing practice and improve safety and quality of care.


Assuntos
Educação em Enfermagem/métodos , Erros de Medicação/enfermagem , Estudantes de Enfermagem/psicologia , Feminino , Humanos , Masculino , Erros de Medicação/prevenção & controle , Near Miss , Dano ao Paciente/enfermagem , Dano ao Paciente/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
14.
BMJ ; 366: l4185, 2019 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315828

RESUMO

OBJECTIVE: To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched. REVIEW METHODS: Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I2 statistic, and publication bias was evaluated. RESULTS: Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10). CONCLUSIONS: Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.


Assuntos
Prática Clínica Baseada em Evidências/métodos , Dano ao Paciente/prevenção & controle , Dano ao Paciente/tendências , Estudos Transversais , Prática Clínica Baseada em Evidências/normas , Humanos , Estudos Observacionais como Assunto , Dano ao Paciente/mortalidade , Segurança do Paciente , Prevalência , Melhoria de Qualidade , Estudos Retrospectivos , Índice de Gravidade de Doença
15.
J Gen Intern Med ; 34(11): 2355-2367, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31183688

RESUMO

BACKGROUND: Physician-to-physician variation in electronic health record (EHR) documentation not driven by patients' clinical status could be harmful. OBJECTIVE: Measure variation in completion of common clinical documentation domains. Identify perceived causes and effects of variation and strategies to mitigate negative effects. DESIGN: Sequential, explanatory, mixed methods using log data from a commercial EHR vendor and semi-structured interviews with outpatient primary care practices. PARTICIPANTS: Quantitative: 170,332 encounters led by 809 physicians in 237 practices. Qualitative: 40 interviewees in 10 practices. MAIN MEASURES: Interquartile range (IQR) of the proportion of encounters in which a physician completed documentation, for each documentation category. Multilevel linear regression measured the proportion of variation at the physician level. KEY RESULTS: Five clinical documentation categories had substantial and statistically significant (p < 0.001) variation at the physician level after accounting for state, organization, and practice levels: (1) discussing results (IQR = 50.8%, proportion of variation explained by physician level = 78.1%); (2) assessment and diagnosis (IQR = 60.4%, physician-level variation = 76.0%); (3) problem list (IQR = 73.1%, physician-level variation = 70.1%); (4) review of systems (IQR = 62.3%, physician-level variation = 67.7%); and (5) social history (IQR = 53.3%, physician-level variation = 62.2%). Drivers of variation from interviews included user preferences and EHR designs with multiple places to record similar information. Variation was perceived to create documentation inefficiencies and risk patient harm due to missed or misinterpreted information. Mitigation strategies included targeted user training during EHR implementation and practice meetings focused on documentation standardization. CONCLUSIONS: Physician-to-physician variation in EHR documentation impedes effective and safe use of EHRs, but there are potential strategies to mitigate negative consequences.


Assuntos
Competência Clínica/normas , Documentação/normas , Registros Eletrônicos de Saúde/normas , Dano ao Paciente/prevenção & controle , Médicos/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Documentação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Gac. sanit. (Barc., Ed. impr.) ; 33(3): 242-248, mayo-jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-183743

RESUMO

Objetivo: Valorar diferencias entre necesidad e implementación de prácticas seguras recomendadas para la seguridad del paciente y utilidad del uso de señales de tráfico para promover su implementación. Método: El estudio constó de dos fases: 1) revisión de recomendaciones sobre prácticas seguras de diferentes organizaciones y 2) encuesta a una muestra de oportunidad de profesionales del ámbito asistencial, organizativo y académico de la seguridad del paciente de España y Latinoamérica para evaluar necesidad y la implementación percibida de las prácticas seguras y la utilidad de las señales para tal fin. Resultados: Se recibieron 365 cuestionarios. Todas las prácticas seguras identificadas fueron valoradas como necesarias (media y límite inferior del intervalo de confianza por encima de 3 sobre 5 puntos). Sin embargo, la implementación se valoró como insuficiente en seis de ellas: escritura ilegible, conciliación de medicación, estandarización de comunicación, sistemas de alerta rápida, aplicación de procedimientos por profesionales o equipos entrenados, y cumplimiento de voluntades del paciente al final de la vida. Mejorar cumplimiento de la higiene de manos, aplicación de precauciones de barrera, asegurar la identificación correcta de los pacientes y utilizar listados de verificación fueron las cuatro prácticas en las que más del 75% de los encuestados encuentran mayor grado de consenso sobre la utilidad de las señales de tráfico para mejorar su implementación. Conclusiones: Las diferencias entre necesidad percibida e implementación real de las prácticas seguras consideradas indican áreas de mejora. El lenguaje común de las señales de tráfico es un instrumento sencillo para mejorar su cumplimiento


