Joaquim Bañeres

Los sistemas de registro y notificación de efectos adversos y de incidentes: una estrategia para aprender de los errores

The need to find strategies of error prevention and promotion of patient safety has stimulated countries to develop models that improve knowledge of adverse events. One of the tools used are reporting systems for gathering information about errors. To review existing reporting systems, to describe the models developed by the countries with the longest tradition in designing strategies for the promotion of patient safety and prevention of adverse events and to determine the factors required for the development of future reporting systems. Adverse event reporting systems were created in nonmedical fields, with the aim of collecting information relating to near-misses (without harm) or accidents (with harm). This information was used to establish a profile of the most frequent problems in an organization and to understand the factors that contribute to errors. There are different types of reporting systems. Nevertheless, independently of the reporting system used, their application and development benefits the organization since they generate opportunities for modeling events, monitoring, increasing awareness of safety problems and more efficient resource use. New strategies should be designed to increase health professionals’ commitment to reporting adverse events. Legal and organizational barriers that hamper their implementation should be analyzed.

Epidemiología de los eventos adversos hospitalarios en Catalunya: un primer paso para la mejora de la seguridad del paciente

It has been published that hospital adverse events are an important source of morbidity and mortality in different countries and settings. The aim of this study was to evaluate the frequency, magnitude, distribution and degree of preventability of adverse events in the Autonomous Community of Catalonia (Spain). We conducted a retrospective cohort study of 4,790 hospital discharges that were selected by simple random sampling after stratified multistage sampling in 15 hospitals in Catalonia. 38.25% of patients had positive risk criteria (screening phase). We identified 356 cases of adverse events, which represent a 7.4% (95%CI: 6.7% to 8.1%). Of these, 43.5% (155 cases) were considered preventable. This study confirms that adverse events in hospitals in Catalonia are frequent, and generate a significant impact on morbidity and mortality. As in other studies, corroborated that a high proportion of these adverse events are considered preventable. It was possible to identify priority areas to focus improvement efforts.

Diseño, implantación y evaluación de un modelo de gestión de la seguridad del paciente en hospitales de Cataluña

Since its inception in 2006, the Alliance for Patient Safety in Catalonia has played a major role in promoting and shaping a series of projects related to the strategy of the Ministry of Health, Social Services and Equality, for improving patient safety. One such project was the creation of functional units or committees of safety in hospitals in order to facilitate the management of patient safety. The strategy has been implemented in hospitals in Catalonia which were selected based on criteria of representativeness. The intervention was based on two lines of action, one to develop the model framework and the other for its development. Firstly the strategy for safety management based on EFQM (European Foundation for Quality Management) was defined with the development of standards, targets and indicators to implement security while the second part involved the introduction of tools, methodologies and knowledge to the management support of patient safety and risk prevention. The project was developed in four hospital areas considered higher risk, each assuming six goals for safety management. Some of these targets such as the security control panel or system of adverse event reporting were shared. 23 hospitals joined the project in Catalonia. Despite the different situations in each centre, high compliance was achieved in the development of the objectives. In each of the participating areas the security control panel was developed. Stable structures for safety management were established or strengthened. Training in patient safety played and important role, 1415 professionals participated. Through these kind of projects not only have been introduced programs of proven effectiveness in reducing risks, but they also provide to the facilities a work system that allows autonomy in diagnosis and analysis of the different risk situations or centre specific safety issues.

Derechos de los pacientes en los principales sistemas de acreditación hospitalaria

Resumen Objetivo Analizar como se abordan los derechos de los pacientes en los principales sistemas de acreditacion del mundo. Material y metodo Estudio de los principales sistemas de acreditacion hospitalaria existentes, empleando una metodologia cualitativa de analisis de textos. Los estandares de derechos de pacientes de los distintos sistemas de acreditacion son agrupados segun el tema que tratan. Se establecen 9 temas principales: Informacion al paciente, Intimidad, trato y apoyo emocional, Proteccion del paciente, Proteccion de la autonomia, Donacion de organos, Codigo de derechos del paciente, Expresion de quejas y reclamaciones, Etica de la organizacion y Nuevos derechos. Resultados No todos los sistemas de acreditacion estudiados incluyen un capitulo sobre derechos de los pacientes. A pesar de las diferencias observadas en la cobertura que los sistemas de acreditacion dan a los derechos de los pacientes, tanto por la profundidad de su analisis como por los aspectos concretos que cubren los estandares, todos los sistemas de acreditacion estudiados tratan este tema, aunque no sea en forma de un capitulo independiente. Conclusiones En la revision realizada se evidencia la creciente importancia del tema de los derechos de los pacientes en los sistemas de acreditacion.

