Patient Safety 2010 Eurobarometer

The supplement on Patient Safety, of the newsletter of the National Health System’s Quality Agency, announces the publication of the Patient Safety 2010 Eurobarometer.

It is a very complete report, with 107 pages, containing the results of 26,663 questionnaires in the 27 EU countries.

Nosocomial infections are the adverse effects perceived as most frequent, followed by misdiagnosis and problems with medication.

When people are asked about the risk of having an adverse effect in the hospital, Greeks express the greatest mistrust, measured at 83%. The EU average stands at 50% and in the case of Spain, by 35%.

When the question refers to the risk in Primary Care, Greeks repeats the worst result, 78%. The EU average is 46% and 32% in Spain.

It is surprising that, despite the different kind of care, there is little difference between the estimation by the citizens of suffering harm in the hospital (35%) or primary care (32%).

Those are good results for Spain in terms of public confidence in the NHS, which compels us to continue working to not disappoint it.


Posted by Fernando Palacio
English version by Erika Céspedes

MedlinePlus: Talking with your doctor

This website presents, in the section "Health News", some advices for patients to prepare for consultation with their doctors so the patient can participate actively in the care process.

The objective of these tips is the patient to reflect about the importance of his participation, from the position of a formed patient, in the healthcare process. The patient should organize information about his disease to be transmitted to the doctor during the visit. He must also raise the questions necessary to understand their disease: what is happening, what is the evolution and how will be the treatment and the follow-up. After the consultation the patient should not have doubts about the information transmitted by the doctor.

In the news you will find links to other documents of interest for patients, related to the medical consultation:

• Be an active member of your health care team (Food and Drug Administration)
• How to talk to your child's Doctor (Nemours Foundation)
• Tips for talking to your Doctor (American Academy of Family Physicians)

The column on the right contains links to topics of interest: Patient Safety, Patient Rights...


Posted by Lola Martín
English version by Erika Céspedes

Interview with Pilar Vicente García, nurse, member of the Spanish Association of Latex Allergy

Latex allergy, although currently very common, is still little known. According some studies, in Spain a 2% of the general population has developed it and in risk groups the number may reach a 15%. Once it appears, any area of a person’s life is involved because, where there is no latex?

We interviewed Pilar Vicente García, a member of the Spanish Association of Latex Allergy (Asociación Española de Alérgicos al Látex), and nurse.

S. & H.: Do you think that health professionals are sensitized or trained in this problem?

P.V.G.: Although the situation has improved in the last two or three years, much remains to be done. Nowadays there are many health professionals that do not know what to do when a latex allergic person arrives to their offices o divisions.

What aspects should be improved?

Basically, two things: information and training. It is a disease partially unknown for many health care professionals.

Could you give us some examples?

Well, one would be when a professional see us with elastic underclothes, and says: "Come on, you are allergic to latex and you wear latex elastic!". It is a very uncomfortable comment for the patient. The first thing you think is that they do not believe you are allergic to latex. Fortunately, patients are increasingly trained in patient safety. Then, as calmly as you can, you explain that there are clothes with synthetic materials elastics that do not harm us.

Another example would be the administration of a drug that comes in a glass vial and has a rubber plug; you instinctively ask "the plug is of natural latex?". Answers may be very different... "but I will not touch the plug" or "so I remove the plug and you're done". And there is an answer more and more frequent "I am going to ask, I will make sure". In the first two cases the patient has to explain that the liquid may contain latex proteins and, even though you remove the plug or not touch it, it can cause a reaction. So what occurs is an estrangement between the professional and the patient that does not benefit either party. The third answer may start a rapport with the professional who shows more interest for the problem and investigates whether the plug is natural or synthetic latex. This situation really benefits both parts.

Another situation that causes surprise is when you explain that there are foods that, having proteins similar to those of natural latex, can cause reactions similar to those caused by latex itself. This is what we call “latex-fruit syndrome", since tropical fruits are the most concerned: kiwi, pineapple, banana... but also tomatoes, oranges, melons...

So, no latex-allergic people can eat these foods?

