Gustavo Debaisi

Evaluation of an improvement strategy on the incidence of medication prescribing errors in a pediatric intensive care unit

UNLABELLED Medical prescribing errors (MPEs) are one of the most common causes of adverse events. Intensive care units are a high-risk setting for their occurrence. OBJECTIVES To describe the incidence and types of MPEs in our Pediatric Intensive Care Unit. To assess whether the implementation of an improvement strategy on MPEs affects their incidence in the short- and long-term. POPULATION AND METHODS Prospective, uncontrolled, before-after study. Universe and sample. All medical prescriptions for patients hospitalized in the Pediatric Intensive Care Unit of the Hospital General de Niños Pedro de Elizalde from July-December, 2013 and from July-August, 2014. RESULTS In the pre-intervention period, MPEs rate was 13.9%, the most common being the absence of the time a given medication was modified, followed by missing a dose or medication. The medication most frequently involved in MPEs was the sedation and continuous analgesia group. After the implementation of an improvement program on MPEs, the incidence decreased to 6.3 errors every 100 prescriptions. The MPE type which showed the greatest reduction was the absence of the time of modification. Except for parenteral hydration and electrolyte supplementation, the rest of the analyzed medication groups showed a marked reduction. One year after having reviewed the situation, the MPE rate was 5.8%, and values remained similar to those of the immediate postintervention period. CONCLUSION Managing an improvement program on MPEs resulted in a decrease in its incidence.

Características de las residencias de terapia intensiva pediátrica de la República Argentina: Encuesta nacional

INTRODUCTION Pediatric intensive care residency programs have been in place in Argentina for just a few years. Knowing their status offers the possibility to establish strategies to help with professional development and training. OBJECTIVES 1) To describe the characteristics of pediatric intensive care residency programs across Argentina. 2) To assess whether certain characteristics are related to a higher vacancy filling rate. 3) To assess job placement in the hospital where residents are trained. DESIGN Descriptive, observational study. National survey. INCLUSION CRITERIA Pediatric intensive care residency programs in place between April 1st, 2014 and May 31st, 2014. RESULTS Thirty-one residency programs were analyzed. Only 11/31 had an annual hospitalization volume >400 patients. There were no guidelines and/or criteria for care in 9/31. The program suited the national reference framework in 17/31. There was no head of residents or resident trainer in 13/31. Only 5/31 had been certified by the Ministry of Health. There were 65 vacancies; this number increased in the past four years; vacancy filling rate decreased from 59% in 2009 to 30% in 2013. Sixty percent of residents got a job in the pediatric intensive care unit where they were trained. A multivariate logistic regression analysis identified the outcome measure annual hospitalization volume >400 patients as an independent predictor of vacancy filling rate >60%. CONCLUSIONS 1) Vacancy filling is deficient. 2) The number of certified residency programs is scarce. 3) Pediatric intensive care units with a higher number of hospitalizations were associated with a higher vacancy filling rate. 4) More than half of residents got a job in the pediatric intensive care unit where they were trained.

Invaginación intestinal en un lactante con diagnóstico de botulismo: Reporte de un caso

Botulism is an important public health problem in Argentina. It is a potentially fatal disease, and its diagnosis may be difficult. There are rare presentation forms of the disease, such as acute abdomen. We present a 4-month baby with a 3-day constipation condition, associated with weakness and abnormal eating attitude in the last 12 hours. The baby presented preserved muscle tone, with no changes in sucking or deglutition according to the mothers observations. Altered sensorium and acute abdomen were found; the patient was entered into the operating room with presumptive diagnosis of intussusception, which was confirmed by pneumatic desinvagination. During hospitalization, the patient did not make good progress and presented weak cry, progressive hypotonia and respiratory failure requiring intensive care. Clostridium botulinum was isolated from the stool sample and botulinum toxin type A was isolated from serum. The patient was treated with equine botulinum toxin. Twenty five days after admission, he was totally recovered.