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1.
Best Pract Res Clin Anaesthesiol ; 35(1): 93-103, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33742581

RESUMO

Incident Reporting Systems (IRS) continue to be an important influence on improving patient safety. IRS can provide valuable insights into how to prevent patients from being harmed at the organizational level. But inadequate expectations and misuse, for performance assessment, patient safety measurement or research, have hindered the full IRS potential. Health care organizations need to develop effective strategies built on trust and truth telling to improve the impact of IRS. This requires strategies to address the limited resources to analyse the near-misses or adverse events; avoid the punitive drift through maintaining the anonymity and protective legislation; integrating IRS and avoiding its confusion with mandatory adverse event response systems; training data analysts to focus on the system instead of the individual through a balanced simple taxonomy; combine the analyses at the local level, to reinforce effective and personalized feedback, with the potential of a national or supranational learning platform.


Assuntos
Anestesia/normas , Complicações Intraoperatórias/epidemiologia , Segurança do Paciente/normas , Assistência Perioperatória/normas , Gestão de Riscos/normas , Anestesia/efeitos adversos , Anestesia/métodos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/prevenção & controle , Assistência Perioperatória/métodos , Gestão de Riscos/métodos
2.
Int J Risk Saf Med ; 32(2): 77-86, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33579877

RESUMO

BACKGROUND: The disease caused by the novel coronavirus SARS-CoV-2 has rapidly spread escalating the situation to an international pandemic. The absence of a vaccine or an efficient treatment with enough scientific evidence against the virus has generated a healthcare crisis of great magnitude. The precautionary principle justifies the selection of the recommended medicines, whose demand has increased dramatically. METHODS: we carried out an analysis of the healthcare risk management and the main measures taken by the state healthcare authorities to a possible shortage of medicines in the most affected countries of the European Union: Spain, France, Italy and Germany. RESULTS: the healthcare risk management in the European Union countries is carried out based on the precautionary principle, as we do not have enough scientific evidence to recommend a specific treatment against the new virus. Some measures aimed to guarantee the access to medicines for the population has been adopted in the most affected countries by the novel coronavirus. CONCLUSIONS: in Spain, Italy and Germany, some rules based on the precautionary principle were pronounced in order to guarantee the supply of medicines, while in France, besides that, the competences of pharmacists in pharmacy offices have been extended to guarantee the access to medicines for the population.


Assuntos
Antivirais/provisão & distribuição , COVID-19 , Atenção à Saúde/tendências , Acesso aos Serviços de Saúde , Gestão de Riscos , Estoque Estratégico/organização & administração , COVID-19/tratamento farmacológico , COVID-19/epidemiologia , União Europeia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Melhoria de Qualidade/organização & administração , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde/normas , Gestão de Riscos/métodos , Gestão de Riscos/normas , SARS-CoV-2
3.
J Healthc Risk Manag ; 40(4): 46-57, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33496013

RESUMO

Health care organizations have had to respond to the Coronavirus disease 2019 (COVID-19) pandemic in unprecedented ways. In the United States, where health risk management is an established profession, health care risk managers (HRMs) contributed to the response by supporting organizations and frontline workers. HRMs advised administrative and clinical leadership on decisions and policies aimed at addressing the medico legal, ethical, and operational dilemmas raised by this public health emergency. This article describes these challenges from the perspective of a New York City (NYC) public hospital located in the "epicenter within the epicenter" of the pandemic and aims to provide practical guidance for HRMs on the front lines of this crisis.


Assuntos
COVID-19/prevenção & controle , Política de Saúde , Hospitais Públicos/normas , Pandemias/prevenção & controle , Guias de Prática Clínica como Assunto , Política Pública , Gestão de Riscos/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Gestão de Riscos/estatística & dados numéricos , SARS-CoV-2
4.
Nurs Res ; 70(1): 72-79, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32956255

