Introdução: A unidade de terapia intensiva (UTI) é conhecida por ser um setor de alta complexidade dos pacientes e por seu alto custo ao sistema hospitalar. A gravidade da doença, o tempo de internação na UTI e a necessidade de ventilação mecânica invasiva (VMI) são fatores conhecidos como influenciadores no custo destas unidades, sendo que aproximadamente 30% dos pacientes internados em UTI necessitam de VMI. Os objetivos deste estudo foram avaliar os custos de internação em UTI comparando unidades com assistência de fisioterapia 24 horas e unidades com assistência de fisioterapia 12 horas e analisar o impacto da fisioterapia nos referidos custos. Método: Este é um estudo observacional, prospectivo, realizado em um hospital geral, público e de grande porte, localizado na cidade de São Paulo. Foram incluídos pacientes clínicos e cirúrgicos com 18 anos de idade ou mais, que estiveram em VMI por um período >= 24 horas e que receberam alta da UTI para a enfermaria. A coleta de dados incluiu diagnóstico de internação hospitalar, diagnóstico de admissão na UTI, gravidade do paciente no momento da admissão na UTI através do Acute Physiology and Chronic Health Disease Classification (APACHE II), tempo de VMI e tempo de internação na UTI; para a análise de custos utilizamos a ferramenta Omega French Score. Um modelo de regressão linear múltipla foi construído para verificar a associação entre o custo de internação em UTI com o turno diário de assistência fisioterapêutica. Resultados: Foram incluídos na amostra 815 pacientes, distribuídos em dois grupos conforme o turno de fisioterapia existente na UTI: 332 pacientes em UTI\'s com 24 horas de assistência fisioterapêutica (PT-24) e 483 pacientes em UTI\'s com 12 horas de assistência fisioterapêutica (PT-12). Os grupos não apresentaram diferença quanto ao APACHE II (p=0,65); comparado ao grupo PT-12 o grupo PT-24 era mais velho (p < 0,001), apresentou menor tempo de VMI (p < 0,001) e de internação na UTI (p=0,013). Quanto a análise de custos o grupo PT-24 apresentou custos menores indicados pela menor pontuação no Omega 3 (p=0,005) e Omega Total (p=0,010), menor custo direto, custo com equipe médica e enfermagem (p=0,010). A análise de regressão linear múltipla indicou associação do custo da internação em UTI com as variáveis APACHE II (p < 0,001), tempo de internação da UTI (p < 0,001) e assistência fisioterapêutica em turnos de 24 horas (p=0,05). Conclusão: O grupo com assistência de fisioterapia em turnos de 24 horas apresentou custos menores sendo que a severidade da doença, o tempo de internação na UTI e a assistência de fisioterapia foram variáveis preditoras para redução de custo de internação na UTI / Background: Intensive care unit (ICU) is considered a complex and expensive hospital department. The severity of illness, the length of ICU stay and the need for invasive mechanical ventilation (IMV) are known as influencing factors of costs to these units and approximately 30% of patients admitted at ICU will need IMV. Our aim is to address the costs related to ICU stay by comparing units with the provision of a daily 24-hour physiotherapy shift to a regular 12-hour PT shift and to analyze the impact of physical therapy in ICU costs. Method: This is a prospective, observational study, carried out in a general, public and large hospital, located in the city of São Paulo. Were included in the sample clinical and surgical patients, aged >=18 years old, invasive mechanically ventilated (IMV) >= 24 hours and discharged to ward were included. Data collection included reason of hospital admission and reason of ICU admission; Acute Physiology and Chronic Health Disease Classification System II (APACHE II); IMV duration; ICU-LOS; for cost analysis we use the Omega French Score. A multiple linear regression model was constructed to verify the association between costs of ICU stay and daily shift of physiotherapy. Results: 815 patients were included, distributed into two groups: 332 patients at ICUs with 24-hour physiotherapy shift (PT-24) and 483 patients in ICUs with 12-hour physiotherapy shift (PT-12). There was no statistical difference between the groups regarding the APACHE II (p=0,65); the PT-24 group was older (p < 0,001), and featured better clinical outcome when compared to the PT-12 group with shorter IMV (p < 0,001) and duration of stay in the ICU (p=0,013). About cost analysis the PT-24 group showed lower scores on Omega 3 (p=0,005) and Omega (p=0,010), lower direct cost, cost of medical and nursing staff (p=0,010). Multiple linear regression reveal that costs of ICU hospitalization to be associated to APACHE II (p < 0,001), length of ICU stay (p < 0,001) and 24-hour physiotherapy assistance (p=0,05). Conclusion: Patients in the group with the assistance of physiotherapy in 24-hour shifts presented decreased total and staff costs, physiotherapy assistance were considered predictor for cost reduction.