No, according to reports only the 50% of those latex-allergic people develop the “latex-fruit syndrome", and not to all fruits, but the truth is that when the reaction to any of these foods appears, the list often starts to grow.

In addition to training and information, as you mentioned at the beginning, what could be done to improve the situation?

We think that it would be desirable that health care professionals invite patients to their meetings, seminars, etc. and give them the opportunity to explain their day-to-day routine, the obstacles they have to overcome because of their latex allergy, their feelings in relation to health care situations. It is not about confronting or criticizing; it is about intercommunicating and listening to each other, it is about gradually changing the current culture.

Patients know that health care professionals and we have a common goal, our safety, patient safety. Strangely we both walk toward that goal but in parallel and with and askance look, and so, we will never meet. We must learn to walk together, side by side.

What would you emphasize of the actions of your organization, the Spanish Association of Latex Allergy?

The spread of the disease has been very important. We have carried out a number of seminars in different regions specifically directed at health professionals, many of which had recognized health interest. Accurate information has been given to all patients allergic to latex. We have conducted studies in which realization we had always the support of the Ministry of Health and Social Policy, the professionals from different disciplines such as chemists, engineers, biochemists, dermatologists, allergists, etc. and the different areas such as universities, hospitals, nursing schools, research centres in biotechnology, etc.

You may see all this on the Association’s website, www.alergialatex.com. The studies mentioned can be downloaded for free from the Web.

Thank you very much for thinking of us and giving the latex-allergic people the opportunity of being present in the Safe and Healthy blog, which is very interesting.

Thank you very much for your attention.


Interview by Clara Formoso for Safe and Healthy
English version by Erika Céspedes

3rd Seminar. Design and implementation of a protocol on users’ unequivocal identification in primary care

The topic of the unequivocal identification of patients was also present at the Seminar, through this presentation of the Guadalquivir Sanitary District, Córdoba. The authors are Hervás Vargas, A. and Gutierrez Sequera, J.L., who summarize their work thus:

Problem Description: In the provision of health care, the identification of patients involves risks that may result in misdiagnosis, testing, surgery or giving medications or blood products to wrong patients.

Proposal for improvement: The Strategy for Patient Safety of the Andalusian Autonomous Government includes among its objectives the unequivocal identification of citizens that contact with the Andalusian Public Health System and says explicitly that all citizens treated in primary care must be unequivocally identified by at least two data, one of them, the Unique Andalusian Health Record Number (NUHSA). Therefore, we have developed a protocol which aims to establish a policy for secure identification of patients that lets identify reliably the patient as the person to whom the treatment, care or service is focused and, in turn, relate the treatment, care or services with that patient.

Strategy: The scope of our work covers all health services that integrate the eight Clinical Management Units of our Health District: primary care centres, emergency departments, domiciliary care, critical care units, minor surgery, etc., and so to all health and non health professionals who have direct care contact at any time with the patient.

The following tools will be used for diffusion:
1. Sessions/Workshops for health and non health professionals.
2. Brochure for the Citizen Advice Service Professionals.
3. Publication of the document on safety and unequivocal identification of patients in local magazines, aimed at citizens.
4. Publication of the document on safety and unequivocal identification of patients, aimed at professionals in newsletters.

+ Info: http://seguridadpaciente.com/Jornadas10/comunicaciones/Resumen% 20020.pdf


Posted by Fernando Palacio
English version by Erika Céspedes

Time to listen: a review of the methods to solicit patient reports of adverse events

As patient participation is a relatively new addition to patient safety reporting systems, the techniques that are most successful and efficient are not yet known.

The journal Quality & Safety in Heath Care has published this literature review on reporting systems used by patients: populations, contact methods, verification, reporting, incentives, incident rates and reporting terminology.

Two databases were searched: PubMed and MEDLINE (English publications only), obtaining finally 17 publications for review. Of these publications, four focused on Primary Care (PC), and one included both primary and hospital care.

PC patient reporting studies used a combination of methods to collect patient reports: telephone recruitment with a follow up in-person interview, patient’s choice of reporting method (online, written or telephone reporting) and telephone survey. The terminology used to ask the patient about the events has also been variable.