Objective: To evaluate differences between the need and degree of implementation of safe practices recommended for patient safety and to check the usefulness of traffic sign iconicity to promote their implementation. Method: The study was developed in two stages: 1) review of safe practices recommended by different organizations and 2) a survey to assess the perceptions for the need and implementation of them and the usefulness of signs to improve their implementation. The sample consisted of professionals from Spain and Latin America working in healthcare settings and in the academic field related to patient safety. Results: 365 questionnaires were collected. All safe practices included were considered necessary (mean and lower limit of confidence interval over 3 out of 5 points). However, in six of the patient safety practices evaluated the implementation was considered insufficient: illegible handwriting, medication reconciliation, standardization of communication systems, early warning systems, procedures performed or equipment used only by trained people, and compliance with patient preferences at the end of life. Improve compliance of with hand hygiene and barrier precautions to prevent infections, ensure the correct identification of patients and the use of checklists are the four practices in which more than 75% of respondents found a high degree of consensus on the usefulness of traffic sings to broaden their use. Conclusion: The differences between perceived need and actual implementation in some safe practices indicate areas for improvement in patient safety. With this aim, the common language and the iconicity of traffic signs could constitute a simple instrument to improve compliance with safe practices for patient safety


Assuntos
Humanos , Segurança do Paciente/normas , Gestão de Riscos/métodos , Dano ao Paciente/prevenção & controle , Doença Iatrogênica/prevenção & controle , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Guias de Prática Clínica como Assunto
17.
Drug Saf ; 42(8): 931-939, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31016678

RESUMO

Classifying harm associated with a medication error can be time consuming and labour intensive and limited studies undertake this step. There is no standardised process, and few studies that report harm assessment provide adequate methods to allow for study replication. Studies typically mention that a clinical review panel classified patient harm and provide a reference to a classification tool. Moreover, in many studies it is unclear whether potential or actual harm was classified as studies refer only to 'error severity'. The tools used to categorise the severity of patient harm vary widely across studies and few have been assessed for inter-rater reliability and criterion validity. In this paper, we describe the systematic process we undertook to synthesise the defining elements and strengths, while mitigating the limitations, of existing harm classification tools to derive the Harm Associated with Medication Error Classification (HAMEC). This new tool provides a harm classification for use across clinical and research settings. The provision of an explicit process for its application and guiding category descriptors are designed to reduce the risk of misclassification and produce results that are comparable across studies. As the World Health Organisation embarks on its international safety challenge of reducing medication-related harm by 50%, accompanying methodological advances are required to measure progress.


Assuntos
Erros de Medicação/classificação , Dano ao Paciente/classificação , Humanos , Dano ao Paciente/prevenção & controle , Terminologia como Assunto
18.
Prensa méd. argent ; 105(2): 53-61, apr 2019. tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1025650

RESUMO

La cirugía de control de daños (CCD), surge con el afán de mejorar los pobres resultados obtenidos con el abordaje quirúrgico tradicional en traumatismos abdominales graves y exanguinantes en pacientes críticos con escasa reserva fisiológica. Se define con una "cirugía por etapas", con un primer tiempo quirúrgico corto para controlar el sangrado y la contaminación con cierre temporario abdominal, seguido de un período de reanimación en unidad de cuidados intensivos y, finalmente, de reparación definitiva de las lesiones. Se revisaron las histrias clínicas de 41 pacientes sometidos a éste tipo de cirugía en el período comprendido entre marzo de 2011 y octubre de 2017 en el Hospital Municipal de Urgencias de la ciudad de Córdoba, 29 hombres y 12 mujeres, en cuanto al mecanismo lesional 23 casos fueron por trauma cerrado y 18 penetrantes. La edad promedio fue de 30 años, 28 pacientes presentaron lesiones asociadas, siendo las más frecuentes las torácicas en 14 pacientes y la mortalidad global de la serie del 41% (17 pacientes). El grupo etario involucrado, la distribución por sexo, y la mortalidad de nuestra serie no difiere de la bibliografía consultada


