Seit Ende des letzten Jahrtausends wird das Thema Patientensicherheit viel diskutiert. Die Sicherstellung der Patientensicherheit stellt eine zentrale Herausforderung der Gesundheitsversorgung dar. ...Ein wichtiges Instrument, um für unerwünschte Ereignisse zu sensibilisieren, aus diesen nachhaltig zu lernen und somit die Patientensicherheit zu fördern, sind Fehlerberichts- und Lernsysteme (Critical Incident Reporting System = CIRS).
Über 17 Jahre nach der Etablierung des hausärztlichen Fehlerberichts- und Lernsystems „jeder-fehler-zaehlt.de“ (JFZ) wurde dieses inhaltlich und technisch überarbeitet. Das überarbeitete webbasierte System kann sowohl für die Berichterstattung als auch für die Klassifikation und die Auswertung von Berichten genutzt werden. In diesem Rahmen erfolgte eine deskriptive Analyse des aktuellen Berichtbestandes mit einem Fokus auf schwerwiegende Arzneimittelfehler. Diese umfasste alle 781 gültigen Fehlerberichte, die zwischen September 2004 und Dezember 2021 eingegangen waren.
In 576 von 781 Berichten (73,8%) war die Hausarztpraxis unmittelbar in das kritische Ereignis involviert. Bei den Fehlertypen überwogen die Prozessfehler (79,8% der Klassifikationen, 99,1% der Berichte) im Vergleich zu Wissens- und Fertigkeitsfehlern (20,2% der Klassifikationen, 39,7% der Berichte). Am häufigsten trug eine fehlerhafte Kommunikation (63,0%) zu kritischen Ereignissen bei, gefolgt von Faktoren aus dem Bereich Aufgaben/Maßnahmen (39,7%). Schwerwiegende und dauerhafte Patientenschädigungen wurden selten berichtet (8,3% der Berichte), während vorübergehende Patientenschädigungen häufiger (40,3% der Berichte) thematisiert wurden. Bei Berichten über Arzneimittelfehler mit mindestens schwerwiegenden Schädigungen wurden insbesondere Substanzen, die die Blutgerinnung beeinflussten, Cortisonpräparate und Opiate genannt.
Unsere Ergebnisse ergänzen die international berichteten Raten im Bereich der Fehlertypen, der Patientenschädigung und der beitragenden Faktoren. Schwerwiegende, aber grundsätzlich vermeidbare Schadensereignisse, sogenannte Never Events, stehen bei den JFZ-Berichten und in der Fachliteratur häufig im Zusammenhang mit dem Medikationsprozess.
Fehlerberichtssysteme können keine genauen Informationen über die Häufigkeit von Fehlern liefern, ermöglichen aber einen wichtigen Einblick in beispielsweise schwerwiegende Arzneimittelfehler. Damit bieten sie sowohl Mitarbeitenden als auch Einrichtungen des Gesundheitssystems eine Möglichkeit zum individuellen und institutionellen Lernen.
The topic of patient safety has been a subject of much discussion since the end of the last millennium. Ensuring patient safety is a central challenge in health care. An important tool to raise awareness for and learn from adverse events and thus promote patient safety are error-reporting and learning systems (Critical Incident Reporting System = CIRS).
More than 17 years after its establishment, the CIRS “jeder-fehler-zaehlt.de” (JFZ) for German primary care has undergone a revision in terms of content and technology. The revised web-based system can be used for reporting as well as for classifying and analyzing incident reports. During this process, a descriptive analysis of the current report inventory was carried out, with a focus on serious medication errors. This included all 781 valid incident reports received between September 2004 and December 2021.
In 576 of the 781 reports (73.8%), the GP practice was directly involved in the critical incident. Among error types, process errors predominated (79.8% of the classifications, 99.1% of the reports) compared with knowledge and skills errors (20.2% of the classifications, 39.7% of the reports). Communication errors (63.0%) were the most common contributing factor to critical incidents, followed by flaws in tasks and measures (39.7%). Serious and permanent patient harm was rarely reported (8.3% of the reports), whereas temporary patient harm was more common (40.3% of the reports). Incident reports about medication errors with at least serious patient harm included, in particular, substances that affected blood clotting, corticosteroids, and opiates.
