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Exp Parasitol ; 208: 107808, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31765613


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 (, 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.

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
Rev Bras Enferm ; 72(3): 707-714, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269136


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.

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
Arch. prev. riesgos labor. (Ed. impr.) ; 22(1): 25-29, ene.-mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-180702


La desinfección de superficies y de material es una tarea imprescindible en los hospitales para evitar la propagación de infecciones asociadas a la estancia hospitalaria de los pacientes. Por eso, en el Instituto Catalán de la Salud (ICS) en el periodo 2008-2017 se han ido sustituyendo los diversos productos desinfectantes que son nocivos para la salud de los trabajadores, como aldehídos y cancerígenos, por otros menos peligrosos, como los productos oxidantes y alcoholes, que dan también un resultado eficiente y seguro en la desinfección del material y de las superficies. Este trabajo recoge esta experiencia como forma de integración de la prevención de riesgos en la empresa

In hospitals, the disinfection of surfaces and medical instruments is essential for preventing the spread of infections associated with hospital admissions. For this reason, between 2008 and now, the Catalonian Institute of Health (ICS, by its Spanish acronym) has been replacing several potentially harmful disinfection products, such as aldehydes and carcinogens, with less hazardous compounds such as oxidizing products and alcohols, that are safe and also efficient for the disinfection of work surfaces and medical instruments. This paper summarizes our experience, as an example of the integration of risk prevention in healthcare institutions

Humanos , Desinfetantes/economia , Controle e Fiscalização de Saneantes , Gestão de Riscos/tendências , Riscos Ocupacionais , Medição de Risco/economia , Desinfetantes/classificação
J Healthc Risk Manag ; 38(3): 24-31, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30184300


Improving safety event reporting has been a focus of increased study. Improved opportunities for patient and family safety event reporting have been described in the literature. Consistent with the organization's patient-centered care philosophy, we launched a safety hotline at Stamford Health. This article describes the process of implementation, vendor selection, understanding initial results, and areas for further study.

Linhas Diretas/normas , Erros Médicos/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Segurança do Paciente/normas , Gestão de Riscos/métodos , Gestão de Riscos/tendências , Connecticut , Previsões , Humanos
Transfusion ; 58 Suppl 3: 3078-3083, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30536438


Wild poliovirus (WPV) is nearing eradication, and only three countries have never interrupted WPV transmission (Pakistan, Afghanistan, and Nigeria). WPV2 was last detected in 1999, and it was declared eradicated in 2015. WPV3 has not been detected since 2012. Since 2016, WPV1 has been detected in only two countries (Afghanistan and Pakistan), with only 22 cases reported in 2017 and 12 cases reported in 2018 (as of July 10). Because of WPV2 eradication and the risk of emergence of type 2 vaccine-derived polioviruses from continued use of trivalent oral polio vaccine (OPV), trivalent OPV was replaced by bivalent OPV (types 1 and 3) in a globally coordinated effort in 2016. WPV2 eradication and trivalent OPV cessation also mean that breach of containment in a facility working with type 2 poliovirus is now a major risk to reseed type 2 circulation in the community. As a result, the World Health Organization has developed a "Global Action Plan to minimize poliovirus facility-associated risk after type-specific eradication of wild polioviruses and sequential cessation of oral polio vaccine use." Because poliovirus has long been used as a standard for qualification of intravenous immunoglobulin, disinfectant products, and sanitation methods, poliovirus containment has implications far beyond poliovirus laboratories.

Contenção de Riscos Biológicos/tendências , Erradicação de Doenças/tendências , Poliomielite/prevenção & controle , Contenção de Riscos Biológicos/métodos , Erradicação de Doenças/métodos , Erradicação de Doenças/organização & administração , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/normas , Instalações de Saúde , Humanos , Vacinas contra Poliovirus/uso terapêutico , Gestão de Riscos/métodos , Gestão de Riscos/organização & administração , Gestão de Riscos/tendências
Rev. esp. anestesiol. reanim ; 65(5): 258-268, mayo 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-177061


