What to do if things go wrong: a guide for junior doctors

This National Patient Safety Agency's booklet is a guide for junior doctors to manage a patient safety incident.

It is organized in 6 sections.

First, a description of a personal experience of having a medical incident. Second, to document the incident in the patient’s medical records and to inform consultant and/or supervisor. Third, to communicate the incident to the patient, family and caregivers and apologise to all. Fourth, to report the incident in a local reporting system. Fifth, the guide enhance that junior doctors, on the frontline of care, are vital in the identification of learning from reporting. Finally, an algorithm is presented to deal with the complaints process in England.

Every section is introduced by an incident description from a relevant medical doctor in England.

It is easy to read and a good example to adapt in every country as a guide to promote good answers to incidents in practice for junior doctors.

Medical error. What to do if things go wrong: a guide for junior doctors


Posted by Pilar Astier
English version by Pilar Astier

Increased reporting of medication errors in a Healthcare Area

Virginia Greciano, of the Area 2 of Madrid, presented an interesting oral communication on medication error reporting, which is summarized below.

Given the necessity to extend definitively the culture of reporting medication errors (ME) and facing an increasing number of targets by the organization, the Functional Unit for Health Risks Management (FUHRM) proposed the Pharmacy Department to develop strategies to promote reporting.

Managers designed a training session on ME for healthcare centers in the Area 2. This session was directed at doctors, pediatricians and nursing, and other non-healthcare professionals. The main objective was to deepen the concept of ME and its differentiation from other adverse events. The content was also aimed at promoting reporting by simple steps, as well as illustrating the session with useful information and examples.

There were a few support messages based on 4 basic principles:

1. Curiosity: about any circumstance that cause surprise about a drug or pharmaceutical product at any time.

2. No doubt: "at the dilemma of whether it is an ME, an adverse reaction or other event, report it. An excess of notification does not hurt anybody and do so could get a risk to the patient ".

3. No blame: the ME is a part of the sanitary work. Reporting is anonymous, encourages a culture of risk and helps us grow as healthcare professionals.

4. Avoid bureaucracy: do not let papers paralyze you. To report a ME, just publicize it and ask for collaboration.

The results of the sessions were very interesting in terms of number of people attending and the number of notifications that have been received later. In less than six months reported a number of EM sufficient to achieve the goal of the year, reaching 42% report a higher than agreed. At the end of 2009, we were the third AP Management goal percentage and fourth in number of notifications.

Having identified the improvement areas and made the balance in the FUHRM, various measures have been proposed to maintain this line of work in the future.

To view the full presentation click here


Posted by Fernando Palacio
English version by Erika Céspedes

Learning from the successes. Safety Meeting’ 10

The Observatory for Patient Safety, of the Quality Agency of Andalusia, has organized this conference on 23 September in Seville.

There will have place roundtables with suggestive titles such as "Improving safety is simple", "Improving safety takes 2 minutes" or "Report of successes".

On the other hand they will project the safe practice experiences sent before 15 September.

The Observatory organized with our group the 2nd Seminar for Patient Safety, held in Granada in 2009, so we know their good job. Therefore we encourage you to go to Seville.

The program and registration are available on this webpage.


Posted by Fernando Palacio
English version by Erika Céspedes

Seminar of the Spanish Society of Preventive Medicine, Public Health and Hygiene: Patient safety, a shared commitment, a general interest

The next September 17 will take place in Alicante a Seminar of the Spanish Society of Preventive Medicine, Public Health and Hygiene (Sociedad Española de Medicina Preventiva, Salud Pública e Higiene), in which also participates the Spanish Society for Quality Healthcare (Sociedad Española de Calidad Asistencial, SECA) and the Spanish Association of Health Risks Management and Patient Safety (Asociación Española de Gestión de Riesgos Sanitarios y Seguridad del Paciente, AEGRIS).

Their slogan: "Patient safety, a shared commitment, a general interest”.

Some of the most committed to patient safety will participate, including our colleague Carlos Aibar, who manages a workshop.