Damaage control surgery (CCD) arises with the aim of imporving the poor results obtained with the traditional surgical approach in severe and exanguinating abdominal trauma in critically ill patients with scarce physiological reserve. It is defined as a "step surgery", with a short surgical first time to control bleeding and contamination with temporary abdominal closure, followed by a period of resuscitation in the intensive care unit and, finally, definitive repair of the injuries. We revierwed the medical rcords of 41 patients undergoing this type of surgery in the period between arch 2011 and October 2017 at the Municipal Emergenci Hospital of the city of Córdoba, 29 men and 12 women, regarding the mechanism of injury 23 cases were due to closed trauma and 18 penetrating. The average age was 30 years, 28 patients had associated injuries, the most frequent being thoracic in 14 patients and the overall mortality of the series of 41% (17 patients). The age group involved, the distributin by sex, and the mortality of our series does not differ from the bibliography consulted


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Índices de Gravidade do Trauma , Indicadores de Morbimortalidade , Redução do Dano , Hipertensão Intra-Abdominal/prevenção & controle , Dano ao Paciente/prevenção & controle , Traumatismos Abdominais/cirurgia
19.
Enferm. nefrol ; 22(1): 27-33, ene.-mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-183591

RESUMO

Los pacientes en hemodiálisis son una población susceptible de padecer eventos adversos por fallos en el proceso asistencial. Objetivo: Evaluar la eficacia de las medidas correctoras en un plan de seguridad del paciente en hemodiálisis para disminuir los eventos adversos. Material y Método: Estudio descriptivo y retrospectivo del registro de hemodiálisis de una unidad hospitalaria. Como método de evaluación se utilizó la metodología propia de nuestro centro (MIDEA) basado en el método Global Trigger Tools. Se revisaron todas las sesiones de hemodiálisis de marzo, mayo y julio de 2016: 2.080 sesiones; y los mismos meses en 2017: 1953 sesiones. Después del análisis de 2016, se implantaron las siguientes medidas correctoras: revisión del procedimiento de anticoagulación del circuito extracorpóreo, actualización del manejo de los accesos vasculares y actualización del procedimiento ante hipotensiones. Resultados: En el año 2016, se revisaron las gráficas de 208 pacientes. Se detectaron 255 eventos adversos (11,8% de las sesiones), siendo los más frecuentes: 85 hipotensiones, 74 coagulaciones del circuito sanguíneo, 31 problemas del acceso vascular y 65 otros eventos adversos. En el año 2017, se revisaron las gráficas de 258 pacientes. Se detectaron 155 eventos adversos (7,9% de las sesiones), siendo los más frecuentes: 60 hipotensiones, 36 coagulaciones del circuito, 30 problemas del acceso vascular y 29 otros eventos adversos. Conclusiones: Los eventos adversos disminuyeron un 39,2% en 2017, y aunque siguen siendo las hipotensiones, coagulaciones del circuito sanguíneo y los problemas derivados del acceso vascular los más frecuentes, pensamos que las medidas correctoras están siendo eficaces


Patients on hemodialysis (HD) are a population susceptible to suffering adverse events (AD) due to failures in the healthcare process. Objective: To evaluate the efficacy of corrective measures in a HD patient safety plan to reduce AD. Material and Method: Descriptive and retrospective study of the HD records of a hospital unit. As an evaluation method, we used the methodology of our center (MIDEA) based on the Global Trigger Tools method. All the HD sessions of March, May and July 2016 were reviewed: 2,080 sessions; and the same months in 2017: 1953 sessions. After the 2016 analysis, the following corrective measures were implemented: revision of the anticoagulation procedure of the extracorporeal circuit, updating of the vascular access management and updating of the procedure before hypotension. Results: In 2016, the clinical records of 208 patients were reviewed. 255 EA were detected (11.8% of the sessions). The most frequent AEs were: 85 hypotension, 74 blood circuit coagulations, 31 vascular access problems and 65 other AD. In 2017, the clinical records of 258 patients were reviewed. 155 AE were detected (in 7.9% of the sessions). The most frequent AEs were: 60 hypotension, 36 circuit coagulations, 30 vascular access problems and 29 other AE. Conclusions: Adverse events decreased by 39.2% in 2017, and although hypotension, blood circuit coagulation and vascular access problems are the most frequent, we consider that corrective measures are being effective


