Seguridad del paciente en los Servicios de Rehabilitación de la Región de Murcia

Abstract

INTRODUCTION The damages that patients may incur and the costs they represent for healthcare systems are so significant that various international organizations have developed strategies to propose plans, actions, and legislative measures to control preventable adverse events in clinical practice. In this context, the Ministry of Health, Social Services and Equality has placed patient safety at the forefront of healthcare policies as one of the key elements for improving quality. Physical Medicine and Rehabilitation is a specialty that involves the diagnosis, evaluation, prevention, and treatment of disabilities aimed at facilitating, maintaining, or restoring the highest degree of functional capacity, independence, and, above all, quality of life. Bearing in mind that one of the objectives of this specialty is to improve the quality of life of patients, healthcare quality is fundamental, and within it, patient safety plays a very important role that should be given significant attention. JUSTIFICATION AND OBJECTIVES It is essential to conduct studies to obtain reliable and exclusive results on patient safety in Rehabilitation in order to reduce the probability of committing such errors and decrease adverse events associated with healthcare work in this specialty. The main objective is to identify, according to experts' opinions, the most common patient safety problems in the Rehabilitation services of the Murcian Health Service. The secondary objective is to establish a list of patient safety problems according to the experts' opinions, ordered by importance. MATERIALS AND METHODS This is a qualitative study divided into three phases: Phase 1: Focus groups, Phase 2: Questionnaire development, and Phase 3: Delphi method. Given the lack of previous information available on the subject and considering the need for the opinion of expert individuals with knowledge and proven experience, the focus group technique was initially chosen (first phase). In a second phase, based on the obtained data, a structured questionnaire was developed in different blocks according to the categories of patient safety problems, with multiple-choice responses, using a Likert scale from 1 to 5 on the level of agreement and the frequency of occurrence of such events. In a third phase, through the Delphi method, using the previous questionnaire, a list of patient safety problems was obtained by consensus according to their relevance in rehabilitation. To consider whether there was agreement, the mean of the responses and an interquartile range lower than 2 were taken into account. RESULTS Three focus groups were conducted with the participation of 15 professionals. The questionnaire consists of 50 questions, 2 identification questions, and 48 questions distributed in 9 blocks according to the categories of patient safety problems. The number of experts who participated was 36, representing all rehabilitation services in the region of Murcia. The profile of the consulted expert was that of a medical professional (56.66%) or physiotherapist (43.33%) who has been working for 21 years or more (50%), from 11 to 15 years (23.3%), from 16 to 20 years (16.6%), from 6 to 10 years (13.3%), and from 1 to 5 years (13.3%). A list of possible safety problems in Rehabilitation was obtained, such as diagnostic errors in rehabilitation services (80-88%), communication problems among different professionals involved in the rehabilitation process due to the lack of appropriate tools (60-92%), deficient computer tools in pharmacological prescription (60%), physiotherapy treatment, and identification of patient anticoagulation (60%); medical transportation déficit (76.66%); errors in the organization of the system (73.33%); lack of qualified personnel in treatment rooms (50%); low patient safety culture as well as notification system (73.33%). CONCLUSIONS The use of the Delphi method has been fundamental given the limited prior scientific evidence available on patient safety in rehabilitation services and the necessity of the opinion of expert individuals, with proven knowledge and experience to obtain the list of most frequent safety issues in the Rehabilitation services of the Murcian health service. The main patient safety issues are related to diagnosis, communication tools, the computerized prescription system for pharmaceuticals and physiotherapy, medical transportation, patient referrals, and the lack of qualified staff in treatment rooms. This list can serve as a basis for developing strategies to be implemented in rehabilitation services, thereby improving the quality of care.