Antecedentes y objetivos: Los sistemas de notificación de incidentes (SNI) se consideran una herramienta que facilita el aprendizaje y la cultura de seguridad. Utilizando la experiencia adquirida con SENSAR, evaluamos la viabilidad y la actividad de un grupo multidisciplinar analizador de incidentes en el paciente quirúrgico notificados a un sistema general comunitario, el del Observatorio para la Seguridad del Paciente (OSP). Material y método: Estudio observacional descriptivo transversal planificado a 2 años. Previa formación en el análisis, se crea un grupo multidisciplinar en cuanto a especialidades y categorías profesionales, que analizarían los incidentes en el paciente quirúrgico notificados al OSP. Se clasifican los incidentes y se analizan sus circunstancias. Resultados: Entre los meses de marzo de 2015 y 2017 se notificaron 95 incidentes (4 por no profesionales). Los facultativos notificaron más que la enfermería, 54 (56,8%) vs. 37 (38,9%). La unidad que más notificó fue Anestesia con 46 (48,4%) (p=0,025). Los tipos de incidentes se relacionaron principalmente con el procedimiento asistencial (30,5%); el momento, con el preoperatorio (42,1%) y el lugar, con el área quirúrgica (48,4%), detectándose diferencias significativas en función de la filiación del notificante (p=0,03). No daño, o morbilidad menor, presentaron el 88% de los incidentes. Se identificaron errores en el 79%. El análisis de los incidentes dirigió las medidas a tomar. Conclusiones: La actividad que mantuvo el grupo multidisciplinar de análisis durante el periodo de estudio propició el conocimiento del sistema entre los profesionales y permitió identificar elementos de mejora en el Bloque Quirúrgico a diferentes niveles

Background and objectives: Incident Reporting Systems (IRS) are considered a tool that facilitates learning and safety culture. Using the experience gained with SENSAR, we evaluated the feasibility and the activity of a multidisciplinary group analyzing incidents in the surgical patient notified to a general community system, that of the Observatory for Patient Safety (OPS). Material and method: Cross-sectional observational study planned for two years. After training in the analysis, a multidisciplinary group was created in terms of specialties and professional categories, which would analyze the incidents in the surgical patient notified to the OPS. Incidents are classified and their circumstances analyzed. Results: Between March 2015 and 2017, 95 incidents were reported (4 by non-professionals). Doctors reported more than nurses, at 54 (56.84%) vs. 37 (38.94%). The anaesthesia unit reported most at 46 (48.42%) (P=.025). The types of incidents mainly related to the care procedure (30.52%); to the preoperative period (42.10%); and to the place, the surgical area (48.42%). Significant differences were detected according to the origin of the notifier (P=.03). No harm, or minor morbidity, constituted 88% of the incidents. Errors were identified in 79%. The analysis of the incidents directed the measures to be taken. Conclusions: The activity undertaken by the multidisciplinary analytical group during the period of study facilitated knowledge of the system among the professionals and enabled the identification of areas for improvement in the Surgical Block at different levels

Humanos , Anestesia/efeitos adversos , Gestão da Segurança/tendências , Segurança do Paciente/normas , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Complicações Intraoperatórias , Notificação de Abuso , Estudos Transversais , Gestão de Riscos/tendências
BMC Geriatr ; 18(1): 74, 2018 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-29548304


BACKGROUND: The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. METHODS: Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy. System based risk management theory and action research method was applied to construct the collaborative procedure utilizing each profession's existing resources in medication risk management of older home care clients. An inventory of clinical measures in usual clinical practice and systematic review of rigorous study designs was utilized in effectiveness study design. DISCUSSION: The new coordinated medication management model (CoMM) has the following 5 stages: 1) practical nurses are trained to identify clinically significant drug-related problems (DRPs) during home visits and report those to the clinical pharmacist. Clinical pharmacist prepares the cases for 2) an interprofessional triage meeting (50-70 cases/meeting of 2 h) where decisions are made on further action, e.g., more detailed medication reviews, 3) community pharmacists conduct necessary medication reviews and each patients' physician makes final decisions on medication changes needed. The final stages concern 4) implementation and 5) follow-up of medication changes. Randomized controlled trial (RCT) was developed to demonstrate the effectiveness of the procedure. The developed procedure is feasible for screening and reviewing medications of a high number of older home care clients to identify clients with severe DRPs and provide interventions to solve them utilizing existing primary care resources. TRIAL REGISTRATION: The study is registered in the Clinical ( NCT02545257 ). Registration date September 9 2015.

