Friday, August 27, 2010

3rd Seminar. Adverse effects detection, a way of sensitizing the professionals to Patient Safety

The interest and promotion of Patient Safety (PS) by National and International agencies in health services, motivated us to make this report with the following objectives:

• To assess the sensitization on PS through educational workshops, measured by the statement of adverse effects (AE) in all teaching units of the autonomous community of Galicia

• To study the frequency, severity and characteristics of the AE reported

The method was developed in two phases. Initially all Teaching Units of Family and Community Medicine of Galicia (senior residents and their tutors) were invited to participate. In the first phase there had place training workshops on PS concepts, types, error analysis and knowledge of the questionary APEAS1. In a second phase the professionals registered the AEs for 15 days, in their daily activities according the APEAS methodology.

During the registration period, 9,024 patients participated in 27 primary care facility. The prevalence of AE was 15.37 ‰: (5.97 ‰ incidents and 9.40 ‰ adverse effects), of which 76.7% were mild, 17.5% moderate and 5.8% severe. The 72% of the AEs were considered avoidable.

The 36.2% of cases the causal factors of the AE were related to medication, 34.2% with communication, and 25.6% to management, followed by other causes.

When we studied the origin of the AEs we found that 65% of them occurred at a primary care facility, 20% at specialized care, 4% at emergency departments, 3% at pharmacy offices and the remaining 8% at "others" as herbalist shops or private practice.

With regard to the care the patient received as a result of the AE, in the 63% the health care was not affected, in a 26% the AE was solved at primary care, the 10% required further consultation or a specialized care and the 1% required hospitalization.

Most professionals have reported at least one AE and its characteristics are similar to those published on other papers.

Reporting AE, with a previous training, may be a useful tool to assess the sensitization to PS, and teaching units, a resource in the development of a culture of PS.

Presented by Clara González-Formoso; M ª Victoria Martín Miguel; Antonio Rial Boubeta; Jose Luis Delgado Martín; M ª José Fernández Domínguez; José Luis Ramil Hermida; Fernando Isidro Lago Deibe; Ana Clavería Fontán; Margarita Pérez García.

+ Info: 20048.pdf

Posted by Fernando Palacio
English version by Erika Céspedes

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