{"id":115341,"date":"2014-06-03T00:00:00","date_gmt":"2014-06-03T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/efectividad-de-una-intervencion-para-reducir-las-discrepancias-y-los-errores-de-conciliacion-de-la-medicacion-al-alta-hospitalaria-en-un-servicio-de-ciruga%c2%ada\/"},"modified":"2014-06-03T00:00:00","modified_gmt":"2014-06-03T00:00:00","slug":"efectividad-de-una-intervencion-para-reducir-las-discrepancias-y-los-errores-de-conciliacion-de-la-medicacion-al-alta-hospitalaria-en-un-servicio-de-ciruga%c2%ada","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/murcia\/efectividad-de-una-intervencion-para-reducir-las-discrepancias-y-los-errores-de-conciliacion-de-la-medicacion-al-alta-hospitalaria-en-un-servicio-de-ciruga%c2%ada\/","title":{"rendered":"Efectividad de una intervenci\u00f3n para reducir las discrepancias y los errores de conciliaci\u00f3n de la medicaci\u00f3n al alta hospitalaria en un servicio de cirugia"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Rosario Albarracin Garcia <\/strong><\/h2>\n<p>Objetivos. objetivo general: evaluar la efectividad de una intervenci\u00f3n mixta (con componentes educativos, de retroinformaci\u00f3n, y de reformas organizativas) para la reducci\u00f3n de errores en la conciliaci\u00f3n de la medicaci\u00f3n al alta hospitalaria en el servicio de cirug\u00eda general del hospital general universitario reina sof\u00eda (hgurs) de murcia. Objetivos espec\u00edficos: describir los tipos de discrepancias y errores de conciliaci\u00f3n de la medicaci\u00f3n. Evaluar la efectividad de una intervenci\u00f3n mixta en la reducci\u00f3n de discrepancias y errores de conciliaci\u00f3n de la medicaci\u00f3n al alta hospitalaria. Identificar los factores asociados a las discrepancias y los errores de conciliaci\u00f3n de la medicaci\u00f3n al alta hospitalaria en el servicio de cirug\u00eda general. Predecir el riesgo de discrepancias y errores de conciliaci\u00f3n de la medicaci\u00f3n. Estimar la frecuencia anual de errores de conciliaci\u00f3n al alta con da\u00f1o potencial para el paciente, en el servicio de cirug\u00eda general, si no se implanta un programa de conciliaci\u00f3n de la medicaci\u00f3n al alta hospitalaria.  material y m\u00e9todo estudio cuasi-experimental de series temporales interrumpidas de dise\u00f1o secuencial con reversi\u00f3n simple. El estudio se desarroll\u00f3 en un hospital general universitario reina sofia, de murcia, de referencia del \u00e1rea , en el servicio de cirug\u00eda general. Se realiz\u00f3 en 3 fases (preintervenci\u00f3n, intervenci\u00f3n y reversi\u00f3n). Se estudiaron los errores de conciliaci\u00f3n de la medicaci\u00f3n prescrita en los informes de alta de los pacientes ingresados un m\u00ednimo de 48 horas en el servicio de cirug\u00eda que cumplieron los criterios de inclusi\u00f3n. Se realizaron 30 observaciones 8dias) en cada fase del mismo, lo que al final supuso, unos 90 d\u00edas de observaci\u00f3n.  Se realiz\u00f3 un muestreo consecutivo. La variable principal del estudio fueron los errores de  conciliaci\u00f3n de medicaci\u00f3n. Los datos fueron recogidos por los farmac\u00e9uticos que participaron en el estudio, de forma concurrente con la estancia del paciente, en la planta de hospitalizaci\u00f3n de cirug\u00eda general. Se utilizaron los siguientes instrumentos para su recogida:1.- Cuestionario con preguntas abiertas para recoger la historia cl\u00ednica y farmacoterap\u00e9utica del paciente. 2.- Formulario electr\u00f3nico de la historia farmacoterap\u00e9utica (hft) que se adjunt\u00f3 a la historia cl\u00ednica electr\u00f3nica del paciente antes del alta hospitalaria, s\u00f3lo en la 2\u00aa fase del estudio o periodo de intervenci\u00f3n.  el m\u00e9dico responsable del alta visualiza esta informaci\u00f3n cuando realiza el informe de alta pudi\u00e9ndola incorporar al informe. Para el an\u00e1lisis el modelo que m\u00e1s se ha utilizado y que hemos empleado en este estudio es el denominado modelo arima (autorregressive, integrated, moving average) desarrollado fundamentalmente por box y jenkins.  