Sistemas de identificación de pacientes en hospitales de Cataluña

Resumen Objetivo Conocer la situacion actual del grado de implantacion de los sistemas de identificacion de los pacientes en los centros hospitalarios de agudos de Cataluna. Metodos Encuesta enviada via electronica y dirigida a la direccion de enfermeria de los hospitales de agudos de Cataluna sobre la utilizacion de sistemas de identificacion de los pacientes, la implantacion en los diferentes servicios hospitalarios y los datos utilizados en el sistema. Resultados De los 75 centros estudiados un 90,7% declaro utilizar algun sistema de identificacion de los pacientes. Solamente el 26,7% de los centros disponian de sistemas de identificacion en todos los servicios de hospitalizacion. Los datos identificativos mas frecuentemente utilizados en el sistema de identificacion fueron: nombre y apellidos del paciente (100%), numero de historia clinica (79,4%), fecha de nacimiento (67,6%) y numero de cama (66,2%). El 77,3% de los centros utilizaban un unico sistema de identificacion de pacientes y el mas frecuente fue el brazalete identificativo (85,3%). El uso del brazalete identificativo solo estaba protocolizado en el 67,2% de los centros y el 50% refirio algun problema con su utilizacion. Conclusiones Hay un buen nivel de implantacion de los sistemas de identificacion de los pacientes en Cataluna; sin embargo, es necesario promover una mayor utilizacion en todos los servicios hospitalarios y potenciar la protocolizacion de su uso, asi como realizar un seguimiento de su cumplimiento.

Seguridad clínica y orientación al paciente: estudio descriptivo en 113 hospitales españoles y similitudes en otros países europeos

Resumen Objetivos Describir el grado de desarrollo del sistema de mejora de calidad de los hospitales de agudos en Espana y la medida en que dan respuesta a algunos requisitos especificos de seguridad y orientacion al paciente. Se presentan tambien datos agregados de otros 7 paises de la Union Europea, con el fin de disponer de datos de referencia que ayuden al analisis de resultados. Material y metodos Estudio transversal descriptivo llevado a cabo en hospitales de agudos de mas de 100 camas de 8 paises europeos. La recogida de datos se realizo mediante un cuestionario compuesto por mas de 500 preguntas cerradas, autoaplicado a traves de internet, que posteriormente validaron evaluadores externos en una muestra por conveniencia de los centros participantes. Resultados Participaron en el estudio 113 hospitales espanoles publicos y privados, lo que representa un 34% de los que cumplen los criterios de inclusion. Ademas, 276 hospitales de otros 7 paises respondieron al cuestionario. Se presentan los resultados de ambos grupos respecto al sistema de gestion de calidad, la seguridad y la orientacion al paciente. Conclusiones Se recomienda trabajar en las principales areas en que los hospitales espanoles tienen un grado de desarrollo menor que el de los demas paises participantes: el acceso publico a los datos de evaluaciones externas de calidad, la implantacion de algunos mecanismos clave para la seguridad del paciente y la implicacion del paciente en la gestion de la organizacion.

Shared Decision making in Catalonia: a new step forward in improving decision making process

Introduction : Over the past decades shared decision making has gained increased awareness by using a wide range of initiatives from passive information provision to more active initiatives seeking to support patients. In this context, the Catalan Patient Advisory Council was created and requested to lead a strategic plan aiming to promote patient empowerment and responding to patients, families and patient associations’ needs. As part of this strategic plan, the shared decision project started by designing and developing specific decision aids (DA) for shared decision making and encourage patients in discussing with their doctors reasonable treatment and decision options, including the choice to do nothing. Methods : A web based DA was designed and elaborated with the participation of families and patient associations and health care professionals (nephrologists, oncologists, radiotherapist and urologists) representing different scientific societies and f. The web based DA aimed to provide patients with the best scientific evidence through the following content: information of the health condition, appropriate treatment options, a test on patient’s values and preferences, and frequently asked questions. Results : As a first stage, two health conditions were elaborated: a web based DA for men with clinically localized prostate cancer aiming to provide option treatments including: active surveillance, surgery, radiation therapy and braquitherapy; pros and cons of each option, and life style conditions. The second web based DA was the advanced chronic kidney disease with the aim of selecting the right choice of treatment among: hemodialysis carried out in specialist centres, hemodialysis carried out at home, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. Both decision aids included stories of patients from the frontline, preference tests and patient resources such as video demonstration on dialysis. Discussion : While the web based DA was reviewed by experts, some content of the DA can still remain subject of discussion since every doctor participating in the process (nephrologist, radiotherapist or oncologist) can see the health condition from their own perspective, and all can have their own preference on presenting for instance treatment options. However, good shared decision making in this process should recognize the complementary areas among the experts and lead in this case to better quality decisions. The shared decision project was designed to address the challenges to improving decision making process. The DA educates patients and emphasizes the availability of multiple treatment options and the role of the patient in this process. In order to facilitate this process, the DA includes a test of preferences that prepares patients to discuss with their doctor their values, opinions and preferences. Conclusions : Both webs based DA will help to ensure that patients start being involved in the treatment decision making with their doctors and this might have an impact in the future in decreasing inappropriate treatments or increasing patient empowerment and satisfaction. There are however still some challenges to cope with in the future such as the evaluation of this new DA and the main barriers and facilitators to overcome for its successful implementation in the decision making process.