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DesafíosparaavanzarenSeguridaddelPacienteDr.LuisVeraBenavides
UnidaddeEducaciónenSalud
UniversidadAutonomadeChile,SedeTalca
DeclaracióndeConflictodeinterés
• Hesidopaciente• ExistealtaprobabilidadqueserepitaestasituacióndadoelaumentodelaexpectativadevidaenChile
• Soyelúnicomédicodemifamilia• Abuelamaternasufrióamputacióndeunodesusbrazosenunahospitalización• AbuelapaternaoperadadeCagástricoincipiente(complicacionesdelareconstruccióndeltránsitodigestivo)
• Suegrofallecidodeinfartomiocardio(retrasoenlallegadadeambulanciaydudasenlaatencióndeurgencia)
• SuegraconextravíodebiopsiaenelHospitalqueyodirigía
Temario
• FormacióndePregrado• Curriculum Seguridad• Razonamientoclínico
• SimulaciónClinica• RolenSeguridaddelpaciente
• CulturadeSeguridad• Implantación• Medición
•¿Porquélosestudiantesdecarrerasdelasaludnecesitaneducaciónenseguridaddelpaciente?
Algunasinterrogantesdesdelaacademiaparaestascompetencias
• Loincorporamos???• Cómoseincorpora???• Cuálessonloscostosinmediatosyalargoplazo???
Sedebeincorporarenelpregradoypostgrado!!!!!
DocenciaClínica:teoríaclásica
• Pasodeprincipiantesaexpertos• Pasandoporuncompetenteconciente• Integrandoconocimientos,destrezasyactitudes.
COMPLEJO!!!!!!!
Razonamientoclínico
Principiantes• Métodoanalítico• Hipotético-deductivo
Expertos• Patrones• Scriptsdereconocimiento• Reflexión• Transferenciaalnuevoescenario• Usoapropiadodelaintuición
Tomadedecisiones
Procesodelrazonamientoclínico
• Procesoscognitivos• Autonomía• Procesamientodeinformación(emoción,rutinas,descanso,etc)• Tomadedecisiones• Resolucióndeproblemas
EnseñanzaClínica:segúnelniveldeentrenamientodelosestudiantes
Fron the educational bench to the clinicalbedside:translating the Dreyfus developmentmodel to the learning ofclinical skills.
Carracio CL,Benson BJ,NixonLJ,Derstine PL.Acad Med2008Aug;83(8):761-7.doi:10.1097/ACM.0b013e31817eb632.
Enseñanzayaprendizajedeacuerdoalniveldelestudiante
• Principiante• Avanzado(principianteavanzado)• Competente• Hábil(proficiente)• Experto• Maestro
Carracio CL,Benson BJ,NixonLJ,Derstine PL.Acad Med 2008Aug;83(8):761-7.doi:10.1097/ACM.0b013e31817eb632.
Tomadedecisiones:desdeelmodelodeDreyfus yDreyfus
• “Noscomportamosotendemosacomportarnoscomoexpertos”
• “Serequiereaplicarelrazonamientoclínicoysusprincipiosdemododevolveraserprincipiantesparaaplicarelmétodo(analítico-hipotético-deductivo)
Carracio CL,Benson BJ,NixonLJ,Derstine PL.Acad Med 2008Aug;83(8):761-7.doi:10.1097/ACM.0b013e31817eb632.
SimulaciónClinica ySeguridaddelPaciente
• “Toerr is human”recomiendaelusodelasimulaciónenseguridaddelpaciente
• entrenamientodelosnuevosfuncionarios• resolucióndeproblemas• manejodecrisis• situacionesnuevasopocofrecuentes(crisisresource management - CRM)• procedimientospotencialmentederiesgo.