Recursos em Saúde/tendências , Serviços de Assistência Domiciliar/tendências , Reconciliação de Medicamentos/tendências , Atenção Primária à Saúde/tendências , Gestão de Riscos/tendências , Idoso , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Reconciliação de Medicamentos/métodos , Farmacêuticos/tendências , Atenção Primária à Saúde/métodos , Estudos Prospectivos , Gestão de Riscos/métodos , Resultado do Tratamento
Rev Bras Enferm ; 71(1): 111-119, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29324952


OBJECTIVE: To evaluate the incidents spontaneously notified in a general hospital in Minas Gerais. METHOD: Retrospective, descriptive, quantitative study performed at a general hospital in Montes Claros - Minas Gerais State. The sample comprised 1,316 incidents reported from 2011 to 2014. The data were submitted to descriptive statistical analysis using Statistical Package for the Social Sciences version 18.0. RESULTS: The prevalence of incidents was 33.8 per 1,000 hospitalizations, with an increase during the investigation period and higher frequency in hospitalization units, emergency room and surgical center. These occurred mostly with adult clients and relative to the medication supply chain. The main causes were noncompliance with routines/protocols, necessitating changes in routines and training. CONCLUSION: There was a considerable prevalence of incidents and increase in notifications during the period investigated, which requires the attention of managers and hospital staff. Nevertheless, we observed development of the patient safety culture.

Hospitais Gerais/estatística & dados numéricos , Gestão de Riscos/tendências , Hospitais Gerais/organização & administração , Humanos , Erros Médicos/tendências , Segurança do Paciente/normas , Prevalência , Estudos Retrospectivos , Gestão de Riscos/métodos
Crit Rev Food Sci Nutr ; 58(2): 297-317, 2018 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-27052385


Nanotechnology has seen exponential growth in last decade due to its unique physicochemical properties; however, the risk associated with this emerging technology has withdrawn ample attention in the past decade. Nanotoxicity is majorly contributed to the small size and large surface area of nanomaterials, which allow easy dispersion and invasion of anatomical barriers in human body. Unique physio-chemical properties of nanoparticles make the investigation of their toxic consequences intricate and challenging. This makes it important to have an in-depth knowledge of different mechanisms involved in nanomaterials's action and toxicity. Nano-toxicity has various effects on human health and diseases as they can easily enter into the humans via different routes, mainly respiratory, dermal, and gastrointestinal routes. This also limits the use of nanomaterials as therapeutic and diagnostic tools. This review focuses on the nanomaterial-cell interactions leading to toxicological responses. Different mechanisms involved in nanoparticle-mediated toxicity with the main focus on oxidative stress, genotoxic, and carcinogenic potential has also been discussed. Different methods and techniques used for the characterization of nanomaterials in food and other biological matrices have also been discussed in detail. Nano-toxicity on different organs-with the major focus on the cardiac and respiratory system-have been discussed. Conclusively, the risk management of nanotoxicity is also summarized. This review provides a better understanding of the current scenario of the nanotoxicology, disease progression due to nanomaterials, and their use in the food industry and medical therapeutics. Briefly, the required rules, regulations, and the need of policy makers has been discussed critically.

Agroquímicos/toxicidade , Poluentes Ambientais/toxicidade , Aditivos Alimentares/efeitos adversos , Contaminação de Alimentos , Nanoestruturas/toxicidade , Gestão de Riscos , Agroquímicos/normas , Animais , Carcinógenos Ambientais/toxicidade , Aditivos Alimentares/normas , Contaminação de Alimentos/legislação & jurisprudência , Contaminação de Alimentos/prevenção & controle , Humanos , Legislação de Medicamentos , Legislação sobre Alimentos , Mutagênicos/toxicidade , Nanoestruturas/efeitos adversos , Nanoestruturas/normas , Oxidantes/efeitos adversos , Oxidantes/normas , Oxidantes/toxicidade , Gestão de Riscos/legislação & jurisprudência , Gestão de Riscos/normas , Gestão de Riscos/tendências , Testes de Toxicidade/normas
Cult. cuid ; 21(49): 25-34, sept.-dic. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-170897