Assuntos
Humanos , Diagnóstico de Enfermagem/métodos , Diálise Renal/efeitos adversos , Unidades Hospitalares de Hemodiálise/normas , Dano ao Paciente/prevenção & controle , Doença Iatrogênica/prevenção & controle , Insuficiência Renal Crônica/terapia , Avaliação de Resultado de Ações Preventivas , Segurança do Paciente/normas , Estudos Retrospectivos
20.
Enferm. nefrol ; 22(1): 42-50, ene.-mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-183593

RESUMO

Objetivo: Determinar los eventos adversos más prevalentes y los factores asociados a su desarrollo en el paciente que se somete a hemodiálisis en el estado de Guerrero, México. Material y Método: Estudio observacional, longitudinal, retrospectivo en 157 pacientes en hemodiálisis afiliados al Instituto Mexicano del Seguro Social en Guerrero, atendidos en 5 unidades privadas y 2 públicas. Se recolectaron variables socio-demográficas, mediciones de laboratorio, evolución de la enfermedad, complicaciones propias de la enfermedad y del tratamiento dialítico. Resultados: Los eventos adversos se presentaron en el 73% de la población estudiada, la principal causa etiológica fue Diabetes mellitus tipo 2 (DM2) e hipertensión arterial. Los eventos adversos más frecuentes fueron: hipotensión (35,5%) infección de angioacceso (24%), cefalea (22,3%), crisis hipertensiva (14,5%), mareos (9,9%), escalofríos (9,9%), y trombosis de fístula arteriovenosa (9,9%). Los factores que se asociaron a su desarrollo fueron: pacientes mayores de 65 años, (OR=6,859IC 95%;1,55-30,35), ser obeso, (OR=1,70, IC95%:1,60-4,81), e hipoalbuminemia (OR=0,251, IC 95%: 0,160-0,593). Conclusión: Los pacientes mayores de 65 años, obesos, con hipertensión diastólica e hipoalbuminemia tienen mayor probabilidad de desarrollar eventos adversos durante el periodo de hemodiálisis


Objective: To determine the most prevalent adverse events and the risk factors associated in the patient undergoing hemodialysis in the state of Guerrero, Mexico. Material and Method: Observational, longitudinal, retrospective study in 157 hemodialysis patients affiliated to the Mexican Institute of Social Security in Guerrero, assisted in 5 private and 2 public units. Socio-demographic variables, laboratory measurements, evolution of the disease, complications of the disease and dialysis treatment were collected. Results: Adverse events occurred in 73% of the studied population, the main etiological cause was Diabetes mellitus type 2 (DM2) and arterial hypertension. The most frequent adverse events were: hypotension (35.5%) angioaccess infection (24.0%), headache (22.3%), hypertensive crisis (14.5%), dizziness (9.9%), chills (9.9%), and thrombosis of arteriovenous fistula (9.9%). The associated risk factors: patients over 65, (OR=6.859, 95% CI:1.55-30.35) being obese, (OR=1.70, 95% CI: 1.60-4.81), and hypoalbuminemia (OR=0.251, 95% CI:0.160-0.593). Conclusion: Patients over 65, obese, with diastolic hypertension and hypoalbuminemia are more likely to develop adverse events during the hemodialysis


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Diagnóstico de Enfermagem/métodos , Diálise Renal/efeitos adversos , Unidades Hospitalares de Hemodiálise/normas , Dano ao Paciente/prevenção & controle , Doença Iatrogênica/prevenção & controle , Insuficiência Renal Crônica/terapia , Segurança do Paciente/normas , Estudos Retrospectivos , México/epidemiologia , Fatores de Risco , Obesidade/complicações , Hipertensão/complicações
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