Errors in preparation and medication management in nursing professionals

The preparation and administration of medications is one of the most common and relevant functions of nurses, demanding great responsibility. Incorrect administration of medication, currently constitutes a serious problem in health services, and is considered one of the main adverse effects suffered by hospitalized patients. Objectives: Identify the major errors in the preparation and administration of medication by nurses in hospitals and know what factors lead to the error occurred in the preparation and administration of medication. Methods: A systematic review of the literature. Deined as inclusion criteria: original scientiic papers, complete, published in the period 2011 to May 2016, the SciELO and LILACS databases, performed in a hospital environment, addressing errors in preparation and administration of medication by nurses and in Portuguese language. After application of the inclusion criteria obtained a sample of 7 articles. Results: The main errors identiied in the pr eparation and administration of medication were wrong dose 71.4%, wrong time 71.4%, 57.2% dilution inadequate, incorrect selection of the patient 42.8% and 42.8% via inadequate. The factors that were most commonly reported by the nursing staff, as the cause of the error was the lack of human appeal 57.2%, inappropriate locations for the preparation of medication 57.2%, the presence of noise and low brightness in preparation location 57, 2%, professionals untrained 42.8%, fatigue and stress 42.8% and inattention 42.8%. Conclusions: The literature shows a high error rate in the preparation and administration of medication for various reasons, making it important that preventive measures of this occurrence are implemented.

Diagnóstico e análise funcional da implementação do Sistema Pyxis no Serviço de Urgência do Hospital Espírito Santo- Évora

Atualmente, existe interesse em determinar o benefício ou contributo do estudo de um determinado tópico para a prática em enfermagem e melhoria do serviço ao utente, o que é percetível na necessidade detetada nessa prática de disponibilizar o medicamento no local adequado, na quantidade exigida e no tempo e gasto mínimos. Neste sentido, verifica-se que o Hospital do Espirito Santo Évora (HESE) adquiriu o sistema Pyxis em 2007 e, até à data, não foi implementado sem se perceber as razões para tal, quer sejam de natureza técnica quer de gestão, o que desperta o interesse no tratamento deste assunto e a relevância do tema. Assim, levanta-se a questão sobre as condições de implementação do Pyxis, o que se traduz num problema, para o qual se procura uma solução com uma metodologia adequada. O presente trabalho tem como objetivo preparar as condições para a implementação do Pyxis. Assim, pretende-se analisar a situação presente e identificar as necessidades de alteração e de ajustamento suportadas nas exigências e requisitos do sistema Pyxis, no que se refere à sua implementação. Em termos metodológicos, para prosseguir o objetivo antes referido, recorre-se ao diagnóstico interno, à descrição do Pyxis, para identificação das condições da sua implementação, à análise funcional e à elaboração do instrumento de inquérito através de questionário, para posterior aplicação. Os resultados obtidos permitem uma verificação dos requisitos e alterações, para a implementação do sistema Pyxis, bem como os benefícios associados a este sistema. Existe a evidência de que o sistema Pyxis é uma nova tecnologia que possibilita ao HESE a diminuição do tempo utilizado pela equipa de saúde no processo logístico de distribuição do medicamento e a melhoraria da qualidade através da diminuição de erro de medicação, sendo fundamental na qualidade dos cuidados de saúde a prestar aos utentes, o que é concordante com o enquadramento teórico efetuado

Prevalence of colonizing bacteria and their association with primary bacteremias in hemodialysis of a university hospital

to be from 2.5 to 5.5 cases per 1,000 catheter-day. the clinical impact is relevant and increases the cost of the HD Unit. Methods: The present study is the irst of 2 phases. It was conducted from January to December of 2012, and included all patients and nurses who were in the HD Unit. The prevalence of Gramnegative bacilli (GNB) and methicillin-resistant Staphylococcus aureus (MrSA) colonizing the nasal passages and the skin is described. Also, phenotypic association was sought by genus, species and sensitivities between colonizing bacterial strains and blood cultures with GNB and MRSA. Results: the study included 70 patients and 10 nurses. the prevalence of nasal colonization in patients by GNB was 9% and 6% in the pericatheter, and no nursing GNB colonization was discovered. The prevalence of MRSA nasal colonization was 19% and 6% in the pericatheter for patients and in the nurses the nasal colonization was 50% and 10% in the hands. We identiied 29 cases of primary bacteremia. The primary bacteremia rate is 1.5 per 1,000 catheter-day or 0.4 episodes per patient per year. Conclusion: We demonstrated a high prevalence of MrSA colonization in patients and nurses in the HD Unit. No relationship was found between primary bacteremia by GNB and patients and nurses’ bacteria colonization by the phenotypic comparison.