Las enfermeras están en una posición clave en la mejora de la calidad de la atención a través de intervenciones y estrategias para la seguridad del paciente. En general, percepciones sobre el impacto de los factores del entorno de trabajo sobre seguridad de los pacientes son engañosas. Este estudio cualitativo tuvo como objetivo explorar la percepción de enfermeras sobre seguridad del paciente. Las entrevistas semiestructuradas se llevaron a cabo con 13 enfermeras en una sala de emergencia en un hospital del noreste de Brasil. Un análisis de contenido convencional fue utilizado y el análisis se llevó a cabo sin imponer clases preconcebidas. Los resultados fueron agrupados en tres categorías: Barreras y facilitadores para la adopción de prácticas de seguridad del paciente, Problemas en la formación en seguridad del paciente y Papel de la enfermera en la calidad de las prácticas de seguridad del paciente. Las enfermeras informaron que los factores que afectan la seguridad del paciente incluyen: deficiencia de recursos, hacinamiento, sobrecarga de trabajo, mala formación y comunicación ineficaz. Los resultados sugieren que la seguridad de los pacientes se puede mejorar mediante el desarrollo y fortalecimiento de la cultura de seguridad y la provisión de infraestructura y mecanismos de apoyo (AU)

Enfermeiras ocupam uma posição-chave na melhoria da qualidade da assistência por meio de intervenções e estratégias para a segurança do paciente. Em geral, percepções sobre o impacto dos inúmeros e complexos fatores do ambiente de trabalho sobre a segurança do paciente são equivocadas. Este estudo qualitativo tem por objetivo explorar percepções de enfermeiras sobre a segurança do paciente no cenário de emergência. Entrevistas semiestruturadas foram conduzidas com 13 enfermeiras de uma unidade de emergência em um hospital localizado no nordeste do Brasil. Uma análise de conteúdo convencional, na qual a análise é executada sem impor categorias préconcebidas, foi utilizada na análise dos dados. Os resultados foram agrupados em três categorias: Barreiras e facilitadores para a adoção de práticas de segurança do paciente, Problemas no treinamento em segurança do paciente e Papel da enfermeira na qualidade das práticas de segurança do paciente. Enfermeiras relataram que os fatores que afetam a segurança do paciente incluem: deficiência de recursos, superlotação, sobrecarga de trabalho, treinamento deficiente e comunicação não efetiva. Os resultados sugerem que a segurança do paciente nas unidades de emergência pode ser melhorada pelo desenvolvimento e reforço da cultura de segurança e pela provisão da infraestrutura e dos mecanismos de suporte necessários (AU)

Nurses are in a key position to improve the quality of healthcare through patient safety interventions and strategies. However, there is a general misunderstanding of the effects of the numerous and complex work environment factors on patient safety. This qualitative study aims to explore nurses’ perceptions of patient safety aspects in an emergency setting. Semi-structured interviews were conducted with 13 Registered Nurses from an emergency ward in a large general hospital located in north-eastern Brazil. Conventional content analysis in which analysis is gained without imposing preconceived categories was used to analyze the collected data. The findings were clustered in three main categories: Barriers and facilitators for the adoption of patient safety practices, Training on patient safety issues, and Nursing role on the quality of patient safety. Nurses reported that the factors influencing patient safety include: lack of resources, hospi tal overcrowding, excessive workload, lack of training, and ineffective communication. Our results suggest that patient safety in the emergency wards could be improved by developing and reinforcing a safety culture and by providing the necessary infrastructure and support mechanisms (AU)

Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Segurança do Paciente , Tratamento de Emergência/tendências , Cuidados de Enfermagem/tendências , Serviço Hospitalar de Emergência/tendências , Enfermagem em Emergência/tendências , Pesquisa Qualitativa , Gestão de Riscos/tendências , Gestão da Segurança/tendências
Anesthesiology ; 127(6): 953-960, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28906266


