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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Safety in healthcare is the absence or the reduction to a minimum acceptable risk of unnecessary harm during the provision of healthcare &#40;source&#58; AMSP&#47;WHO&#58; International Classification for Patient Safety&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Haemodialysis &#40;HD&#41; entails a series of procedures and techniques&#44; some of which are complex&#44; involving cutting-edge technology &#40;water treatment&#44; monitors&#44; etc&#46;&#41;&#44; the administration of medicinal products and pharmacovigilance&#46; All this occurs in fragile elderly patients with many comorbidities&#44; who make use of healthcare systems in an intense and fragmented fashion&#44; meaning they are at an increased risk of suffering from significant effects&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#44;2</span></a> The likelihood of errors is therefore higher&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a> so it is necessary to establish prevention strategies for healthcare-related adverse events&#46; This should be done through a prioritisation system&#44; in accordance with their frequency&#44; severity of the effects and how detectable they are&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a> Only close observation of the procedures can guarantee high quality healthcare with better clinical results&#44; fewer complications&#44; the elimination of inadequate procedures and greater patient satisfaction&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The most commonly reported adverse events in kidney diseases occur in hospitalised patients&#46; These include medication errors of up to 40&#46;7&#37;&#44; of which 30&#46;2&#37; were considered avoidable&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a> Overall&#44; inadequate monitoring &#40;28&#46;3&#37;&#41;&#44; excessive dosing &#40;21&#46;7&#37;&#41;&#44; selection of an inadequate drug &#40;15&#46;0&#37;&#41;&#44; failure to prescribe the required drug &#40;15&#46;0&#37;&#41; and drug interactions &#40;11&#46;7&#37;&#41; are the most common errors causing avoidable adverse events&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Few studies describe the type and frequency of adverse events and the errors made in HD units&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#8211;9</span></a> The majority are based on notification by healthcare personnel&#44; thus requiring a higher degree of involvement in the culture of safety which is not always present&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">To identify the risk areas in HD and understand the prevailing attitudes and concerns&#44; questionnaires have been used which were designed specifically for patients and healthcare professionals&#46; The results of these surveys conclude that&#58; dialysis centres share significant safety risks&#59; patients are more concerned about safety practices than personnel had thought they would&#59; personnel believe units are safer than what the available data actually show&#59; and a specific safety team must be in place to focus on the different risk areas and establish objectives to improve safety&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Several studies summarise the most common HD safety problems into 5 groups<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11&#8211;13</span></a>&#58; &#40;1&#41; patient failure&#59; &#40;2&#41; medication errors &#40;including deviation from prescribed dialysis&#44; allergic reactions and omission of medication&#41;&#59; &#40;3&#41; access-related events &#40;coagulation&#44; infiltrates&#44; limited blood flow&#44; difficult cannulation&#41;&#59; &#40;4&#41; technical errors &#40;incorrect dialyser or dialysis fluid and equipment-related sepsis&#41;&#59; and &#40;5&#41; blood loss or prolonged bleeding&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Strategies to prevent errors and adverse events</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Safety culture</span><p id="par0035" class="elsevierStylePara elsevierViewall">The most common causes of safety protocol violation in HD units are unintentional human errors and inadequate communication amongst healthcare personnel&#46; It is therefore crucial to educate healthcare personnel on the culture of safety&#44; so that they understand why these initiatives are necessary and how they can apply them&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> It is not only important for healthcare professionals to have skills and knowledge based on scientific evidence&#44; but they must also be able to communicate appropriately and know how to act and react in unexpected situations&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> which is a key factor in healthcare safety&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The organisations that have developed a culture of safety generally agree that this has been a key element in achieving their objectives&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> In fact&#44; the lack of a positive culture towards patient safety favours the onset of adverse events&#44; drug administration errors&#44; patient complaints and more fistula thrombosis incidents&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> Some experiences have shown that hypotension&#44; venous needle disconnection and