Impact of a fall prevention program in the Internal Medicine wards of a tertiary care university hospital

Objective: To determine whether a falls prevention program reduces the incidence of falls within a hospital. Materials and methods: Each patient admitted to the Internal Medicine ward was classiied into a risk category (high, medium, low) according to the scale of J.H. Downton, and then various general and speciic measures were applied by risk group. Interventions included appointments, teaching materials, and training of medical staff and family. Furthermore, a registration system was developed that allowed adverse event fe edback to the program and identiicat ion of the causes of the fall. The SPSS version 20.0 was used for the data analysis. Descriptive analysis was used for quantitative variables, and qualitative variables were expressed as proportions. To compare the rate of pre- and post-program implementation falls, x 2 was used, with a  = 0.05 determining a signiicant statistical value. Results: Since the implementation of the program, the rate of falls per 1000 days/patient decreased from 1.9 in 2007 to 0.67 in the period 2008-2013, representing a decrease of the rate of falls of up to 70%, with a statistically signiicant difference (P=.02). Conclusions: The implementation of a falls prevention program is an effective tool and reduces the rate and complications associated with them.

Hernia de Amyand, reporte de un caso: Hospital Vicente Corral Moscoso

La hernia de Amyand es una entidad rara que se caracteriza por la presencia del apéndice vermiforme en el saco herniario de una hernia inguinal. La prevalencia es de aproximadamente el 1% y, por lo general, se presenta en hernias ubicadas al lado derecho; su diagnóstico habitual se realiza durante la intervención quirúrgica. En el presente caso se describe a un paciente de 67 años que acude al servicio de emergencia del Hospital Vicente Corral Moscoso presentando esta patología y su correspondiente manejo.

Attention Deficit Hyperactivity Disorder in a Patient With Congenital Mirror Movement Disorder and Colpocephaly

Introduction: Congenital mirror movement disorder designates involuntary movements on one side of the body that occur as mirror of the intentional movements on the contralateral side. Colpocephaly is described as persistence of fetal configuration of lateral ventricles. Case Presentation: A two-month old male infant was brought to the hospital due to bilateral identical movements of the hands. Except for bilateral involuntary synkinetic imitative movements in hands, neurological and physical examination was normal. Cranial MRI showed corpus callosum dysgenesis, hypogenesis and dilation of bilateral lateral ventricular posterior horns (colpocephaly). At the age of 7 years, he was started to use metylphenydate to mitigate attention deficit and hyperactivity disorder. The mirror movements were decreasing in amplitude by years and were not so serious to affect normal life activities. Conclusions: Mirror movements, diagnosed usually during childhood, may be congenital or secondary to neurological diseases. Although they generally do not affect normal life activities, in some cases severity of mirror movements causes a real debilitating disease. In our case the patient was diagnosed at the age of 2 months and on follow-up no debilitating problems were observed. This is the first case to describe the association of colpocephaly and mirror movements. The exact mechanism of this association is not known. Although it is known that mirror movements may be in relation with some pychiatric pathologies, this is the first report of attention deficit and hyperactivity disorder in conjunction with mirror movements and/or colpocephaly. Managing comorbidities, either physical or psyhchological, will help the patient to live in good health without trying to cope with other pathological diseases.