Utili F, Morales C. Rol de la simulación clínica en la seguridad del paciente. https://www.alasic.org/
Ventajas
• Ofreceambienteseguro• Discutirlibrementelosproblemasyerrores,conotrosprofesionalesdelasaludyalejadosdelospacientesysusfamiliares
• Practicarestrategiasóptimasensituacionespocofrecuentes,inseguras,demanejodelicado
• Procedimientosdealtacomplejidad(Dieckman P.,2008)Utili F, Morales C. Rol de la simulación clínica en la seguridad del paciente. https://www.alasic.org/
Resultados:trabajoenequipo
• Reduccióndel27%delatasaderotacióndeenfermeríaymejoríaenlosresultadosdesatisfacciónconlacapacitaciónentrabajodeequipo.8(Dimeglio K.,2005)
• Reducciónenlastasasdeerrorclínicodel30,9al4,4%almejorarlasactitudesdetrabajoenequipoenserviciosdeurgencia.(MoreyJ.C.,2002)Utili F, Morales C. Rol de la simulación clínica en la seguridad del paciente. https://www.alasic.org/
Resultados:trabajoenequipo
• Reduccióndel50%enloseventosadversosdespuésdeunaintervencióneneltrabajoenequipo(MannS.,2006)
• Pabellónconunaintervenciónsobrelaactituddetrabajoconequiposalineadosseobservóundescensodel50%enlastasasdesepsispost-operatoria(Sexton J.,2006)
Utili F, Morales C. Rol de la simulación clínica en la seguridad del paciente. https://www.alasic.org/
SimulaciónySeguridaddelPaciente
• Permiteelmejoramientocontinuoenlacalidaddelaatencióndelospacientes
• Centradoenaspectosdedesempeñodelosprofesionalesdelasalud• Habilidadestécnicas• Comunicacionales• Actitudinales
• Fortalecerunaatenciónsegurayadecuadaparatodosnuestrospacientes.
Utili F, Morales C. Rol de la simulación clínica en la seguridad del paciente. https://www.alasic.org/
Bundles vsListadeChequeo
• Nosonlomismo• Paquetesdealtaefectividad• Multidisciplinarios:
• TODOSparticipan
Culturadeseguridad:
Patrónintegradodecomportamientoindividualydelaorganización,basadoencreenciasyvalorescompartidos,quebuscacontinuamentereduciralmínimoeldañoquepodríasufrirelpacientecomoconsecuenciadelosprocesosdeprestacióndeatención.
Comite of Experts on Management of Safety and Quality in Health Care. Glossary of terms related to patient and medication safety – approved terms. Council of Europe. 2005
Disponible en: http://www.bvs.org.ar/pdf/seguridadpaciente.pdf
30
Incidentesyeventosadversos:lapartevisibledelainseguridaddelpaciente
31
Incidentesyeventosadversos:lapartevisibledelainseguridaddelpaciente
• Recurrir a la memoria
• Excesivo número de traslados de los pacientes
• Procedimientos no normalizados
• Turnos de trabajo prolongados• Sobrecarga de trabajo, estrés• Escasez de feedback• Procesamiento rápido de múltiples fuentes de datos para la
toma de decisiones• …
Elfactorhumano:facilitadoresdelerror
33
1. Evitar la dependencia de la memoria2. Simplificar3. Estandarizar
4. Emplear la estandarización cuando la actividad lo permita
5. Utilizar los protocolos y listas de verificación
6. Mejorar el acceso a la información
7. Reducir los traslados y los cambios de servicio8. Mejorar feedback
¿Cómoreducirloserrores?
34
Aspectosclaves:Aranaz2003
Algunaevidenciadelaevaluacióndelaculturadeseguridaddelaatención
Exploring patient safety culture in primarycareNATASHA J. VERBAKEL1, MARIJE VAN MELLE1, MAAIKE LANGELAAN2, THEO J.M. VERHEIJ1,CORDULAWAGNER2,3 AND DORIEN L.M. ZWART1
1Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht,The Netherlands, 2Quality and Organization, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands, and3Department of Public and Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands
Address reprint requests to: Natasha J. Verbakel, UMCU, Julius Center, Str. 6.131, PO Box 85500, 3508 GAUtrecht, The Netherlands.Tel: +31-0-88-75-68-195; fax: +31-0-88-7568099; E-mail: [email protected]
Accepted for publication 30 June 2014
Abstract
Objective. To explore perceptions of safety culture in nine different types of primary care professions and to study possible dif-ferences.
Design. Cross-sectional survey.
Setting. Three hundred and thirteen practices from nine types of primary care profession groups in the Netherlands.
Participants. Professional staff from primary care practices. Nine professions participated: dental care, dietetics, exercise therapy,physiotherapy, occupational therapy, midwifery, anticoagulation clinics, skin therapy and speech therapy.
Main Outcome Measure(s). Perceptions of seven patient safety culture dimensions were measured: ‘open communication andlearning from error’, ‘handover and teamwork’, ‘adequate procedures and working conditions’, ‘patient safety management’,‘support and fellowship’, ‘intention to report events’ and ‘organizational learning’. Dimension means per profession were pre-sented, and multilevel analyses were used to assess differences between professions. Also the so-called patient safety grade wasself-reported.
