Sítios assistenciais: modelo de organização e classificação de pacientes em UTI

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Desenvolvimento de modelo auto-regressivo para previsão em pronto-atendimento

The 1988 constitution makes an life is a supreme good when increased health as the fundamental condition requiring that all ill patient has the right to be treated in a public hospital (CF, art. 196). In this sense, the goal of this work is to generate a weekly forecast of hospital care by means of an advanced prediction model. It is expected that the model of self-regressivas seasonal moving averages SARIMA generate reliable and adherent to issue forecasts analyzed, thus enabling better resource allocation and more efficient hospital management

Desenvolvimento de modelo auto-regressivo para previsão em pronto-atendimento

The 1988 constitution makes an life is a supreme good when increased health as the fundamental condition requiring that all ill patient has the right to be treated in a public hospital (CF, art. 196). In this sense, the goal of this work is to generate a weekly forecast of hospital care by means of an advanced prediction model. It is expected that the model of self-regressivas seasonal moving averages SARIMA generate reliable and adherent to issue forecasts analyzed, thus enabling better resource allocation and more efficient hospital management

Sistemas de custeio na gestão hospitalar

The cost management in any organization provides a number of benefits such as security in the good management of resources, but it is little used in the public hospital sector which is shaped like a paradox, facing the complexity of hospital organization and the underfunding situation of Cheers. The purpose of this book was to develop and submit an application method of a costing system in public hospitals. This proposal was developed in partnership with the Secretariat of the State of Paraná Health, with financial support from PPSUS and Araucaria Foundation. The study was conducted as an action research in two public hospitals in Paraná, but it can be replicated in any hospital from the premises of the developed method. For this, We developed the concepts of administration and public governance, the right to health in Brazil, the costs in the public sector and the detailed presentation of the proposed costing system model. The results constitute an important management tool for hospitals and Ministry of Health, enabling greater security leaders in the face of difficulties and challenges in this segment. Thus, it is expected that the book will contribute to governments for better management of public funds allocated to health; with academia, as a still incipient theme in literature; and society, so that more hospitals were professionalize its cost management and thereby provide a more efficient and effective service.

Estudio sobre la aplicación de Lean Healthcare en el sector hospitalario en Medellín

A pesar de que parece a veces simple, no es fácil explicar la esencia del término Lean -- Lean ayuda a las organizaciones a optimizar sus costos a través de la eliminación de los desperdicios lo que conlleva a un aumento de productividad que se debe traducir en una mejora en la rentabilidad de la empresa -- Esta mejora en la productividad es un elemento clave al momento de elegir Lean como herramienta de trabajo, debido a que está demostrado que no es una moda pasajera y que verdaderamente su aplicación puede rendir frutos en la manufactura y los servicios -- El presente trabajo pretende partir del termino Lean desde sus generalidades, examinando once herramientas que apoyan su implementación tanto en ambientes de manufactura como de servicios, para llegar a lo que se conoce hoy como Lean Healthcare, examinando la aplicación de esas mismas herramientas en ambientes hospitalarios -- Se realizó una revisión de la literatura que abarca tanto Lean como Lean Healthcare, haciendo énfasis en once herramientas (Hoshin Kanry, fábrica visual, 5´s, VSM, Poka Yoke, Heijunka, Kanban, Andon, Jidoka, Kaizen, Smed) que permiten identificar la aplicación de estas tanto en ambientes industriales como hospitalarios -- El resultado describe que herramientas son las más usadas en el sector hospitalario, en qué áreas se han aplicado los conceptos de Lean Healthcare, que impactos ha tenido la aplicación de estas herramientas y que implicaciones ha tenido para las instituciones la aplicación Lean Healthcare -- Toda esta revisión se enfocó luego en las instituciones de salud de la ciudad de Medellín a las cuales se les aplicó una encuesta para medir el grado de familiaridad que tienen en relación con las técnicas lean mencionadas

Errors in the administration of medication in inpatient hospitals: A systematic review of the research literature on commercial computerized physician order entry systems

