Hrvatski liječnički zbor Hrvatsko društvo za poboljšanje kvalitete zdravstvene zaštite. 4. Radionica bolničkih koordinatora.
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1 Hrvatski liječnički zbor Hrvatsko društvo za poboljšanje kvalitete zdravstvene zaštite 4. Radionica bolničkih koordinatora 09 u RH Zagreb, 16. lipnja 2009.
2 Radionica 09, 16. lipnja Obavijesti faza indikatora: nastavak aktivnosti (konačan dogovor o prihvaćenim indikatorima, opisne liste indikatora, metodologija prikupljanja podataka), J Mesarić Pauza faza indikatora - rasprava Financijski indikator, Ivan Lukovnjak Financijski indikator, Ivan Mihaljević Anketa o kulturi bolesnikove sigurnosti u bolnici (izvor AHRQ), Ivan Šklebar Slijedeći termin radionice: 17. rujna u HLZ? 17. rujna, Okrugli stol Kvaliteta zdravstvene zaštite, Društvo i Agencija
3 Obavijesti EVIDENCIJA SUDIONIKA RADIONICA 09 U RH PODACI ZA KONTAKT ( adrese i telefon) REGISTRACIJA BOLNICA (WHO I JM)
4 KBC Zagreb KB Sestre Milosrdnice, Zagreb KB Sveti Duh, Zagreb Klinika za dječje bolesti, Zagreb Klinika za tumore Zagreb Sveučilišna klinika Vuk Vrhovac, Zagreb KBC Rijeka KB Osijek OB Zadar OB Karlovac OB Gospić OB Vukovar OB Dr. Tomislav Bardek Koprivnica OB Bjelovar OB Pula OB Vinkovci OB Zabok OB Virovitica OB Varaždin OB Našice Psihijatrijska bolnica Sveti Ivan Zagreb Psihijatrijska bolnica Rab Psihijatrijska bolnica Ugljan Neuropsihijatrijska bolnica Dr Ivan Barbot, Popopvača SB za medicinsku rehabilitaciju Kalos, Vela Luka SB bolnica za medicinsku rehabilitaciju Lipik SB za medicinsku rehabilitaciju Krapinske toplice Bolnica Thalasotherapija, Crikvenica SB za produženo liječenje Duga Resa SB za zaštitu djece s neurorazvojnim i motoričkim smetnjama Goljak, Zageb 09 REGISTRACIJA BOLNICA 26
5 nastavak - obavijesti MAILING LISTA ZA KOMUNIKACIJU TIMA ALAT ZA RASPRAVU SURADNJA S TVRTKOM ZA ANALIZU PODATAKA (osiguranje anonimnosti analize) KONTINUIRANA PITANJA / ODGOVORI / NEJASNOĆE TIJEKOM PRIKUPLJANJA PODATAKA DEFINIRANJE ODGOVORNOSTI PARTNERSKI HLK
6 nastavak - obavijesti Razvoj specifičnih pokazatelja Regarding development of specific indicators for psychiatric and rehabilitation hospitals, please identify one or two members for the taskforce (opinion leader or more experience with using indicator in their facility or more motivation for being actively involved) and forward the name, affiliation and contact details to us. Ann - Lise, WHO, May 12 Pedijatrija Dijabetes
7 ODABIR POKAZATELJA 1. FAZE
8 Ustanova C-section use Case fatalities for AMI Case fatalities for AMI Postoperative PE/DVT Length of stay Day surgery Needle injury Staff smoking KBC Zagreb KBC Rijeka KB SM Zagreb KB SD + Zagreb KB Osijek K za DB Zagreb KZT Zagreb SKVV Zagreb
9 Ustanova C-section use Case fatalities for AMI Case fatalities for Stroke Postoperative PE/DVT Length of stay Day surgery Needle injury Staff smoking OB Zadar OB Karlovac OB Gospić OB Vukovar OB Koprivnica OB Bjelovar OB Pula OB Vinkovci
10 Ustanova C-section use Case fatalities for AMI Case fatalities for Stroke Postoperative PE/DVT Length of stay Day surgery Needle injury Staff smoking OB Zabok OB + + Virovitica SB PSH Sveti Ivan Zagre b SB PSH Rab SB PSH Ugljan SB MRH + + Vela Luka SB MRH + + Lipik SB MRH Krapinske Toplice
11 Ustanova C-section use Case fatalities for AMI Case fatalities for Stroke Postoperative PE/DVT Length of stay Day surgery Needle injury SB Duga Resa + + Staff smoking SB Goljak Zagreb Ukupno bolnica