Prevalencia y factores de riesgo de la incontinencia urinaria de esfuerzo en mujeres atendidas en consulta externa de urología y ginecología del Hospital Vicente Corral Moscoso. Periodo enero 2012 - diciembre 2014

Antecedentes. La incontinencia urinaria de esfuerzo (IUE) es el tipo más común en mujeres, no es una enfermedad que ponga en peligro la vida del paciente, pero deteriora significativamente la calidad de vida. Objetivo: Establecer la prevalencia y factores de riesgo de la IUE en mujeres que fueron atendidas en consulta externa de Urología y Ginecología del Hospital Vicente Corral Moscoso. Material y métodos. Con un diseño transversal se recopiló información de las historias clínicas de 2418 mujeres atendidas en el período enero 2012 a diciembre 2014. Se describen características demográficas y se analiza: multiparidad, edad mayor a 45 años, obesidad y diabetes, como factores de IUE. Resultados. El 52.4% (n = 1268) de la población de estudio fue mayor a los 45 años, 88% (n = 2128) multíparas, 28.2% (n = 682) obesas y el 11.1% (n = 268) diabéticas. La prevalencia de la IUE fue del 10.3%. Se encontró asociación significativa de la IUE con: multiparidad [OR 2.2 (IC95% 1.3 – 3.8)] P = 0.002, edad mayor a 45 años [OR 1.8 (IC95% 1.4 – 2.4)] P < 0.001 y obesidad [OR 1.5 (IC95% 1.2 – 2.0)] P = 0.001. No se encontró asociación con la diabetes [OR 0.9 (IC95% 0.6 – 1.4)] P = 0.880. Conclusión. Las características de la población de estudio fueron similares a las reportadas por la literatura médica. La no asociación con diabetes se explicaría por la baja prevalencia global de IUE en pacientes diabéticos mayores de 65 años

Frecuencia y características del trauma en pacientes de 0 a 16 años que acuden a emergencia del Hospital Vicente Corral Moscoso julio-diciembre, Cuenca 2014

ANTECEDENTES: la elevada concurrencia de pacientes pediátricos a las salas de emergencia de los diferentes hospitales por causas traumáticas, ha generado preocupación en la colectividad y principalmente en las personas que laboran en las casas de salud. OBJETIVO GENERAL: determinar la frecuencia y las características del trauma en pacientes de 0 a 16 años que acuden a emergencia del Hospital Vicente Corral Moscoso de la ciudad de Cuenca, en un período comprendido entre julio a diciembre del 2014. METODOLOGÍA: se realizó un estudio de tipo descriptivo-retrospectivo, mediante la revisión de historias clínicas de emergencia y formularios del SOAT. En el periodo de estudio se registraron 6891 consultas en la emergencia, de los cuales 3128 pacientes de 0 a 16 años consultaron por trauma. Se valoraron variables como: sexo, edad, área de residencia, causas, escenario físico, persona o institución que lleva al niño, forma de transporte, tipos de lesiones, el horario y calendario en el que se presentó el trauma. La información se analizó con la base de datos en Excel 2010, SPSS versión 19. RESULTADOS: el 59,6% de los pacientes fue de sexo masculino, con una edad promedio 7 años, presentaron mayormente caídas 51,11% y el trauma de cabeza 35.81% de acuerdo a la lesión. La mayoría de pacientes en un 61% fueron de zona urbana; el lugar más frecuente de producción del accidente fue el domicilio con 54.53%. Un 93.9% de niños fueron llevados por sus familiares en forma ambulatoria con 73.6%, acudieron al hospital dentro de la primera hora después del percance un 67.3%

Conciliación de medicamentos e identificación de los tipos de discrepancias al ingreso, durante la hospitalización y al alta en pacientes del área de ginecología del Hospital Vicente Corral Moscoso. Cuenca, 2015

La conciliación de medicamentos es la adecuada combinación de conocimientos y evidencias científicas de las reacciones, interacciones y necesidades de los pacientes, constituye en esencial el buen uso de los medicamentos. Objetivo general: Establecer la conciliación de medicamentos e identificar los tipos de discrepancias existentes al ingreso, durante la hospitalización y al alta en las pacientes del área de ginecología del Hospital Vicente Corral Moscoso. Cuenca, durante los meses noviembre – diciembre 2015. Metodología: Se diseñó un estudio descriptivo, con un población de 200 pacientes hospitalizadas en el área de ginecología del Hospital Vicente Corral Moscoso, durante 2 meses del 2015, recolectamos los datos mediante un formulario de dos etapas para la conciliación, a partir de las prescripciones de la historia clínica y entrevista a las pacientes, los que fueron ingresados en el software SPSS 15.0 para su tabulación, análisis, y presentación en tablas. Resultados: Se encontró 161 errores de conciliación y 42 discrepancias justificadas, en promedio 1,87discrepancias no justificadas por paciente. El error de conciliación más frecuente al ingreso corresponde a diferente dosis, vía y frecuencia de administración con un 84,6%, durante la hospitalización y al alta, correspondió a prescripciones incompletas con el 40% y 60,3% respectivamente. Conclusiones: La frecuencia con la que se realiza la conciliación de medicamentos en el Hospital Vicente Corral Moscoso fue del 15%. El 52% de pacientes están expuestos a riesgo por discordancias en las prescripciones, de ellos 43% son errores en la conciliación y un 9 % son discordancias justificadas

