jueves, 4 de junio de 2009

Eventos Adversos 03 EL DAÑO EN LA ATENCIÓN A LA SALUD: LOS EVENTOS ADVERSOS


Evento adverso es una desviación desfavorable de la salud basal, por incidente no intencionado o complicación accidental, que no obedece a la propia enfermedad o estados subyacentes, consecuencia de la atención que recibe de los profesionales de la salud durante el tratamiento medico, que ha causado o podido causar daño evitable al paciente, que requiere o prolonga la hospitalización, puede provocar discapacidad grave, amenaza la vida o resulta en fallecimiento.
Los eventos adversos pueden ser por fallas en los procesos o errores de las personas y suelen ocurrir mayoritariamente en los hospitales, porque el riesgo asociado es mas alto, pero pueden suceder en todos los lugares en donde se atienden pacientes (ambulatorios, consultorios privados, farmacias, laboratorios, casas de convalecencia, etc.) porque cada punto del proceso de atención contiene cierto grado de riesgo inherente (medicamentos, dispositivos médicos, fallas sistémicas evidentes y latentes, inmunizaciones, etc.) a lo que debe añadirse el producto de fallas en el diseño del sistema, en la organización y en la operación.

La severidad de los eventos adversos se clasifica en:

Leve.-conciencia del signo o síntoma, fácilmente favorable, no requiere terapia o intervención médica.

Moderado.- molestia que produce interferencia con las actividades habituales, requiere intervención médica o terapia mínima.

Severo.- incapacita, inhabilita para trabajar o efectuar actividades habituales, requiere intervención y terapia médica importante.

Serio.- evento adverso que amenaza la vida, requiere o prolonga la hospitalización, produce una anomalía congénita o defecto al nacer, provoca incapacidad persistente significativa, compromete o pone en peligro la vida de una persona, necesita de una intervención para evitar daño o deterioro permanente o produce la muerte.

Los eventos adversos pueden derivarse de fallas sistémicas o de errores humanos (generalmente son procesos mentales) como olvido, distracción, deficiente motivación, falta de cuidado, negligencia o imprudencia), las fallas sistémicas que llevan a errores humanos se derivan de las condiciones en las que los individuos trabajan y no de la perversidad humana.
Error es una acción equivocada, es un suceso desfavorable asociado temporalmente y atribuible a un mal juicio, ignorancia, negligencia o impericia, son acciones innecesarias (sobreutilización), ejecución inadecuada de maniobras necesarias (mala utilización) u omisión de intervenciones benéficas (subutilización). Error es una falla en completar una acción planeada como era la intención, o uso de un plan incorrecto para alcanzar el objetivo. A los errores también se les conoce como lapsus o desliz, pudiendo ser accidentales y prevenibles, los errores llevan a eventos adversos (relaciones causales, asociaciones).
Error médico, es un error inexcusable (si no usa todos los medios a su alcance), por negligencia, no hacer lo que se debería haber hecho (omisivo), imprudencia, hacer sin las precauciones debidas (comisivo) o por impericia, hacer mal (ineptitud). El error puede ser ético, no necesita haber daño, civil o penal, en donde el daño es el factor relevante.

Son indicadores centinela de eventos adversos, el suicidio de pacientes, los errores de medicación, las complicaciones intra o postoperatorias, la cirugía del sitio erróneo, retraso en tratamiento, caída del paciente, homicidio, asalto, violación, muerte, injuria, fuga de pacientes y errores de transfusión.
Ejemplos de eventos adversos son las caídas de pacientes, heridas con la cama, errores de medicación, infecciones hospitalarias, tasas de readmisión, laceración o punción accidental, complicaciones de anestesia, úlceras de decúbito, cuerpos extraños olvidados, neumotórax iatrogénico, dosificación de medicamentos, errores médicos, malas transfusiones, infecciones hospitalarias, infecciones nosocomiales, hematomas o hemorragias, fracturas de cadera, alteraciones metabólicas o psicológicas, trombosis venosas profundas o tromboembolismo del pulmón, insuficiencia respiratoria, sepsis, reacción transfusional, trauma del recién nacido, trauma obstétrico en parto por cesárea, trauma obstétrico en parto vaginal con instrumentación, trauma obstétrico en parto vaginal sin instrumentación.
En medicina, las decisiones se toman en condiciones de incertidumbre o al menos de riesgo: el médico se puede comprometer con el proceso pero no con los resultados. Muchas veces por evitar errores de comisión se producen errores de omisión; el riesgo de producir daños involuntarios tiene al médico como segunda víctima, la obligación primaria de no dañar puede llevar al extremo de no actuar, al considerar la inocuidad como cualidad suprema, propicia remedios inofensivos, pero también ineficaces, olvidando que la atención de la salud es una ecuación de producir mínimos daños a cambio de grandes beneficios.
No obstante el creciente número de eventos adversos (enfermedades, traumatismos, defunciones) al recibir atención sanitaria (3.5 a 16% de los ingresos), en promedio uno de cada diez pacientes sufre alguna forma de daño evitable, la elevada incidencia de efectos adversos, que disminuyen la calidad de la atención y son causa importante (y evitable) de sufrimiento humano, perdidas financieras y costos de oportunidad es difícil conocer la epidemiología de los errores médicos, por la tendencia natural al ocultamiento, el temor a demandas y reclamaciones, la falta de madurez para admitir errores propios y la ausencia de cultura en sacar ventaja de ellos.

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