Mejora en la seguridad del paciente quirúrgico en el Hospital J.M. Morales Meseguer

Abstract

INTRODUCTION Surgery is one of the most complex actions of the health services, and annually more than 100 million people require surgical treatment in the world. The operated patients present postsurgical complications in 25% of the cases, being between 3% and 16% major complications. Quality of care is considered an important area in the healthcare process. In our work we have followed the line of study of the Patient Safety Strategy in the National Health System 2015-2020 where the development of the Regional Surgical Patient Safety Program in the Murcian Health Service is proposed. OBJECTIVE Improve the quality and safety of the patient who is going to undergo a surgical intervention at Hospital Morales Meseguer. To address the primary objective, the following secondary objectives were proposed: 1. Analyse the safety culture of healthcare professionals in the surgical block 
 2. Evaluate the safety of patients operated on at the Morales Meseguer Hospital 
 3. Design and implementation of interventions of proven effectiveness in order to demonstrate the quality of care in surgical patients 
 4. Evaluation of the implementation and effectiveness of the measures applied 
 5. Analyse the safety culture of healthcare professionals in the surgical block. 
 METHODS A "Before and After" study of patient safety has been carried out, following the methodology of a quality improvement cycle. The quality indicators based on the quality indicators designed by the regional surgical patient safety working group have been selected to assess the quality and safety of care for surgical patients at Hospital Morales Meseguer. A data collection sheet has been prepared, on which a baseline evaluation will be carried out. After the first evaluation, a series of interventions have been designed and implemented to improve the evaluation results.
 Finally, a second evaluation of the same indicators has been carried out to assess whether or not there have been improvements in the quality of care with the interventions applied. Statistical analysis was performed using the SPSS 22.0 package for Windows (SPSS® Inc., Chicago, IL). RESULTS We obtained a response to the safety culture survey from a total of 158 professionals (74.9%) from the surgical block. Regarding the results by dimensions, in the evaluation of safety culture in health professionals, the best qualified in our work was "Expectations and actions of the management / supervision of the service to promote safety" with a rate of positive responses from 71.9%, followed by "Teamwork in the Service" with a favourable result of 65.2%. The worst valued dimension, with a negative result of 62.2%, was the dimension “Staffing”. The average grade obtained in terms of the degree of safety of the professionals is 7.2. A relative and absolute improvement has been obtained in the indicators: monitoring of normothermia, preoperative fasting, use of the Surgical Check List, adequacy of thromboembolic prophylaxis and adequacy of antibiotic prophylaxis; obtaining statistically significant results in all of them, except for monitoring normothermia with a non-statistically significant result. CONCLUSIONS In the analysis of the safety culture of professionals in the surgical area, “Staffing” stands out as a negative aspect, so that an increase in staff could improve patient safety. We have achieved improvement in the indicators: preoperative fasting, adequacy of antibiotic prophylaxis, use of LVQ, maintenance of normothermia, and adequacy of thromboembolic prophylaxis.