resultados \t\tel porcentaje medio de discrepancias en la medicaci\u00f3n por paciente, ha sido superior al 95% en los periodos preintervenci\u00f3n y reversi\u00f3n, con una reducci\u00f3n de las mismas casi a la mitad en el periodo de intervenci\u00f3n. El porcentaje medio de errores de conciliaci\u00f3n por paciente, al alta hospitalaria, ha sido superior al 66% en los periodos preintervenci\u00f3n y reversi\u00f3n, reduci\u00e9ndose a menos del 25% en el de intervenci\u00f3n. Se han producido uno o m\u00e1s errores, como m\u00ednimo en el 90% de los pacientes dados de alta durante los periodos sin intervenci\u00f3n, disminuyendo al 52% en el de intervenci\u00f3n. El tipo de error mas frecuente en la conciliaci\u00f3n de la medicaci\u00f3n al alta hospitalaria, en los periodos preintervenci\u00f3n y reversi\u00f3n, ha consistido en la omisi\u00f3n de medicamentos, seguido por la prescripci\u00f3n incompleta. La categor\u00eda de gravedad m\u00e1s frecuente en los errores de conciliaci\u00f3n al alta, en los periodos preintervenci\u00f3n y reversi\u00f3n ha sido el error con gravedad de categor\u00eda b. El porcentaje medio de medicamentos con error de conciliaci\u00f3n con da\u00f1o potencial o que requiera monitorizaci\u00f3n  por paciente, al alta hospitalaria, fue inferior al 20% en los periodos preintervenci\u00f3n y reversi\u00f3n, disminuyendo a un 7% en el periodo de intervenci\u00f3n. Este tipo de error afect\u00f3 al 40% de los pacientes en los periodos sin intervenci\u00f3n. Los factores de riesgo significativamente asociados a los errores de conciliaci\u00f3n con da\u00f1o potencial o que requieren monitorizaci\u00f3n, al alta hospitalaria, en el servicio de cirug\u00eda general, durante los periodos de preintervenci\u00f3n y reversi\u00f3n han sido la edad del paciente, el tipo de ingreso, el d\u00eda de ingreso, la edad del medico y la procedencia al ingreso. Las ecuaciones y modelos, obtenidos mediante regresi\u00f3n log\u00edstica multivariante, para predecir el riesgo de error de conciliaci\u00f3n, adolecen de una escasa eficacia predictiva. El n\u00famero anual de los errores de conciliaci\u00f3n al alta con da\u00f1o potencial o que requieran monitorizaci\u00f3n se estima en unos 1.900, y afectar\u00e1n a unos 675 pacientes en el servicio de cirug\u00eda general, si no se implanta un programa de conciliaci\u00f3n de la medicaci\u00f3n.  conclusiones considerando las anteriores conclusiones, que se deducen directamente de los resultados obtenidos tras una rigurosa aplicaci\u00f3n de la metodolog\u00eda descrita, recomendamos a las administraciones sanitarias implementar, de manera generalizada y sistem\u00e1tica, estrategias eficientes como la descrita en nuestro estudio, que conducir\u00e1n a una sensible disminuci\u00f3n de los errores de conciliaci\u00f3n de la medicaci\u00f3n. Ello contribuir\u00e1, de manera objetiva y efectiva, al logro de una mayor calidad asistencial, lo que constituye un imperativo \u00e9tico inexcusable.  objectives.  general objective: to assess the effectiveness of a mixed intervention (educational components, feedback, and organizational reforms) to reduce errors in medication reconciliation at hospital discharge in the department of surgery of the hospital general universitario reina sof\u00eda (hgurs) of murcia. Specific objectives: describe the types of discrepancies and errors in medication reconciliation. To assess the effectiveness of a joint intervention in reducing discrepancies and errors medication reconciliation at hospital discharge. Identify factors related to discrepancies and errors of medication reconciliation at discharge in general surgery. Predicting the risk of discrepancies and reconciliation errors medication. To estimate the annual frequency of reconciliation errors at high potential harm to the patient, in the department of general surgery, if a program of medication reconciliation is not implanted at discharge.  material and methods  quasi -experimental interrupted time series study of sequential design with single reversal. The study was conducted in a general hospital universitario reina sofia, murcia, reference area, in the department of surgery . Was performed in 3 phases (pre-intervention, intervention and reversal) . Reconciliation errors in the prescribed discharge reports of patients admitted medication at least 48 hours in the department of surgery who met the inclusion criteria were studied. 