Wednesday, March 10, 2010

BAD HOSPITAL MEDICAL PRAXIS





Abstract from NYTimes.

Starting from their personal and professional experience, Dr Peter J Provonost (Quality and Safety Research Group/Johns Hopkins Hospital/Baltimore), has written a book: "Safe Patients, Smart Hospitals", in which he develops a series of security’s measures for hospitalized patients. A current topic in Peru in which certain cases of bad practice (amputation of healthy leg, hospital infections, etc.), has ocurred. Very young, Pronovost, attended his father's death diagnosed mistakenly of leukemia (he had lymphoma). He saw also the death of a girl of 18 months infected from a catheter plugged in her blood vessels. An event very frequent (11 infections for each 1000 catheter insertions), due according to Provonost to the little time (minutes) that doctors pass with their patients in which nobody contradicts their orders, while nurses or close relatives remain but of 12 hs with the patient lacking voice and vote.

According to Pronovost but of 30% of doctors doesn't wash their hands before carrying out medical procedures, recommending he a checkup list, to wash the hands, to clean medical skins with chlorhexidine, not to insert catheters in the groin, to cover the patient and the physicians while a catheter is inserted, to have sterile fields and to evaluate the risk-benefit of inserting a catheter. He insists on having medications very close and all necessary and important in order that doctors does not obviate steps. He adds that it is necessary to give to the nurses more power to watch and get attention of doctors. Their suggestions have allowed to go down the infection rates to zero in certain hospitals.


MALAS PRACTICAS MEDICAS INTRAHOSPITALARIAS


A partir de su experiencia personal y profesional, el Dr. Peter J. Pronovost (Quality and Safety Research Group/Johns Hopkins Hospital/Baltimore), ha escrito un libro : “Safe Patients, Smart Hospitals”, en el que desarrolla una serie de medidas de seguridad para pacientes hospitalizados. Un tema actual en el Perú dados ciertos casos de mala praxis (amputación de pierna sana, infecciones intrahospitalarias,etc.). Muy joven Pronovost, asistio a la muerte de su padre diagnosticado equivocadamente de leucemia (tenia linfoma). Asimismo vio morir a una niña de 18 meses infectada a partir de un cateter insertado en sus vasos sanguineos. Un evento por lo demas frecuente (11 infecciones por cada 1000 inserciones de catéter), debido segun el al poco tiempo (minutos), que los médicos pasan con sus pacientes en los que nadie contradice sus ordenes, mientras enfermeras o familiares cercanos que permanecen mas de 12 hs con el paciente continúan careciendo de voz y voto.

Según Pronovost mas del 30% de los médicos no se lava las manos antes de realizar procedimientos a pacientes, recomendando por ello una lista de chequeo, lavarse las manos, untarse la piel con chlorhexidina, no insertar cateteres en la ingle, cubrir al paciente y a si mismo mientras se inserta un catéter, disponer de campos esteriles y evaluar el riesgo-beneficio de insertar un catéter. Insiste en tener a la mano medicamentos y enseres necesarios e importantes ya que no encontrarlos induce a obviar pasos. Agrega que es necesario dar mas poder a las enfermeras para vigilar y llamar la atención a los médicos. Sus sugerencias han permitido bajar las tasas de infección en ciertos hospitales a cero.

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