Evaluation of the degree of implementation of zero projects in critical care units of Galicia (Spain) through internal audits

Abstract

Objective: The objective of this study was to assess the implementation of Zero Projects in Critical Care Units (CCUs) through Internal Audits (IA).

Materials and methods: Design: Real-time observational safety analysis. A questionnaire was developed with defined items to ensure objectivity. After IAs, a survey was conducted with the auditors.

Scope: 11 CCUs in hospitals of the Servizo Galego de Saúde and Ribera-POVISA.

Patients or participants: 24 auditors in 9 teams composed of medical, nursing, and quality personnel from health areas and 34 patients were assessed.

Main variables of interest: Compliance with the quality standard (≥60% of items), strengths, areas for improvement, auditor's interest in IA, conformity with the organization and items.

Results: 100% CCUs met the quality standard. 18.03% of items were fulfilled by all CCUs. Strengths: staff motivation, positive reception of auditors, and use of computer tools in some CCUs. Areas for improvement: deficit of automatic systems for controlling endotracheal tube cuff pressure (compliance rate in 9.1% of CCUs), training needs, communication issues, and not using checklists (45.5% of the reports). Auditors found IA very interesting, and 19% suggested improving organization and items.

Conclusions: All CCUs met the previously agreed-upon quality standard. Numerous improvement opportunities were identified and communicated to the audited CCUs. For greater homogeneity and objectivity, a review of previously agreed items and definitions is required.

Keywords: Auditorías; Clinical audit; Critical care; Cuidados críticos; Cultura de seguridad; Paquetes de medidas; Patient care bundles; Proyectos zero; Safety culture; Zero projects.