Malpractice and patient safety descriptors: an innovative grid to evaluate the quality of clinical records

Introduction: The medical record contains all the health information related to the patient’s clinical condition and its evolution during hospitalization. It was defined by the Italian Ministry of Health in 1992 as "The information tool designed to record all relevant demographic and clinical information about a patient during a single episode of hospitalization". The documents and information in a Medical Record must meet the following criteria: traceability, clarity, accuracy, authenticity, pertinence and completeness. The objectives of our study was to develop a tool capable of assessing the quality of the clinical record and pointed the critical point at the Organizational, Technical - Professional, Managerial level. Methods: To evaluate the quality of the medical documentation, we created an assessment grid composed of 4 sections with a total of 92 criteria. This grid was tested on 200 medical records that were randomly selected from 25 (18 medical and 7 surgical) wards of a teaching hospital in Rome. Results: The grid contains 4 sections. The first part regards administrative and clinical data; the second assesses the quality of hospital stay and surgical/invasive procedures; the third part is concerned with the discharge of the patient and the fourth aims to identify the presence of advisory reports given to the patient. This grid has been validated to verify internal consistency with Cronbach's Alpha = 0,743. Conclusions: Medical records were analyzed using a validated tool with grids to identify critical issues in care activities. Weaknesses in the system were identified in order to improve planning. The sample testing also in terms of ‘self-assessment' represents a tool to introduce activities to improve safety and quality of care, greatly reducing the costs of litigation

Prevalence of influenza vaccination among physicians and related enhancing and preventing factors in Italy

Introduction: Several studies proved the convenience of vaccinating health care workers (HCWs), especially physicians, and vaccination is recommended by health authorities in many Countries. Nonetheless in Italy only a small part of HCWs get vaccinated. The aim of this study is to conduct a systematic review in order to estimate the pooled prevalence of influenza vaccinations among physicians in Italy and to investigate the enhancing/preventing factors associated with this kind of preventive tool.Methods: Relevant articles up to 1st May 2010 have been identified through Scopus, PubMed and Google Scholar; data extraction and quality assessment were performed independently by two researchers.The analysis was performed using StatsDirect 2.7.8.Results: Sixteen studies, performed between 1990 and 2008, reported vaccination rates with pooled prevalence among all HCWs. From nine of them data regarding physicians have been extracted and analysed, finding a pooled proportion of 23.18% (95% CI = 17.85-28.98%). One study allowed an analysis of the reasons encouraging and preventing influenza vaccination. The main ones are on one side self protection, and patients' and family's protection, and on the other side "not caring about influenza," followed by "fear of adverse effects" and "belief that vaccine isn't effective."Discussion: Italy has a good overall influenza vaccination coverage, and national records are available for population aged over 65 years or with chronic illness. Unfortunately there isn't any national record about HCWs or physicians vaccination, and from the data gathered from the studies examined in this analysis vaccination prevalence is low. The reasons brought from physicians are worrying because of their position in the society and in the health care system, in close contact with patients.This shows a great need for well-done information and educational campaigns stressing the importance of prevention

Quality assessment of medical record as a tool for clinical risk management: a three year experience of a teaching hospital Policlinico Umberto I, Rome

Introduction: The medical record was defined by the Italian Ministry of Health in 1992 as "the information tool designed to record all relevant demographic and clinical information on a patient during a single hospitalization episode". Retrospective analysis of medical records is a tool for selecting direct and indirect indicators of critical issues (organizational, management and technical). The project’s aim being the promotion of an evaluation and self-evaluation process of medical records as a Clinical Risk Management tool to improve the quality of care within hospitals. Methods: The Authors have retrospectively analysed, using a validated grid, 1,184 medical records of patients admitted to the Teaching Hospital “Umberto I” in Rome during a three-year period (2013-2015). Statistical analysis was performed using SPSS for Windows © 19:00. All duly filled out criteria (92) were examined. “Strengths” and "Weaknesses" were identified through data analysis and Best and Bad Practice were identified based on established criteria. Conclusion: The data analysis showed marked improvements (statistically significant) in the quality of evaluated clinical documentation and indirectly upon behaviour. However, when examining some sub-criteria, critical issues emerge; these could be subject to future further corrective action

Legionella control in the water system of antiquated hospital buildings by shock and continuous hyperchlorination: 5 years experience

To control the presence of Legionella in an old hospital water system, an integrated strategy of water disinfection-filtration was implemented in the university hospital Umberto I in Rome. Due to antiquated buildings, hospital water system design and hospital extension (38 buildings), shock hyperchlorination (sodium hypochlorite, 20-50 ppm of free chlorine at distal points for 1-2 h) followed by continuous hyperchlorination (0.5-1.0 mg/L at distal points) were adopted, and microbiological and chemical monitoring of the water supply was carried out in the university hospital (December 2006-December 2011). Overall, 1308 samples of cold 45°C (17.8%) water were collected, determining residual free chlorine (0.43 ± 0.44 mg/L), pH (7.43 ± 0.29) and trihalomethanes (8.97 ± 18.56 μg/L). Legionella was isolated in 102 (9.8%) out of 1.041 water samples without filters (L. pneumophila sg 1 17.6%, L. pneumophila sg 2-14 28.4%, L. non pneumophila 53.9%), and in none of the 267 samples with filters. Legionella was recovered in 23 buildings out of 38 and 29 samples (28.4%) exceeded 103 cfu/L. When considering the disinfection treatment Legionella was isolated: before shock hyperchlorination (21.1%), 15 days after shock hyperchlorination (7.8%), 30 days after shock hyperchlorination (3.5%), during continuous hyperchlorination (5.5%) and without continuous hyperchlorination (27.3%). Continuous hyperchlorination following the shock treatment achieved >70% reduction of positive samples, whereas no continuous hyperchlorination after shock treatment was more frequently associated to Legionella isolation (OR 6.41; 95% CI 3.10-13.26; p 0.5 < 1.0 mg/L) deteriorated water quality (organoleptic and chemical). However, shock and continuous hyperchlorination remains a valid-term option in old buildings with no water system rational design, managing problems due to hospital extension and absence of a proper hot water recirculation system