RESUMO

BACKGROUND: Investigators conducting studies that include potentially suicidal individuals are obligated to develop a suicide risk management (SRM) protocol. There is little available in the literature to guide researchers in SRM protocol development. OBJECTIVES: The aim of the study was to describe an SRM protocol developed for a randomized controlled trial (RCT) currently enrolling cardiac patients who report moderate to severe levels of hopelessness. METHODS: The SRM protocol identifies suicidal ideation and measures ideation severity through use of the Columbia-Suicide Severity Rating Scale risk factor questions. Based on responses, study participants are deemed safe or at low, moderate, or high risk for suicide. The SRM protocol guides research staff through a plan of action based on risk level. The protocol further guides staff through a plan over the course of this prospective study-from hospital enrollment to home-based visits. RESULTS: Research staff are well trained to identify suicidal ideation risk factors, initiate specific questioning about suicidal intent, determine level of risk, identify protective factors and a safe environment, and make referrals if needed. Of the 51 patients hospitalized with cardiac disease who reported moderate to severe hopelessness, 43 scored at a safe suicide risk level and 8 scored at low risk. Thirty-five of the 51 patients enrolled in the RCT. Of the 35 participants who received home visits to date, there have been three instances of low and one instance of moderate suicide risk. The SRM protocol has been consistently and accurately used by research personnel in both hospital and home settings. One modification has been made to the protocol since study activation, namely, the addition of an assessment of counseling history and encouragement of continued counseling. Booster training sessions of research staff will continue throughout the course of the RCT. DISCUSSION: Use of the SRM protocol identifies study participants who are safe or at risk for suicide in both hospital and home settings, and research staff can refer participants accordingly. CONCLUSION: The SRM protocol developed for this RCT can serve as a model in the development of SRM protocols for future research in acute care, community, or home-based settings.


Assuntos
Cardiopatias/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Gestão de Riscos/métodos , Gestão de Riscos/normas , Estresse Psicológico/prevenção & controle , Suicídio/prevenção & controle , Suicídio/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores de Risco , Estados Unidos
5.
Rev. enferm. UERJ ; 28: e55415, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1146355

RESUMO

Objetivo: analisar o plano de contingência para infecção humana pelo Covid-19 e apresentar um modelo conceitual de gestão de risco para o Covid-19. Método: estudo de avaliação executiva, com análise seguindo os passos: Descrição da política; diagnóstico do problema; desenho da política; implementação; governança; resultados e impactos; que permitiu estabelecer o panorama geral acerca do Plano de Contingência Nacional para Infecção Humana pelo novo Coronavírus. Resultados: foram utilizados os passos metodológicos para apontar pontos positivos e fragilidades do plano de contingência e a construção de um modelo conceitual sobre a gestão de risco para o COVID-19. Conclusão: o cenário nacional enriquecido de condições socioambientais desfavoráveis, expõe o quão é vulnerável a nossa população e o sistema de saúde. Além disso, o estudo apontou para déficits de pessoal, materiais e preparação prévia para situações de risco como fatores a serem tratados dentro do processo de mitigação dos riscos.


Objective: to examine the contingency plan for human infection by Covid-19 and present a conceptual model of risk management for Covid-19. Method: in this executive evaluation study, the analysis followed the steps: policy description; problem diagnosis; policy design; implementation; governance; results and impacts; to establish an overall panorama of the National Human Infection Contingency Plan for the new Coronavirus. Results: the methodological steps were used to highlight the strengths and weaknesses of the contingency plan, and to construct a conceptual model of risk management for COVID-19. Conclusion: the scenario in Brazil, enhanced by unfavorable socio-environmental conditions, exposed how vulnerable its population and the health system are. The study also indicated that deficits in personnel, material and prior preparation for risk situations were factors to be addressed in the risk mitigation process.


Objetivo: examinar el plan de contingencia para la infección humana por Covid-19 y presentar un modelo conceptual de gestión de riesgos para Covid-19. Método: en este estudio de evaluación ejecutiva, el análisis siguió los pasos: descripción de la política; diagnóstico de problemas; diseño de políticas; implementación; gobernancia; resultados e impactos; Establecer un panorama general del Plan Nacional de Contingencia de Infección Humana por el nuevo Coronavirus. Resultados: los pasos metodológicos se utilizaron para resaltar las fortalezas y debilidades del plan de contingencia y para construir un modelo conceptual de gestión de riesgos para COVID-19. Conclusión: el escenario en Brasil, potenciado por condiciones socioambientales desfavorables, expuso la vulnerabilidad de su población y el sistema de salud. El estudio también indicó que los déficits en personal, material y preparación previa para situaciones de riesgo fueron factores a ser abordados en el proceso de mitigación de riesgos.