O objetivo do presente trabalho foi identificar a frequência de inadequação entre a quantidade de Terapia Nutricional Enteral (TNE) prescrita e aquela recebida por pacientes internados em hospital geral, e estudar as condições associadas que podem levar a essa inadequação. Adultos hospitalizados (201), que receberam exclusivamente TNE, foram acompanhados por até 21 dias por equipe de especialistas em Terapia Nutricional, que registrou o processo em fichas específicas. Todos os doentes receberam fórmulas enterais industrializadas por sondas enterais ou nasoenterais, gastrostomias ou jejunostomias em sistema aberto. As causas de discordância entre prescrição e recebimento de NE não foram mutuamente excludentes. A análise estatística foi feita através de regressão logística pelo modelo de Cox. Dos 152 pacientes considerados na análise, 36 (23,5%) ficaram internados em enfermarias e 116 (76,5%) em UTI. Oitenta por cento dos pacientes receberam mais de 80% das necessidades energéticas diárias, a partir do quarto dia do acompanhamento. Existe inadequação entre a quantidade de TNE prescrita e aquela recebida em 20% dos pacientes. As causas de não recebimento de NE foram: atraso na administração de TNE (3,1%), distensão abdominal (5,6%), recusa do paciente (6,8%), obstrução de acesso enteral (8,6%), vômitos (10,5%), diarreia (17,9%), causa desconhecida (17,9%), suspensão de TNE por interferência de profissional não integrante da equipe especializada em TN (25,9%), perda acidental de acesso enteral (34%), estase gástrica (34%) e problemas logísticos (99,4%). A análise univariada apontou associação entre o grupo de pacientes que recebeu menos que 60% da energia prescrita e suspensão de TNE por interferência de profissional não integrante da equipe especializada em TN (p=0,016). Houve associação linear (p=0,025) entre o tipo de leito hospitalar e percentual de adequação no recebimento de dieta quanto maior a adequação entre prescrição e recebimento de dieta, menor foi o número de pacientes em UTI. A regressão logística apontou que pacientes com doenças neurológicas têm maior chance de receber mais que 80% da dieta prescrita que pacientes com doenças cardiológicas (OR=3,75; p<0,01). Pacientes com doenças cardiológicas e pacientes em UTIs estão mais sujeitos a receber menos que o total de NE prescrita / We investigated factors leading to a reduction in enteral nutrition (EN) prescribed by a nutritional support team (NST) at a general hospital in Brazil. In this prospective, observational study, hospitalized adults receiving only EN therapy via tube feeding were followed for up to 21 days between July and October 2008. The 152 subjects analyzed included 36 (23.5%) ward patients and 116 (76.5%) intensive care unit (ICU) patients. Eighty percent of the targeted feeding volume was achieved on day 4 by 80% of the patients. Inadequacy between prescription and intake of EN was 20%. Reasons for not receiving the total amount of EN prescribed included delay in the EN administration (3.1%), abdominal distention (5.6%), patient refusal to treatment (6.8%), feeding tube obstruction (8.6%), vomiting (10.5%), diarrhea (17.9%), unknown causes (17.9%), interference by a non-NST physician (25.9%), accidental feeding tube loss (34%), presence of high gastric residual (34%), and operational logistics at the hospitals Nutrition and Dietetics Service (99.4%). There was a significant association between patients who received less than 60% of the prescribed EN and external physician interference (p=0.016). Patients in ICU also received inadequate EN (p=0.025). Neurologic patients had a greater chance of receiving more than 80% of the prescribed EN amount than cardiac patients (Odds Ratio=3.75, p<0.01). Cardiologic patients and ICU patients are at a higher risk of inadequacy between prescription and intake of EN

Les patients de réanimation sont des patients à très haut risque de survenue de candidoses invasives associées à une importante mortalité. Les espèces du genre Candida sont retrouvées en troisième position des agents infectieux les plus fréquemment isolés au cours des septicémies. Le diagnostic reste difficile en raison d’une clinique aspécifique et d’une sensibilité médiocre des hémocultures. Des scores prédictifs, des biomarqueurs ou encore des PCR ont été développés de manière à améliorer le diagnostic et l’identification des patients à risque. Dans ce travail, la première partie présente les données de l’évolution de l’écologie fongique, des candidoses invasives, des prescriptions d’antifongiques et des sensibilités aux antifongiques sur une période de dix ans dans un service de réanimation. Au cours de cette période, les