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2.
Br J Nurs ; 29(1): 10, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31917942

RESUMO

Neesha Ridley, Senior Lecturer, University of Central Lancashire, discusses the importance of hand hygiene in preventing healthcare-associated infections.


Assuntos
Infecção Hospitalar/prevenção & controle , Higiene das Mãos/normas , Gestão de Riscos/métodos , Humanos
3.
Exp Parasitol ; 208: 107808, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31765613

RESUMO

There is a plethora of meat-borne hazards - including parasites - for which there may be a need for surveillance. However, veterinary services worldwide need to decide how to use their scarce resources and prioritise among the perceived hazards. Moreover, to remain competitive, food business operators - irrespective of whether they are farmers or abattoir operators - are preoccupied with maintaining a profit and minimizing costs. Still, customers and trade partners expect that meat products placed on the market are safe to consume and should not bear any risks of causing disease. Risk-based surveillance systems may offer a solution to this challenge by applying risk analysis principles; first to set priorities, and secondly to allocate resources effectively and efficiently. The latter is done through a focus on the cost-effectiveness ratio in sampling and prioritisation. Risk-based surveillance was originally introduced into veterinary public health in 2006. Since then, experience has been gathered, and the methodology has been further developed. Guidelines and tools have been developed, which can be used to set up appropriate surveillance programmes. In this paper, the basic principles are described, and by use of a surveillance design tool called SURVTOOLS (https://survtools.org/), examples are given covering three meat-borne parasites for which risk-based surveillance is 1) either in place in the European Union (EU) (Trichinella spp.), 2) to be officially implemented in December 2019 (Taenia saginata) or 3) only carried out by one abattoir company in the EU as there is no official EU requirement (Toxoplasma gondii). Moreover, advantages, requirements and limitations of risk-based surveillance for meat-borne parasites are discussed.


Assuntos
Carne/parasitologia , Doenças Parasitárias/prevenção & controle , Gestão de Riscos/métodos , Animais , Prioridades em Saúde/classificação , Prioridades em Saúde/organização & administração , Humanos , Doenças Parasitárias/transmissão , Fatores de Risco , Gestão de Riscos/organização & administração , Gestão de Riscos/normas , Gestão de Riscos/tendências , Taenia saginata/isolamento & purificação , Teníase/prevenção & controle , Teníase/transmissão , Toxoplasma/isolamento & purificação , Toxoplasmose/prevenção & controle , Toxoplasmose/transmissão , Trichinella/isolamento & purificação , Triquinelose/prevenção & controle , Triquinelose/transmissão
4.
Nursing ; 50(1): 32-37, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31855984

RESUMO

Hospital-acquired delirium often goes unnoticed because the signs and symptoms resemble those of dementia and depression, making diagnosis difficult. This article explores the differences between delirium, dementia, and depression and discusses the role of nursing in patient assessment and education.


Assuntos
Delírio/enfermagem , Doença Iatrogênica/prevenção & controle , Delírio/complicações , Delírio/etiologia , Diagnóstico Diferencial , Humanos , Diagnóstico de Enfermagem , Educação de Pacientes como Assunto , Gestão de Riscos/métodos
5.
Z Evid Fortbild Qual Gesundhwes ; 147-148: 58-66, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31767377

