Non Quality Issues Related to Ventilator-associated Pneumonia in an Intensive Care Unit of Medellin, 2012
DOI:
https://doi.org/10.17533/udea.rfnsp.v34n1a09Keywords:
quality of health care, patient safety, respiration artificial, pneumoniaAbstract
Objective: to explore non quality issues in the clinical care of patients with ventilator-associated pneumonia (VAP) in an adult Intensive Care Unit in Medellin, Colombia. Methodology: a qualitative study using the case study strategy. Reason’s Organizational Model of Causality and Adverse Events was used as the source for analytical categories and the hospital operating conditions were not controllable by the research team. Results: during the analytical phase, through open coding, 441 codes were identified from interviews and 25 from medical records. They were reorganized by axial coding into 14 subcategories and 4 analytical categories. It was found that a management decision (limiting the hiring of qualified staff to take care of patients’ airways with mechanic ventilation and replacing it with support staff) was perceived as a determining factor leading to the incidence of VAP, even in presence of a relevant approach and solid safety barriers.
Downloads
References
(1). National Research Council. To Err Is Human: Building a Safer Health System. Washington, DC: The National Academies Press; 2000.
(2). Ali M, Marks J, Stroup D. Gerberding, J. Actual causes of death in the United States, 2000. JAMA. 2000; 291 (10): 1238–1245.
(3). Organización Mundial de la Salud. Calidad de la atención: seguridad del paciente. Informe de la secretaría. Ginebra: OMS; 2004.
(4). Organización Mundial de la Salud. La alianza mundial para la seguridad del paciente [Internet]. [Consultado 2013 Abr 24]. Disponible en: http://www.fundacionmhm.org/pdf/Mono8/Articulos/articulo14.pdf.
(5). España. Ministerio de Sanidad y Consumo. Estudio Nacional sobre los Efectos Adversos Ligados a la Hospitalización, ENEAS 2005 Informe. Madrid: El Ministerio; 2006.
(6). Aranaz J, Aibar C, Limón R, Amarilla A, Restrepo F. Urroz O, et al. Diseño del estudio IBEAS: prevalencia de efectos adversos en hospitales de Latinoamérica. Rev Calid Asist. 2011; 26(3):194-200.
(7). Augustyn B. Ventilator-Associated Pneumonia: Risk Factors and Prevention. Crit Care Nurse 2007; 27: 32-39.
(8). Coffin S, Klompas M, Classen D, Arias K, Podgorny K. Anderson D. et al. Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals. Infection Control and Hospital Epidemiology 2008; 29(1): 31-40.
(9). Allegranzi B, Bagheri-Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D. Burden of endemic health-careassociated infection in developing countries: systematic review and meta-analysis. Lancet 2011; 377: 228–241.
(10). Colombia. Ministerio de la Protección Social. Guía técnica: Buenas prácticas para la atención de la seguridad del paciente en la atención en salud. Bogotá D.C: El Ministerio; 2009.
(11). Colombia. Ministerio de Salud y de la Protección Social. Reducir el riesgo de la atención del paciente crítico: Guía buenas prácticas para la seguridad del paciente en la atención en salud”. Bogotá D.C: El Ministerio; 2009.
(12). Pola B, Nercelles P, Pohlenz M, Otaíza F. Costo de las infecciones intrahospitalarias en Hospitales chilenos de alta y mediana complejidad. Rev. chil. infectol 2003; 20(4): 285-290.
(13). Benítes L, Ricart M. Patogénesis y factores ambientales de la neumonía asociada a ventilación mecánica. Rev. Enfermedades infecciosas y microbiología clínica 2005; 23 (3): 10-17.
(14). Lemos E, De la Hoz F, Alvis N, Quevedo E, Cañon O, León Y. Mortalidad por Acinetobacter baumannii en unidades de cuidados intensivos en Colombia. Rev Panam Salud Pública 2011; 30 (4): 287-294.