changements observés dans la prescription d’antifongiques n’ont pas entrainé de modifications significatives de l’écologie fongique ni d’apparition de résistances. Dans une deuxième partie, nous présentons les résultats d’une étude prospective observationnelle bicentrique réalisée chez 435 patients non neutropéniques de réanimation. L’analyse de plusieurs variables (facteurs de risque de candidose invasive, colonisation à Candida sp., dosages d’antigène mannane et d’anticorps anti-mannane) a permis l’élaboration d’un score prédictif de survenue de candidose invasive. Finalement, la dernière partie du travail présente la mise au point de PCR Candida en temps réel dans le sang ainsi qu’une évaluation de la technologie de digital PCR. / Patients in intensive care units (ICU) are at very high risk of invasive candidiasis associated with high mortality rate. Candida species are the third cause of septicemia. Clinical signs lack of specificity and blood cultures lack of sensitivity, and therefore the diagnosis remains a challenge. In order to improve the identification of patients with invasive candidiasis, predictive rules, biomarkers and PCR have been developed. The first part of this work describes the evolution over a ten years period in one ICU in Candida species distribution, susceptibility to antifungal drugs and consumption of antifungal agents. Changes in antifungal drug consumption were observed but they were not associated with significant changes in fungal ecology or with the emergence of resistant species. In a second part, we present a prospective, observational and bicentric study performed in 435 non-neutropenic patients in ICU. Several variables (risk factors of invasive candidiasis, Candida colonization, mannan antigen and anti-mannan antibodies) were analyzed and a predictive score of invasive candidiasis has been developed. Finally, the last part presents the development of Candida real-time PCR in blood, as well as the evaluation of a digital PCR.

Bakgrund: 100 000 vårdskador uppstår i Sverige varje år. Patienter som vårdas på intensivvårdsavdelningar löper störst risk att drabbas. För att minska riskerna och höja patientsäkerheten krävs kunskap om vilka risker som finns och vilka misstag som begås. Syfte: att beskriva i vilka sammanhang intensivvårdssjuksköterskor upplever att patientsäkerheten brister. Metod: en empirisk studie med kvalitativ design har utförts. Datainsamlingen har skett i två fokusgrupper med intensivvårdssjuksköterskor. Materialet analyserades och presenteras i form av teman och kategorier. Resultat: brister sågs i organisationen och sjuksköterskorna. Sjuksköterskorna upplevde även att brister i samarbetet och kommunikationen uppstod mellan individer samt mellan individer och organisationen. Slutsats: organisationen måste bistå med patientsäkra lokaler och lyfta patientsäkerheten på avdelningen. Sjuksköterskorna i sin tur måste följa författningar och lokala rutiner. Detta för att skydda patienter och för att inte själva straffas för vårdskador. Organisationen och sjuksköterskorna måste därtill tillsammans förbättra samarbetet och kommunikationen dem emellan. Klinisk betydelse: studien kan användas i ett förbättringsarbete på den undersökta avdelningen samt stärka gruppsamhörigheten för intensivvårdssjuksköterskorna. / Background: 100 000 adverse events occur annually in Swedish hospitals. Patients being treated in intensive care units are most at risk. To reduce risks and improve patient safety requires knowledge of the risks involved and the mistakes made. Aim: to describe in which context intensive care nurses experience that patient safety fails. Method: an empirical study with a qualitative design has been made. Data has been collected in two focus groups with intensive care nurses. The material was analyzed and presented in terms of themes and categories. Results: patient safety deficiencies were found in the organization and among the nurses. The nurses also described deficiencies in the cooperation and communication between individuals and between individuals and the organization. Conclusion: the organization must give priority to patient safety issues and provide facilities well adapted to carry out safe care. As for the nurses, they must follow regulations and local procedures in order to prevent harm to patients and to avoid being punished for adverse events. The organization and the nurses must together improve cooperation and communication to promote patient safety. Clinical importance: this study can be used to improve patient safety at the investigated intensive care unit and strengthen the group cohesion among the critical care nurses.

