La investigación de incidentes y eventos adversos como herramienta para mejorar la cultura de seguridad de pacientes

[Resumen] Antecedentes: La cultura de seguridad es un paso esencial para conseguir una atención al paciente, segura y de calidad. Objetivo: Evaluar la eficacia de una intervención educativa para mejorar la cultura de seguridad de pacientes en las Unidades Docentes de Medicina Familiar y Comunitaria de Galicia. Método: Estudio experimental unifactorial de dos grupos, control e intervención, llevado a cabo en dichas Unidades Docentes. Se envió el cuestionario SOPS a todos los residentes de 4º año y sus tutores. Se aleatorizaron los que aceptaron participar. El grupo de intervención recibió formación específica, registraron incidentes durante 15 días con el cuestionario APEAS y feedback posterior. En el grupo control no se realizó ninguna actuación. Finalizada la intervención, se pasó nuevamente el cuestionario a todos los participantes. Protocolo aprobado por el Comité de Ética de Investigación Clínica de Galicia. Resultados: La tasa de participación fue 58,7% y 45 facultativos notificaron incidentes. La intervención tiene un efecto en el Grado de seguridad positivo 0,278 (0,153-0,395) con p= 0,021. En el Número de incidentes notificados, fue positivo RRR=27,82 (2,89-267,77) y significativo en la notificación de 3 o más. Los principales factores causales implicados en los incidentes son comunicación y medicación. Conclusión: La intervención educativa propuesta en las Unidades Docentes de Medicina Familiar y Comunitaria de Galicia es efectiva para mejorar la cultura de seguridad.[Resumo] Antecedentes: A cultura de seguridade é un paso esencial para conseguir una atención ao paciente segura e de calidade. Obxectivo: Avaliar a eficacia dunha intervención educativa para mellorar a cultura de seguridade de pacientes nas Unidades Docentes de Medicina Familiar e Comunitaria de Galicia. Método: Estudo experimental unifactorial de dous grupos, control e intervención, levado a cabo nestas Unidades Docentes. Enviouse o cuestionario SOPS a todos os residentes de 4 año e os seus titores. Aleatorizáronse os que aceptaron participar. O grupo de intervención recibiu formación específica, rexistraron incidentes durante 15 días co cuestionario APEAS e feedback posterior. No grupo control non se realizou ningunha actuación. Finalizada a intervención, pasouse novamente o cuestionario a todos os participantes. Protocolo aprobado polo Comité de Ética de Investigación Clínica de Galicia. Resultados: A taxa de participación foi 58,7% e 45 facultativos notificaron incidentes. A intervención ten un efecto no Grado de seguridad positivo 0,278 (0,153-0,395) con p= 0,021. No Número de incidentes notificados, ten efecto significativo positivo RRR=27,82 (2,89-267,77) na notificación de 3 o más incidentes. Os principais factores causales implicados nos incidentes foron a comunicación e medicación. Conclusión: A intervención educativa proposta nas Unidades Docentes de Medicina Familiar e Comunitaria de Galicia é efectiva para mellorar a cultura de seguridade.[Abstract] Background: Patient safety culture is an essential step to quality and safety in health care. Objective: To evaluate the effectiveness of an educational intervention to improve patient safety culture in the Teaching Units of Family and Community Medicine of Galicia. Method: Unifactorial experimental study of two groups, control and intervention, carried out in these teaching units. SOPS questionnaire was sent to all residents of fourth years and their tutors. Those who agreed to participate were randomized. The intervention group received specific training, recorded incidents for 15 days with the questionnaire APEAS and subsequent feedback. In the control group, no action was performed. After the intervention, the questionnaire was sent to all participants. Protocol approved by the Ethics Committee for Clinical Research of Galicia. Results: The participation rate was 58.7% and 45 physicians reported incidents. The intervention has independent effect on Patient Safety Grade, 0.278 (0.153 to 0.395) with p = 0.021. In the Number of Incidents Reported, it was positive with RRR = 27.82 (2.89 to 267.77) in the notification of 3 or more. The main causal factors involved in the incidents are communication and medication. Conclusion: The educational intervention proposed in the Teaching Units of Family Medicine and Community of Galicia is effective in improving the safety culture

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial

Methods: A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. Results: 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity ≥50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. Conclusions: Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness

Detección precoz del uso problemático de Internet en adolescentes, en pediatría de atención primaria