Assuntos
Gestão de Riscos/normas , Infecções por Coronavirus/epidemiologia , Planos de Contingência , Pandemias , Betacoronavirus , Administração em Saúde Pública , Brasil , Política de Saúde
6.
J Healthc Risk Manag ; 40(2): 28-33, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32734687

RESUMO

Many writers and organizations have postulated that health care facilities and providers may need to implement a "crisis standard of care" to deal with the exigent circumstances associated with the massive influx of patients infected with the novel coronavirus and suffering from COVID-19. There is a relative scarcity of critical resources, such as intensive care unit beds, emergency department beds, ventilators, personal protective equipment, and medications. Facilities can become overwhelmed. A crisis standard of care can act as a guidepost for rationing supplies and care, should that become necessary. However, that is not without danger. Health care facilities and providers should plan carefully and then act with due deliberation in implementing a crisis standard of care to mitigate or prevent future liability.


Assuntos
Infecções por Coronavirus , Serviço Hospitalar de Emergência/normas , Unidades de Terapia Intensiva/normas , Pandemias , Pneumonia Viral , Guias de Prática Clínica como Assunto , Gestão de Riscos/normas , Padrão de Cuidado/normas , Humanos
7.
Rev Col Bras Cir ; 47: e20202549, 2020 Jun 03.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32578820

RESUMO

Currently doctors and health professionals are facing a challenging pandemic caused by a new strain called 2019 Novel Coronavirus (COVID-19). Human infection with COVID-19 does not yet have the clinical spectrum fully described, and the pattern of lethality, mortality, infectivity and transmissibility is not known with precision. There is no specific vaccine or medication available. Treatment is supportive and nonspecific. In Brazil, as in the rest of the world, the number of COVID-19 cases has grown alarmingly, leading to an increase in the number of hospitalizations as well as in mortality from the disease. Currently, the states with the highest number of cases are, respectively, São Paulo, Rio de Janeiro, Distrito Federal and Ceará. The objective of this work is to offer alternatives in order to guide surgeons regarding the surgical management of the airways in patients with suspicion and / or confirmation for COVID-19 infection.


Assuntos
Manuseio das Vias Aéreas/métodos , Betacoronavirus , Infecções por Coronavirus/cirurgia , Pneumonia Viral/cirurgia , Manuseio das Vias Aéreas/normas , Infecções por Coronavirus/prevenção & controle , Contaminação de Equipamentos/prevenção & controle , Humanos , Músculos Laríngeos/cirurgia , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Cuidados Pós-Operatórios/normas , Gestão de Riscos/normas , Cirurgiões/normas , Traqueostomia/normas
8.
J Crohns Colitis ; 14(Supplement_3): S815-S819, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-32520311

RESUMO

The severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]-causing coronavirus disease [COVID]-19 pandemic poses major challenges for patients with inflammatory bowel disease [IBD] to be recruited and maintained in clinical trials. However, clinical trials offer patients who have failed multiple drugs access to study medications with alternative modes of action and the potential for relief from inflammation-mediated symptoms. Therefore, the continuation of clinical trials in IBD during the COVID-19 pandemic is important both for participants and for the community of IBD patients, due to the dire need for an expanded therapeutic armamentarium. As the safety of patients in clinical trials is the leading principle, we are providing ten specific rules to guide patients and principal investigators safely through the challenging time.


Assuntos
Anti-Inflamatórios/uso terapêutico , Betacoronavirus , Ensaios Clínicos como Assunto/normas , Infecções por Coronavirus/prevenção & controle , Fármacos Gastrointestinais/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Projetos de Pesquisa/normas , Ensaios Clínicos como Assunto/métodos , Infecções por Coronavirus/complicações , Saúde Global , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Doenças Inflamatórias Intestinais/complicações , Pneumonia Viral/complicações , Gestão de Riscos/métodos , Gestão de Riscos/normas
9.
Reumatol. clín. (Barc.) ; 16(3): 222-228, mayo-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194355