Le mode de ventilation neurally adjusted ventilatory assist (NAVA) est faisable, bien toléré, et permet la synchronie entre le patient et le ventilateur pendant la ventilation non invasive aux soins intensifs pédiatriques : étude physiologique croisée

Introduction: La ventilation non invasive (VNI) est un outil utilisé en soins intensifs pédiatriques (SIP) pour soutenir la détresse respiratoire aigüe. Un échec survient dans près de 25% des cas et une mauvaise synchronisation patient-ventilateur est un des facteurs impliqués. Le mode de ventilation NAVA (neurally adjusted ventilatory assist) est asservi à la demande ventilatoire du patient. L’objectif de cette étude est d’évaluer la faisabilité et la tolérance des enfants à la VNI NAVA et l’impact de son usage sur la synchronie et la demande respiratoire. Méthode: Étude prospective, physiologique, croisée incluant 13 patients nécessitant une VNI dans les SIP de l’hôpital Ste-Justine entre octobre 2011 et mai 2013. Les patients ont été ventilés successivement en VNI conventionnelle (30 minutes), en VNI NAVA (60 minutes) et en VNI conventionnelle (30 minutes). L’activité électrique du diaphragme (AEdi) et la pression des voies aériennes supérieures ont été enregistrées pour évaluer la synchronie. Résultats: La VNI NAVA est faisable et bien tolérée chez tous les enfants. Un adolescent a demandé l’arrêt précoce de l’étude en raison d’anxiété reliée au masque sans fuite. Les délais inspiratoires et expiratoires étaient significativement plus courts en VNI NAVA comparativement aux périodes de VNI conventionnelle (p< 0.05). Les efforts inefficaces étaient moindres en VNI NAVA (résultats présentés en médiane et interquartiles) : 0% (0 - 0) en VNI NAVA vs 12% (4 - 20) en VNI conventionnelle initiale et 6% (2 - 22) en VNI conventionnelle finale (p< 0.01). Globalement, le temps passé en asynchronie a été réduit à 8% (6 - 10) en VNI NAVA, versus 27% (19 - 56) et 32% (21 - 38) en périodes de VNI conventionnelle initiale et finale, respectivement (p= 0.05). Aucune différence en termes de demande respiratoire n’a été observée. Conclusion: La VNI NAVA est faisable et bien tolérée chez les enfants avec détresse respiratoire aigüe et permet une meilleure synchronisation patient-ventilateur. De plus larges études sont nécessaires pour évaluer l’impact clinique de ces résultats.

Continuous quality improvement in a Maltese hospital using logical framework analysis

Purpose: The purpose of this paper is to present the application of logical framework analysis (LFA) for implementing continuous quality improvement (CQI) across multiple settings in a tertiary care hospital. Design/methodology/approach: This study adopts a multiple case study approach. LFA is implemented within three diverse settings, namely, intensive care unit, surgical ward, and acute in-patient psychiatric ward. First, problem trees are developed in order to determine the root causes of quality issues, specific to the three settings. Second, objective trees are formed suggesting solutions to the quality issues. Third, project plan template using logical framework (LOGFRAME) is created for each setting. Findings: This study shows substantial improvement in quality across the three settings. LFA proved to be effective to analyse quality issues and suggest improvement measures objectively. Research limitations/implications: This paper applies LFA in specific, albeit, diverse settings in one hospital. For validation purposes, it would be ideal to analyse in other settings within the same hospital, as well as in several hospitals. It also adopts a bottom-up approach when this can be triangulated with other sources of data. Practical implications: LFA enables top management to obtain an integrated view of performance. It also provides a basis for further quantitative research on quality management through the identification of key performance indicators and facilitates the development of a business case for improvement. Originality/value: LFA is a novel approach for the implementation of CQI programs. Although LFA has been used extensively for project development to source funds from development banks, its application in quality improvement within healthcare projects is scant.