Background: Use of the Internet has grown exponentially and adolescents are considered one of the most vulnerable groups in this new environment. Hence the problematic use of the Internet (PIU) at this stage has become a concern for a growing number of researchers. Taking into account the interest that this issue has generated at many levels, the aim of this paper is to find the prevalence of PIU among adolescents in the health area of Vigo (Spain). Methods: Cross-sectional descriptive study. The PIU validated scale was applied to children between 10 and 16 years old, captured by systematic sampling with replacement in the primary care consultations of four health centers. A descriptive and bivariate analysis was performed. Results: The questionnaire was applaid to 165 children, 51.2% men. Problematic Internet use was observed in 38.8% (95% CI: 31.7-46.4), higher in women (46.3%) than in men (31.8%), with no significant differences (p 0.07). By age groups, the positive rate on the scale reached 36.8% in the 13-14 year range and 48.6% in the 15-16 range. The item that reached the highest score was “When I am online, I feel that time flies and hours pass without me realizing it” (60.6%). Conclusions: The prevalence of UPI in children / adolescents is similar to that observed in Asian adolescents. This study is the first to apply a scale validated and adapted to the Spanish cultural context in the daily practice of Primary Care consultations. Its use would allow to identify the PIU in this context and intervene if necessary.Fundamentos: El uso de Internet ha crecido exponencialmente y los adolescentes son considerados uno de los grupos más vulnerables en este nuevo contexto. De ahí que el uso problemático de Internet (UPI) en esta etapa se haya convertido en una preocupación para un número creciente de investigadores. Teniendo en cuenta el interés que este tema ha generado en muchos niveles, el objetivo de este trabajo fue conocer la prevalencia del uso problemático de Internet entre los niños/adolescentes del área sanitaria de Vigo (España). Métodos: Se realizó un estudio descriptivo transversal. Se aplicó la escala validada EUPI-a a niños entre 10 y 16 años, captados por muestreo sistemático con reposición en las consultas de atención primaria de cuatro centros de salud. Se elaboró posteriormente un análisis descriptivo y bivariante. Resultados: Se entregó el cuestionario a 165 niños, de los que el 51,2% eran varones. Se objetivó un uso problemático de Internet en el 38,8% (IC 95%: 31,7-46,4), mayor en mujeres (46,3%) que en varones (31,8%), aunque no se constataron diferencias estadísticamente significativas (p=0,07). Por grupos de edad, la tasa de positivos en la escala alcanzó un 36,8% en la franja de 13-14 años y un 48,6% en la de 15-16 años. El ítem que alcanzó mayor puntuación fue “Cuando me conecto siento que el tiempo vuela y pasan las horas sin darme cuenta” (60,6%). Conclusiones: La prevalencia de UPI en niños/adolescentes es similar a la observada en adolescentes asiáticos. Este estudio es el primero en aplicar una escala validada y adaptada al contexto cultural español en la práctica diaria de una consulta de atención primaria. Su utilización en este entorno permitiría identificar el UPI e intervenir si fuera preciso

Effectiveness of an educational intervention to improve the safety culture in primary care: a randomized trial

Abstract Background Fostering a culture of safety is an essential step in ensuring patient safety and quality in primary care. We aimed to evaluate the effectiveness of an educational intervention to improve the safety culture in the family and community medicine teaching units in an Atlantic European Region. Methods Randomized study conducted in family and community medicine teaching units in Galicia (Spain). Participants were all fourth-year residents and their tutors (N = 138). Those who agreed to participate were randomized into one of two groups (27 tutors/26 residents in the intervention group, 23 tutors/ 23 residents in the control one).All were sent the Survey on Patient Safety Culture. After that, the intervention group received specific training in safety; they also recorded incidents over 15 days, documented them following a structured approach, and had feedback on their performance. The control group did not receive any action. All participants completed the same survey four months later. Outcome measures were the changes in safety culture as quantified by the results variables of the Survey: Patient Safety Grade and Number of events reported. We conducted bivariate and adjusted analyses for the outcome measures. To explore the influence of participants’ demographic characteristics and their evaluation of the 12 dimensions of the safety culture, we fitted a multivariate model for each outcome. Results Trial followed published protocol. There were 19 drop outs. The groups were comparable in outcome and independent variables at start. The experiment did not have any effect on Patient safety grade (− 0.040) in bivariate analysis. The odds of reporting one to two events increased by 1.14 (0.39–3.35), and by 13.75 (2.41–354.37) the odds of reporting 3 or more events. Different dimensions had significant independent effects on each outcome variable. Conclusion A educational intervention in family and community medicine teaching units may improve the incidents reported. The associations observed among organizational dimensions and outcomes evidence the complexity of patient safety culture measurement and, also, show the paths for improvement. In the future, it would be worthwhile to replicate this study in teaching units from different settings and with different health professionals engaged. Trial registration It was retrospectively registered with (ISRCTN41911128, 31/12/2010)