RESUMO

OBJETIVOS: 1) Revisar sistemática y críticamente la evidencia sobre las características de uso, eficacia y seguridad de los glucocorticoides (GC) en la artritis reumatoide (AR); 2) emitir recomendaciones prácticas sobre su utilización. MÉTODOS: Se realizó una revisión sistemática de la literatura con una estrategia de búsqueda bibliográfica sensible en Medline, Embase y Cochrane Library. Se seleccionaron ensayos clínicos aleatorizados que analizasen la eficacia y/o la seguridad de los GC en pacientes con AR. Dos revisores realizaron la primera selección por título y abstract y 10, la selección tras lectura en detalle y la recogida de datos. La calidad se evaluó con la escala de Jadad. En una reunión de grupo nominal con base en sus resultados se consensuaron una serie de recomendaciones. RESULTADOS: Se incluyeron 47 artículos. Los GC, en combinación con los fármacos antirreumáticos modificadores de la enfermedad, ayudan a controlar la actividad de la enfermedad y a inhibir la progresión radiográfica, especialmente en el corto-medio plazo y en las AR de inicio. Los GC pueden mejorar la función y el dolor. Distintos tipos y vías de administración son eficaces, sin que exista un esquema de tratamiento estandarizado (dosis de inicio, desescalada y duración del tratamiento con los GC) superior a otro. Los acontecimientos adversos de los GC son muy frecuentes, dependientes de la dosis, de gravedad variable, muchos de ellos leves. Se generaron 7 recomendaciones sobre el uso y la gestión del riesgo de los GC. CONCLUSIONES: Estas recomendaciones pretenden resolver algunos interrogantes clínicos habituales y facilitar la toma de decisiones con respecto al uso de GC en la AR


OBJECTIVES: 1) To systematically and critically review the evidence on the characteristics, efficacy and safety of glucocorticoids (CS) in rheumatoid arthritis (RA); 2) to generate practical recommendations. METHODS: A systematic literature review was performed through a sensitive bibliographic search strategy in Medline, Embase and the Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of CS in patients with RA. Two reviewers performed the first selection by title and abstract. Then 10 reviewers selected the studies after a detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. In a nominal group meeting, based on the results of the systematic literature review, related recommendations were reached by consensus. RESULTS: A total of 47 articles were finally included. CS in combination with disease-modifying antirheumatic drugs help control disease activity and inhibit radiographic progression, especially in the short-to-medium term and in early RA. CS can also improve function and relieve pain. Different types and routes of administration are effective, but there is no standardized scheme (initial dose, tapering and duration of treatment) that is superior to others. Adverse events when using CS are very frequent and are dose-dependent and variable severity, although most are mild. Seven recommendations were generated on the use and risk management of CS. CONCLUSIONS: These recommendations aim to resolve some common clinical questions and aid in decision-making for CS use in RA


Assuntos
Humanos , Resultado do Tratamento , Glucocorticoides/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Composição de Medicamentos/normas , Gestão de Riscos/normas , Sociedades Médicas/normas
10.
J Athl Train ; 55(6): 587-593, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32383984

RESUMO

CONTEXT: The relative availability of clinicians as well as the types and training of health care providers have been associated with morbidity and mortality in non-athletic health care settings. Whether staffing variations are associated with injury incidence in collegiate athletes is unknown. OBJECTIVE: To evaluate whether the institutional ratio of athletes to athletic trainers (patient load) or the ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers or both is associated with the incidence of injuries sustained by male ice hockey athletes at the school. DESIGN: Descriptive epidemiology study. SETTING: National Collegiate Athletic Association (NCAA) men's ice hockey teams. PATIENTS OR OTHER PARTICIPANTS: Collegiate men's ice hockey athletes. MAIN OUTCOME MEASURE(S): The NCAA Injury Surveillance Program collected data from collegiate men's ice hockey athletes. Staffing patterns were obtained through telephone interviews. Injury counts, injury rates per 1000 athlete-exposures, and injury rate ratios with 95% confidence intervals were calculated and compared between the following groups: (1) schools with high (versus low) patient load and (2) schools with high (versus low) ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers. RESULTS: Both the patient load and relative number of staff athletic trainers were associated with variations in the incidences and types of diagnosed injuries in male ice hockey players. Specifically, fewer injuries were diagnosed by clinicians at institutions with high patient loads. The rates of injury overall and non-time-loss injuries were lower in the high patient-load group. Time-loss injury rates, severe injury rates, concussion rates, and overall rates of injury during competition were greater in the group with a higher proportion of staff athletic trainers, whereas non-time-loss injury rates were lower. CONCLUSIONS: In this study of collegiate men's ice hockey players, athlete health outcomes were directly related to the number and types of clinicians available. Future researchers should evaluate whether this finding extends beyond men's ice hockey.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Hóquei/lesões , Gestão de Riscos , Medicina Esportiva , Recursos Humanos , Adulto , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/epidemiologia , Concussão Encefálica/etiologia , Humanos , Incidência , Masculino , Avaliação de Resultados em Cuidados de Saúde , Administração de Recursos Humanos , Gestão de Riscos/economia , Gestão de Riscos/normas , Medicina Esportiva/métodos , Medicina Esportiva/organização & administração , Estados Unidos , Universidades/estatística & dados numéricos
11.
Endoscopy ; 52(6): 483-490, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32303090