HD patient failure are associated with an unfavourable environment at work&#46; They also showed that the aspects with the biggest influence on the suitability of this environment were the doctor-nurse relationship&#44; the nurses&#8217; ability to provide healthcare and the quality of nursing care&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The development of a culture of safety is a structural requirement for creating the conditions that allow personnel to learn from errors and to ensure they are not repeated&#46; However&#44; the results obtained do not provide sufficient evidence of the impact of the procedures for creating a culture of safety&#46; The investigations into the culture of safety have been primarily aimed at evaluating personnel and patient satisfaction and the climate of safety &#40;the personnel&#39;s attitudes and perceptions in this regard&#41;&#44; with less focus being placed on evaluating its association with different clinical results&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">19&#44;20</span></a> In this sense&#44; several instruments have been developed to measure the degree to which this culture has been implemented&#46; These questionnaires are designed to gain an understanding of the organisations&#8217; specific situation and to identify actions for improvement&#46; One of these questionnaires is created by the Agency for Health Care Research and Quality &#40;<a href="http://www.ahqr.gov/">www&#46;ahqr&#46;gov</a>&#41; and includes several indicators of patient safety&#44; one of which may be related to HD &#40;central venous catheter-related blood infection&#41;&#46; This agency also established a series of 22 safety practices&#58; ten of these are highly recommended&#44; including the real-time use of ultrasound for the placement of central venous catheters&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Coordination and communication amongst different working teams</span><p id="par0050" class="elsevierStylePara elsevierViewall">The collaboration of Hospital Pharmacy and the laboratory&#39;s measurement and incorporation of glomerular filtration rate have been some of the strategies implemented to reduce errors in hospitalised patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">21&#44;22</span></a> Other experiences have included the implementation of alert systems within the hospital&#44; which recommend adjusting the drug dose depending on the level of renal function during hospitalisation&#46; Furthermore&#44; a consensus guideline for the use of medicinal products in kidney failure has recently been published&#46; The work generating this guideline was funded by the College of Pharmacists of Barcelona &#40;Colegio de Farmac&#233;uticos de Barcelona&#44; 2010&#8211;2011 edition&#41; and the Supervised Traineeship Teaching Unit of Universidad de Barcelona&#46; Besides the obvious benefits of reducing errors&#44; all these actions illustrate the need for appropriate coordination and communication amongst the different teams involved in order to be successful&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Involvement of family members and patients</span><p id="par0055" class="elsevierStylePara elsevierViewall">It is important that the implementation of a safety plan does not only involve the participation of healthcare professionals&#44; but also that of healthy people &#40;family members&#41; and the patients themselves&#58; patient observations and their participation in reducing errors have shown to increase the efficacy of safety efforts&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">23&#44;24</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Information and communication technologies</span><p id="par0060" class="elsevierStylePara elsevierViewall">It is important to recognise the role of information and communication technologies as a tool for reducing errors and improving safety&#46; However they are not effective if they are not implemented correctly because they may even lead to errors &#40;&#8220;e-iatrogenesis&#8221;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a> Another aspect of patient safety is the safety of the information&#46; An organisation that implements a well developed safety policy will have no issues in terms of the safety of the information contained in the patients&#8217; medical records&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">To reduce adverse events&#44; emphasis needs to be placed on four aspects&#44; which can be summarised as follows&#58; &#40;1&#41; accept that we are fallible and can make mistakes&#59; &#40;2&#41; apply systems for detecting all errors and their causes&#59; &#40;3&#41; design care systems designed to reduce the likelihood of errors&#59; and &#40;4&#41; 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Given that the incorporation of any change is a complicated procedure&#44; such changes must constitute a clear improvement over what it was established&#59; then&#44; the proposed changes will be accepted and fully incorporated into the operating procedures of the organisation and will be recognised by all members&#46;</p></span></span></span>"
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Editorial
Safety on haemodialysis: Team work paradigm
Seguridad en hemodiálisis: paradigma del trabajo en equipo
Maria Dolores Arenas Jiméneza,
Corresponding author
lola@olemiswebs.com

Corresponding author.