RESUMO

OBJECTIVE: Potential sources for errors or critical incidents in healthcare may arise not just within a healthcare facility, but also between healthcare facilities (e. g., in the communication between in- and outpatient care). This study aims to test the content validity of the reporting sheet and to optimize the cross-sectoral critical incident reporting system (CIRS-CS). METHOD: The CIRS-CS was developed as a part of the project "solimed ePflegebericht" based on the expertise of the participating organizations as well as existing literature and existing reporting systems (e. g., the recommendations of the "German Coalition for Patient Safety"). In addition, a pre-test was conducted among the organizations participating in the "solimed ePflegebericht" to assess the content validity of the reporting sheet. Content validity was assessed using cognitive interviews (N=11) with health professionals. The interviews were conducted on the basis of predefined scenarios and probing questions. RESULTS: The reporting sheet that was used for the pre-test consisted of 16 components such as reason for reporting/description of the problem, location of the patient at the time of reporting and suggested solution to the problem. The results of the pre-test indicated that participants found it challenging to relate to components such as In which type of healthcare service did the problem occur, What was the cause of the problem and Which factors contributed to the problem. For instance, some participants found it difficult to decide in which type of healthcare service (e. g., emergency care, routine care) the underlying problem occurred as this component could be reported from different perspectives, i. e. where the incident arose versus where the problem occurred. Thus, depending on the interpretation of this component, the participants questioned the feasibility since there was a lack of knowledge as to under which circumstances the incident arose. CONCLUSION: The results of the pre-test of the CIRS-CS suggest that the description of the causes as well as potential solutions via the cross-sectoral reporting sheet is unfeasible and may be better approached with an interdisciplinary investigation team panel as part of the reporting system, in which the participating representatives are able to enter a structured dialogue based on the reported problems. Furthermore, the results indicate that investigation team panels enable an interprofessional exchange and may thus promote transparency between healthcare facilities. At this point, there is little research on the content validity of reporting sheets for cross-sectoral reporting systems. Hence, our results may contribute to the development of comprehensible and feasible cross-sectoral CIRS.


Assuntos
Assistência à Saúde , Serviços Médicos de Emergência , Segurança do Paciente , Gestão de Riscos , Lista de Checagem , Alemanha , Humanos , Gestão de Riscos/métodos , Gestão de Riscos/normas , Autoavaliação
6.
Sci Total Environ ; 694: 133733, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31756837

RESUMO

Over the past decade, the health care sector has become increasingly aware of the impact of pharmaceutical emissions to the environment. Yet, it remains unclear which compounds are the most relevant to address and at what point emission control is most effective. This study presents a modelling framework to prioritize pharmaceuticals based on their relative risks for aquatic organisms, using purchase and prescription data from hospitals. The framework consists of an emission prediction module and a risk prioritization module. The emission prediction module accounts for three different routes of intake (oral, intravenous, rectal), for non-patient consumption, and for delayed athome excretion due to relatively long half-lives or prescription durations of selected pharmaceuticals. We showcase the modelling framework with 16 pharmaceuticals administered at two Dutch academic hospitals. Predictions were validated with experimental data from passive sampling in the sewer system. With the exception of metformin, all predictions were within a factor of 10 from measurements. The risk prioritization module ranks each pharmaceutical based on its predicted relative risk for aquatic organisms. The resulting prioritization suggests that emission mitigation strategies should mainly focus on antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs).


Assuntos
Monitoramento Ambiental/métodos , Preparações Farmacêuticas/análise , Poluentes Químicos da Água/análise , Hospitais , Gestão de Riscos/métodos
7.
BMC Health Serv Res ; 19(1): 791, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684924

RESUMO

BACKGROUND: Some medications carry increased risk of patient harm when they are given in error. In incident reports, names of the medications that are involved in errors could be found written both in a specific medication field and/or within the free text description of the incident. Analysing only the names of the medications implicated in a specific unstructured medication field does not give information of the associated factors and risk areas, but when analysing unstructured free text descriptions, the information about the medication involved and associated risk factors may be buried within other non-relevant text. Thus, the aim of this study was to extract medication names most commonly used in free text descriptions of medication administration incident reports to identify terms most frequently associated with risk for each of these medications using text mining. METHOD: Free text descriptions of medication administration incidents (n = 72,390) reported in 2016 to the National Reporting and Learning System for England and Wales were analysed using SAS® Text miner. Analysis included text parsing and filtering free text to identify most commonly mentioned medications, followed by concept linking, and clustering to identify terms associated with commonly mentioned medications and the associated risk areas. RESULTS: The following risk areas related to medications were identified: 1. Allergic reactions to antibacterial drugs, 2. Intravenous administration of antibacterial drugs, 3. Fentanyl patches, 4. Checking and documenting of analgesic doses, 5. Checking doses of anticoagulants, 6. Insulin doses and blood glucose, 7. Administration of intravenous infusions. CONCLUSIONS: Interventions to increase medication administration safety should focus on checking patient allergies and medication doses, especially for intravenous and transdermal medications. High-risk medications include insulin, analgesics, antibacterial drugs, anticoagulants, and potassium chloride. Text mining may be useful for analysing large free text datasets and should be developed further.