Införandet av en mobil intensivvårdsgrupp (MIG) har visat sig ha goda resultat utomlands med minskade andningsstopp och mortalitet inom pediatrisk vård. Vid Astrid Lindgrens Barnsjukhus i Solna, Sverige (ALB) finns långt framskridna planer på att starta en MIG-verksamhet. Syftet med denna studie var att beskriva pediatriska patienter som faller in under potentiella MIG-kriterier innan inläggning på barnintensivvårdsavdelningen/barnintermediäravdelningen (BIVA/BIMA) på ALB. Studien gjordes retrospektivt genom journalgranskning av inskrivna pediatriska patienter på BIVA/BIMA under 2009. Totalt inkluderades 148 pediatriska patienter i åldern 0-18 år i studien. Resultat visade att Andningsbesvär var den vanligaste inskrivningsorsaken och att Andning var den vanligast förekommande kontaktorsaken. Provtagning var den mest förekommande åtgärden som utfördes på akutmottagningen/vårdavdelningen innan förflyttning till BIVA/BIMA. Slutsatsen blev att det skulle kunna finnas cirka 300 pediatriska patienter per år på ALB som skulle kunna vara aktuella för MIG-uppdrag. Det är en klar indikation för att starta en MIG-verksamhet på ALB för att minska inläggningar på BIVA/BIMA samt identifiera dessa pediatriska patienter i ett tidigt skede innan akut försämring. / The implementation of Pediatric Medical Emergency Team (PMET) has proven to reduce respiratory arrest and mortality in Pediatric hospitals worldwide. At Astrid Lindgrens Barnsjukhus in Solna, Sweden (ALB) there are advanced plans to start a PMET. The aim of this study was to describe pediatric patients that met potential PMET-criteria before being admitted to pediatric intensive care unit/high demand unit (PICU/HDU) at ALB. The study was a retrospective chart review of admitted pediatric patients at PICU/HDU during 2009. Totally 148 pediatric patients between the age of 0 to 18 years were included in the study. The result showed that respiratory problems were the most common reason for being admitted to the hospital and problems with breathing was the most frequent PMET-criteria. Before the patient moved to the PICU/HDU the most common intervention performed in the emergency department/wards was sample-taking. The conclusion was that around 300 pediatric patients a year could benefit from a PMET at ALB. That is a clear indication that a PMET should be started at ALB to reduce admitted patients to PICU/HDU and identify the patients at risk for acute worsening.

L’aérosolthérapie est une pratique ancienne de plusieurs siècles. Progressivement l’administration inhalée de bronchodilatateurs et de corticoïdes s’est imposé comme le traitement au long cours de référence des maladies pulmonaires obstructives. Plus récemment de nouvelles molécules, comme les antibiotiques ou les mucomodulateurs, ont été administrées avec succès par voie inhalée, particulièrement chez les patients atteints de mucoviscidose. Alors que ces succès de l’aérosolthérapie ont été obtenus chez les patients en ventilation spontanée et traités essentiellement dans le contexte ambulatoire, les données sont beaucoup plus parcellaires concernant l’aérosolthérapie chez les patients admis en réanimation et plus particulièrement ceux soumis à la ventilation artificielle. Néanmoins, l’effet physiologique des bronchodilatateurs et des corticoïdes a été documenté chez les patients soumis à la ventilation artificielle et plusieurs études expérimentales et de recherche clinique [ont] documenté la faisabilité de l’antibiothérapie inhalée chez ces patients. Cinq travaux ont été réalisés dans le cadre de la thèse, faisant appel à des méthodes de recherche expérimentale sur banc, d’expérimentation animale, de recherche clinique et épidémiologique concernant l’aérosolthérapie en réanimation. Les deux premiers travaux ont consisté en une enquête internationale par voie électronique auprès des huit cents médecins exerçant en réanimation et d’une étude prospective observationnelle durant deux semaines dans quatre-vingts services de réanimation. Les résultats principaux de ces travaux sont que l’aérosolthérapie était très fréquente en réanimation et concernait près d’un quart des patients. Les molécules administrées étaient essentiellement des bronchodilatateurs et des corticoïdes, mais l’antibiothérapie inhalée était également pratiquée. […] L’aérosolthérapie est apparue comme bien tolérée à court terme […]. Le troisième travail a consisté en une évaluation sur banc des systèmes de nébulisation pneumatique synchronisée intégrés dans quatre ventilateurs de réanimation. Les résultats principaux de ce travail sont que ces systèmes permettaient un bon contrôle du volume courant délivré au patient durant la nébulisation ; en revanche la synchronisation inspiratoire n’était pas optimale […]. Le quatrième travail a consisté en une étude clinique évaluant la pharmacocinétique sérique de l’amikacine après son administration inhalée à forte dose chez vingt-deux patients soumis à la ventilation artificielle et atteints