Adverse events were corroborated only in three publications, none of PC. The incidence of nosocomial infections, pressure ulcers and drug-related events reported by patients was shown to be comparable to rates documented by healthcare providers in hospitals and to rates reported in patient safety literature.

The incidence rate for adverse events across settings and populations varied considerably, ranging from less than 0.1 to 5.8 per patient. The results are not comparable. The same happens with the classification of reports.

Thus, the variability found among the publications reviewed is extensive in terms of healthcare settings, method of reporting, time span, terminology, criteria for assessment and response rates, which makes establishing definitive conclusions impossible. It seems that higher response rates are achieved with open questions and solicitation techniques based exclusively on personal experiences by interview. Further research is required to determine the optimal language, method, format and tool for patient reporting. The utility of the incentives should also be studied.

In short, the participation of patients in reporting adverse events is a very interesting field, which represents a valuable new perspective to improve their security, but is soon to offer final conclusions. Further research is required to reach its implementation and to achieve its potential benefits.


A King, J Daniels, J Lim, et al. Time to listen: a review of Methods to request patient reports of adverse events. Qual Saf Health Care 2010 19: 148-157


Posted by Marisa Torijano
English version by Erika Céspedes

AEMPS: Information about the use of drugs in case of heat wave

As usual at this time, the Spanish Agency for Drugs and Health Care Products (AEMPS) has issued a safety communication giving information about the use of drugs in case of heat wave.

The Spanish Society of Family and Community Medicine (semFYC) also published in June 2009, in the section of its website aimed at population, its recommendations for preventing the effects of excessive heat.

SemFYC advise to exercise extreme caution with the most vulnerable people including the elderly, the chronically ill and bedridden, obese, young children, psychiatric patients and those who take certain medications.

"The drugs that physician should take into account include diuretics (to increase the amount of urine), antihistamines (allergy), anticholinergics (depression, Parkinson's, etc), beta blockers (hypertension), phenothiazines (mental disorders)."

"In any case, you should never remove or reduce the pharmacological treatment without the risk-benefit assessment."


Posted by Jesús Palacio
Englilsh version by Erika Céspedes

What European population knows about the use of antibiotics. Eurobarometer 2010

Antimicrobial resistance is a threat to world public health. Recognizing this, the European Union (EU) has launched a Community strategy against antimicrobial resistance, which includes initiatives to promote its safe use and to combat misconceptions about antibiotics.

Thus, since 2008, the EU organizes an annual campaign to raise awareness on the proper use of antibiotics, coordinated by the European Centre for Disease Prevention and Control - ECDC. We have echoed these campaigns in this blog.

However, despite these and other initiatives, the results published in 2010 in the antimicrobial resistance Eurobarometer shows that citizens ignore issues such as when to take and what are antibiotics.

The study was conducted through a survey of 26 761 inhabitants of the EU member countries. A summary of the most relevant results are shown in the following presentation that compares the situation of our country (Spain) with the rest of Europe.

Conocimiento de la población europea con respecto al uso de antibióticos. Eurobarómetro 2010

View more presentations from Sano y Salvo.

As a conclusion, future campaigns on antibiotics should be more consistent and show that antibiotics are completely ineffective against viruses. The broadcasts on television that target the public in general are still valid, because they reach large numbers of people.

Citizens rely on their doctors to obtain adequate information regarding the use of antibiotics, so these professionals can and should participate actively in these campaigns.


Posted by Guadalupe Olivera
English version by Erika Céspedes

Versión en español de esta entrada

V International Conference on Patient Safety

Under the Spanish Presidency of the U.E. Madrid was held at the V International Conference on Patient Safety. Impeccable organization and excellent speakers at tables rather moderate.

A lot and very good. How to summarize? I chose to reflect what has impressed me most as a family doctor who has left these days its small and saturated query to continue learning to improve the safety of care patients receive.

I encourage the rest of the attendees to write their impressions on this blog from the same or from other points of view and thereby enrich my comment.