12 Steps Timeline Responsibilities Commitment of participating countries and hospitals list closed coordinators in hospitals appointed By end January 09 Country coordinator Finalize data collection tools for 1 st wave of indicators By end February 09 EURO, WHO CC, with external partners Organize locally to facilitate national networking Dec- Feb. 09 Country coordinator 2 days-training (modalities to be discussed locally) by national coordinators for data collection and to initiate networking (might invite As external consultant advisory board member or country coordinator from other country) By end May By end February Country coordinator Collect data for 1 st wave of indicators March June 09 Hospitals with support from national coordinators June -July New website with forum and other interactive modalities opened (upon availability of ICT funds) By July 09 Krakow with support from external consultant Finalize data collection tool for 2 nd wave of indicators By July 09 EURO, CC, with external partners Results for 1 st wave of indicators available By October 09 Country coordinators with external support if needed (modalities to be defined maybe workshop with all Country Coordinators) Collect data for 2 nd wave (and repeat data collection for indicators in 1 st wave where relevant) September- November 09
13 POKAZATELJI 1. FAZE DEFINIRANJE PRIKUPLJANJA I OPISNIH LISTA POKAZATELJA VREMENSKO RAZDOBLJE PODPOKAZATELJI LOKALNA PRILAGODBA: (1) eksplicitna (2) suglasnost (3) obavijest Međunarodnom tajništvu SZO RASPRAVA
14 Gotov obrazac (Excel) Unutar tjedan dana (20.6.) se očekuje dostavljanje obrasca u sve bolnice koje sudjeluju u programu Svaki pokazatelj ima svoj obrazac Uz obrazac bit će dostavljene i upute kako ga ispuniti, a u slučaju potrebe na raspolaganju je i pomoć putem a
15 u zadnjem obliku dokumenta za upis podataka sve će biti jasno objašnjeno tablice za pojedinu godinu biti će jedna ispod tablice za pojedinu godinu biti će jedna ispod druge u tom obrascu
16 POKAZATELJI 1. FAZE 09 Početak obrasca, veze na sve sastavnice za podatke koji se prikupljaju
17
18 POKAZATELJ: UČESTALOST CARSKOG REZA Agregirani (grupni) podaci Rok za prikupljanje: 30. srpanj Uzorkovanje: travanj Izvor podataka: Retrospektivno iz administrativne baze (otpusna pisma); kasnije, nakon uspostavljanja - prospektivno Konverzija ICD-9 u ICD-10 (Dodatak A i Dodatak B) Procjena na razini bolnice koji je % carskog reza elektivan; u Excel obrascu će biti dodana rubrika za raspon: 0-5%; 5-10%; 10-15%; >15%? Podaci na razini rodilje Podpokazatelji: dob majke, status zdravstvenog osiguranja majke, elektivno vs hitno, dan/vrijeme poroda, TT novorođenčeta, BMI majke Srodni pokazatelji: dužina boravka majke, DVT, antibiotskaprofilaksa prije elektivnog carskog reza, AGPAR score Prilagođavanje unutar grupe bolnica (razlike!) Postoje li nacionalne smjernice za carski rez?
19 POKAZATELJ: UČESTALOST POSLIJEOPERACIJSKE PE / DVT Individualni podaci Rok za prikupljanje: 30. srpanj Uzorkovanje: travanj ; kriterij uključivanja i isključivanja Izvor podataka: retrospektivno iz administrativne baze (otpusna pisma) Konverzija ICD-9 u ICD-10 WHO šifre za DVT ili PE Npr. u travnju ukupno 130 kirurških otpusta / 3 PE ili DVT? Prilagođeni pokazatelji: dob; spol; kirurški postupci (DTS?); rizični čimbenici Povezani pokazatelji: ponovni prijam; duljina boravka Postoji li mogućnost za podatak tip operativnog zahvata (DTS) za travanj 2009? Kreiranje potpuno novog Excel obrasca Postoje li nacionalne smjernice?
20 Individualni podaci POKAZATELJ: STOPA SMRTNOSTI OD AIM Rok za prikupljanje: 30. srpanj Uzorkovanje: travanj ; kriterij uključivanja i isključivanja Izvor podataka: retrospektivno iz administrativne baze (otpusna pisma)? Prilagođeni pokazatelji: dob; spol; podjela prema vrsti premještaja Postoje li nacionalne smjernice?
21 POKAZATELJ: STOPA SMRTNOSTI OD MOŽDANOG UDARA Individualni podaci Rok za prikupljanje: 30. srpanj Uzorkovanje: travanj ; kriterij uključivanja i isključivanja Izvor podataka: retrospektivno iz administrativne baze (otpusna pisma)? Prilagođeni pokazatelji: dob, spol (OECD); podjela prema vrsti premještaja; duljina boravka, komorbiditet.. Povezani pokazatelji: duljina boravka i ponovni prijam Postoje li nacionalne smjernice?