Our results complement the rates that are reported internationally for error types, patient harm, and contributing factors. Serious but preventable adverse events, so-called never events, are frequently associated with the medication process in both JFZ reports and the literature.
Critical incident reporting systems cannot provide accurate information about the frequency of errors in health care, but they can offer important insights into, for example, serious medication errors. Therefore, they offer both employees and healthcare institutions an opportunity for individual and institutional learning.
Die COVID-19-Pandemie stellte das Gesundheitssystem und insbesondere die Pflege vor große Herausforderungen. Dabei stand häufig die Intensivpflege im Zentrum der Aufmerksamkeit. Doch auch die ...ambulante Pflege wurde mit einschneidenden Veränderungen konfrontiert, wobei weitgehend unbekannt ist, wie sich die Arbeitssituation durch die Pandemie – auch in Abhängigkeit der Trägerschaft ambulanter Pflegedienste – für Beschäftigte verändert hat.
Im Mai und Juni 2022 wurde via Akquise über Pflegedienste (N = 16.608) eine bundesweite Online-Erhebung unter ambulant Pflegenden durchgeführt. Die „work intensification“ der „Intensification of job demands scale (IDS)“ sowie eine offene Frage zu Veränderungen der Arbeitssituation durch die Pandemie wurden eingesetzt.
Mehr als zwei Drittel der 976 befragten ambulant Pflegenden stimmten den jeweiligen Aussagen zur Arbeitsintensivierung (z.B. weniger Pausen, Arbeitstätigkeiten gleichzeitig verrichten, nicht ausreichend Zeit zur Verfügung zu haben) zu. Zusätzliche Faktoren für psychische Arbeitsbelastung während der Pandemie fielen insbesondere in den Bereich der Arbeitsorganisation (z.B. krankheits- und quarantänebedingter Personalausfall, impfpflichtbedingte Kündigungen, zusätzlicher Aufwand durch Umgang mit Schutzkleidung). Beschäftigte von Pflegediensten in privater Trägerschaft erlebten weniger COVID-19-bedingte Veränderungen als ambulant Pflegende bei freigemeinnützigen Trägern.
In zukünftigen Krisensituationen sollten insbesondere ein gutes Informationsmanagement (z.B. einheitliche, widerspruchsfreie und verständliche Vorgaben und Handlungsempfehlungen) sowie Möglichkeiten zur Kompensation personeller Engpässe geschaffen werden.
The COVID-19 pandemic posed major challenges to the health care system, particularly to nursing. Intensive care was often the focus of attention. However, home care nursing was also confronted with drastic changes, while it is largely unknown how the work situation changed for employees as a result of the pandemic – also depending on the sponsorship of home care nursing services.
A nationwide online survey of home-care nurses was conducted in May and June 2022. The Intensification of Job Demands Scale (IDS) and an open question regarding changes in the work situation due to the pandemic were used among other instruments.
More than two-thirds of the 976 home-care nurses surveyed agreed with the respective statements regarding work intensification (e.g., taking fewer breaks, doing work activities at the same time, not having enough time). Additional factors for psychological workload during the pandemic primarily fell within the scope of work organization (e.g., staff absences due to illness and quarantine, vaccination related leaves and terminations, additional workload due to handling protective clothing). Employees of privately run care services experienced fewer COVID-19-related changes than home care nurses employed by non-profit providers.
In future crisis situations, good information management (e.g., uniform, consistent and comprehensible guidelines and recommendations for action) and ways to compensate for staff shortages should be created.
