[Scale Mosaic: definition and testing of a tool for assessing the risk of falling and the care planning during hospitalization]

INTRODUCTION

in year 2008 the Ausl of Ravenna had a small number of patients at risk among the patients fallen, and among the patients evaluated with risk for fall. This could be due to the rating scale used (Conley) that does not recognize the risk factors "drug therapy" and "conditions clinical care".

OBJECTIVES

to experiment a rating scale (Mosaic), to evaluate the performance indicators compared to the scales Conley, Fall Risk Assessment Scoring System (FRASS), Stratity; evaluate the effectiveness of actions taken to manage the risk; Operators remain vigilant about the risk falls.

METHODOLOGY

using the scale Mosaic for patients admitted in 16 Hospital Units for two-months. Performance indicators: sensitivity, specificity, positive predictive value and negative. Studies considered for comparison: Hospital (AO) Bologna for Conley, AO Bologna and AO Niguarda Cà Granda Milan for Stratify, AO Bergamo for FRASS.

RESULTS

were analyzed 1474 tabs. Males are 848 (57.5%) and females 626 (43.5%), the average age is 70.8 years. Of these 42 patients have fallen (2.8%), including 25 males and 17 females and the average age is 72.2. Are not at risk 426 (29%) patients and at risk 1048 (71%) patients. In other assessments the patients at risk was 31% in AUSL Ravenna, 59% (Conley) and 13% (Stratify) in AO Bologna and 41.5% (FRASS) in AO Bergamo. The scale Mosaic has a sensitivity of 0.98 (Conley, Stratify and FRASS amounted to 0.69, to 0.20, to 0.50), a specificity of 0.30 (Conley, Stratify and FRASS amounted to 0.41, 0.87, 0.59.) The patients fallen are at risk in 41 cases (97%) and of these 24 low-risk. The most frequent risk factors are: "mobility and gait" (1209 items), "drug therapy" (850 items) , "conditions clinical care" (841 items). Planned actions have an average of 2.2 in patients fallen, of 3.5 in low-risk patients and of 4.48 in patients at high risk. Compared with the previous year shows a decrease of 14 falls and an increase in the level of outcome "no one" (from 61% to 73.5%).

DISCUSSION

the greater number of falls occur among low-risk patients, the average number of shares increases with increasing levels of risk and decreases in the patients fallen. Patients are at increased risk and therefore, in the hospital, it is essential to evaluate the factors drug therapy and conditions clinical care. The scale Mosaic has a very good performance for the sensitivity but not the specificity. The indicators in the studies are very different. This poses a reflection: what is the sense of the indicators when the rated instrument is part of a multifactorial prevention project whose implementation, usually, improves the level of security by preventing the occurrence of the event? Analysis of the tool can not be based only on numerical data. The true value of each scale is the level of attention that triggers in Health Care Workers, which activate preventive measures that allow an efficient management of risk.

CONCLUSION

the card Mosaic has been adopted in Ausl because it improved the level of security of patients with risk of fall.

[The experience of the Root Cause Analysis (RCA) regarding the adverse event "missing sample from the patient source"]

Creation of the Root Cause Analysis (RCA) represents a phase of clinical risk management and is the instrument chosen for reactive analysis of adverse events. It is important to consider RCA in the context of the entire clinical risk management process and to understand the interrelationships with the previous and subsequent phases, in order to identify the necessary input and the expected output of such activity. In this study the input consisted of the adverse event which occurred after a health worker had been exposed to a biological risk and the "source patient sample" could not be found. The hospital and nursing authorities analyzed the event to understand its dynamics and causes. The results, or output, obtained indicate the steps necessary to go on to the next phase, namely treatment of the risk and the need for systemic measures: improvement of communication , revision of hospital procedures for managing blood samples and modification of the laboratory computer programs.

[Mental and physical equilibrium for better quality of care: experience of the Ravenna CNAI group]

The current orientation of health services is a progressive reduction of resources and a constant increase of efficiency and efficacy: this implies a greater demand on health personnel with the risk of stress and demotivation. In this context , well-balanced mental and physical conditions are essential and health workers should be given all the support they need to obtain and maintain such conditions, also to avoid repercussions on patients. For this purpose a satellite group of the CNAI nursing association organized two formative events based on guided imagery and mindfulness , to increase self-awareness, aimed not only at nurses but also rehabilitation and other health care workers. Results were evaluated using a questionnaire and demonstrated better awareness , less psychosomatic stress-related problems , improved quality of life and well-being.

[The definition of continuity and emergency planning for home care: experience of the millennium bug in the health setting]

The information scientist problem well-known as Millennium Bug behaved a lot of preliminary precautionary measures for possible critics events for Health Service. The aim of this article is to report how was done the Emergency and Continuance's Plain for sick persons who make use of electromedical devices in their own houses.