22 POKAZATELJ: STOPA OPERACIJSKIH ZAHVATA U DNEVNOJ BOLNICI (DNEVNA KIRURGIJA) Identifikacija dnevne kirurgije u RH? Bolesnici podvrgnuti planiranoj dnevnoj kirurgiji koji su nakon zahvata primljeni u bolnicu zbog kliničkih ili organizacijskih razloga? Rok za prikupljanje: 30. srpanj Uzorkovanje: travanj ; kriterij uključivanja i isključivanja? Izvor podataka: retrospektivno iz administrativne baze (otpusna pisma) Zahvati koji se prate? konverzija ICD-9 u ICD-10 Artroskopija koljena odabir Ingvinalna hernija? Tonzilektomija i/ili adenoidektomija Holecistektomija Varikozne vene- uklanjanje i podvezivanje iz navedenog popisa + zahvat koji se još uvijek premalo primjenjuje u dnevnoj kirurgiji u RH (veći potencijal za poboljšanje) Postoje li nacionalne smjernice?
23 Prijevod u tijeku POKAZATELJ: DULJINA BORAVKA? Rok za prikupljanje: 30. srpanj Uzorkovanje: travanj ; kriterij uključivanja i isključivanja? Izvor podataka: retrospektivno iz administrativne baze (otpusna pisma) Dijagnoze/stanja za pratiti? konverzija ICD-9 u ICD-10 AIM Moždani udar U bolnici stečena upala pluća Fraktura kuka CABG (aorto-koronarno premoštenje) Postoje li nacionalne smjernice?
24 POKAZATELJ: UBODNI INCIDENT Prijevod u tijeku Vremensko razdoblje? Projekt MZSS Istraživanje rizika izloženosti bolničkog osoblja infekcijama koje se prenose krvlju u hrvatskim bolnicama dr Čivljak Rok
25 POKAZATELJ: SAMOPROCJENA ZA BOLNICE BEZ DIMA poseban obrazac koji će ispuniti bolnički koordinator za 09, a on prikazuje stanje vezano uz pušenje Upitnik o statusu pušenja - ENSH (European Network of Smoke-free hospitals) (u postupku je prijevoda)
26 Indikatori 2. faze?
27 Antibiotska profilaksa u izradi je prijedlog (doc. Tambić)
28 Transfundirani krvni pripravci po tipu operacije u izradi je prijedlog (JM)
29 BREASTFEEDING POKAZATELJ IN the frame of the redevelopment of descriptive sheet, we would appreciate: to contact hospitals with the UNICEF/WHO Baby Friendly Hospital label. They might provide some interesting insight on monitoring of breastfeeding (not just the rate but also the factors related to continuation and termination of breastfeedingand whether exclusive or not). If you have an active Baby Friendly network/hospital in your country, could you please send the contact details or enquire with them about their interest to contribute to the descriptive sheet (and data collection tool)
30 Financijski pokazatelj preporuka za izradu (definiranje i odabir) od strane SZO financial indicators are needed to have indeed a comprehensive picture on the hospital performance (and maybe also to attract the attention of hospital managers to initiative) it is not realistic to develop a one-size-fit-all and that each country would agree on one to three indicators that would typically be the indicators that are the most commonly looked at by the financial director when those indicators have been decided within country - inform the international secretariat
31 Istraživanje (SURVEY) o bolesniku; o djelatnicima OB Karlovac Sveučilišna klinika Vuk Vrhovac OB Zabok OB Bjelovar Upitnik za specijalizante Anketa bolesnika Anketa bolesnika Anketa za zaposlenike Klinike Opažanja i primjedbe bolesnika o pruženoj zdravstvenoj skrbi Anketa o kulturi sigurnosti pacijenata u bolnici (HSPSC) Ostali
32 Name of the instrument Belgian versions of the Hospital Survey on Patient Safety Culture (1;2) by the Agency for Healthcare Research and Quality (AHRQ) By Dr Johan Hellings, Ziekenhuis Oost-Limburg A.V. & University Hasselt (3) Characteristic Description Origin and year of launch USA, launched in 2004 Belgium launched in 2005 in Flemish and French Please also see currently used PSCI in Scotland for more information. Language(s) Health care organizations can use the instrument to: Assess staff s opinion on patient safety issues, medical error, and event reporting in the hospital Track changes in patient safety over time Evaluate the impact of patient safety interventions. Original language: American Known translations (as the original tool and modified): - Croatian - Dutch - Finnish - Flemish - French - Greek - Italian - Mandarin (Chinese) - Norwegian - Portuguese - Serbian - Spanish - Sweden - Swiss German - Turkish
33 ZAKLJUČAK RADIONICA 4-09, 16. lipnja 2009.
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