Este escrito indaga en las dinámicas de relacionamiento entre vendedores callejeres de un barrio de la Ciudad de Buenos Aires (Argentina) y les agentes que se encargan de su control, en el contexto ...de la pandemia. En ese sentido, explora las transformaciones sucedidas tras la pandemia en las formas en la que les vendedores se establecieron en el espacio público, pero, también, se pregunta por las continuidades y vigencias de aquello que sucedía previamente. Para eso se recupera tanto el trabajo de campo realizado con vendedores callejeres durante la pandemia como el de periodos anteriores, en el marco de una investigación doctoral (en curso) de carácter etnográfico. Así, tras reconstruir las interacciones cotidianas entre les vendedores y les agentes de control, se da cuenta de las cambiantes prácticas policiales y de las acciones de respuesta de les vendedores durante el contexto de la pandemia. Además, estas relaciones se analizan con base en experiencias y procesos de más larga data que afectaron y dotaron de particulares sentidos a las formas de disputar el uso del espacio público en pandemia.
•We assessed anxiety and depression before a medical consultation.•A quarter of urology patients reported clinically relevant emotional distress.•Anxiety and depression significantly predicted higher ...decisional conflict.•We recommend systematic assessment of emotional distress in clinical consultation.•Ultimately, this may result in better outcomes of shared decision making.
Emotional distress can be a potential barrier to shared decision making (SDM), yet affect is typically not systematically assessed in medical consultation. We examined whether urological patients report anxiety or depression prior to a consultation and if emotional distress predicts decisional conflict thereafter.
We recruited a large sample of urological outpatients (N = 397) with a range of different diagnoses (42 % oncological). Prior to a medical consultation, patients filled in questionnaires, including the Hospital Anxiety and Depression Scale. After the consultation, patients completed the Decisional Conflict Scale. We scored the rate of anxiety and depression in our sample and conducted multiple regression analysis to examine if emotional distress before the consultation predicts decisional conflict thereafter.
About a quarter of patients reported values at or above cut-off for clinically relevant emotional distress. Emotional distress significantly predicted a higher degree of decisional conflict. There were no differences in emotional distress between patients with and without uro-oncological diagnosis.
Emotional distress is common in urology patients – oncological as well as non-oncological. It predicts decisional conflict after physician consultation.
Emotional distress should be systematically assessed in clinical consultations. This may improve the process and outcome of SDM.
The present work aims to describe and analyze the changes in the morals of street vendors in informal commerce in relation to citizenship based on the individual micro-entrepreneur, a legal figure ...who popularized the business form as a means of formalization. An ethnographic research was carried out through a focus group and participant observation with formal and informal street traders. Based on the data found, it is possible to describe the dilemmas and divergences of the camels who believe and those who do not believe in the possible benefits of formalization. The activity of selling on the streets, historically, is associated with informality and marginality. Through the corporate legal figure, some interlocutors believe that it is possible, by becoming entrepreneurs, to carry out a moral cleansing of this economic activity. One of the crucial factors for this is the idea of paying taxes that this formalization provides, thus becoming a tax-paying citizen.
O presente trabalho tem como objetivo descrever e analisar as mudanças das moralidades dos vendedores ambulantes do comércio informal em relação a cidadania a partir do microempreendedor individual, figura jurídica que popularizou a forma empresarial como expediente de formalização. A pesquisa, de caráter etnográfico, foi realizada por meio de um grupo focal e de observação participante junto aos comerciantes ambulantes formais e informais. A partir dos dados coletados é possível descrever os dilemas e divergências dos camelôs que acreditam e os que não acreditam nas eventuais benesses da formalização. A atividade de vender nas ruas, historicamente, é associada à informalidade e à marginalidade. Por meio da figura jurídica empresarial, alguns interlocutores creem que é possível, tornando-se empresário, realizar uma limpeza moral dessa atividade econômica. Um dos fatores cruciais para isso é a ideia do pagamento de impostos que essa formalização proporciona, tornando-se assim um cidadão pagador de impostos.