It is useful to review the programme and participants and, if you can go, the registration is free, in order of application.


+Info on this web page


Posted by Safe and Healthy
English version by Erika Céspedes

Improving quality of antibiotics’ prescription in primary care: a qualitative evaluation of combined training intervention

BMC Family Practice publishes this paper focused on an intervention designed to change primary healthcare professionals’ antibiotic prescription habits.

The educational STAR program (Stemming the Tide of Antibiotic Resistance) has the aims of improving antibiotics’ prescription and to increase the awareness of the problem of antibiotic resistance among primary care physicians.

STAR program is composed of five main parts, complemented by a forum in the web about the course (part 6), and a reinforcement session (part 7) given approximately six months after completing the main program of the course.

Parts 1 and 2 include an online-introduction to antibiotic resistance and prescription. Participants present their own points of view on the subject. Clinical cases are also presented to discuss as well as some of most recent scientific evidence (graphics and abstracts). The objective of these two first parts is to raise clinicians’ awareness on how they treat common infections in everyday practice.

Part 3 consists of a practical seminar, where attendants meet in presence of a STAR instructor who contributes to the discussion about their prescription habits and data on resistances, collected from samples offered by professionals during the five to ten years previous to the study.

Part 4 presents online videos reflecting clinical settings or patient simulations to show key communication skills to employ in practice, useful for better understanding patients’ attitudes, expectations and worries.

In part 5 physicians are asked to describe three examples of their own clinical experience and to think them over, in order to consolidate the achieved knowledge.

The program’s effectiveness was evaluated in a randomized controlled study in which 244 primary care physicians and nurses took part. This text shows part of the study’s evaluation.

Evaluation was performed by a partly structuralized telephone interview, with digital data registration, to a 31 participants sample, by means of analysis of contents.

The majority of subjects reported higher awareness of antibiotic resistance, greater self confidence to reduce antibiotics’ prescription and at least some change in practice and attitude towards antibiotics’ prescription. Reported changes in practice included adoption of some policy to decrease prescription of antibiotics. Many physicians also reported their increased interest in patients’ expectances that contributes to improve the relationship between patient and physician.

The parts of the intervention that showed greatest influence to change professional’s behaviour were the update of available evidence, the simple and effective communication skills presented on online videos, and self reporting of antibiotic prescription data, combined with showing local resistance data.

Participants considered this educational intervention acceptable, necessary and feasible, obtaining a great impact and positive changes in attitudes and in clinical practice as a result of participation in STAR educational program.


Bekkers MJ, Simpson SA, Dunstan F, Hood K, Hare M, Evans J, et al. Enhancing the quality of antibiotic prescribing in primary care: qualitative evaluation of a blended learning intervention. BMC Fam Pract. 2010;11:34.





Posted by Lola Martín
English version by Erika Céspedes

3rd Seminar. Medication errors with vaccines: improving with the professionals

Problem description:

The objective of the 2009 program-contract in our area on medication errors reporting was to report at least 109 errors, which means a 5% of the expected in an area like ours.

The total in 2009 was 192 errors reported. The 26% of these was related to vaccine administration.

Analysis of causes:

A working group is formed with 12 professionals involved in immunization and motivated on patient safety: a pediatrician, nurses and immunization managers. Members of the risk unit of the area coordinate the group.

The group performs an analysis of causes of vaccine-reported errors.

Professionals: lack of training, unclear labeling, bad registration on patient's medical records, bad anamnesis, more than one professional to vaccinate a patient.

Organizational: lack of information in the admission of new professionals and substitutes, neither clear labels nor clear information on vaccine refrigerators, no registration of the vial opening date, failure to follow protocols and institutional advices.

Agents and resources: Errors in OMI drug list, frequent changes in laboratory supplier, multi-dose vaccines, different vaccines with similar labeling, prescribing information in other language, small print on the packaging.

Improvement actions:

Elaboration of an informative brochure and poster on the most common mistakes with vaccines.

The brochure will be given to new professionals and substitutes who will work with vaccines at their welcome, and there will be named a manager for this task in each facility.