BACKGROUND: Recent reports have raised concerns that public reporting of 30-day mortality after cardiac surgery may delay decisions to withdraw life-sustaining therapies for some patients. The authors sought to examine whether timing of mortality after coronary artery bypass graft surgery significantly increases after day 30 in Massachusetts, a state that reports 30-day mortality. The authors used New York as a comparator state, which reports combined 30-day and all in-hospital mortality, irrespective of time since surgery. METHODS: The authors conducted a retrospective cohort study of patients who underwent coronary artery bypass graft surgery in hospitals in Massachusetts and New York between 2008 and 2013. The authors calculated the empiric daily hazard of in-hospital death without censoring on hospital discharge, and they used joinpoint regression to identify significant changes in the daily hazard over time. RESULTS: In Massachusetts and New York, 24,864 and 63,323 patients underwent coronary artery bypass graft surgery, respectively. In-hospital mortality was low, with 524 deaths (2.1%) in Massachusetts and 1,398 (2.2%) in New York. Joinpoint regression did not identify a change in the daily hazard of in-hospital death at day 30 or 31 in either state; significant joinpoints were identified on day 10 (95% CI, 7 to 15) for Massachusetts and days 2 (95% CI, 2 to 3) and 12 (95% CI, 8 to 15) for New York. CONCLUSIONS: In Massachusetts, a state with a long history of publicly reporting cardiac surgery outcomes at day 30, the authors found no evidence of increased mortality occurring immediately after day 30 for patients who underwent coronary artery bypass graft surgery. These findings suggest that delays in withdrawal of life-sustaining therapy do not routinely occur as an unintended consequence of this type of public reporting.

Ponte de Artéria Coronária/mortalidade , Ponte de Artéria Coronária/tendências , Mortalidade Hospitalar/tendências , Vigilância em Saúde Pública , Gestão de Riscos/tendências , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Mortalidade/tendências , New York/epidemiologia , Vigilância em Saúde Pública/métodos , Estudos Retrospectivos , Gestão de Riscos/métodos , Fatores de Tempo
BMC Health Serv Res ; 17(1): 464, 2017 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-28683748


BACKGROUND: In 2009, the Dutch Health Care Inspectorate (IGZ) observed several serious risks to safety involving medication within elderly care facilities. However, by 2011, high risks had been reduced in almost all the organisations we visited. And yet the IGZ analysed too the alarming increase in the number of incidents arising in the self-reported national indicator of medication safety between 2009 and 2010. The aim of this study was to understand the factors that can explain this contradiction between the increase in self-reported medication incidents and the observation of the IGZ in reducing the risks to medication safety through supervision. METHODS: We interviewed health care professionals of ten care facilities, visited by the IGZ, who were involved in, or responsible for, the improvement of medication safety in their institutions. As outcome measures we used the rate of medication safety risk per facility; the perceptions of the participant with regard to the reports of medication incidents; the level of medication safety of the facility; the measures used to improve medication safety; and the supervision of medication safety. This was a mixed methods study, qualitative in that we used semi-structured interviews, and quantitative, by calculating risks for the different organisations we visited. The findings from both study methods resulted in a comprehensive view and an in-depth understanding of this contradiction. RESULTS: The contradiction between the increase in self-reported medication incidents and the observation of reduced risks was explained by three themes: activities designed to improve medication safety, the reporting of medication incidents, and, lastly, the impact of supervision. The focus of the IGZ on issues of medication safety stimulated most elderly care facilities to reduce medication risks. Also, a change in the culture of reporting incidents caused an increase in the number of reported incidents. CONCLUSIONS: Supervision contributed to an improvement in actions geared towards reducing the risks associated with the safety of medication. It also increased a willingness to report such incidents. The more incidents reported are therefore not necessarily a sign of an increase in the risks, but can also be considered as a sign of a safer culture.