El presente trabajo tiene como objetivo describir y analizar los cambios en las moralidades de los vendedores ambulantes del comercio informal en relación a la ciudadanía basada en el microempresario individual, figura jurídica que popularizó la forma empresarial como medio de formalización. La investigación etnográfica se llevó a cabo a través de un grupo focal y observación participante con comerciantes ambulantes formales e informales. A partir de los datos recopilados, es posible describir los dilemas y divergencias de los vendedores ambulantes que creen y los que no creen en los posibles beneficios de la formalización. La actividad de venta en la calle, históricamente, está asociada a la informalidad y la marginalidad. A través de la figura jurídica societaria, algunos interlocutores creen que es posible, convirtiéndose en empresario, realizar una limpieza moral de esta actividad económica. Uno de los factores cruciales para ello es la idea de pago de impuestos que proporciona esta formalización, convirtiéndo así en un ciudadano contribuyente.
Emergency service providers are facing the following problem: how and where to locate vehicles in order to cover potential future demand effectively. Ambulances are supposed to be located at ...designated locations such that in case of an emergency the patients can be reached in a time-efficient manner. A patient is said to be covered by a vehicle if (s)he can be reached by an ambulance within a predefined time limit. Due to variations in speed and the resulting travel times it is not sufficient to solve the static ambulance location problem once using fixed average travel times, as the coverage areas themselves change throughout the day. Hence we developed a multi-period version, taking into account time-varying coverage areas, where we allow vehicles to be repositioned in order to maintain a certain coverage standard throughout the planning horizon. We have formulated a mixed integer program for the problem at hand, which tries to optimize coverage at various points in time simultaneously. The problem is solved metaheuristically using variable neighborhood search. We show that it is essential to consider time-dependent variations in travel times and coverage respectively. When ignoring them the resulting objective will be overestimated by more than 24%. By taking into account these variations explicitly the solution on average can be improved by more than 10%.
Uma vez que a actividade da zunga é caracterizada como um fenómeno social que afecta principalmente a população mais pobre, este trabalho tem como objecto de estudo saber quais são as principais ...causas da venda ambulante (zunga) no distrito do Golfe, bem como analisar a situação sócio-económica das zungueiras dentro de um processo de combate à pobreza, as condições de venda dos produtos e dos seus destinatários, os tipos de produtos, e o modo de conservação. Assim, acreditamos que, com o desenvolver desta pesquisa podemos ajudar o Estado angolano a fazer um melhor enquadramento técnico legal do fenómeno zunga, concomitantemente a garantir uma melhor protecção para as pessoas que em risco optam por esta actividade.
La ciudad de Madrid se modernizó de manera muy significativa entre 1890 y 1936. Fue un período en el que el mercado laboral se diversificó con claridad, adquiriendo renovados semblantes en sectores ...tan representativos como el de la distribución comercial. Dentro de este último, la actividad concebida como informal, asociada a la venta ambulante o itinerante, mantuvo una tendencia creciente. Coadyuvó al cumplimiento de unas relevantes funciones sociales entre las clases populares y en determinados espacios urbanos en términos dotacionales. Pese a ello, su incremento generó problemáticas entre quienes se ocuparon del gobierno de la ciudad, que delimitaron sistemáticos intentos de control, reglamentación y restricción con respecto a un escenario concebido como escasamente representativo e incluso desacompasado con respecto a unos nuevos tiempos. Este artículo indaga en la evolución del anterior proceso, enfatizando tanto las políticas progresivamente tomadas por el poder local con respecto a la venta ambulante como las dinámicas de protesta y reivindicación de derechos articuladas por los integrantes de ese sector.
El objetivo de esta investigación fue identificar la importancia del buñuelo como un producto tradicional en los puntos de venta de comida callejera del barrio Santo Domingo Savio de Medellín, y los ...cambios de la receta tradicional a la comercial. Se realizaron entrevistas a los vendedores de buñuelo en el sector y se identificaron las posibles variaciones en la receta del producto. Los resultados obtenidos demostraron que el buñuelo está presente de manera significativa en los puntos de venta callejera del sector; y además la receta tradicional presenta cambios frente a la receta comercial. Finalmente se concluye que este producto tradicional puede presentarse como una alternativa de generación de ingresos para las personas del barrio Santo Domingo Savio.
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