The poster will be located in all offices at the primary care facility.

Rearrangement of vaccines in the refrigerator by age of administration.

Development of visible reminders in the refrigerator on the identification and proper placement of vaccines.

Results:

We improve the involvement of professionals in the security ambit.

A professional group makes improvement proposals, which will facilitate its acceptance.

We will assess the impact of these measures with the report of the errors with vaccines throughout 2010.

Presentation by María Dolores Martínez Patiño, UFGRS of the 5th Area of Madrid.

+ Info: http://seguridadpaciente.com/Jornadas10/comunicaciones/Resumen% 20030.pdf


Posted by Fernando Palacio
English version by Erika Céspedes

3rd seminar. Safety incident with the defibrillator gel in health centers. Root cause analysis

Problem description:

There are CPR training courses at primary care facilities in the 5th Primary Care area of Madrid. In reviewing the crash cart, the teacher finds in some facilities the presence of an alcohol gel bottle next to the defibrillator.

The gels for manual defibrillator must be alcohol free, because its use could burn patients.

Analysis of causes:

Professional causes: ignorance, not reviewing the composition of the gel, the defibrillator’s instruction manual and the provision of the crash cart, the coexistence of a semi-automated defibrillator that does not need gel.

Organizational causes: inexistence of a crash cart manager, rotative reviewing among the professionals, not separating the ultrasound gels (for ultrasonography and physical therapy) with alcohol.

Agents and resources: the trading house that provides the gel submits to the competitive acquisition a container identified with a sticker "for ECG and defibrillator”, but brought an alcohol gel, with the sticker "gel for ultrasound".

Working conditions: In some cases, the sonographic instrument and the crash cart are in the same room, and gels are exchanged.

Improvement actions:

Verification the competitive acquisition of the correct gel. Sample: the bottle says "ECG and defibrillator", without alcohol. Current product says "ultrasound transmission gel”, containing alcohol.

Appointment with the trading house, to clarify the supply of a product other than awarded.

Reporting the incident by fax, internal mail and e-mail to all professional; publishing on the website; notifying that there is defibrillator gel available in crash carts.

Sending the centers a correct gel container with a newsletter.

Edition of the book "Quality assurance in the use of health material and apparatus".
That includes a specific section on use and maintenance of defibrillators.

Although no damage has occurred, it is crucial the deployment of measures to prevent it in the future.

Oral presentation by Mercedes Martínez

+ Info: http://seguridadpaciente.com/Jornadas10/comunicaciones/Resumen% 20029.pdf


Posted by Fernando Palacio
English version by Erika Céspedes

3rd Seminar. Involving professionals in patient safety

Cristina Cedrún of the Primary Care Area 5 of Madrid, presented the interventions undertaken to improve reporting of incidents.

These interventions achieved the declaration of a 76% above the proposed objective.

The information and involvement were again the key.

The authors are: Cedrún Lastra, C; Martínez Patiño, M.D; Piédrola Martínez, M.


+ Info: http://seguridadpaciente.com/Jornadas10/comunicaciones/Resumen% 20028.pdf

Several posts on reporting adverse events have been published in this blog. Those can be accessed by typing in the search box on the right column the word “notification”.


Posted by Fernando Palacio
English version by Erika Céspedes

3rd Seminar. A project to systematize the communication in drugs administration at emergency situations

The Primary Care Management of Talavera de la Reina presented many presentations at the Seminar. In this one, they comment a very important topic, the risk of error in drugs administration at emergency situations.

Raised the issue, they developed a protocol on this subject that was presented with a video in all healthcare facilities.

The main author is Belen de La Hija.


+ Info: http://seguridadpaciente.com/Jornadas10/comunicaciones/Resumen% 20014.pdf


Posted by Belen de La Hija and Fernando Palacio
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

Interview with Miguel Angel Máñez. Can we sell better the safety culture?

We met Miguel Angel Máñez at the Security Master developed by the Spanish Ministry of Health and Social Policy and the Miguel Hernández University. We felt he provided a new –and very necessary- point of view respecting safety culture. That is why we asked to interview him and he has kindly answered.