Errors in the administration of medication represent a significant loss of medical resources and pose life altering or life threatening risks to patients. This paper considered the question, what impact do Computerized Physician Order Entry (CPOE) systems have on medication errors in the hospital inpatient environment? Previous reviews have examined evidence of the impact of CPOE on medication errors, but have come to ambiguous conclusions as to the impact of CPOE and decision support systems (DSS). Forty-three papers were identified. Thirty-one demonstrated a significant reduction in prescribing error rates for all or some drug types; decreases in minor errors were most often reported. Several studies reported increases in the rate of duplicate orders and failures to remove contraindicated drugs, often attributed to inappropriate design or to an inability to operate the system properly. The evidence on the effectiveness of CPOE to reduce errors in medication administration is compelling though it is limited by modest study sample sizes and designs. ^

A guide for studying the utilization of nursing service personnel in Veterans Administration hospitals.

Cover title.

Memorandum on the medical charities of the metropolis : with special reference to the proposal for an inquiry in regard to the administration and common organisation of voluntary hospitals and diopensaries, and poor-law infirmaries and dispensaries /

Included at end is another report with title: Special committee for promoting an enquiry by a Royal Commission or Select Committee of the House of Lords, with regard to the financial and general management and common organisation of medical charities in the metropolis. Interim report, June 1890. London : Charity Organisation Society, 1890. (15 p.).

The investigation of the administration of the Cook County Health and Hospitals Governing Commission /

Prepared for the Auditor General to be presented to the Legislative Audit Commission and members of the General Assembly.

Antimicrobial drug administration errors identified in Brazilian multicentric study

Medication administration errors (MAE) are the most frequent kind of medication errors. Errors with antimicrobial drugs (AD) are relevant because they may interfere inpatient safety and in the development of microbial resistance. The aim of this study is to analyze the AD errors detected in a Brazilian multicentric study of MAE. It was a devcriptive and explorotory study carried out in clinical units in five Brazilian teaching hospitals. The hospitals were investigated during 30 days. MAE were detected by observation technique. MAE were classified in categories: wrong route(WR), wrong patient(WP), wrong dose(WD) wrong time (WT) and unordered drug (UD). AD with MA E were classified by Anatomical-Therapeutical-Chemical Classification System. AD with narrow therapeutic index (NTI) wet-e identified A descriptive statistical analysis was performed using SPSS version 11.5 software. A total of 1500 errors were observed, 277 (18.5%) of them were error with AD. The hopes of AD error were: WT87.7%, QD 6.9%, WR 1.5%, UD 3.2% and WP 0.7%. The number of AD found was 36. The mostly ATC class were fluoroquinolones 13.9%, combinations of penicillin 13.9%, macrolides 8.3% and third-generation cephalosporines 5.6%. The parenteral drug dosage form was associated with 55.6% of AD. 16.7% of AD were NTI. 47.4% of WD and 21.8% WT were with NTI drugs. This study shows that these errors should be considered potential areas for improvement in the medication process and patient safety plus there is requirement to develop rational drug use of AD.

Cyclophosphamide levels in sites of preparation and administration of antineoplastic drugs

The extensive use of antineoplastic agents in chemotherapy may be at risk to health care workers involved in the preparation and administration of these drugs. In this study cyclophosphamide, a drug classified as a human carcinogen, was quantified by adapting a previous analytical method using gas chromatography coupled to mass spectrometry (GC-MS) after solid phase extraction with diatomaceous earth. The drug was measured by analysis in surfaces (wipe samples) and gloves, collected from four different hospitals, before and after the practice of cleaning procedures, and the use of a closed-system device for the preparation and administration. Validation results were satisfactory and cyclophosphamide levels ranging from below the quantification limit to 141000 ng. Our findings demonstrated that surfaces and materials contamination was found in all hospitals during the traditional open technique for preparation and administration of cyclophosphamide and a significant reduction in contamination when a closed-system device was used. However, some values were considered unexpected, especially those obtained from samples collected after the cleaning surfaces.