Le mode de ventilation neurally adjusted ventilatory assist (NAVA) est faisable, bien toléré, et permet la synchronie entre le patient et le ventilateur pendant la ventilation non invasive aux soins intensifs pédiatriques : étude physiologique croisée

Introduction: La ventilation non invasive (VNI) est un outil utilisé en soins intensifs pédiatriques (SIP) pour soutenir la détresse respiratoire aigüe. Un échec survient dans près de 25% des cas et une mauvaise synchronisation patient-ventilateur est un des facteurs impliqués. Le mode de ventilation NAVA (neurally adjusted ventilatory assist) est asservi à la demande ventilatoire du patient. L’objectif de cette étude est d’évaluer la faisabilité et la tolérance des enfants à la VNI NAVA et l’impact de son usage sur la synchronie et la demande respiratoire. Méthode: Étude prospective, physiologique, croisée incluant 13 patients nécessitant une VNI dans les SIP de l’hôpital Ste-Justine entre octobre 2011 et mai 2013. Les patients ont été ventilés successivement en VNI conventionnelle (30 minutes), en VNI NAVA (60 minutes) et en VNI conventionnelle (30 minutes). L’activité électrique du diaphragme (AEdi) et la pression des voies aériennes supérieures ont été enregistrées pour évaluer la synchronie. Résultats: La VNI NAVA est faisable et bien tolérée chez tous les enfants. Un adolescent a demandé l’arrêt précoce de l’étude en raison d’anxiété reliée au masque sans fuite. Les délais inspiratoires et expiratoires étaient significativement plus courts en VNI NAVA comparativement aux périodes de VNI conventionnelle (p< 0.05). Les efforts inefficaces étaient moindres en VNI NAVA (résultats présentés en médiane et interquartiles) : 0% (0 - 0) en VNI NAVA vs 12% (4 - 20) en VNI conventionnelle initiale et 6% (2 - 22) en VNI conventionnelle finale (p< 0.01). Globalement, le temps passé en asynchronie a été réduit à 8% (6 - 10) en VNI NAVA, versus 27% (19 - 56) et 32% (21 - 38) en périodes de VNI conventionnelle initiale et finale, respectivement (p= 0.05). Aucune différence en termes de demande respiratoire n’a été observée. Conclusion: La VNI NAVA est faisable et bien tolérée chez les enfants avec détresse respiratoire aigüe et permet une meilleure synchronisation patient-ventilateur. De plus larges études sont nécessaires pour évaluer l’impact clinique de ces résultats.

What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? : An Individual Patient Data Meta-analysis

Background To identify those characteristics of self-management interventions in patients with heart failure (HF) that are effective in influencing health-related quality of life, mortality, and hospitalizations. Methods and Results Randomized trials on self-management interventions conducted between January 1985 and June 2013 were identified and individual patient data were requested for meta-analysis. Generalized mixed effects models and Cox proportional hazard models including frailty terms were used to assess the relation between characteristics of interventions and health-related outcomes. Twenty randomized trials (5624 patients) were included. Longer intervention duration reduced mortality risk (hazard ratio 0.99, 95% confidence interval [CI] 0.97–0.999 per month increase in duration), risk of HF-related hospitalization (hazard ratio 0.98, 95% CI 0.96–0.99), and HF-related hospitalization at 6 months (risk ratio 0.96, 95% CI 0.92–0.995). Although results were not consistent across outcomes, interventions comprising standardized training of interventionists, peer contact, log keeping, or goal-setting skills appeared less effective than interventions without these characteristics. Conclusion No specific program characteristics were consistently associated with better effects of self-management interventions, but longer duration seemed to improve the effect of self-management interventions on several outcomes. Future research using factorial trial designs and process evaluations is needed to understand the working mechanism of specific program characteristics of self-management interventions in HF patients.