RESUMO

We are currently living in the throes of the COVID-19 pandemic that imposes a significant stress on health care providers and facilities. Europe is severely affected with an exponential increase in incident infections and deaths. The clinical manifestations of COVID-19 can be subtle, encompassing a broad spectrum from asymptomatic mild disease to severe respiratory illness. Health care professionals in endoscopy units are at increased risk of infection from COVID-19. Infection prevention and control has been shown to be dramatically effective in assuring the safety of both health care professionals and patients. The European Society of Gastrointestinal Endoscopy (www.esge.com) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (www.esgena.org) are joining forces to provide guidance during this pandemic to help assure the highest level of endoscopy care and protection against COVID-19 for both patients and endoscopy unit personnel. This guidance is based upon the best available evidence regarding assessment of risk during the current status of the pandemic and a consensus on which procedures to perform and the priorities on resumption. We appreciate the gaps in knowledge and evidence, especially on the proper strategy(ies) for the resumption of normal endoscopy practice during the upcoming phases and end of the pandemic and therefore a list of potential research questions is presented. New evidence may result in an updated statement.


Assuntos
Infecções por Coronavirus/transmissão , Endoscopia Gastrointestinal/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Pneumonia Viral/transmissão , Gestão de Riscos/normas , Infecções por Coronavirus/prevenção & controle , Endoscopia Gastrointestinal/métodos , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Gestão de Riscos/métodos
12.
J Athl Train ; 55(6): 580-586, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32348154

RESUMO

CONTEXT: Structural features of health care environments are associated with patient health outcomes, but these relationships are not well understood in sports medicine. OBJECTIVE: To evaluate the association between athlete injury outcomes and structural measures of health care at universities: (1) clinicians per athlete, (2) financial model of the sports medicine department, and (3) administrative reporting structure of the sports medicine department. DESIGN: Descriptive epidemiology study. SETTING: Collegiate sports medicine programs. PATIENTS OR OTHER PARTICIPANTS: Colleges that contribute data to the National Collegiate Athletic Association (NCAA) Injury Surveillance Program. MAIN OUTCOME MEASURE(S): We combined injury data from the NCAA Injury Surveillance Program, sports medicine staffing data from NCAA Research, athletic department characteristics from the United States Department of Education, and financial and administrative oversight model data from a previous survey. Rates of injury, reinjury, concussion, and time loss (days) in NCAA athletes. RESULTS: Compared with schools that had an average number of clinicians per athlete, schools 1 standard deviation above average had a 9.5% lower injury incidence (103.6 versus 93.7 per 10000 athlete-exposures [AEs]; incidence rate ratio [IRR] = 0.905, P < .001), 2.7% lower incidence of reinjury (10.6 versus 10.3 per 10000 AEs; IRR = 0.973, P = .004), and 6.7% lower incidence of concussion (6.1 versus 5.7 per 10000 AEs; IRR = 0.933, P < .001). Compared with the average, schools that had 1 standard deviation more clinicians per athlete had 16% greater injury time loss (5.0 days versus 4.2 days; IRR = 1.16, P < .001). At schools with sports medicine departments financed by or reporting to the athletics department (or both), athletes had higher injury incidences (31% and 9%, respectively). CONCLUSIONS: The financial and reporting structures of collegiate sports medicine departments as well as the number of clinicians per athlete were associated with injury risk. Increasing the number of sports medicine clinicians on staff and structuring sports medicine departments such that they are financed by and report to a medical institution may reduce athlete injury incidence.


