17 research outputs found
Hospital-Acquired Urinary Tract Infections: Results of a Cohort Study Performed in an Internal Medicine Department
Introduction: Urinary tract infections are the most frequent healthcare associated infections, being related to both high costs and morbidity. Our intention was to carry out an epidemiological characterization of hospital acquired urinary tract infections that occurred in an internal medicine department of a Portuguese hospital.
Material and methods: Retrospective cohort study (historic cohort). Data were analysed from a systematic random sample of 388 patients, representative of the 3492 admissions occurred in 2014 in that department.
Results: One in four patients underwent the placement of a bladder catheter [24.7% (n = 96); 95% CI: 20% - 29%], 36.5% (95% CI: 33% - 48%) of which in the absence of clinical criteria for that procedure. The global cumulative incidence rate for nosocomial urinary tract infections was 4.6% (95% CI: 2.5% - 6.7%). Most hospital acquired urinary tract infections (61.1%) were related to bladder catheter use. We quantified 3.06 infections / 1000 patient-days and 14.5 infections / 1000 catheter-days. Catheter associated urinary tract infection occurred at an early stage of hospitalization. The vast majority of patients (66.7%) that developed a catheter associated urinary tract infection were subjected to bladder catheter placement at emergency department. Seventy one per cent of catheter associated urinary tract infection occurred in patients that were subjected to bladder catheter placement without criteria.
Discussion: These results point to an excessive and inadequate use of urinary catheters, highlighting the need for judicious use taking into account the formal clinical indications. The incidence of catheter associated urinary tract infection is similar to what we found in other studies. Nevertheless we found a very high incidence density per catheter-days that may foresee a problem probably related to the absence of early withdrawal of the device, and to both bladder catheter placement and maintenance practices. A significant part of catheter associated urinary tract infection occurred in patients that had the bladder catheter placed in the emergency department, before the admission to the internal medicine ward, which highlights the need to assess the urinary catheterization practices in those departments.
Conclusion: The high rate of catheter associated urinary tract infection that occurred in the absence of bladder placement indication reinforces the need to implement prevention strategies that contemplate the reduction of its use. Emergency departments should be part of quality improvement projects in this area. Causes for the early onset of catheter associated urinary tract infection in this cohort should be investigated.info:eu-repo/semantics/publishedVersio
Identifying risk factors for bladder catheterization in Internal Medicine patients: can it be helpful for clinical practice?
info:eu-repo/semantics/publishedVersio
Upper lobe cavity with intracavitary mass: an unexpected diagnosis
info:eu-repo/semantics/publishedVersio
The Concept of Health and My Internal Medicine Practice
info:eu-repo/semantics/publishedVersio
Radial artery pseudoaneurysm: rare complication of a frequent procedure
info:eu-repo/semantics/publishedVersio
results of a cohort study performed in an internal medicine department
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Contributions to the Portuguese National Plan for Patient Safety 2021–2026: A Robust Methodology Based on the Mixed-Method Approach
Introduction: Several countries prioritize patient safety in
their health policies. In Portugal, following the implementation of the National Plan for Patient Safety (NPPS) 2015–
2020, the research team of the National School of Public
Health (NSPH) carried out extensive work to continue improving aspects of the previous Plan. This work was focused
on identifying the strengths and weaknesses of NPPS 2015–
2020 and aspects related to its applicability and main challenges and opportunities for the implementation of the
NPPS 2021–2026. Methods: Methodological dynamic process was based on the most relevant international and national guidelines and the feedback from key patient safety
stakeholders. We developed a cross-sectional mixed-methods study from January to August 2021. We used documentation and periodical reports from National Health Service
(NHS) healthcare institutions as secondary sources of information. For primary data collection, we used an online survey (applied to elements in the different quality and safety
structures of hospitals and primary care units), interviews, and focus groups to collect information from patient safety
experts. Results and Discussion: Strengthening safety culture, patient safety training, communication, leadership involvement, patient and family engagement, and monitorization process is considered essential. We also identified local
limitations such as the lack of resources and protected time
for the healthcare professionals and lack of leadership involvement on patient safety strategies for dedicating to patient safety actions. Most of the patient safety stakeholders
agreed that the safety and health of clinical teams and new
modalities of healthcare (such as telemedicine, home hospitalization, home care) should be a priority for patient safety
strategies. Conclusions: In our study, we used a robust methodology with a participatory process involving different
stakeholders. An alignment between local, regional, and national levels in terms of measuring indicators, the definition
of priorities, and actions and activities to improve patient
safety is recommended. Reinforced partnerships and alignment between the institution’s mission, and safety priorities
will be crucial to enhance patient safety. Additionally, this
work highlights the added value for health systems achieved
through strong partnerships between public administration
and academic institutions to improve healthcare quality and
patient safetyinfo:eu-repo/semantics/publishedVersio
Catheter-associated urinary tract infection in medical patients of a Portuguese hospital: incidence and risk factors
info:eu-repo/semantics/publishedVersio
Healthcare Professionals Perception of the Reconciliation Medication Process in a Hospital Context: Case Study
Introdução: O processo de reconciliação terapêutica visa, em momentos de transição entre níveis de prestação de cuidados de saúde, diminuir os incidentes com medicamentos e contribuir para o uso seguro da
medicação. Com este estudo pretendeu-se explorar barreiras e fatores que influenciam o processo de reconciliação terapêutica num serviço de Medicina Interna de um hospital de nível distrital e identificar oportunidades de melhoria.
Métodos: Estudo de natureza qualitativa, do tipo de estudo de caso único e exploratório, com a realização
de entrevistas semiestruturadas a médicos, enfermeiros e farmacêuticos.
Resultados: Destacam-se as dificuldades na comunicação com o doente, família, entre os profissionais de
saúde, serviços e outras instituições. A nível informático, dificuldades na prescrição em contexto de emergência, alertas de medicação repetidos e o não acesso à plataforma de dados de saúde pelos farmacêuticos.
Como oportunidades de melhoria na reconciliação terapêutica, os profissionais de saúde apontaram para
a formação, seguimento do doente após alta hospitalar, melhoria da comunicação entre as instituições de
saúde e integração entre os sistemas de informação em saúde.
Conclusão: Os resultados obtidos demonstram que as barreiras ao processo de reconciliação terapêutica
persistem, com consequências expetáveis a nível da qualidade dos cuidados prestados. Este estudo alerta
para a necessidade de implementação de medidas que as permitam mitigar.info:eu-repo/semantics/publishedVersio