Assuntos
Mineração de Dados , Erros de Medicação/estatística & dados numéricos , Gestão de Riscos/métodos , Inglaterra , Humanos , País de Gales
8.
Isr Med Assoc J ; 21(10): 671-675, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599509

RESUMO

BACKGROUND: Recently, Israel established the first national-level adult cardiac surgery database, which was linked to the Society of Thoracic Surgeons (STS). OBJECTIVES: To validate and compare the STS predicted risk of mortality (PROM) to logistic EuroSCORE I (LESI) and EuroSCORE II (ESII) in Israeli patients undergoing cardiac surgery. METHODS: We retrospectively studied 1279 consecutive patients who underwent cardiac surgeries with a calculable PROM. Data were prospectively entered into our database and used to calculate PROM, LESI, and ESII. Scores were normalized and correlated using linear regression and Pearson's test. To examine model calibration, we plotted the total observed versus expected mortality for each score and across five risk-score subgroups. Model discrimination was assessed by measuring the area under the receiver operating curves. RESULTS: The observed 30-day operative mortality was 1.95%. The median (IQ1; IQ3) PROM, LESI, and the ESII scores were 1.45% (0.69; 3.22), 4.54% (2.28; 9.27), and 1.88% (1.18; 3.54), respectively, with observed over expected ratios of 0.63 (95% confidence interval [95%CI] 0.42-0.93), 0.59 (95%CI 0.40-0.87), and 0.24 (95%CI 0.17-0.36), respectively, (STS vs. ESII P = 0.36, STS vs. LESI P = 0.0001). There was good correlation among all scores. All models overestimated mortality. Model discrimination was high and similar for all three scores. Model calibration of the STS, PROM, and ESII were more accurate than the LESI, particularly in higher risk subgroups. CONCLUSIONS: All scores overestimated mortality. In Israeli patients, the STS, PROM, and ESII risk-scores were more reliable metrics than LESI, particularly in higher risk patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Gestão de Riscos/métodos , Gestão de Riscos/estatística & dados numéricos , Idoso , Bases de Dados Factuais , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Índice de Gravidade de Doença , Sociedades Médicas , Cirurgia Torácica
9.
Artigo em Inglês | MEDLINE | ID: mdl-31500229

RESUMO

The widespread industrial application of nanotechnology has increased the number of workers exposed to engineered nanomaterials (ENMs), but it is not clear to what extent prevention guidance is practiced. Our aim was to explore the extent that companies manufacturing and/or using ENMs apply risk assessment and management measures. Thirty-four companies were surveyed with an international 35-item questionnaire investigating company and workforce features, types of ENM handled, and risk evaluation and preventive measures adopted. Among participating companies, 62% had a maximum of 10 employees. Metal-based nanomaterials were most frequently identified (73%). Environmental monitoring was performed by 41% of the companies, while engineering exposure controls were approximately reported by 50%. Information and training programs were indicated by 85% of the sample, only 9% performed specific health surveillance for ENM workers. Personal protective equipment primarily included gloves (100%) and eye/face protection (94%). This small-scale assessment can contribute to the limited amount of published literature on the topic. Future investigations should include a greater number of companies to better represent ENM workplaces and a direct access to industrial settings to collect information on site. Finally, deeper attention should be paid to define standardized frameworks for ENM risk assessment that may guide nano-specific preventive actions.