de pneumonie nosocomiale. L’administration était réalisée à l’aide d’un système de nébulisation pneumatique innovant, adapté à la ventilation artificielle. Le résultat principal de ce travail a été que la nébulisation de 60 mg/Kg d’amikacine s’est avéré faisable chez le patient sous ventilation artificelle et que les concentrations sériques observées étaient inférieures à celles observées après perfusion intraveineuse. […] Enfin, le dernier travail a consisté en une étude animale comparant la pharmacocinétique sérique de l’amikacine après administration intraveineuse, nébulisation et aérosolisation in situ à l’extrémité de la sonde d’intubation de porcelets soumis à la ventilation artificielle avec des poumons non infectés. Le principal résultat est que l’aérosolisation in situ a permis d’administrer de grandes quantitiés d’amikacine en très peu de temps. Néanmoins, les concentrations intra-parenchymateuses étaient très hétérogènes après aérosolisation in situ et fréquemment faibles […]. / Aerosoltherapy is a centuries-old practice. Inhaled bronchodilatators and corticosteroids have become the long-term treatment of choice for obstructive lung diseases. More recently, new molecules, such as antibiotics or mucus modulators have been successfully administrated by inhalation, particularly in patients with cystic fibrosis. While the success of aerosoltherapy were obtained in patients breathing spontaneously and essentially treated in the outpatient setting, data are much scarcer concerning aerosoltherapy in patients admitted to intensive care and especially those undergoing mechanical ventilation. Nevertheless, the physiological effects of bronchodilators and corticosteroids have been documented in patients undergoing mechanical ventilation and several experimental and clinical researches documented the feasibility of inhaled antibiotic therapy in these patients. The thesis comprises five works carried out using methods of experimental bench research, animal experimentation so as clinical and epidemiological research concerning aerosoltherapy in the intensive care setting. The first two works consisted of an international electronic survey among eight hundred physicians working in intensive care and a two-week prospective cross-sectional study in eighty intensive care units. The main results of those works are that aerosoltherapy appeared very common in the intensive care unit and concerned about a quarter of all admitted patients. The molecules administrated were essentially bronchodilatators and corticosteroids, but inhaled antibiotic therapy was also practiced. Although implementation of aerosoltherapy, especially during mechanical ventilation, appeared frequently at odds with optimal practice, or even dangerous, it was well tolerated in the short term since only a hundred side effects were observed during the nine thousand aerosol administrations collected in the prospective study. The third work evaluated, in a bench model of mechanical ventilation, synchronized pneumatic nebulization systems integrated in four intensive care ventilators. The main results of this work are that these systems provided good control of the tidal volume during nebulization ; however inspiratory synchronization was not optimal since a significant proportion of nebulization occurred during expiration, due ti gas compression/decompression upstream of the nebulizer. The fourth work consisted of a clinical study evaluating serum pharmacokinetics of amikacin after high dose inhalation in twenty-two patients undergoing mechanical ventilation and suffering nosocomial pneumonia. Administration was carried out using an innovative pneumatic nebulization system adapted to mechanical ventilation. The main result of this work was that nebulization of 60 mg / kg of amikacin proved feasible in patients on mechanical ventilation and serum concentrations observed were lower than those observed after intravenous infusion. An increase in the dose and / or the yield of the nebulization system may be considered to promote greater lung deposition in order to favour improved efficacy. The presence or absence of a heated humidifier did not influence the results, thus allowing considering active humidification during prolonged nebulization within a high-dose strategy. Finally, the last work was an animal study comparing serum pharmacokinetics of amikacin after intravenous administration, nebulization and in situ aerosolisation at the end of the endotracheal tube in piglets with healthy lungs undergoing mechanical centilation. The main results are that in situ aerosolisation allowed administrating large amounts of amikacin in a very short time. Nevertheless, intra-parenchymal concentrations were very heterogeneous after in situ aerosolisation and often low, while nebulization allowed observing globally more homogeneous concentrations. Immuno-histological amikacin staining allowed observing lung deposition of amikacin at the tissue level.

