Revista de Calidad Asistencial最新文献

Objective

To determine the perception of healthcare professionals (tutors, residents and teaching collaborators) involved in specialist medical training on the core values and skills to develop their tasks.

Methods

A tailor-made questionnaire aimed at healthcare professionals in 9 health care centres and a referral hospital. Questionnaire: 4 sections and 51 variables (scale 1-10).

Results

A total of 287 professionals participated, which included 97% tutors (n = 59), 38% residents (n = 61), and 56% others (97 teaching collaborators and 70 not associated with teaching). The alfa Cronbach coefficient was 0.945. Best rated values were work compliance (8.7 points), ethics in professional practice (8.6 points), and respect for their team (8.3 points). The best rated competence was communication with patients and families (8.1 points), followed by self-motivating leadership (7.9 points), and the practical application of medical and healthcare theoretical knowledge (7.8 points). The values received, on average, 0.7 points above competences (95% CI: 0.5-0.9). There were no differences between tutors and residents, although differences were found between doctors and nurses, and between males and females.

Conclusion

Most of the professionals (tutors, residents, and teaching collaborators) share the same perception of the values and competencies that influence their professional development. This perception was influenced by the professional category and gender, but not age or working in a hospital or primary health care.

This study aimed to carry out the pharmacotherapeutic follow-up of patients with depression and to assess its impact on the resilience of the patients. Patients were followed-up for 8 months. The pharmacist evaluated depressive symptoms, resilience, and the need for pharmaceutical intervention. The measurement tools used were the Dader method, PHQ-9, and a resilience scale. Data were analysed using BioStat 5.0 software and the performing of the Wilcoxon and Pearson correlation tests. There was a reduction in the rate of depressive symptoms from 12.9 to 5.2 (P < .0001), and an increase in the resilience score from 112.4 to 149.0 (P < .0001). Pharmaceutical interventions were made to resolve the drug related problems in the form of oral communication between pharmacist-patient or pharmacist-patient-doctor. The pharmaceutical care was effective in decreasing depression and contributed to the increased resilience of patients.

Objective

To determine, from the point of view of the oncological patient, who made the decision about their treatment, as well as the major barriers and facilitators that enabled Shared Decision Making to be implemented.

Material and methods

A cross-sectional, descriptive, sand association study using a self-report questionnaire to selected cancer patients, with casual sampling in different oncology clinics and random time periods. A total of 108 patients provided analysable data. The information was collected on sociodemographic and clinical variables, who made the decision about treatment, and level of agreement or disagreement with various barriers and facilitators.

Results

More than one-third (38.1%) of patients claimed to have participated in shared decision making with their doctor. Barriers such as, time, the difficulty of understanding, the paternalism, lack of fluid communication, and having preliminary and often erroneous information influenced the involvement in decision-making. However, to have or not have sufficient tools to aid decision making or the patient's interest to participate had no effect. As regards facilitators, physician motivation, their perception of improvement, and the interest of the patient had a positive influence. The exception was the possibility of financial incentives to doctors.

Conclusions

The little, or no participation perceived by cancer patients in decisions about their health makes it necessary to introduce improvements in the health care model to overcome barriers and promote a more participatory attitude in the patient.

Objective

To assess the impact of a long-term initiative to improve safety culture among professionals working in a Health Area, and to know their perceived usefulness.

Material and methods

An uncontrolled intervention study was designed in a public health care organization including a 3 rd level hospital and 5,000 professionals. To measure the impact, the AHRQ Survey was conducted by telephone. A total of 7 dimensions of culture were measured, before starting the project (2012, n = 100) and 3 years later (2015, n = 207). Variations between 2012 and the respondents aware of the project in 2015 (RAP) were compared, as also between this last group and the rest of respondents (RNAP). The utility was assessed using a 5-item Likert scale, defining higher utility by medians 4 or higher.