Results. Five hundred and nineteen practices responded (response rate: 24%) of which 313 (625 individual questionnaires) wereincluded for analysis. Overall, patient safety culture was perceived as being positive. Occupational therapy and anticoagulationtherapy deviated most from other professions in a negative way, whereas physiotherapy deviated the most in a positive way.In addition, most professions graded their patient safety as positive (mean = 4.03 on a five-point scale).
Conclusions. This study showed that patient safety culture in Dutch primary care professions on average is perceived positively.Also, it revealed variety between professions, indicating that a customized approach per profession group might contribute tosuccessful implementation of safety strategies.
Keywords: primary care, patient safety, safety culture, survey
Introduction
The establishing of an open, constructive patient safety cultureis believed to be important for improving patient safety.Culture refers to the shared values, attitudes, norms, beliefs,practices, policies and behaviours about safety issues in dailypractice [1]. Several safety culture surveys were developed toassess safety culture in healthcare [1–4].Until recently, patient safety research mostly addressed hos-
pitalized care whereas a major part of health care is deliveredin primary care settings. Although the risk for patient harm islower in primary care, due to the high numbers of patient con-tacts, absolute numbers seem significant [5]. Few studies have
assessed patient safety culture in a primary care setting [6–11].Some studies adapted and validated existing questionnairesdeveloped for hospitals, others developed own questionnaires.Also, the Manchester Patient Safety Framework (MaPSaF), adiscussion tool, was customized [12, 13].In the Netherlands, primary care is easily accessible, and for
medical care, it serves as a gatekeeper to hospital care. Mostpractices consist of staff members stemming from several dif-ferent disciplines, but practice sizes are relatively small. Whenprimary care gained more attention in patient safety research,the Dutch hospital version of the HSOPS [14, 15] was firstadapted for general practice [16]. Subsequently, other primarycare professional associations expressed their interest in this
International Journal for Quality in Health Care vol. 26 no. 6© The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care;all rights reserved 585
International Journal for Quality in Health Care 2014; Volume 26, Number 6: pp. 585–591 10.1093/intqhc/mzu074Advance Access Publication: 1 August 2014
by guest on March 23, 2015
Dow
nloaded from
Exploring patient safety culture in primarycareNATASHA J. VERBAKEL1, MARIJE VAN MELLE1, MAAIKE LANGELAAN2, THEO J.M. VERHEIJ1,CORDULAWAGNER2,3 AND DORIEN L.M. ZWART1
1Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht,The Netherlands, 2Quality and Organization, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands, and3Department of Public and Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands
Address reprint requests to: Natasha J. Verbakel, UMCU, Julius Center, Str. 6.131, PO Box 85500, 3508 GAUtrecht, The Netherlands.Tel: +31-0-88-75-68-195; fax: +31-0-88-7568099; E-mail: [email protected]
Accepted for publication 30 June 2014
Abstract
Objective. To explore perceptions of safety culture in nine different types of primary care professions and to study possible dif-ferences.
Design. Cross-sectional survey.
Setting. Three hundred and thirteen practices from nine types of primary care profession groups in the Netherlands.
Participants. Professional staff from primary care practices. Nine professions participated: dental care, dietetics, exercise therapy,physiotherapy, occupational therapy, midwifery, anticoagulation clinics, skin therapy and speech therapy.
Main Outcome Measure(s). Perceptions of seven patient safety culture dimensions were measured: ‘open communication andlearning from error’, ‘handover and teamwork’, ‘adequate procedures and working conditions’, ‘patient safety management’,‘support and fellowship’, ‘intention to report events’ and ‘organizational learning’. Dimension means per profession were pre-sented, and multilevel analyses were used to assess differences between professions. Also the so-called patient safety grade wasself-reported.
Results. Five hundred and nineteen practices responded (response rate: 24%) of which 313 (625 individual questionnaires) wereincluded for analysis. Overall, patient safety culture was perceived as being positive. Occupational therapy and anticoagulationtherapy deviated most from other professions in a negative way, whereas physiotherapy deviated the most in a positive way.In addition, most professions graded their patient safety as positive (mean = 4.03 on a five-point scale).
Conclusions. This study showed that patient safety culture in Dutch primary care professions on average is perceived positively.Also, it revealed variety between professions, indicating that a customized approach per profession group might contribute tosuccessful implementation of safety strategies.
