Comportamiento de crecimiento y reproductivo en hembras bovinas
3. PREVALENCE OF VARIANTS ASSOCIATED WITH GENETIC DISEASES OF ROMOSINUANO CATTLE IN
A review of country experiences (Box 2.2) revealed six quality indicators related to care effectiveness and user safety most commonly used in institutional settings and available nationally (Box 2.3):
●
Prevalence of pressure ulcers (i.e. bedsores).●
Incidence of falls and fall-related fractures.1●
Incidence of use of physical restraint.●
Incidence of over medication and medication errors.●
Prevalence of unplanned weight loss.●
Incidence of depression.Box 2.2. Examples of indicators on clinical aspects on care effectiveness and user safety
Canada: Incidence of pressure ulcers, percentage of pressure ulcers worsened, incidence of depression, percentage of residents whose behavioural symptoms worsened/improved, percentage of residents with symptoms of delirium, percentage of residents whose ADL functioning worsened/improved/remained, percentage of residents whose bowel/bladder continence worsened/improved, prevalence of tube feeding, percentage of residents whose cognitive ability worsened, percentage of residents whose ability to communicate worsened, percentage of residents with pain worsened, percentage of residents on antipsychotics without a diagnosis of psychosis, percentage of residents with one or more infections, percentage of residents who developed a respiratory condition.
Germany: Provision of medication in accordance with doctor’s instruction, appropriate handling of medication, systematic assessment of pain, close co-operation with doctor’s in case of patients with chronic pain, residents with chronic pain receive prescribed medication, appropriate handling of tracheal cannula, time and place documented when chronic wound/ulcer was first diagnosed, measures taken to battle chronic wounds or ulcers are state of the art, assessment of individual risk of falling, assessment of individual risk of decubitus/ulcer, implementation of falling prophylaxis, development of weight of patient in last six months, implementation of measures in case independent food intake is limited, appropriate nutritional condition of patients, documentation of individual resources and risks for patient with incontinence or catheter, consideration of biography and daily routine of dementia patient in care planning, implementation of appropriate measures of
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I.2. MEASURING QUALITY IN LONG-TERM CARE
A GOOD LIFE IN OLD AGE? MONITORING AND IMPROVING QUALITY IN LONG-TERM CARE © OECD/EUROPEAN COMMISSION 2013
Box 2.2. Examples of indicators on clinical aspects on care effectiveness and user safety (cont.)
body hygiene, assessment of legal and professional control of restricting measures, implementation of necessary provisions for residents with incontinence or a catheter, state of nutrition (as being influenced by the nursing home) (both items also apply to the supply of liquids), assessment of individual resources and risks.
Korea: Prevalence of pressure ulcers, prevention and management of bedsores, mini- mental state examination (MMSE) test rate, proportion of patients with declined ability to perform daily activities, percentage of clients with urinary tract infection, HbA1c test rate for diabetic patients, prevalence of use of physical restraints, residents with indwelling catheters.
Netherlands: Prevalence of pressure ulcers, prevalence of unplanned weight loss, incidence of depression, prevalence of behaviour symptoms affecting others, percentage of residents with UTI, percentage of residents given the seasonal influenza vaccine, incidence of falls, prevalence of use of physical restraints, the organisational unit can prove that they have a demonstrable policy for the prevention of restricting measures, the percentage of clients that has used anti-psychotic, anti-anxiety medication, the percentage of clients that has been involved in a medicine-related incidents over the past 30 days, residents with indwelling catheters.
Portugal: Prevalence of pressure ulcers, prevalence of unplanned weight loss, outcomes in physical autonomy by typology of care, incidence of falls, percentage of residents with one or more infections.
United States: Prevalence of pressure ulcers (i.e. bedsores), prevalence of unplanned weight loss, incidence of depression, prevalence of behaviour symptoms affecting others, percentage of residents whose need for help with activities of daily living has increased, prevalence of tube feeding, percentage of residents who were assessed and appropriately given the seasonal influenza vaccine and pneumococcal vaccine, incidence of falls, residents with indwelling catheters.
Box 2.3. Six quality indicators: Definitions, risk factors and relevance
Pressure ulcers, also known as bedsores, are clinical conditions of soreness on the skin. Frail elderly people whose mobility is limited are at risk of getting pressure ulcers because pressure ulcers are caused by unrelieved pressures to soft tissues of the skin. The level of severity can be categorised into four stages.