Drug-drug interactions (DDI) represent a growing concern for the health units. Therefore, monitoring of pharmaceutical prescriptions in hospitals can rationalize pharmacotherapy. To evaluate the effect of pharmaceutical intervention in identifying and managing drug interactions in an intensive care unit (ICU), in Northeastern of Brazil. Methods: Initially, we performed a systematic review from the search of electronic databases, Jan. 1960 to Aug 2010. After that, we realized a longitudinal study in the ICU, in a private hospital in the city of Aracaju-SE, between 2008 and 2009, which was identified in the prevalence and clinical relevance of the DDI. During the study pharmaceutical interventions were aimed at the management of DDI. The systematic review, only seven articles met all inclusion criteria and the specific sample sizes ranged from 200 to 1785 patients. As for the longitudinal study, 6085 prescriptions were collected, of which 213 contained DDI clinically relevant. Of these 178 were moderate and 35 major severity. The clinical pharmacy interventions consisted in the preparation of reports for physicians, allowing the reduction of 40% of all DDI. The data obtained allow inferring that the participation of clinical pharmacists in the DDIs identification and management may have been essential to promote the safety of ICU patients. / As interações medicamentosas (IM) representam uma crescente preocupação para as unidades de saúde. Por isso, o acompanhamento farmacêutico das prescrições nos hospitais pode racionalizar a farmacoterapia. Avaliar o efeito da intervenção farmacêutica na identificação e manejo de interações medicamentosas em uma unidade de terapia intensiva (UTI), no nordeste do Brasil. Inicialmente, foi realizada uma revisão sistemática sobre a qualidade dos estudos que envolvem o papel do farmacêutico na identificação de IM em hospitais, a partir da busca nos bancos de dados eletrônicos, janeiro de 1960 a agosto de 2010. A revisão utilizou como critérios de inclusão: (i) estudos realizados em hospitais; (ii) identificação de IM com a participação do farmacêutico; (ii) texto em língua inglesa. Em seguida, foi realizado um estudo longitudinal, na UTI, em um hospital privado do município de Aracaju-SE, entre 2008 e 2009, no qual foi identificada a prevalência e relevância clínica das IM do tipo fármaco-fármaco. Durante o estudo foram realizadas intervenções farmacêuticas que visavam o manejo da IM. Na revisão sistemática, apenas seis artigos atenderam a todos os critérios de inclusão específicos e o tamanho das amostras variou de 200 a 1785 pacientes. Quanto ao estudo longitudinal, foram coletadas 6.085 prescrições, sendo que 213 continham IM clinicamente relevantes. Destas 178 apresentaram severidade moderada e 35grave. As intervenções da farmácia clínica consistiram na elaboração de laudos para os médicos, que possibilitaram a redução de 40% de todas as interações. Os dados obtidos permitem inferir que a participação do farmacêutico clínico na identificação e manejo de IM, pode ter sido essencial para promover a segurança de pacientes da UTI.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2015-07-20T14:05:34Z No. of bitstreams: 1 Ligia Maria Quiterio.pdf: 3090898 bytes, checksum: f660fb6118707979a5a91e1b08534f0a (MD5) / Made available in DSpace on 2015-07-20T14:05:34Z (GMT). No. of bitstreams: 1 Ligia Maria Quiterio.pdf: 3090898 bytes, checksum: f660fb6118707979a5a91e1b08534f0a (MD5) Previous issue date: 2014-11-21 / The purpose of this study was to investigate patients’ safety incidents that may be associated with management communication failures in Intensive Care Units (ICUs) with the purpose of providing information to develop strategies to increase patient safety and improve the quality of health care. This is an empirical, retrospective study of a descriptive nature, conducted through documental, literature research and action research with a quantitative and qualitative approach to the problem. The study period was from May 25 to August 25, 2009, with a population of 202 admissions of ICU patients from a public hospital, tertiary. We identified 999 patient safety incidents and we analyzed according to the international classification for patient safety (ICPS), with predominance of no harm incidents, with 626 (62.66%), and 248 (24.82%) incidents of harm. Age of patients who have suffered harm incidents was 52.77 years (average, SD = 20.01), with minimum variation of 15 and maximum of 96 years; the average length of stay in the units was 10.09 days (SD = 10.14), ranging from 0 to 70 days. Evaluating the