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Available online 1 August 2024
Evaluation of the degree of implementation of zero projects in critical care units of Galicia (Spain) through internal audits
Evaluación del grado de implementación de los Proyectos Zero en las unidades de críticos de Galicia mediante auditorías internas
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I. Losada-Castillo
Corresponding author
, M.O. Roca-Bergantiños, R. Vázquez-Mourelle, Group of Auditors for Zero Projects in Critical Units in Galicia
Quality Healthcare Service, Subdirección Xeral de Atención Hospitalaria, Servizo galego de saúde, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, Spain
Group of Auditors for Zero Projects in Critical Units in Galicia
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Table 1. Percentage of item compliance according to unit type, hospital size, and number of audited patients.
Table 2. Percentage of item compliance.
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Abstract
Objective

The objective of this study was to assess the implementation of Zero Projects in Critical Care Units (CCUs) through Internal Audits (IA).

Materials and methods

Design: Real-time observational safety analysis. A questionnaire was developed with defined items to ensure objectivity. After IAs, a survey was conducted with the auditors. Scope: 11 CCUs in hospitals of the Servizo Galego de Saúde and Ribera-POVISA. Patients or participants: 24 auditors in 9 teams composed of medical, nursing, and quality personnel from health areas and 34 patients were assessed. Main variables of interest: Compliance with the quality standard (≥60% of items), strengths, areas for improvement, auditor's interest in IA, conformity with the organization and items.

Results

100% CCUs met the quality standard. 18.03% of items were fulfilled by all CCUs. Strengths: staff motivation, positive reception of auditors, and use of computer tools in some CCUs. Areas for improvement: deficit of automatic systems for controlling endotracheal tube cuff pressure (compliance rate in 9.1% of CCUs), training needs, communication issues, and not using checklists (45.5% of the reports). Auditors found IA very interesting, and 19% suggested improving organization and items.

Conclusions

All CCUs met the previously agreed-upon quality standard. Numerous improvement opportunities were identified and communicated to the audited CCUs. For greater homogeneity and objectivity, a review of previously agreed items and definitions is required.

Keywords:
Zero projects
Critical care
Clinical audit
Patient care bundles
Safety culture
Resumen
Objetivo

Evaluar la implementación de los Proyectos Zero en las unidades de cuidados críticos (UCC) mediante auditorías internas (AI).

Materiales y métodos

Análisis observacional de seguridad en tiempo real. Se elaboró un cuestionario con los ítems a evaluar que se definieron para garantizar la objetividad. Tras las AI se realizó una encuesta a los auditores. Ámbito: 11 UCC de los hospitales del Servizo Galego de Saúde y Ribera-POVISA. Pacientes o participantes: 24 auditores en 9 equipos compuestos por: personal médico, de enfermería y de calidad de las áreas sanitarias. Se valoraron 34 pacientes.

Variables principales

Cumplimiento del estándar de calidad (≥60% de los ítems), puntos fuertes, oportunidades de mejora, interés de la AI para el auditor, conformidad con la organización y con los ítems.

Resultados

El 100% de las UCC cumplieron el estándar de calidad. El 18,03% de los ítems fueron cumplidos por todas las UCC. Puntos fuertes: motivación del personal, buena acogida a los auditores y herramientas informáticas, en algunas UCC. Principales oportunidades de mejora: dotación de sistemas automáticos para controlar la presión de neumotaponamiento (cumplimiento en el 9,1% de las UCC), necesidades de formación, problemas de comunicación y no usar listados de verificación (45,5%). Las AI fueron muy interesantes para los auditores, aunque el 19% sugirieron mejorar la organización y los ítems.

Conclusiones

Todas las UCC cumplieron con el estándar de calidad acordado previamente. Se identificaron numerosas oportunidades de mejora que fueron comunicadas a las UCC auditadas. Para mayor homogeneidad y objetividad se requiere revisar ítems y definiciones acordadas previamente.

Palabras clave:
Proyectos zero
Cuidados críticos
Auditorías
Paquetes de medidas
Cultura de seguridad

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