Agent based risk patient management

This paper explores the role of information and communication technologies in managing risk and early discharge patients, and suggests innovative actions in the area of E-Health services. Treatments of chronic illnesses, or treatments of special needs such as cardiovascular diseases, are conducted in long-stay hospitals, and in some cases, in the homes of patients with a follow-up from primary care centre. The evolution of this model is following a clear trend: trying to reduce the time and the number of visits by patients to health centres and derive tasks, so far as possible, toward outpatient care. Also the number of Early Discharge Patients (EDP) is growing, thus permiting a saving in the resources of the care center. The adequacy of agent and mobile technologies is assessed in light of the particular requirements of health care applications. A software system architecture is outlined and discussed. The major contributions are: first, the conceptualization of multiple mobile and desktop devices as part of a single distributed computing system where software agents are being executed and interact from their remote locations. Second, the use of distributed decision making in multiagent systems, as a means to integrate remote evidence and knowledge obtained from data that is being collected and/or processed by distributed devices. The system will be applied to patients with cardiovascular or Chronic Obstructive Pulmonary Diseases (COPD) as well as to ambulatory surgery patients. The proposed system will allow to transmit the patient's location and some information about his/her illness to the hospital or care centre

An exploration of treatment burden and patient capacity in people with stroke

Background and aims: Advances in modern medicine have led to improved outcomes after stroke, yet an increased treatment burden has been placed on patients. Treatment burden is the workload of health care for people with chronic illness and the impact that this has on functioning and well-being. Those with comorbidities are likely to be particularly burdened. Excessive treatment burden can negatively affect outcomes. Individuals are likely to differ in their ability to manage health problems and follow treatments, defined as patient capacity. The aim of this thesis was to explore the experience of treatment burden for people who have had a stroke and the factors that influence patient capacity. Methods: There were four phases of research. 1) A systematic review of the qualitative literature that explored the experience of treatment burden for those with stroke. Data were analysed using framework synthesis, underpinned by Normalisation Process Theory (NPT). 2) A cross-sectional study of 1,424,378 participants >18 years, demographically representative of the Scottish population. Binary logistic regression was used to analyse the relationship between stroke and the presence of comorbidities and prescribed medications. 3) Interviews with twenty-nine individuals with stroke, fifteen analysed by framework analysis underpinned by NPT and fourteen by thematic analysis. The experience of treatment burden was explored in depth along with factors that influence patient capacity. 4) Integration of findings in order to create a conceptual model of treatment burden and patient capacity in stroke. Results: Phase 1) A taxonomy of treatment burden in stroke was created. The following broad areas of treatment burden were identified: making sense of stroke management and planning care; interacting with others including health professionals, family and other stroke patients; enacting management strategies; and reflecting on management. Phase 2) 35,690 people (2.5%) had a diagnosis of stroke and of the 39 co-morbidities examined, 35 were significantly more common in those with stroke. The proportion of those with stroke that had >1 additional morbidities present (94.2%) was almost twice that of controls (48%) (odds ratio (OR) adjusted for age, gender and socioeconomic deprivation; 95% confidence interval: 5.18; 4.95-5.43) and 34.5% had 4-6 comorbidities compared to 7.2% of controls (8.59; 8.17-9.04). In the stroke group, 12.6% of people had a record of >11 repeat prescriptions compared to only 1.5% of the control group (OR adjusted for age, gender, deprivation and morbidity count: 15.84; 14.86-16.88). Phase 3) The taxonomy of treatment burden from Phase 1 was verified and expanded. Additionally, treatment burdens were identified as arising from either: the workload of healthcare; or the endurance of care deficiencies. A taxonomy of patient capacity was created. Six factors were identified that influence patient capacity: personal attributes and skills; physical and cognitive abilities; support network; financial status; life workload, and environment. A conceptual model of treatment burden was created. Healthcare workload and the presence of care deficiencies can influence and be influenced by patient capacity. The quality and configuration of health and social care services influences healthcare workload, care deficiencies and patient capacity. Conclusions: This thesis provides important insights into the considerable treatment burden experienced by people who have had a stroke and the factors that affect their capacity to manage health. Multimorbidity and polypharmacy are common in those with stroke and levels of these are high. Findings have important implications for the design of clinical guidelines and healthcare delivery, for example co-ordination of care should be improved, shared decision-making enhanced, and patients better supported following discharge from hospital.