Assuntos
Monitoramento Ambiental/métodos , Instalações Industriais e de Manufatura/estatística & dados numéricos , Nanoestruturas/análise , Exposição Ocupacional/análise , Exposição Ocupacional/prevenção & controle , Medição de Risco/métodos , Gestão de Riscos/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipamento de Proteção Individual
10.
Cancer Radiother ; 23(6-7): 517-519, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31471256

RESUMO

Ten years after the beginning of CREX in radiotherapy departments we wanted to know about users' feeling. We sent a survey to 168 centers in the whole country and a hundred of them answer. The time, top management's involvement and professionals' training seem to be the key success factors. Systemic analysis methods and mainly the Orion© one are not identified as an issue. The main challenge for the next years will be the effectiveness check of actions.


Assuntos
Comitês Consultivos/organização & administração , Institutos de Câncer , Pesquisas sobre Serviços de Saúde , Gestão de Riscos/estatística & dados numéricos , França , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Comitê de Profissionais , Gestão de Riscos/métodos
11.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(4): 303-306, 2019 Jul 30.
Artigo em Chinês | MEDLINE | ID: mdl-31460728

RESUMO

OBJECTIVE: To explore the high-risk fault risk of CT simulator and the main causes of the risk, and to put forward effective risk management strategies. METHODS: The failure mode and effect analysis method was used to identify and control the operational fault risk of CT simulator. RESULTS: 5 major fault components, 8 fault failure models and 17 failure causes were analyzed. The top 5 failure causes are:anode target surface burn caused by direct scanning without warming up the tube (590.4), tube failure (518.2), burnout of joints caused by aging of high voltage cables (424.2), motor carbon brush wear (304.8) and belt break (296.4). CONCLUSIONS: The failure mode and effect analysis method can effectively identify the risk of equipment failure, and thus specifically formulate risk management and control measures to ensure the normal operation of equipment and the safety of doctors and patients.


Assuntos
Falha de Equipamento , Gestão de Riscos , Tomografia Computadorizada por Raios X , Falha de Equipamento/estatística & dados numéricos , Humanos , Gestão de Riscos/métodos , Tomografia Computadorizada por Raios X/normas
12.
Cien Saude Colet ; 24(8): 2895-2908, 2019 Aug 05.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31389537

RESUMO

An integrative review was performed to identify and analyze national studies on barriers to patient safety incident reporting by health professionals within Brazilian health services. A search in the Virtual Health Library (BVS) Portal, PubMed and Web of Science was performed in January 2017 for papers published in the last ten years. One thousand and seven publications were identified and, following application of inclusion and exclusion criteria, eight papers were analyzed, five of which were qualitative and three quantitative. All research was conducted in hospitals, exclusively with nursing professionals, and 75% was conducted in Southeast Brazil. Most studies showed an under-reporting of incidents, and the main reasons were fear about reporting, reporting focused on more severe incidents, lack of knowledge about the subject or how to report and, registered nurse-centered reporting. While study of this theme is still incipient in Brazil, this review found important weaknesses in the process and barriers to incident reporting by professionals, revealing a need for encouraging their participation, eliminating or reducing such barriers with a view to strengthening patient safety.


Assuntos
Recursos Humanos de Enfermagem no Hospital/organização & administração , Segurança do Paciente , Gestão de Riscos/métodos , Brasil , Pessoal de Saúde/organização & administração , Humanos , Erros Médicos/estatística & dados numéricos
13.
Rev Bras Enferm ; 72(3): 707-714, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269136

RESUMO

OBJECTIVE: to analyze patient safety incidents identified by caregivers of hospitalized children. METHOD: a qualitative, exploratory-descriptive study was carried out with 40 caregivers of children hospitalized in three hospital institutions in the city of Porto Alegre, Rio Grande do Sul State, Brazil, from April to December 2016. Semi-structured, recorded and transcribed interviews were carried out in their entirety, submitted to a thematic analysis using the NVivo 11.0 software. RESULTS: reports related to falls, infant feeding, patient/caregiver identification, medication process, communication, hand hygiene and hygiene of the hospital environment, spread of diseases, relations between caregivers and professionals and care processes/procedures were all cited. FINAL CONSIDERATIONS: communication and the relations among caregivers and professionals are the main contributory factors for patient safety incidents, interfering with the quality of care. The participation of caregivers and engagement in child care may be strategies to be developed to promote a safety culture.