Charlson comorbidity scale incidents by communication failures were more frequent (87.6%) when compared with other incidents (p <0.0005). This finding, can be partially explained, since patients with more comorbidities require intensified nursing care, as well as higher number of medications, more exams requests, so are patients who are more prone to incidents in general, standing out there communication. The incidents with no harm were related to documentation and to verbal communication, generating 62.66% of incidents. Written communication failures were associated to medications, diets and clinical processes and procedures. They accounted for most incidents with harm: 24.82%. In this study, all incidents related to communication failures were of preventable type. We developed a form to be used as a check list to reduce communication incidents that can be employed to improve communication and to increase patient safety in hospitals, especially those related to critical care. The detection of communication incidents were originated at medical prescriptions, nursing controls, medical rounds and nursing care. We identified 152 communication failures, in which 49.67% were related between physicians and the ICU nursing staff. Conclusion: The most observed safety incidents due to communication failure were those related to medications, diets and clinical processes and procedures. All of them were of avoidable type, demonstrating that healthcare manager may have a role in the prevention of patient safety incidents while propose strategies to improve the communication among ICU actors. / O objetivo deste trabalho foi estudar os incidentes de segurança que podem estar associados a falhas gerenciais de comunicação em Unidades de Terapia Intensiva (UTIs), com o propósito de fornecer informações para desenvolver estratégias para aumentar a segurança do paciente e aprimorar a qualidade de assistência à saúde. É um estudo empírico, retrospectivo de natureza descritiva, realizado por meio de pesquisa documental, bibliográfica e pesquisa-ação, com abordagem quantitativa e qualitativa do problema. O período de estudo foi de 25 de maio a 25 de agosto de 2009, com uma população de 202 admissões de pacientes internados em UTIs de um hospital público, terciário, de São Paulo. Foram identificados 999 incidentes de segurança e analisados de acordo com a classificação internacional para a segurança do doente (CISD), tendo predominância os incidentes sem danos, com 626 (62,66). A média de idade dos pacientes que sofreram incidentes com danos foi de 52,77 anos (DP=20,01), com variação mínima de 15 e máxima de 96 anos; o tempo médio de permanência nas unidades foi de 10,09 dias (DP=10,14), variando de 0 a 70 dias. Avaliando as comorbidades pela escala de Charlson, os incidentes por falhas de comunicação foram mais frequentes (87,6%), quando comparados com os outros incidentes (p<0.0005), fato esse que pode ser parcialmente explicado, uma vez que pacientes com maior número de comorbidades necessitam de cuidados de enfermagem intensificados, assim como maior número de medicações, maior número de solicitações de exames complementares, logo são pacientes que estão mais sujeitos a incidente em geral, destacando-se aí os de comunicação. Os incidentes sem danos estão relacionados à documentação e à comunicação verbal, e geraram 62,66% dos incidentes. As falhas de comunicação escrita estão associadas a medicações, dietas e aos processos e procedimentos clínicos, e representaram a maioria dos incidentes com danos: 24,82%. Neste estudo, todos os incidentes relacionados às falhas de comunicação foram do tipo evitáveis. A proposta de um instrumento norteador para redução de incidentes de comunicação poderá ser empregada, com o objetivo de melhorar a comunicação e aumentar a segurança dos pacientes em ambiente hospitalar, notadamente relacionados aos cuidados críticos. Quanto à origem dos incidentes de comunicação, as prescrições médicas, controles de enfermagem, as visitas médicas e de enfermagem foram fontes de identificação dos incidentes de segurança dos pacientes. Foram detectadas 152 falhas de comunicação sendo que 49,67% estão associadas à comunicação entre médico e enfermagem da UTI. Conclusão: Falhas de comunicação em UTI foram frequentes no nosso estudo. As mais comuns foram aquelas relacionadas às medicações, às dietas e aos processos e procedimentos clínicos. Todas foram do tipo evitáveis, demonstrando que o gestor pode ter papel na prevenção de incidentes de segurança do paciente ao elaborar estratégias para aprimoramento da comunicação entre os atores da UTI.