Instituição de Longa Permanência para Idosos/organização & administração , Erros Médicos/prevenção & controle , Erros Médicos/tendências , Casas de Saúde/organização & administração , Gestão de Riscos/tendências , Idoso , Órgãos Governamentais , Pessoal de Saúde , Humanos , Entrevistas como Assunto , Assistência de Longa Duração , Países Baixos , Gestão da Segurança
Clin Oncol (R Coll Radiol) ; 29(9): 557-561, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28662794


The purpose of this report is to review and compile what have been and can be learnt from incidents and accidents in radiation oncology, especially in external beam and brachytherapy. Some major accidents from the last 20 years will be discussed. The relationship between major events and minor or so-called near misses is mentioned, leading to the next topic of exploring the knowledge hidden among them. The main lessons learnt from the discussion here and elsewhere are that a well-functioning and safe radiotherapy department should help staff to work with awareness and alertness and that documentation and procedures should be in place and known by everyone. It also requires that trained and educated staff with the required competences are in place and, finally, functions and responsibilities are defined and well known.

Acidentes/tendências , Radioterapia (Especialidade)/métodos , Gestão de Riscos/tendências , Humanos
Soins Psychiatr ; 38(310): 12-16, 2017.
Artigo em Francês | MEDLINE | ID: mdl-28476249


From confinement to the philosophy of care in the community, the history of psychiatry testifies to the evolution of practices in the matter of the restriction of freedom. The French National Health Authority still too often recommends practices based on restraint. Caregivers, in relation to the clinical aspect of the patients, need clearly identified therapeutic projects. While training can be vital for them, risk management policies can prove to be a hindrance to patients' freedom.

Transtornos Mentais/enfermagem , Transtornos Mentais/psicologia , Isolamento de Pacientes/psicologia , Isolamento de Pacientes/tendências , Restrição Física/psicologia , Gestão de Riscos/tendências , Previsões , França , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Relações Enfermeiro-Paciente , Isolamento de Pacientes/legislação & jurisprudência , Autonomia Pessoal , Filosofia em Enfermagem , Restrição Física/legislação & jurisprudência , Restrição Física/estatística & dados numéricos , Gestão de Riscos/legislação & jurisprudência
Int J Qual Health Care ; 29(2): 243-249, 2017 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-28453824


Objective: To establish categories of professionals' attitudes toward incident reporting by analyzing the trends in incident reporting while accounting for general risk indicators. Design: The incident reporting system was evaluated over 6 years. Reporting rates, stratified by year and profession, were estimated using the non-mandatory reported events/full-time equivalent (NM-IR/FTE) rate. Other indicators were collected using the hospital's official database. Staff attitudes toward self-reporting were analyzed. Univariate and multivariable analyses were performed. Setting: A 1000-bed Italian academic hospital. Participants: Staff of the hospital (over 3200 professionals). Interventions: None. Main outcome measures: NM-IT/FTE rates, self-reported rates, patient complaints/praises, work accidents among professionals and 30-day readmissions. Results: The overall reporting rate was 0.44 (95% confidence interval [CI]: 0.42-0.46) among doctors and 0.40 (95% CI: 0.39-0.41) among nurses. Between 2010 and 2015, only the doctors' reporting rate increased significantly (P = 0.04), from 0.29 (95% CI: 0.25-0.34) to 0.67 (95% CI: 0.60-0.73). Patient complaints decreased from 384 to 224 (P < 0.001) and work accidents decreased from 296 to 235 (P = 0.01), while other indicators remained constant. Multivariable logistic regression showed that self-reporting was more likely among nurses than doctors (odds ratio: 1.51; 95% CI: 1.31-1.73) and for severe events than near misses (odds ratio: 1.78; 95% CI: 1.11-2.87). Conclusions: Because the doctors' reporting rates increased during the study period, doctors may be more likely to report adverse events than nurses, although nurses reported more events. Incident reporting trends and other routinely collected risk indicators may be useful to improve our understanding and measurement of patient safety issues.

Atitude do Pessoal de Saúde , Segurança do Paciente , Gestão de Riscos/tendências , Gestão da Segurança/tendências , Centros Médicos Acadêmicos , Acidentes de Trabalho/estatística & dados numéricos , Feminino , Humanos , Itália , Masculino , Corpo Clínico Hospitalar/psicologia , Readmissão do Paciente/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Autorrelato