Assuntos
Traumatismos em Atletas , Gestão de Riscos , Medicina Esportiva , Recursos Humanos , Atletas/estatística & dados numéricos , Traumatismos em Atletas/classificação , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/prevenção & controle , Coleta de Dados , Humanos , Incidência , Modelos Organizacionais , Administração de Recursos Humanos , Gestão de Riscos/economia , Gestão de Riscos/normas , Medicina Esportiva/métodos , Medicina Esportiva/organização & administração , Estados Unidos , Universidades/estatística & dados numéricos
13.
Rev Saude Publica ; 54: 21, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32049211

RESUMO

OBJECTIVE: This study aims to assess the development and the validity analysis of the Assessment of Risk Management in Health Care Questionnaire (AGRASS). METHODS: This is a validation study of a measurement instrument following the stages: 1) Development of conceptual model and items; 2) Formal multidisciplinary assessment; 3) Nominal group for validity analysis with national specialists; 4) Development of software and national pilot study in 62 Brazilian hospitals 5) Delphi for validity analysis with the users of the questionnaire. In stages 3 and 5, the items were judged based on face validity, content validity, and utility and viability, by a 1-7 Likert scale (cut-off point: median < 6). Accuracy and reliability of the questionnaire were analyzed with the Confirmatory Factor Analysis and the Cronbach's alpha. RESULTS: The initial version of the instrument (98 items) was adapted during stages 1 to 3 for the final version with 40 items, which were considered relevant, of adequate content, useful, and viable. The instrument has 2 dimensions and 9 subdimensions, and the items have closed-ended questions (yes or no). The software for the automatic collection and analysis generates indicators, tables, and automatic graphs for the assessed institution and aggregated data. The adjustment indices confirmed a bi-dimensional model composed of structure and process (X2/gl = 1.070, RMSEA ≤ 0.05 = 0.847, TLI = 0.972), with high reliability for the AGRASS Questionnaire (α = 0.94) and process dimension (α = 0.93), and adequate for the structural dimension (α = 0.70). CONCLUSIONS: The AGRASS Questionnaire is a potentially useful instrument for the surveillance and monitoring of the risk management and patient safety in health services.


Assuntos
Segurança do Paciente/normas , Qualidade da Assistência à Saúde/normas , Gestão de Riscos/métodos , Inquéritos e Questionários/normas , Adulto , Brasil , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Reprodutibilidade dos Testes , Gestão de Riscos/normas
14.
Rev Bras Enferm ; 73(1): e20170905, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32049219

RESUMO

OBJECTIVE: to describe risk management implementation in the safety of patients with mental disorders through action research. METHOD: an action research carried out with a multidisciplinary team from a reference hospital in mental health in Southeast Brazil. RESULTS: three strategies considered as managerial technologies for the mentally ill patient were developed: risk management diagram for patient safety; patient safety protocols; and textual proposal of software for internal management of incident notifications. FINAL CONSIDERATIONS: this action research allowed a collective discussion by the whole multidisciplinary team, enabling strategy drafting for risk management implementation and improvement of care quality in the safety of patients with mental disorders at the study site.


Assuntos
Transtornos Mentais/complicações , Segurança do Paciente/normas , Gestão de Riscos/métodos , Brasil , Pessoal de Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto/métodos , Transtornos Mentais/psicologia , Segurança do Paciente/estatística & dados numéricos , Pesquisa Qualitativa , Gestão de Riscos/normas , Gestão de Riscos/tendências
15.
BMC Palliat Care ; 19(1): 6, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31918702

RESUMO

BACKGROUND: Palliative care trials have higher rates of attrition. The MORECare guidance recommends applying classifications of attrition to report attrition to help interpret trial results. The guidance separates attrition into three categories: attrition due to death, illness or at random. The aim of our study is to apply the MORECare classifications on reported attrition rates in trials. METHODS: A systematic review was conducted and attrition classifications retrospectively applied. Four databases, EMBASE; Medline, CINHAL and PsychINFO, were searched for randomised controlled trials of palliative care populations from 01.01.2010 to 08.10.2016. This systematic review is part of a larger review looking at recruitment to randomised controlled trials in palliative care, from January 1990 to early October 2016. We ran random-effect models with and without moderators and descriptive statistics to calculate rates of missing data. RESULTS: One hundred nineteen trials showed a total attrition of 29% (95% CI 28 to 30%). We applied the MORECare classifications of attrition to the 91 papers that contained sufficient information. The main reason for attrition was attrition due to death with a weighted mean of 31.6% (SD 27.4) of attrition cases. Attrition due to illness was cited as the reason for 17.6% (SD 24.5) of participants. In 50.8% (SD 26.5) of cases, the attrition was at random. We did not observe significant differences in missing data between total attrition in non-cancer patients (26%; 95% CI 18-34%) and cancer patients (24%; 95% CI 20-29%). There was significantly more missing data in outpatients (29%; 95% CI 22-36%) than inpatients (16%; 95% CI 10-23%). We noted increased attrition in trials with longer durations. CONCLUSION: Reporting the cause of attrition is useful in helping to understand trial results. Prospective reporting using the MORECare classifications should improve our understanding of future trials.