Procedimiento de canalización y cuidados del reservorio subcutáneo FEMORA

Este procedemento pretende documentar os coidados que se lle van realizar ao paciente portador dun reservorio subcutáneo incorporando a mellor evidencia existente. A súa finalidade é a estandarización dos criterios de actuación e reducir a variabilidade clínica coa incorporación das mellores prácticas na actividade asistencial diaria dos profesionais, garantindo a seguridade, confort, así como a continuidade asistencial do paciente en todos os niveis asistenciais.Este procedimiento pretende documentar los cuidados que se le van a realizar al paciente portador de un reservorio subcutáneo incorporando la mejor evidencia existente. Su finalidad es la estandarización de los criterios de actuación y reducir la variabilidad clínica con la incorporación de las mejores prácticas en la actividad asistencial diaria de los profesionales, garantizando la seguridad, confort, así como la continuidad asistencial del paciente en todos los niveles asistenciales

Adverse events analysis as an educational tool to improve patient safety culture in primary care: A randomized trial

<p>Abstract</p> <p>Background</p> <p>Patient safety is a leading item on the policy agenda of both major international health organizations and advanced countries generally. The quantitative description of the phenomena has given rise to intense concern with the issue in institutions and organizations, leading to a number of initiatives and research projects and the promotion of patient safety culture, with training becoming a priority both in Spain and internationally. To date, most studies have been conducted in a hospital setting, even though primary care is the type most commonly used by the public, in our experience.</p> <p>Our study aims to achieve the following:</p> <p>- Assess the registry of adverse events as an education tool to improve patient safety culture in the Family and Community Teaching Units of Galicia.</p> <p>- Find and analyze educational tools to improve patient safety culture in primary care.</p> <p>- Evaluate the applicability of the Hospital Survey on Patient Safety Culture by the Agency for Healthcare Research and Quality, Spanish version, in the context of primary health care.</p> <p>Design and methods</p> <p>Design</p> <p>Experimental unifactorial study of two groups, control and intervention.</p> <p>Study population</p> <p>Tutors and residents in Family and Community Medicine in last year of studies in Galicia, Spain.</p> <p>Sample</p> <p>From the population universe through voluntary participation. Twenty-seven tutor-resident units in each group required, randomly assigned.</p> <p>Intervention</p> <p>Residents and their respective tutor (tutor-resident pair) in teaching units on Family and Community Medicine from throughout Galicia will be invited to participate. Tutor-resident pair that agrees to participate will be sent the Hospital Survey on Patient Safety Culture. Then, tutor-resident pair will be assigned to each group-either intervention or control-through simple random sampling. The intervention group will receive specific training to record the adverse effects found in patients under their care, with subsequent feedback, after receiving instruction on the process. No action will be taken in the control group. After the intervention has ended, the survey will once again be provided to all participants.</p> <p>Outcome measures</p> <p>Change in safety culture as measured by Hospital Survey on Patient Safety Culture</p> <p>CONSORT Extension for Non-Pharmacologic Treatments 2008 was applied.</p> <p>Discussion</p> <p>The most significant limitations on the project are related to selecting a tool to measure the safety environment, the training calendar of residents in Family and Community Medicine in last year of studies and the no-answer bias inherent to research conducted through self-administered surveys.</p> <p>The development and application of a safety culture in the health sector, specifically in primary care, is as yet limited. Thus, identifying the strengths and weaknesses in the safety environment may assist in designing strategies for improvement in the primary care health centers of our region.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN41911128">ISRCTN41911128</a></p

Métodos de innovación docente aplicados a los estudios de Ciencias de la Comunicación

Se analiza el fenómeno de la implantación del Espacio Europeo de Educación Superior (EEES) a los estudios de Ciencias de la Comunicación, desde el punto de vista del profesorado. En este sentido se analizan experiencias educativas como: cuadernos de visionado para la iniciación de los alumnos en el comentario fílmico; la utilización didáctica de recursos audiovisuales; el uso de películas como herramientas en la educación de estudiantes; el uso de la televisión informativa; y la aplicación de técnicas de aprendizaje colaborativo entre otras propuestas. Asimismo, se estudia el estado de implantación del EEES en España y se describen propuestas de aplicación del mismo a diferentes áreas de los estudios de Ciencias de la Comunicación. También se dedican estudios a la descripción de nuevas estrategias docentes en el marco del EEES y se proponen fórmulas de evaluación de los aprendizajes. Por último se presta atención a la aplicación de las Tecnologías de la Información y la Comunicación a los citados estudios y se definen nuevas herramientas para apoyar a los estudiantes en su labor.MadridBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín 5 -3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]