Pro re nata medication for psychoses: an audit of practice in two metropolitan hospitals

Objective: To examine the use of pro re nata (PRN) (as needed) medication in hospitalized patients with psychotic disorders. Methods: Retrospective chart reviews were conducted at two large public psychiatry units situated in inner city general hospitals. Pro re nata medication prescription, administration and outcomes were examined during inpatient episodes of care for 184 consecutive admissions of patients diagnosed with a psychotic disorder. Patient demographics, diagnoses, and regularly prescribed medication were also recorded. All admissions were drawn from a three-month period from December 1998-February 1999. Results: The most prevalent diagnoses were schizophrenia related disorders (n = 111) and mania (n = 34). Substance use disorders (n = 49) were the most common comorbid dis-orders. Pro re nata medication was administered during the acute phase of 82% of admissions. Drugs prescribed Pro re nata were mostly typical antipsychotics, benzodiazepines and/or anti-cholinergics. Coprescription of typical antipsychotics PRN with regularly scheduled atypical antipsychotics was common (64%). Pro re nata medications accounted for 31% of the total antipsychotic dose and 28% of the total anxiolytic dose administered during acute treatment. Higher daily doses of PRN medication were given to manic patients, males, younger patients and those with substance use disorders. Pro re nata prescriptions usually specified a maximum daily dose (87%) but rarely gave indications for use (6%). Adminis-tration records frequently lacked a specified reason for use (48%) or a notation of outcome (64%). Unit staff noted medication-related morbidity in 37% of patients receiving PRN medication, compared to 3% of patients receiving only regularly scheduled medication. Extrapyramidal symptoms (EPS) were most frequently associated with administration of PRN haloperidol (Relative Risk vs other PRN medications = 5.61, 95% CI = 2.36-13.73). Conclusions: Pro re nata medications comprised a significant part of the treatment which psychotic patients received. The common practice of coprescribing PRN typical antipsychotics with scheduled atypical antipsychotics is potentially problematical since administration of PRN medication is associated with significant medication related morbidity. Preferential use of benzodiazepines as PRN agents may minimize this morbidity and foster subsequent compliance with regularly prescribed antipsychotics.

Post-surgical wound infections involving Enterobacteriaceae with reduced susceptibility to ß-lactams in two Portuguese hospitals

The post-surgical period is often critical for infection acquisition. The combination of patient injury and environmental exposure through breached skin add risk to pre-existing conditions such as drug or depressed immunity. Several factors such as the period of hospital staying after surgery, base disease, age, immune system condition, hygiene policies, careless prophylactic drug administration and physical conditions of the healthcare centre may contribute to the acquisition of a nosocomial infection. A purulent wound can become complicated whenever antimicrobial therapy becomes compromised. In this pilot study, we analysed Enterobacteriaceae strains, the most significant gram-negative rods that may occur in post-surgical skin and soft tissue infections (SSTI) presenting reduced β-lactam susceptibility and those presenting extended-spectrum β-lactamases (ESBL). There is little information in our country regarding the relationship between β-lactam susceptibility, ESBL and development of resistant strains of microorganisms in SSTI. Our main results indicate Escherichia coli and Klebsiella spp. are among the most frequent enterobacteria (46% and 30% respectively) with ESBL production in 72% of Enterobacteriaceae isolates from SSTI. Moreover, coinfection occurred extensively, mainly with Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (18% and 13%, respectively). These results suggest future research to explore if and how these associations are involved in the development of antibiotic resistance.

Antineoplastic drugs contamination of workplace surfaces in two Portuguese hospitals

Despite the classification as known or suspected human carcinogens, by the International Agency for Research on Cancer, the antineoplastic drugs are extensively used in cancer treatment due to their specificity and efficacy. As human carcinogens, these drugs represent a serious threat to the healthcare workers involved in their preparation and administration. This work aims to contribute to better characterize the occupational exposure of healthcare professionals to antineoplastic drugs, by assessing workplace surfaces contamination of pharmacy and administration units of two Portuguese hospitals. Surface contamination was assessed by the determination of cyclophosphamide, 5-fluorouracil, and paclitaxel. These three drugs were used as surrogate markers for surfaces contamination by cytotoxic drugs. Wipe samples were taken and analyzed by HPLCDAD. From the total of 327 analyzed samples, in 121 (37%) was possible to detect and quantify at least one drug. Additionally, 28 samples (8.6 %) indicate contamination by more than one antineoplastic drug, mainly in the administration unit, in both hospitals. Considering the findings in both hospitals, specific measures should be taken, particularly those related with the promotion of good practices and safety procedures and also routine monitoring of surfaces contamination in order to guarantee the appliance of safety measures.