Assuntos
Cuidadores/psicologia , Segurança do Paciente/normas , Brasil , Criança , Criança Hospitalizada/psicologia , Pré-Escolar , Hospitalização , Humanos , Entrevistas como Assunto/métodos , Pesquisa Qualitativa , Gestão de Riscos/métodos , Gestão de Riscos/tendências , Gestão da Segurança/métodos
16.
Healthc Q ; 22(1): 48-53, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31244468

RESUMO

Healthcare is a complex, high-risk industry as evidenced by frequent accounts of unintended patient and staff harm as well as other disruptions leading to financial, reputational and facility losses. Canadian healthcare organizations have struggled to adopt effective organization-wide risk management programs to reduce the likelihood and impact of these losses. This paper outlines an evidence-based initiative to spread, at scale, an effective and efficient program for integrated risk management. National results and benchmarks from the first three years of implementation are provided.


Assuntos
Assistência à Saúde/organização & administração , Gestão de Riscos/organização & administração , Canadá , Assistência à Saúde/economia , Assistência à Saúde/métodos , Humanos , Liderança , Cultura Organizacional , Medição de Risco/métodos , Medição de Risco/normas , Gestão de Riscos/métodos
17.
Scand J Rheumatol ; 48(5): 345-352, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31210083

RESUMO

Objective: In 2011, we started to offer cardiovascular (CV) risk screening to rheumatoid arthritis (RA) patients with a high CV risk. After 1 year, we assessed whether patients labelled as high CV risk had started preventive treatment when indicated, and whether the CV risk score had changed. Methods: CV risk screening was performed in both a large outpatient rheumatology clinic and a general hospital in the Netherlands, and the general practitioner or the internist was informed about the results of the CV screening, including specific advice on the initiation or adjustment of cardiopreventive drugs. National guidelines were used to assess how many patients were eligible for preventive treatment. After 1 year, CV risk, lifestyle, and treatment were re-evaluated. Patients with a history of CV disease at baseline or who experienced a CV event during follow-up were excluded from the analyses. Results: A high 10 year CV risk (> 20%) was present in 58%, and 55% had an indication for anti-hypertensives, statins, or both. At follow-up, cardiopreventive drug treatment had been started or adjusted in only one-third of patients with an indication for treatment. After screening, 42% of patients reported having changed their lifestyle, through more exercise (24%), diet adaption (20%), and weight loss (11%). Conclusion: Despite clear guidelines to improve CV risk, the results of a programme comprising active screening, targeted advice, and referral to the general practitioner or internist prove that primary prevention remains a major challenge in high-risk RA patients.


Assuntos
Artrite Reumatoide/complicações , Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Previsões , Programas de Rastreamento/métodos , Medição de Risco/métodos , Gestão de Riscos/métodos , Artrite Reumatoide/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Causas de Morte/tendências , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Estudos Prospectivos , Taxa de Sobrevida/tendências
19.
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
20.
Semin Cardiothorac Vasc Anesth ; 23(2): 171-187, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31064319

RESUMO

Publications of note from 2018 are reviewed for the cardiothoracic transplant anesthesiologist. Strategies to expand the availability of donor organs were highlighted, including improved donor management, accumulating experience with increased-risk donors, ex vivo perfusion techniques, and donation after cardiac death. A number of reports examined posttransplant outcomes, including outcomes other than mortality, with new data-driven risk models. Use of extracorporeal support in cardiothoracic transplantation was a prominent theme. Major changes in adult heart allocation criteria were implemented, aiming to improve objectivity and transparency in the listing process. Frailty and prehabilitation emerged as targets of comprehensive perioperative risk mitigation programs.


Assuntos
Transplante de Coração/métodos , Transplante de Pulmão/métodos , Doadores de Tecidos , Adulto , Morte , Humanos , Gestão de Riscos/métodos , Obtenção de Tecidos e Órgãos/métodos
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