Assuntos
Guias como Assunto/normas , Cuidados Paliativos/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Sujeitos da Pesquisa/psicologia , Gestão de Riscos/normas , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/tendências , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Gestão de Riscos/métodos , Gestão de Riscos/tendências
17.
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
18.
Ergonomics ; 63(2): 210-224, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31738666

RESUMO

The validity of methods is an ongoing issue in ergonomics. Inconsistent definitions and approaches to evaluation exacerbate this challenge. In this study, the construct and criterion-referenced validity of a new near miss reporting form was evaluated to determine the extent to which it comprehensively captures near miss incidents and is aligned with the systems thinking approach to accident causation. Interview data were used as the reference standard in the evaluation. Using signal detection theory (SDT), a high average hit rate (HR), predictive value (PV) and sensitivity index (SI) were found, with an almost perfect ranking for the index of concordance. The findings show that the reporting form has strong construct and criterion-referenced validity. It is proposed that the approach used in this study could be used by researchers and practitioners when testing the validity of incident data collection tools. Practitioner summary: The validity of methods is a key issue in ergonomics. In this study, we test the validity of a near miss reporting form using interview data as a standard. This approach could be used by practitioners when testing the validity of other ergonomics methods.


Assuntos
Ergonomia , Near Miss , Gestão de Riscos/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Nurs Ethics ; 27(2): 348-359, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31113285

RESUMO

BACKGROUND: Nurses must balance their perceived duty to care against their perceived risk of harm to determine their willingness to report during disaster events, potentially creating an ethical dilemma and impacting patient care. RESEARCH AIM: The purpose of this study was to investigate nurses' perceived duty to care and whether there were differences in willingness to respond during disaster events based on perceived levels of duty to care. RESEARCH DESIGN: A cross-sectional survey research design was used in this study. PARTICIPANTS AND RESEARCH CONTEXT: Using a convenience sample with a snowball technique, data were collected from 289 nurses throughout the United States in 2017. Participants were recruited through host university websites, Facebook, and an American Nurses Association discussion board. ETHICAL CONSIDERATIONS: Institutional review board approval was obtained from the University of Texas at Tyler and the University of Arkansas. FINDINGS: Analysis of willingness to report to work based on levels of perceived duty to care resulted in the emergence of two groups: "lower level of perceived duty to care group" and "higher level of perceived duty to care group." The most discriminating characteristics differentiating the groups included fear of abandonment by co-workers, reporting because it is morally the right thing to, and because of imperatives within the Nursing Code of Ethics. DISCUSSION: The number of nurses in the lower level of perceived duty to care group causes concern. It is important for nursing management to develop strategies to advance nurses' safety, minimize nurses' risk, and promote nurses' knowledge to confidently work during disaster situations. CONCLUSION: Level of perceived duty to care affects nurses' willingness to report to work during disasters. Primary indicators of low perceived duty to care are amenable to actionable strategies, potentially increasing nurses' perceived duty to provide care and willingness to report to work during disasters.


Assuntos
Obrigações Morais , Enfermeiras e Enfermeiros/psicologia , Cuidados de Enfermagem/ética , Adulto , Arkansas , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/tendências , Cuidados de Enfermagem/psicologia , Gestão de Riscos/métodos , Gestão de Riscos/normas , Inquéritos e Questionários , Texas
20.
Nurs Ethics ; 27(2): 609-620, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31331231

RESUMO

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.


Assuntos
Liderança , Erros Médicos/ética , Enfermeiras e Enfermeiros/psicologia , Gestão de Riscos/métodos , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Masculino , Erros Médicos/efeitos adversos , Erros Médicos/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Gestão de Riscos/ética , Gestão de Riscos/normas , Inquéritos e Questionários
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