Bakgrund Att bli förälder till ett barn som vårdas på en neonatalavdelning kan upplevas som en mycket chockartad och stressande händelse, vilket kan försvåra för föräldrarna att knyta an till barnet. Barnets behov av professionell vård hindrar föräldrarna att ge barnet naturlig omsorg, vilket kan skapa känslor av förlust av föräldrarollen. Ofta separeras barnet från sina föräldrar. Denna separation kan få negativa effekter på såväl anknytning som på föräldraskap. För att främja anknytning och stärka föräldrarollen är det viktigt att föräldrarna är delaktiga och tar ansvar för barnets omvårdnad. Sjuksköterskan har en viktig roll i att stödja föräldrarna i detta.   Syfte Syftet med föreliggande studie var att beskriva upplevelser av delaktighet hos föräldrar till barn som vårdas på neonatalavdelning med fokus på faktorer som påverkar delaktighet.   Metod Som metod användes en allmän litteraturöversikt med deskriptiv kvalitativ ansats. Studien inkluderar 14 vetenskapliga artiklar som inhämtades från databaserna PubMed och CINAHL samt via sekundärsökningar.   Resultat Utifrån litteraturgenomgången kunde fem teman urskiljas som utgör såväl främjande som hindrande faktorer för föräldrars upplevelser av delaktighet: bemötande, kommunikation, information, aktivt deltagande och vårdmiljö.   Slutsats Delaktighet är en viktig förutsättning för anknytning och för föräldrarollen. Det är därför centralt att underlätta för föräldrar att vara delaktiga i vården av sitt barn. Sjuksköterskan har en avgörande roll genom att bjuda in föräldrarna till att delta i omvårdnadshandlingar samt erbjuda föräldrarna ett gott bemötande, en öppen och ärlig kommunikation, kontinuerlig information och en familjevänlig vårdmiljö. / Background To become a parent to a child that is treated in a neonatal intensive unit can be a shocking and stressful experience, which can result in hindering the parents’ ability to bond with the child. The child’s need for professional care hampers the parents’ ability to give their child natural care, which can lead to feelings of powerlessness and of a loss of their parental role. The child is often separated from the parents. This separation can cause negative effects on bonding as well as the parental role. Parents’ participation in and responsibility for their infant’s care are important factors to strengthen bonding and to empower parents in their parental role. Nurses have an important role in supporting the parents to achieve this.    Aim The aim of this study was to describe parents’ experiences of participation in their child’s care in a neonatal intensive unit with focus on affecting factors.   Method This study was conducted as a literature review with a qualitative descriptive approach. It includes 14 scientific articles conducted in PubMed and CINAHL and through secondary searches.   Results From the literature review five themes were identified as supportive factors or barriers for parents’ experiences of participation: treatment, communication, information, active participation and care environment.   Conclusion Participation is important for bonding and parenting. Thus, it is central to support parents to participate in the care of their child. Nurses have a crucial role by inviting parents to participate in caregiving activities and offering good treatment, an open and honest communication, continuous information and a family friendly care environment.

Neonatal abstinence syndrome (NAS) refers to the withdrawal infants exposed to opioids in utero may experience following birth. In recent years, the number of infants born who present with NAS has grown exponentially. This increase in the number of infants with NAS has led to a new population within the caseloads of speech-language pathologists (SLPs) who work in neonatal intensive care units (NICUs). SLPs’ knowledge base and skill set of assessment and treatment of swallowing and feeding disorders in infancy play a vital role in the treatment of infants with NAS in the NICU. A dearth of research exists regarding the specific nature of the feeding problems and skills of infants with NAS and whether SLP intervention for infants with NAS needs to differ from that of other infant NICU populations. Identifying how SLPs can best serve infants with NAS in the NICU is essential to their immediate well-being as well as the development of these infants. The purpose of this survey-based research study was to examine NICU SLPs’ perceptions of infants with NAS, and more specifically, how NAS affects the infants’ feeding skills, structural, and oral-motor characteristics. A questionnaire was developed based on an in-depth literature review to collect information on NAS, caseloads, treatment environment, and respondent demographics. The survey consisted of three sections: NAS (further divided into Assessment, Treatment, and Education), Environmental Description, and Respondent Demographics. The secure web-based questionnaire was distributed through SurveyMonkey™, an online survey platform. Survey research was conducted, and hospital-based speech-language pathologists within the USA acted as respondents. The findings will contribute to establishing a preliminary base of information on this topic. The results are expected to further inform the field as well as current practices in evidenced-based practice care for infants with NAS.