Results

The response rates were above 80%. In 2015, the 41.5% of respondents were RAP (95% CI: 34.8-48.3), which was perceived as of high utility. Negative variations were detected in “sense of security” (−9.9%, P < .01, vs. 2012, and −4.2% between 2015 groups) and “feedback and communication errors” (−10.0% vs. 2012, and −8.9% between 2015 groups, P < .05). There was a not-significant positive variation in “openness in communication” (1.3% vs. 2012, and 6.9% between 2015 groups). The “management support” showed a not-significant improve in 2015 (37.0%, 95% CI: 30.9-43.1, in RAP; and 38.3%, 95% CI: 33.1-43.4, in RANP) in comparison to 2012 (31.4%, 95% CI: 28.4-39.7).

Conclusions

A paradoxical worsening is detected in several dimensions, this probably due to immaturity of the organization and the instrument used. Thus, tools explicitly considering the degree of maturity may be more appropriate to measure cultural changes, although more studies are needed.

Introduction

There is an increasing and more complex demand for sedation for procedures out of the operating room. For different reasons, nowadays the administration of sedation varies considerably. We believe that a patient safety approach rather an approach out of corporate or economic interests is desirable.

Method

We created a working group of experts within the Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR) to prepare a series of recommendations through a non-systematic review. These recommendations were validated by an expert panel of 31 anaesthesiologists through two rounds of an adaptation of the Delphi Method where more than 70% agreement was required.

Results

The resulting recommendations include previous evaluation, material and staffing needs for sedation for procedures, post-sedation recommendations and activity and quality control advice.

Conclusion

We present patient centred recommendations for the safe use of sedation for out of the operating room procedures from the point of view of the professionals with the most experience in its administration. We believe that these can be used as a guide to reduce variability and increase patient safety in the organisation of healthcare.

Objective

To determine the level of risk in the preparation and administration of antibiotics frequently used in the Intensive Care Unit using a risk matrix.

Material and method

A study was conducted using situation analysis and literature review of databases, protocols and good practice guidelines on intravenous therapy, drugs, and their administration routes. The most used antibiotics in the ICU registered in the ENVIN-HELICS program from 1 April to 30 June 2015 were selected. In this period, 257 patients received antimicrobial treatment and 26 antibiotics were evaluated. Variables studied: A risk assessment of each antibiotic using the scale Risk Assessment Tool, of the National Patient Safety Agency, as well as pH, osmolarity, type of catheter recommended for administration, and compatibility and incompatibility with other antibiotics studied.

Results

Almost two-thirds (65.3%) of antibiotics had more than 3 risk factors (represented by a yellow stripe), with the remaining 34.7% of antibiotics having between 0 and 2 risk factors (represented by a green stripe). There were no antibiotics with 6 or more risk factors (represented by a red stripe). Most drugs needed reconstitution, additional dilution, and the use of part of the vial to administer the prescribed dose.

Conclusion

More than half of the antibiotics studied had a moderate risk level; thus measures should be adopted in order to reduce it. The risk matrix is a useful tool for the assessment and detection of weaknesses associated with the preparation and administration of intravenous antibiotics.

Background

To determine the level of satisfaction and the sociodemographic characteristics of patients who receive epidural analgesia during labour.

Material and Methods

A SERVQHOS questionnaire administered, with consecutive sampling, to 140 patients who had received an epidural anaesthetic for pain control during labour between January and June 2014, at the Hospital San Pedro.

Results

A total of 140 questionnaires were completed. The mean overall satisfaction (SERVQHOS scale) was 4.4 with standard deviation (SD): ± 0.9, with the best results being obtained in the subjective ítems: (4.3; SD 0.81) compared to the objective ítems (4; SD: 0.9). The large majority (84.3%) showed satisfaction with the epidural anaesthetic, and 100% would ask for it again.

No significant differences were found in epidural satisfaction or pain perception related to socioeconomic variables (age, nationality, employment conditions, education level or marital status).

As regards nationality, 119 (85%) were Spanish, and 14.3% (20) of other nationalities, with 1 patient not answering the nationality question. As regards marital status, 79.3% (111) were married, 1.4% (2), single, and 2.9% (4) were widows or separated, and 2.9% (4) did not answer. The mean age was 33.3 years (SD: 4.4).

Prior to the administration of the epidural anaesthetic 93.2% of the Spanish citizens group described the pain as severe compared to 95% of the other nationalities group, but this difference had no statistical significance (p=.279).

Conclusion

The level of satisfaction reported by the patients with this technique was high, with subjective items (good manners and trust) being appreciated more.