Miguel Angel Máñez is an economist. He is currently the Deputy Manager of Economic and Human resources of the Alicante-Sant Joan Health Department. He is the author of Salud con Cosas, a blog on healthcare management, since 2007. His areas of interest are leadership and clinical governance, innovation, social marketing applied to healthcare organizations, health 2.0 and change management. He has participated in courses and seminars on Internet and health, healthcare management and marketing; and he has also written articles in various media on these topics.

- S & H: Why, if we all agree on the "primun non nocere", in the ethical principle of nonmaleficence, are there difficulties for health professionals to take on the problems on patient safety?

- M. A. M.: The custom and culture of each organization play an important role in how professionals behave. To generate a behaviour change is complex in humans and that is why incentives or rewards are often used to make this change not only fast but also durable. However, in the healthcare environment, the incentives associated with the implementation of a new culture based on patient safety are not very effective (in the case of economic incentives) and difficult to apply (the non-economic).

A clear comparison is the behaviour change in business environment, since to get a consumer buy a product is to create a purchase impulse that can produce positive results in just three minutes, but to change behaviour is something very long.

Finally, in the case of patient safety, the benefits are invisible to the professional, as they directly affect third parties, making the change difficult.

And counting on it, from your point of view, what are the strategies to succeed in introducing this culture? How can we “sell” it?

First, we must show that there is a direct benefit for the professional. Without demonstrating that the change creates value for both professionals and their activities, we can not move forward. Social marketing techniques seek to modify behaviour based on an exchange, analyzing the attitudes of members of the organization to the proposed behaviour, and providing each professional skills and motivation both necessary to understand he can make that change.

We have to dissociate the "sale" of that culture of the monetary concept of the term "sale." Economic incentives only work in the short-run and, indeed, any change brought whit an economic incentive disappears when the incentive disappears. The design of incentives should be conducted in a manner that achieves a long-term change, appealing to professional values, beliefs and their abilities to overcome obstacles.

Moreover, a new culture implies that we must know exactly how the professionals of the organization are in order to detect the leaders, innovators and "early adopters" (in Rogers’s terminology) who are going to serve as engine and example. In addition, managers must act according to the new culture, to keep the professional look at their own bosses trying to implement a new way of doing things that they do not follow.

Finally, we need a consistent and innovative training base: workshops in the workplace, courses, training for managers of each unit, reminders, etc. Any support material is welcome, but also the originality and innovation will be appreciated to reach the professional’s attention.

Finally, what role do patients play in this topic?

The patient plays a central role, because if healthcare organizations seek to generate a cultural change aimed at the improvement in security, is because it has been shown that there is improvement in patient care: more quality, more safety. Perhaps we have gone through a culture of wellness and safety time for the professional, sometimes forgetting, in the process design, that the ultimate objective of health services is to provide a range of patient cares.

One way that lately has been used to achieve these changes in the culture we are discussing is to use the patient as a means of transmitting the professional the need to make things differently. Within the National Health Service (NHS) it has been much criticized, as there are professionals very reluctant to the idea of a patient requiring them to perform a task one way or another, but it is usually very effective. In fact, we are conducting in our center a project in social marketing and hand washing aimed to relate each type of marketing strategy with a change in professional’s behaviour.

Thank you very much for talking to us. Now it is time to reflect on what we have expressed and to work, more focused, to keep trying to create that culture of safety.

Thank you very much


+ Info: a very interesting link, his class in the Patient Safety Master of the Spanish Ministry of Health and Social Policy and the Miguel Hernández University, where Miguel Angel Máñez develops some of the ideas reviewed in the interview.


Posted by Safe and Healthy
English version by Erika Céspedes

3rd Seminar. Safe practices presented by the Functional Unit of Health Risks Management, 4th Area of Madrid

The Functional Unit of Health Risks Management of the 4th Area of Madrid presented the safe practices identified in the last four years.