, Manuel Macía-Herasb
a Servicio de Nefrología, Vithas Hospital Perpetuo Internacional, Alicante, Spain
b Servicio de Nefrología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Safety in healthcare is the absence or the reduction to a minimum acceptable risk of unnecessary harm during the provision of healthcare &#40;source&#58; AMSP&#47;WHO&#58; International Classification for Patient Safety&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Haemodialysis &#40;HD&#41; entails a series of procedures and techniques&#44; some of which are complex&#44; involving cutting-edge technology &#40;water treatment&#44; monitors&#44; etc&#46;&#41;&#44; the administration of medicinal products and pharmacovigilance&#46; All this occurs in fragile elderly patients with many comorbidities&#44; who make use of healthcare systems in an intense and fragmented fashion&#44; meaning they are at an increased risk of suffering from significant effects&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#44;2</span></a> The likelihood of errors is therefore higher&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a> so it is necessary to establish prevention strategies for healthcare-related adverse events&#46; This should be done through a prioritisation system&#44; in accordance with their frequency&#44; severity of the effects and how detectable they are&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a> Only close observation of the procedures can guarantee high quality healthcare with better clinical results&#44; fewer complications&#44; the elimination of inadequate procedures and greater patient satisfaction&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The most commonly reported adverse events in kidney diseases occur in hospitalised patients&#46; These include medication errors of up to 40&#46;7&#37;&#44; of which 30&#46;2&#37; were considered avoidable&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a> Overall&#44; inadequate monitoring &#40;28&#46;3&#37;&#41;&#44; excessive dosing &#40;21&#46;7&#37;&#41;&#44; selection of an inadequate drug &#40;15&#46;0&#37;&#41;&#44; failure to prescribe the required drug &#40;15&#46;0&#37;&#41; and drug interactions &#40;11&#46;7&#37;&#41; are the most common errors causing avoidable adverse events&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Few studies describe the type and frequency of adverse events and the errors made in HD units&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#8211;9</span></a> The majority are based on notification by healthcare personnel&#44; thus requiring a higher degree of involvement in the culture of safety which is not always present&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">To identify the risk areas in HD and understand the prevailing attitudes and concerns&#44; questionnaires have been used which were designed specifically for patients and healthcare professionals&#46; The results of these surveys conclude that&#58; dialysis centres share significant safety risks&#59; patients are more concerned about safety practices than personnel had thought they would&#59; personnel believe units are safer than what the available data actually show&#59; and a specific safety team must be in place to focus on the different risk areas and establish objectives to improve safety&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Several studies summarise the most common HD safety problems into 5 groups<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11&#8211;13</span></a>&#58; &#40;1&#41; patient failure&#59; &#40;2&#41; medication errors &#40;including deviation from prescribed dialysis&#44; allergic reactions and omission of medication&#41;&#59; &#40;3&#41; access-related events &#40;coagulation&#44; infiltrates&#44; limited blood flow&#44; difficult cannulation&#41;&#59; &#40;4&#41; technical errors &#40;incorrect dialyser or dialysis fluid and equipment-related sepsis&#41;&#59; and &#40;5&#41; blood loss or prolonged bleeding&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Strategies to prevent errors and adverse events</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Safety culture</span><p id="par0035" class="elsevierStylePara elsevierViewall">The most common causes of safety protocol violation in HD units are unintentional human errors and inadequate communication amongst healthcare personnel&#46; It is therefore crucial to educate healthcare personnel on the culture of safety&#44; so that they understand why these initiatives are necessary and how they can apply them&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> It is not only important for healthcare professionals to have skills and knowledge based on scientific evidence&#44; but they must also be able to communicate appropriately and know how to act and react in unexpected situations&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> which is a key factor in healthcare safety&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The organisations that have developed a culture of safety generally agree that this has been a key element in achieving their objectives&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> In fact&#44; the lack of a positive culture towards patient safety favours the onset of adverse events&#44; drug administration errors&#44; patient complaints and more fistula thrombosis incidents&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> Some experiences have shown that hypotension&#44; venous needle disconnection and HD patient failure are associated with an unfavourable environment at work&#46; They also showed that the aspects with the biggest influence on the suitability of this environment were the doctor-nurse relationship&#44; the nurses&#8217; ability to provide healthcare and the quality of nursing care&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The