While this definition is commonly acknowledged, some countries do not include those with stage 1 pressure ulcers in data collection. As a preventive measure, assessing the risk of residents and recipients, providing special mattresses and/or padding, avoiding incontinence, keeping skin dry, providing good nutrition, and above all, regularly turning if mobility is limited help to reduce the risk of pressure ulcers and avoiding conditions to become severe and fatal (CIHI, 2011; National Pressure Ulcer Advisory Panel, 2011).
Falls are leading causes of hospitalisation or death among elderly people, especially among women. Falls can be accounted for muscle weakness and walking problems of older people in nursing home residents and home-care recipients (CDC, 2012). Environmental hazards such as conditions of facilities, vision problems and side effects from medications are known risk factors (CIHI, 2011). Fall incidents most commonly result in hip and wrist fractures, hip and shoulder dislocations, head injuries and bruises.
Box 2.3. Six quality indicators: Definitions, risk factors and relevance (cont.)
The use of physical restraints is a method used to limit or restrict the movement of residents and recipients. There are different types of restraints including physical and mechanical restraints (hand mitts, restrictive chairs such as Gerichairs, vests that tie nursing home residents to their chairs or beds, wrist and ankle restraints, and bedrails.), chemical restraints (medications given to residents to lessen pacing, restlessness, and unco-operative behaviour), and environmental restraints. Research shows that restraints can increase falls, as well as increase the risk of pressure ulcers and asphyxiation, worsen an injury if a fall occurs while in restraint, and worsen depression and a sense of helplessness (Health Quality Ontario, 2011).
Medication errors and over prescribed medication refer to cases such as inappropriate and wrong medication causing or potentially causing harms to residents and recipients of care. Such examples include prescribing, monitoring, administration or dispensing. Medication errors and over use of medication are known to be common across health care and long-term care, however, more so among residents of nursing homes. LTC users with multi-morbidity conditions can take many medications a day, however, other factors that lead physicians to prescribe medications or may cause medication errors are: inappropriate resident behaviours, such as aggressiveness, a lack of information sharing about a complete list of prescriptions available to physicians and pharmacists for the review of safety, especially for home care users who see multiple doctors (e.g. specialists) and fill prescriptions at different pharmacies (Health Quality Ontario, 2011).
Involuntary weight loss seen among elderly people can be a cause for acute and chronic illnesses and normal (hyperthyroidism, diabetes mellitus, or mal-absorption) and reduced appetites (cancer, chronic infections, cardiovascular, pulmonary, or renal disease) (Huffman, 2002). Depression is also known to trigger unintentional weight loss and it is usually higher among those living in nursing home than receiving care at home. Bereavement is another significant factor and men are shown to be more influenced than women. Importantly, elderly people with dementia are at high risk of unintentional weight loss. Drugs and medications also play a role in reduced appetites (Rehman, 2005). Increasing age, disability, coexisting medical conditions, history of hospital admission, low education level, presence of cognitive impairment, smoking, and low baseline body weight are also associated with unintentional weight loss among elderly people (Rehman, 2005). Although there is no clear consensus, the most well-accepted definition of clinically important weight loss is 5% over a period of 6-12 months (Rehman, 2005).
Depressions, also known as mood disorders, are the most common mental illness among elderly people. However, symptoms tend to be under reported because it is often under detected or considered natural reaction to physical conditions. Depressions are more prevalent among those living in nursing homes than those receiving care at home. Residents express social isolation especially with initial move to Long-term care facilities. A decline in general health makes people feel depressed. Depression in later life frequently coexists with other medical illnesses and disabilities. Major causes of depression are known to be related to health problems (illness and disability, chronic pain, cognitive decline, etc.), loneliness and isolation, reduce sense of purpose, fears, and recent bereavement. Deaths of friends and family which become more common with age can lead to depression (Health Quality Ontario, 2011). Although it is not feasible to see zero prevalence of depression, there are known to be effective measures available including providing meaningful activities, social networks, visitors, medications or pet therapy (CIHI, 2011).
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I.2. MEASURING QUALITY IN LONG-TERM CARE
A GOOD LIFE IN OLD AGE? MONITORING AND IMPROVING QUALITY IN LONG-TERM CARE © OECD/EUROPEAN COMMISSION 2013
Box 2.3. Six quality indicators: Definitions, risk factors and relevance (cont.)
These six indicators chosen satisfy soundness criteria such as: 1) the indicators focus on an important performance aspect, are scientifically sound, and potentially feasible; 2) the indicator focuses on quality and not utilisation; 3) the indicator reflect technical quality; 4) the indicator can be used for quality assessment at the health care system level, not just at the provider level; 5) the indicator can be constructed from administrative data or registries using uniform or standardised coding systems; and 6) the indicator is widely available and could be standardised for cross-country comparison.