8days 30 observations) were performed in each phase of it, which ultimately led to about 90 days of observation. A consecutive sampling was performed. The primary outcome was the medication reconciliation errors. Data were collected by pharmacists who participated in the study, concurrently with the patient&apos;s stay in the hospital ward of general surgery. Questionnaire with open questions to collect clinical and medication history of the patient &#8211; 1: the following instruments were used for collection. 2 &#8211; . Electronic form pharmacotherapeutic history (hft ) that was attached to the electronic patient record prior to discharge only in the 2nd phase of the study or intervention period . the physician responsible for the high displays this information when making the report to incorporate high pudi\u00e9ndola report. To analyze the model that has been used and we have used in this study is the so-called arima (autorregressive , integrated , moving average) mainly developed by box and jenkins.   results  the average percentage of discrepancies in medication per patient was higher than 95 % in the pre-intervention and reversal periods with a reduction thereof by almost half in the intervention period. The average percentage of reconciliation errors per patient at discharge, has been above 66% in the pre-intervention period and reversal, falling to less than 25% in the intervention group. There have been one or more errors, at least in 90 % of patients discharged during periods without intervention, decreasing to 52% in the intervention group. The most frequent error type in the medication reconciliation at hospital discharge in the pre-intervention and reversal periods consisted of the omission of medications, followed by incomplete prescription. The most frequent category of severity in reconciliation errors at discharge, in the pre-intervention period and reversal error was gravely category b. The average percentage of drug reconciliation error or potential damage that requires monitoring per patient at hospital discharge was less than 20 % in the pre-intervention and reversal periods, decreasing to 7% in the intervention period. This type of error affecting the 40 % of patients during periods without intervention. Risk factors significantly associated with reconciliation errors or potential harm that require monitoring at the hospital, in the department of surgery , during periods of pre-intervention and reversal were patient age , type of admission, day of admission , age and origin of the physician income . The equations and models, obtained by multivariate logistic regression to predict the risk of error reconciliation, suffer from poor predictive power. The annual number of reconciliation errors with high potential to damage or requiring monitoring is estimated at about 1,900, and will affect about 675 patients in the general surgery service, if a program of medication reconciliation is not implanted.  conclusions.  considering the above findings, which follow directly from the results obtained after a rigorous application of the above methodology, we recommend implementing health administrations, of widespread and systematic, efficient strategies as described in our study, which will lead to a significant reduction errors medication reconciliation. This will help to objectively and effectively, to achieve a higher quality of care, which is an inexcusable ethical imperative.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Efectividad de una intervenci\u00f3n para reducir las discrepancias y los errores de conciliaci\u00f3n de la medicaci\u00f3n al alta hospitalaria en un servicio de cirugia<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Efectividad de una intervenci\u00f3n para reducir las discrepancias y los errores de conciliaci\u00f3n de la medicaci\u00f3n al alta hospitalaria en un servicio de cirugia <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Rosario Albarracin Garcia <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 06\/03\/2014<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Mar\u00eda  Dolores Perez Carceles<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: pascual Parrilla paricio <\/li>\n<li>Rafael Pacheco guevara (vocal)<\/li>\n<li>isabel Tovar zapata (vocal)<\/li>\n<li>m. isabel Fortea gorbe (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Rosario Albarracin Garcia Objetivos. objetivo general: evaluar la efectividad de una intervenci\u00f3n mixta (con componentes educativos, de 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