development of a culture of safety is a structural requirement for creating the conditions that allow personnel to learn from errors and to ensure they are not repeated&#46; However&#44; the results obtained do not provide sufficient evidence of the impact of the procedures for creating a culture of safety&#46; The investigations into the culture of safety have been primarily aimed at evaluating personnel and patient satisfaction and the climate of safety &#40;the personnel&#39;s attitudes and perceptions in this regard&#41;&#44; with less focus being placed on evaluating its association with different clinical results&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">19&#44;20</span></a> In this sense&#44; several instruments have been developed to measure the degree to which this culture has been implemented&#46; These questionnaires are designed to gain an understanding of the organisations&#8217; specific situation and to identify actions for improvement&#46; One of these questionnaires is created by the Agency for Health Care Research and Quality &#40;<a href="http://www.ahqr.gov/">www&#46;ahqr&#46;gov</a>&#41; and includes several indicators of patient safety&#44; one of which may be related to HD &#40;central venous catheter-related blood infection&#41;&#46; This agency also established a series of 22 safety practices&#58; ten of these are highly recommended&#44; including the real-time use of ultrasound for the placement of central venous catheters&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Coordination and communication amongst different working teams</span><p id="par0050" class="elsevierStylePara elsevierViewall">The collaboration of Hospital Pharmacy and the laboratory&#39;s measurement and incorporation of glomerular filtration rate have been some of the strategies implemented to reduce errors in hospitalised patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">21&#44;22</span></a> Other experiences have included the implementation of alert systems within the hospital&#44; which recommend adjusting the drug dose depending on the level of renal function during hospitalisation&#46; Furthermore&#44; a consensus guideline for the use of medicinal products in kidney failure has recently been published&#46; The work generating this guideline was funded by the College of Pharmacists of Barcelona &#40;Colegio de Farmac&#233;uticos de Barcelona&#44; 2010&#8211;2011 edition&#41; and the Supervised Traineeship Teaching Unit of Universidad de Barcelona&#46; Besides the obvious benefits of reducing errors&#44; all these actions illustrate the need for appropriate coordination and communication amongst the different teams involved in order to be successful&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Involvement of family members and patients</span><p id="par0055" class="elsevierStylePara elsevierViewall">It is important that the implementation of a safety plan does not only involve the participation of healthcare professionals&#44; but also that of healthy people &#40;family members&#41; and the patients themselves&#58; patient observations and their participation in reducing errors have shown to increase the efficacy of safety efforts&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">23&#44;24</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Information and communication technologies</span><p id="par0060" class="elsevierStylePara elsevierViewall">It is important to recognise the role of information and communication technologies as a tool for reducing errors and improving safety&#46; However they are not effective if they are not implemented correctly because they may even lead to errors &#40;&#8220;e-iatrogenesis&#8221;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a> Another aspect of patient safety is the safety of the information&#46; An organisation that implements a well developed safety policy will have no issues in terms of the safety of the information contained in the patients&#8217; medical records&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">To reduce adverse events&#44; emphasis needs to be placed on four aspects&#44; which can be summarised as follows&#58; &#40;1&#41; accept that we are fallible and can make mistakes&#59; &#40;2&#41; apply systems for detecting all errors and their causes&#59; &#40;3&#41; design care systems designed to reduce the likelihood of errors&#59; and &#40;4&#41; recognise quickly the emotional problems of those who care for patients&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">26</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">To improve patient safety&#44; the magnitude and characteristics of the clinical risk should be assessed&#59; the factors contributing to the onset of incidents related to patient safety should be understood&#59; an assessment should be made of the impact of adverse effects on patients and the healthcare system&#59; and effective&#44; feasible and sustainable solutions should be identified in order to achieve a safer healthcare provision and prevent incidents and adverse effects&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">4&#44;27</span></a> Likewise&#44; it is also necessary to assume that actions aimed at attaining optimum conditions&#44; in which risks and errors are reduced to an absolute minimum&#44; should be effectively coordinated with all parties involved&#46; Given that the incorporation of any change is a complicated procedure&#44; such changes must constitute a clear improvement over what it was established&#59; then&#44; the proposed changes will be accepted and fully incorporated into the operating procedures of the organisation and will be recognised by all members&#46;</p></span></span></span>"
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

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