(15). Palacio, R. Alonso, R. Romero, S. Bazet, C. Costos de infecciones intrahospitalarias por Staphylococcus aureus; meticilino resistente vs. meticilino sensible. Rev. panam. Infectol 2006; 8(1): 33-38.
(16). Ortiz G, Rocha N, Pérez J, Gómez J, Dueñas C, Molina F, et al. Epidemiología de la neumonía asociada a ventilador en 35 unidades de cuidados intensivos de Colombia: 2007-2008. Acta Colombiana de Cuidado Crítico 2009; 9(1): 50-56.
(17). Vincent C. Framework for analysing risk and safety in clinical medicine. BMJ 1998; 316:1154-1157.
(18). Vincent C, TaylorAdams S, Chapman J, Hewett D, Prior S, Strange P, Tizzard A. How to investigate and analyse clinical incidents: Clinical Risk Unit and Association of Litigation and Risk Management protocol. BMJ 2000; 320: 777-781.
(19). Polit D, Hungler B. Investigación científica en ciencias de la salud. México: McGraw.-Hill; 2000.
(20). Yin R. Case study research: design and methods. 2a ed. Thousand Oaks: Sage; 1994.
(21). Miles M, Huberman M. Qualitative data analysis. 2ª ed. Thousand Oaks: Sage; 1994.
(22). Coffey A, Atkinson P. Encontrar el sentido a los datos cualitativos: estrategias complementarias de investigación. Medellín: Editorial Universidad de Antioquia; 2003.
(23). Cifuentes Y, Robayo C, Ostos O, Muñoz L, Hernández R. Neumonía asociada a la ventilación mecánica: un problema de salud pública. Rev. colombiana de ciencias químico farmacéuticas 2008; 37 (2): 150-163.
(24). Colombia. Ministerio de la Protección Social. Decreto 1011, abril 3, por el cual se establece el Sistema Obligatorio de Garantía de Calidad de la Atención de Salud del Sistema General de Seguridad Social en Salud. Bogotá: El Ministerio; 2006.
(25). Lorente, L. Manejo de la vía aérea para prevenir la neumonía asociada a ventilación mecánica. Rev. Medicina intensiva 2005; 29 (2): 88-102.
(26). España. Ministerio de sanidad y política social. Unidad de cuidados intensivos estándares y recomendaciones. España: El Ministerio; 2010.
Downloads
Published
How to Cite
Issue
Section
License
The contents of the articles are the responsibility of the authors
The editorial committee has editorial independence from the National School of Public Health "Héctor Abad Gómez" of the University of Antioquia.
The editorial committee is not responsible for aspects related to copying, plagiarism or fraud that may appear in the articles published in it.
When you are going to reproduce and disclose photographs or personal data in printed or digital format, informed consent is required. Therefore, this requirement is required of the author at the time of receipt of the manuscript.
Authors are responsible for obtaining the necessary permissions to reproduce any material protected by reproduction rights.
The authors preserve the moral rights and assign the economic rights that will correspond to the University of Antioquia, to publish it, distribute electronic copies, include them in indexing services, directories or national and international databases in Open Access, under the Creative Commons Attribution license -Not Commercial-Share Equal 4.0 International Commercial (CC BY-NC-SA) which allows others to distribute, remix, retouch, and create from the work in a non-commercial way, as long as the respective credit and license are granted. new creations under the same conditions.
The authors will sign the declaration of transfer of economic rights to the University of Antioquia, after the acceptance of the manuscript.
The editorial committee reserves the right to reject the articles whose authors do not offer satisfactory explanations about the contribution of each author, to meet the criteria of authorship in the submission letter. All authors must meet the four criteria of authorship according to ICMJE: "a) .- That there is a substantial contribution to the conception or design of the article or to the acquisition, analysis or interpretation of the data. b) That they have participated in the design of the research work or in the critical review of its intellectual content. c) .- That has been intervened in the approval of the final version that will be published.d). That they have the capacity to respond to all aspects of the article in order to ensure that issues related to the accuracy or integrity of any part of the work are adequately investigated and resolved. "