Keywords: primary care, patient safety, safety culture, survey
Introduction
The establishing of an open, constructive patient safety cultureis believed to be important for improving patient safety.Culture refers to the shared values, attitudes, norms, beliefs,practices, policies and behaviours about safety issues in dailypractice [1]. Several safety culture surveys were developed toassess safety culture in healthcare [1–4].Until recently, patient safety research mostly addressed hos-
pitalized care whereas a major part of health care is deliveredin primary care settings. Although the risk for patient harm islower in primary care, due to the high numbers of patient con-tacts, absolute numbers seem significant [5]. Few studies have
assessed patient safety culture in a primary care setting [6–11].Some studies adapted and validated existing questionnairesdeveloped for hospitals, others developed own questionnaires.Also, the Manchester Patient Safety Framework (MaPSaF), adiscussion tool, was customized [12, 13].In the Netherlands, primary care is easily accessible, and for
medical care, it serves as a gatekeeper to hospital care. Mostpractices consist of staff members stemming from several dif-ferent disciplines, but practice sizes are relatively small. Whenprimary care gained more attention in patient safety research,the Dutch hospital version of the HSOPS [14, 15] was firstadapted for general practice [16]. Subsequently, other primarycare professional associations expressed their interest in this
International Journal for Quality in Health Care vol. 26 no. 6© The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care;all rights reserved 585
International Journal for Quality in Health Care 2014; Volume 26, Number 6: pp. 585–591 10.1093/intqhc/mzu074Advance Access Publication: 1 August 2014
by guest on March 23, 2015
Dow
nloaded from
RESEARCH ARTICLE Open Access
Assessment of patient safety culture: whattools for medical students?M. Chaneliere1,2,3,4*, F. Jacquet2, P. Occelli2,3, S. Touzet2,3, V. Siranyan1,2 and C. Colin1,2,3
Abstract
Background: The assessment of patient safety culture refers mainly to surveys exploring the perceptions of healthprofessionals in hospitals. These surveys have less relevance when considering the assessment of the patient safetyculture of medical students, especially at university or medical school. They are indeed not fully integrated in careunits and constitute a heterogeneous population. This work aimed to find appropriate assessment tools of thepatient safety culture of medical students.
Methods: Systematic review of the literature. Surveys related to a care unit were excluded. A typology of thepatient safety culture of medical students was built from the included surveys.
Results: Eighteen surveys were included. In our typology of patient safety culture of medical students(15 dimensions), the number of dimensions explored by survey (n) ranged from 1 to 12, with 6 “specialized”tools (n ≤ 4) and 12 “global” tools (N ≥ 5). These surveys have explored: knowledge about patient safety,acknowledgment of the inevitability of human error, the lack of skills as the main source of errors, the errors reportingsystems, disclosure of medical errors to others health professionals or patients, teamwork and patient involvement toimprove safety in care.
Conclusions: We recommend using Wetzel’s survey for making an overall assessment of the patient safety culture ofmedical students at university. In a specific purpose—e.g. to assess an educational program on medical errordisclosure—the authors recommend to determine which dimensions of patient safety will be taught, to selectthe best assessment tool. Learning on patient safety should however be considered beyond the university.International translations of tools are required to create databases allowing comparative studies.
Keywords: Patient safety culture, Medical student, Assessment, Survey
BackgroundFor many years adverse events (AE) have been reportedin the literature under various names [1] e.g. PatientSafety Incident (PSI). The book “To err is human” [2],led to international awareness of their frequency andgravity. Patient safety (PS) should be a constant concernof all healthcare professionals (HP) who should all learnacceptable patient safety culture (PSC) during their ini-tial training. The International Classification for PatientSafety (ICPS) [3] described “patient safety” as “the
reduction of risk of unnecessary harm associated withhealthcare to an acceptable minimum”. This is a defin-ition integrated in a systemic approach as described byJames Reason several years ago [4]. The concept of“safety culture” was first used by the InternationalAtomic Energy Agency after the Chernobyl accident [5]and then in healthcare with PSC. Sammer et al [6] haveidentified seven factors affecting PSC (leadership, team-work, evidence-based medicine, communication, learn-ing, “just culture”, and patient-centered) but severaldefinitions of PSC exist [7–9]. The European Society forQuality in Health Care [7] defined it as “an integratedpattern of individual and organizational behaviour, basedupon shared beliefs and values, that continuously seeksto minimize patient harm which may result from the
* Correspondence: [email protected] Services and Performance Research (HESPER), 162 Avenue LacassagneBât A—F69424, Lyon cedex 03, France2Claude Bernard University Lyon 1 (UCBL), 8 avenue Rockefeller, F 69373,Lyon Cedex 08, FranceFull list of author information is available at the end of the article
© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Chaneliere et al. BMC Medical Education (2016) 16:255 DOI 10.1186/s12909-016-0778-y
RESEARCH ARTICLE Open Access
Assessment of patient safety culture: whattools for medical students?M. Chaneliere1,2,3,4*, F. Jacquet2, P. Occelli2,3, S. Touzet2,3, V. Siranyan1,2 and C. Colin1,2,3
Abstract
Background: The assessment of patient safety culture refers mainly to surveys exploring the perceptions of healthprofessionals in hospitals. These surveys have less relevance when considering the assessment of the patient safetyculture of medical students, especially at university or medical school. They are indeed not fully integrated in careunits and constitute a heterogeneous population. This work aimed to find appropriate assessment tools of thepatient safety culture of medical students.