About infections associated with health care and antimicrobial resistance I noted: Over 50% of the Spanish adult population admitted having taken antibiotics in the last year (30% "with the flu").

Antibiotic consumption is associated with increased bacterial resistance which cause delays in the administration of effective treatments and therefore increase morbidity and mortality, prolonged hospital stay and high economic costs. Resistance increases with increased use. It is shown that less use increase complications in patients with infectious disease.
In Spain, 92% of antibiotics are acquired by prescription (in France 97%, with a European average of 95%).

Other data for comparison with the rest of Europe: we consume more broad-spectrum antibiotics and continues the upward trend in the prevalence of MRSA in our hospitals (the French show that this trend can be reversed).

Research on antibiotic therapy is virtually idle since the 60s (currently only a research compound against gram negative).

There is decrease in the supply of active ingredients while raising presentations. The EFG represent 43% of prescriptions.

What I can do?

Non-pharmacological interventions:

Prudent use of antibiotics: only when necessary, correct intervals and duration.

Optimization of empirical treatments. Prescribing based on evidence.

Help end the illegal practice of giving antibiotics without a prescription at the pharmacy (for example, not providing the same into the patient).

Ask to enhance research in antibiotics (eg, not favoring my requirements that the business is in selling so many drugs that do not represent steps)

Find information and training and quality transparent

Collaborate with health authorities in health education campaigns for proper use of antibiotics and other initiatives related to patient safety.

Regarding measures to be taken to prevent transmission of pathogens themselves that we use and abuse the most powerful tool to address infections associated with health care: hand hygiene. Compliance through this simple but effective measure is only 38% and fewer doctors that nurses meet.

I keep taking note of the representatives of our patients tell us they are in health care silence and concealment of errors, reactive actions to prevail against those aimed at preventing them.

We ask for proactive risk management, teamwork, improve communication with and among us, standardization of procedures based on best available knowledge to care "partnerships" with industry to establish and therefore we do not focus on the sophisticated technology in the pursuit of our interest but in the promotion of good practice and in them, our patients.

They in turn are considering what to do for health systems and better use of resources and effort to ask for and offer honesty, transparency and participation.

Already in the last speech heartened to hear that primary care matters a great deal, how to tell us so little!

But beyond the first moment of pride that we have to take rather this phrase as a warning: be so important in AP extent of the risk does not appear to be reaching for now strategies to achieve safer health care in the same So get to other levels of care.

I recommend to visit the website of the Linneaus project.

For my part I try, and this week in my small and saturated consultation, follow some concrete recommendations for action by his representative: Do not lose sight of the importance of good interaction with the patient to understand and follow my explanations, explanations should be improving day by day and manage my time so you can establish routines that allow me to advance the consultation of the patient if something can not go well and record, report, analyze and learn from the failures and errors.


Posted by Marian López Orive
English version by Jesús Moreno

Drugs and driving

The Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) has posted on its website a new section of drugs and driving.

The packages of medicines that can produce effects that impair the ability to operate a car or a dangerous machine shall have the symbol illustrated here before 2011.

You can consult on this page which active ingredients have to use or not the symbol.

Posted by Jesús Palacio
English version by Erika Céspedes

Welcome to the English version of Sano y Salvo

Sano y Salvo is currently the only website focused on patient safety in primary care. We receive visits from all over the world, which has made us consider the publication of our contents in English.

So we have created the blog safeanhealthypatient.org, in which we will publish the translation of sanoysalvo.es posts.

Publication at this site of the spanish originals will not be exhaustive or synchronous. We will publish the translation of new posts and, as we can, some of the older posts.

Sano y Salvo is currently a collection of the most relevant items published about patient safety in primary care, both at the national (Spain) and international level. Our web searcher engine and the links on the right column allow anyone to find relevant contents and interesting experiences to improve patient safety in primary care.

Now we also consider making these material worldwide available, in English.


Posted by Jesus Palacio, editor of sanoysalvo.es and Erika Céspedes, manager of the English version published in safeandhealthypatient.org