La mobilità interregionale dei ricoveri ospedalieri in regime ordinario in Italia: analisi delle SDO relative ai DRG chirurgici della MDC 5 dall’archivio ministeriale negli anni 2010-2011-2012

Il gruppo di lavoro CIDICS, dopo l’atlante delle procedure della MDC 5, utilizza le SDO del Ministero della Salute (anni 2010-2011-2012) per l’analisi del fenomeno della mobilità interregionale per ricoveri ordinari nel nostro Paese. Dopo aver ricordato alcune pubblicazioni sul tema, come il quaderno monografico di Agenas 2012 ed i Rapporti SDO del Ministero relativi agli anni 2010-2011-2012, si presentano le schede relative alla geografia regionale della mobilità per ricovero ordinario, per ciascuno dei 30 DRG chirurgici della MDC 5. I flussi migratori sono quelli compresi nell’arco temporale che va dal 2010 al 2012

Attività di Ricerca ed attività professionale degli igienisti nel settore “Igiene degli alimenti e della nutrizione” in ambito universitario.

L’alimentazione rappresenta uno dei principali determinanti di salute, in grado di condizionare fortemente patologie acute e croniche a tutte le età. E se da un lato del mondo la malnutrizione e la scarsità di alimenti sani e sicuri rappresentano i più gravi problemi di sanità pubblica, nel mondo occidentale è sempre più incombente l’epidemia dell’obesità e del sovrappeso anche in età infantile e adolescenziale. E mentre l’Unione Europea propone aggiornamenti dei Regolamenti a garanzia della sicurezza alimentare con una rinnovata attenzione alla prevenzione e alle ricadute ecologiche dell’alimentazione, diverse organizzazioni Internazionali (OMS, FAO e la stessa UE) fanno proprie la necessità di porre la giusta attenzione agli aspetti nutrizionali dell’alimentazione e alle sue conseguenze in termini di salute, mentre sono i più disagiati in termini economici a fare le spese di un’alimentazione in difetto o in eccesso. La Società Italiana di Igiene, medicina preventiva e sanità pubblica (SItI) pone da sempre grande attenzione al tema dell’alimentazione, sia sotto il profilo della sicurezza igienica che nutrizionale, ed ha attivato dal 2010 uno specifico Gruppo di lavoro che ha favorito la collaborazione ed il confronto fra il mondo accademico e quello dei Servizi dei Dipartimenti di Prevenzione, in particolare i Servizi di Igiene degli Alimenti e della Nutrizione (SIAN). Si è trattato di una preziosa occasione di incontro e confronto fra diversi professionisti che hanno condiviso strategie ed obiettivi per il raggiungimento di un risultato comune: la tutela della salute, gli interessi dei consumatori senza trascurare lo sviluppo economico del Paese

Alimentare la salute. Dedicato a chi ha fiducia nella prevenzione

L’alimentazione rappresenta uno dei principali determinanti di salute, in grado di condizionare fortemente patologie acute e croniche a tutte le età. E se da un lato del mondo la malnutrizione e la scarsità di alimenti sani e sicuri rappresentano i più gravi problemi di sanità pubblica, nel mondo occidentale è sempre più incombente l’epidemia dell’obesità e del sovrappeso anche in età infantile e adolescenziale. E mentre l’Unione Europea propone aggiornamenti dei Regolamenti a garanzia della sicurezza alimentare con una rinnovata attenzione alla prevenzione e alle ricadute ecologiche dell’alimentazione, diverse organizzazioni Internazionali (OMS, FAO e la stessa UE) fanno proprie la necessità di porre la giusta attenzione agli aspetti nutrizionali dell’alimentazione e alle sue conseguenze in termini di salute, mentre sono i più disagiati in termini economici a fare le spese di un’alimentazione in difetto o in eccesso. La Società Italiana di Igiene, medicina preventiva e sanità pubblica (SItI) pone da sempre grande attenzione al tema dell’alimentazione, sia sotto il profilo della sicurezza igienica che nutrizionale, ed ha attivato dal 2010 uno specifico Gruppo di lavoro che ha favorito la collaborazione ed il confronto fra il mondo accademico e quello dei Servizi dei Dipartimenti di Prevenzione, in particolare i Servizi di Igiene degli Alimenti e della Nutrizione (SIAN). Si è trattato di una preziosa occasione di incontro e confronto fra diversi professionisti che hanno condiviso strategie ed obiettivi per il raggiungimento di un risultato comune: la tutela della salute, gli interessi dei consumatori senza trascurare lo sviluppo economico del Paese

Microbiological safety of glasses dispensed at 3D movie theatres

Recent popularity of three-dimensional movies raised some concern about microbiological safety of glasses dispensed into movie theatres. In this study, we analysed the level of microbiological contamination on them before and after use and between theatres adopting manual and automatic sanitation systems. The manual sanitation system was more effective in reducing the total mesophilic count levels compared with the automatic system (P< 0.05), but no differences were found for coagulase-positive staphylococci levels (P= 0.22). No differences were found for mould and yeast between before and after levels (P= 0.21) and between sanitation systems (P= 0.44). We conclude that more evidences are needed to support microbiological risk evaluation