Methods: Systematic review of the literature. Surveys related to a care unit were excluded. A typology of thepatient safety culture of medical students was built from the included surveys.
Results: Eighteen surveys were included. In our typology of patient safety culture of medical students(15 dimensions), the number of dimensions explored by survey (n) ranged from 1 to 12, with 6 “specialized”tools (n ≤ 4) and 12 “global” tools (N ≥ 5). These surveys have explored: knowledge about patient safety,acknowledgment of the inevitability of human error, the lack of skills as the main source of errors, the errors reportingsystems, disclosure of medical errors to others health professionals or patients, teamwork and patient involvement toimprove safety in care.
Conclusions: We recommend using Wetzel’s survey for making an overall assessment of the patient safety culture ofmedical students at university. In a specific purpose—e.g. to assess an educational program on medical errordisclosure—the authors recommend to determine which dimensions of patient safety will be taught, to selectthe best assessment tool. Learning on patient safety should however be considered beyond the university.International translations of tools are required to create databases allowing comparative studies.
Keywords: Patient safety culture, Medical student, Assessment, Survey
BackgroundFor many years adverse events (AE) have been reportedin the literature under various names [1] e.g. PatientSafety Incident (PSI). The book “To err is human” [2],led to international awareness of their frequency andgravity. Patient safety (PS) should be a constant concernof all healthcare professionals (HP) who should all learnacceptable patient safety culture (PSC) during their ini-tial training. The International Classification for PatientSafety (ICPS) [3] described “patient safety” as “the
reduction of risk of unnecessary harm associated withhealthcare to an acceptable minimum”. This is a defin-ition integrated in a systemic approach as described byJames Reason several years ago [4]. The concept of“safety culture” was first used by the InternationalAtomic Energy Agency after the Chernobyl accident [5]and then in healthcare with PSC. Sammer et al [6] haveidentified seven factors affecting PSC (leadership, team-work, evidence-based medicine, communication, learn-ing, “just culture”, and patient-centered) but severaldefinitions of PSC exist [7–9]. The European Society forQuality in Health Care [7] defined it as “an integratedpattern of individual and organizational behaviour, basedupon shared beliefs and values, that continuously seeksto minimize patient harm which may result from the
* Correspondence: [email protected] Services and Performance Research (HESPER), 162 Avenue LacassagneBât A—F69424, Lyon cedex 03, France2Claude Bernard University Lyon 1 (UCBL), 8 avenue Rockefeller, F 69373,Lyon Cedex 08, FranceFull list of author information is available at the end of the article
© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Chaneliere et al. BMC Medical Education (2016) 16:255 DOI 10.1186/s12909-016-0778-y
Desafíos:resumen
• Abordarlaincorporacióndelrazonamientoclínicoenloscurriculumdepreypostgrado
• DarlealTrabajoenEquipoyMultidisciplinarioelenfoquedeSeguridaddelpaciente
• FortalecerelroldelaSimulaciónClínicaconperspectivadeSeguridaddelPaciente,másalládelensayodeescenarioscomunes
• ConstruirCulturadeSeguridadenlosestudiantesdesdeelPregrado
Temario
• FormacióndePregrado• Curriculum Seguridad• Razonamientoclínico
• SimulaciónClinica• RolenSeguridaddelpaciente
• CulturadeSeguridad• Implantación• Medición