They define a safe practice as "an action, according to the evidence and knowledge available, to avoid or reduce health risks or adverse effects. It may respond to a particular health care situation or may be useful and/or generalizable to other facilities because of their potential impact on patient safety, frequency or importance. "

In their presentation there is a list of safe practices that are widespread. It is a very interesting list for those who want to implement them in their area of influence.

The authors are Asunción Cañada Dorado, Inmaculada García Ferradal, Carmen García Cubero, Sergio Serrablo Requejo, María Antonia Sánchez Márquez y María José Montero Fernández.

+ Info: http://www.seguridadpaciente.com/Jornadas10/comunicaciones/Resumen% 20059.pdf

See also in this blog: Entrevista a Asunción Cañada a propósito de las Unidades Funcionales de Gestión de Riesgos Sanitarios (Interview with Asunción Cañada about the Functional Units of Health Risks Management)


Posted by Fernando Palacio
English version by Erika Céspedes

The Ministry of Health and Social Policy has posted on the network the presentations of the 5th Conference

Our readers will remember that the last June 3 and 4 was held in Madrid the 5th International Conference on Patient Safety, which has already been reviewed in this blog.

The Spanish Ministry of Health and Social Policy has posted on its Patient Safety Web Site, the presentations of that conference.

It is also an opportunity to visit -for those who have not yet done it- the specific Patient Safety Web which provides interesting and important contents.

Posted by Fernando Palacio
English version by Erika Céspedes

Manual of Patient Safety for nursing

Nurses play a vital role in improving the safety and quality of patient care, not only in health care facilities but also community-based care and the care performed by family members. That is why we echo a publication of 2008 of the Agency for Healthcare Research and Quality (AHQR) that may be useful for nurses to select techniques and interventions with proven effecacy.

The publication of 1 400 pages, is titled Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

It is structured in the following sections:

- Patient Safety and Quality
- Evidence-Based Practice
- Patient-Centered Care
- Work Conditions and Work Environment
- Critical Opportunities for Patient Safety and Quality
- Tools

It is a complete, clear, scientific and practical book.

Hughes RG (ed.). Patient safety and quality: An evidence-based handbook for nurses. (Prepared with support from the Robert Wood Johnson Foundation). AHRQ Publication No. 08-0043. Rockville, MD: Agency for Healthcare Research and Quality, March 2008.


Contribution by Jesús Moreno, a nurse. Entrimo Health Center (Terrachan), Spain.
English version by Erika Céspedes

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

The Gaal questionnaire, a tool to introduce the Safety Culture

We have uploaded to “sanoysalvo files" the spanish version of the questionnaire developed by Sander Gaal, to know the perception that the health professionals of the risks to patient safety.

It is a very interesting questionnaire that has two parts. The first presents 10 situations of everyday practice and the second presents 15 factors that can influence the safety of patients. The questionnaire requests the value from 1 (not committed / not increase the risk for patient safety) to 5 (patient safety is very committed / greatly increases the risk) each of the 25 items.

It is not a questionnaire to evaluate, since there are no right answers, but is useful for input to the subject. The discussion of each of the situations or the importance of risk factors can facilitate an introduction-based daily practice, the concepts related to patient safety.

This approach to how professionals value the risks is essential in order to improve the safety culture, for if the perception of risk is low will be more difficult to be aware of the problem.

+ info: Patient safety in primary care: a survey of general practitioners in The Netherlands.
Gaal S, Verstappen W, Wensing M.
BMC Health Serv Res. 2010 Jan 21;10:21.


Posted by Fernando Palacio
English version by Jesús Moreno

The relationship between patient safety culture and the implementation of organizational patient safety defences at emergency departments

VAN NOORD I, DE BRUIJNE MC, TWISK JWR

Int J Qual Health Care 22: 162–169 [PMID: 20382661]

Objective: The objective of this study was to investigate the association between 11 patient safety culture dimensions and the implementation of 7 organizational patient safety defences: a resident orientation program, the training, the skills assessment of residents, the presence of protocols, the review of patient records, the structured monitoring and the review of radiodiagnostics results.

Design: Data were gathered within a cross-sectional, retrospective survey. Setting: Emergency departments (EDs) in the Netherlands. Participants: Thirty-three EDs of non-academic hospitals, which belong to the clientele of Dutch largest medical liability insurer. Main outcome measures: Implementation of the separate organizational patient safety defences (0 = insufficient/sufficient, 1 = good).

Results: Analyses showed that several culture dimensions were negatively or positively associated with the implementation of the patient safety defences. A culture in which hospital handoffs and transitions were perceived adequate was related to less frequent implementation of four of seven organizational patient safety defences, whereas a culture with well-perceived hospital management support for patient safety predicted more frequent implementation of four of seven organizational patient safety defences: the structured monitoring, the review of radiodiagnostics results, the resident orientation program and the review of patient records. The perception of a hospital management supporting patient safety was associated with more frequent application of four of the seven organizational defences for patient safety: the presence of protocols, the review of radiodiagnostics results, the resident orientation program and the review of patient records.

Conclusions: Results suggest that well-perceived culture dimensions might inhibit improvements by lack of a sense of urgency as well as facilitate improvements by inducing feelings of support for organizational changes and improvements. The influence of patient safety culture appeared to be not always as straightforward as it seems to be in advance.

Although the study took place at the emergency departments, we comment it because it poses a design that may be of interest in primary care to investigate the relationship between the culture of patient safety and the effective implementation of organizational defences that assure it.


Posted by José Angel Maderuelo
English version by Erika Céspedes

The nursing organization, access to training and motivation are key to safety in hospitals.

The next day May 21 will be held in Madrid, at the Carlos III Health Institute, the symposium "Nurse staffing and its Impact on Patient Safety: towards a Better forecast of human resources in nursing needs", organized by Investen. During this event will be the study RN4CAST that although referred to hospitals, is worth seeing
for the uniqueness of your starting point: studies of Linda Aiken.

In 2002 and 2003, Aiken released his studies (see links at the bottom) on the so-called "magnetic hospitals,"those who attract the best medical and nursing professionals. They showed that nursing human resources influence the quality of the results of these hospitals, in aspects such as mortality or neglect of patient calls, in addition to its own welfare of nurses. Since then the concern for proper management of nursing resources and the design of planning models needs of these resources has been increasing. It should be noted that the results of Aiken were adjusted for other resources, such as doctor / beds or others.

In this sense, the project is underway Forecasting Registered Nurse (RN4CAST) that aims to collect data from 15,000 nurses and 10,000 patients in 330 hospitals in 11 countries participating in the study. Data are being collected from the environment and human resource nurses through the hospital and the nurses themselves.

These data will be associated with patient outcomes, which will be drawn from the records afterthe high standard of patients.

Data collection will take place in acute general hospitals and in them the majority of working nurses are responsible for the greatest number of medical errors and the biggest share of health spending.

The project is coordinated by the Center for Health Services and Nursing Research of the Katholieke Universiteit Leuven, Belgium, together with the Center for Health Outcomes and Policy Research at the University of Pennsylvania (USA) as vice-coordinator.

Participating countries are Belgium, Finland, Germany, Greece, Ireland, Poland, Spain, Sweden, Switzerland,Netherlands, UK, U.S. and three international cooperation partners (Botswana, China, and South Africa).

In Spain, the project is coordinated by the Instituto de Salud Carlos III, through INVESTEN.

With the results of the project will support the creation of standards for human resource planning in nursing.

It would be interesting that studies be undertaken similar to this one focusing on the area of primary care,which allow us to explore in an objective manner, what is the influence of staffing ratios on patient safety.


Aiken, LH, Clarke SP, Sloane DM, (2002) Hospital staffing, organization, and quality of care: cross-national Findings Nurs. Outlook, 50.187-194
Aiken, LH, Clarke SP, Cheung RB, Sloane, DM, Silber JH (2003) Educational Levels of hospital nurses and surgical patient mortality. JAMA, 290.1617-1623


Posted by Juan José Jurado
English version by Jesús Moreno

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