Introdução: A assistência hospitalar a pacientes portadores de queimaduras é altamente dispendiosa devido aos recursos humanos, materiais e estruturais necessários à sua viabilização. O conhecimento financeiro relativo a essa temática ainda é escasso, especialmente no que tange aos custos dos procedimentos executados por profissionais de enfermagem a pacientes, grandes queimados, em condições críticas. Objetivo: Identificar o custo direto médio (CDM) dos procedimentos realizados, com maior frequência, por profissionais de enfermagem, a pacientes grandes queimados internados em uma Unidade de Terapia Intensiva de Queimaduras (UTIQ). Método: Esta pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso único, foi conduzida na UTIQ da Unidade de Queimaduras do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. O CDM foi calculado multiplicando-se o tempo (cronometrado) despendido por profissionais de enfermagem na execução dos procedimentos, objeto de estudo, pelo custo unitário da mão de obra direta, somando-se ao custo dos materiais e soluções/medicamentos. Para a realização dos cálculos utilizou-se a moeda brasileira (R$). Resultados: A partir de 1354 observações, relativas a 12 procedimentos frequentemente realizados na UTIQ, obteve-se o CDM de R$ 1,88 (DP=1,04) para controle dos sinais vitais; R$ 28,78 (DP=69,74) para administração de medicamentos via intravenosa; R$ 16,97 (DP=7,92) para mensuração de diurese; R$ 2,68 (DP=1,20) para verificação de glicemia capilar; R$ 6,71(DP=2,20) para administração de medicamentos via sonda nasoenteral; R$ 50,07 (DP=11,89) para higiene íntima no leito; R$ 3,64 (DP=2,01) para auxílio alimentação; R$ 55,88 (DP=18,98) para banho no leito/arrumação da cama; R$ 287,11 (DP=372,87) para curativo; R$ 6,65 (DP=2,09) para higiene oral; R$ 3,13 (DP=1,08) para administração de medicamentos via oral e R$ 8,51 (DP=1,79) para administração de medicamentos via subcutânea. Conclusão: A apuração dos custos dos recursos consumidos nos procedimentos requeridos pelos pacientes, grandes queimados, em UTI, pode fundamentar as tomadas de decisão gerenciais subsidiando a sua eficiência alocativa, evitando a ocorrência de desperdícios e, quando possível, indicando estratégias de contenção/minimização de custos sem prejuízos à qualidade da assistência de enfermagem. / Introduction: Hospital care for critical burn patients is highly costly due to human, material and structural resources required for its viability. The financial knowledge concerning this subject is still scarce, especially in regard to the cost of procedures performed by nurses in critical burn patients. Objective: To identify the average direct cost (ADC) of the nursing procedures carried out with greater frequency for burn patients admitted into the burn intensive care unit (BICU). Methodology: This quantitative exploratory and descriptive single case study was conducted in BICU at the Burn Unit of the Hospital das Clinicas of the Faculty of Medicine, Universidade de Sao Paulo. The ADC was calculated by multiplying the time (chronometering) spent by nursing professionals in procedures, object of this study, by the unit cost of direct labor adding to the cost of materials and solutions/drugs. For the purposes of the calculation, the Brazilian currency (R$) was used. Results: Based on 1354 observations related to 12 procedures often performed in BICU, it was obtained the ADC of R$ 1.88 (SD=1.04) for \"control the vital signs\"; R$ 28.78 (SD=69.74) for \"administering medication intravenously\"; R$ 16.97 (SD=7.92) for \"measurement of diuresis\"; R$ 2.68 (SD=1.20) to \"check Capillary Blood Glucose\"; R$ 6.71 (SD=2.20) for \"drug administration via nasogastric tube\"; R$ 50.07 (SD=11.89) for \"patient intimate hygiene; R$ 3.64 (SD=2.01) for \"food aid\"; R$ 55.88 (SD=18.98) for \"bed bathing/make the bed\"; R$ 287.11 (SD=372.87) for \"dressing\"; R$ 6.65 (SD=2.09) for \"oral hygiene\"; R$ 3.13 (SD=1.08) for \"oral drug administration\" and R$ 8.51 (SD=1.79) for \"drug administration subcutaneously\". Conclusion: The calculation of the resource costs spent in the procedures required by critical burn patients, in ICU, justify the decision making of subsidizing its allocative efficiency, avoiding the occurrence of waste and, when possible, indicating control strategies/minimizing strategy costs without impairing the quality of nursing care

Over 13 million adolescents sustain traumatic injuries yearly, resulting in functional disability, disfigurement, psychosocial problems and fractures. These fractures are increasingly being treated with orthopedic external fixation devices (EFDs). The purpose of this study was to describe the experience of traumatically injured adolescents treated with EFDs. The 4 aims of the study focused on the circumstances leading to the traumatic event, experiences following the traumatic event, the impact of EFD treatment, and adolescents’ role in pin-care self-management, which is crucial to preventing infection. This longitudinal, qualitative descriptive study used purposive sampling to recruit 5 male and 4 female adolescents, 13-20 years old, from a New England level-1 trauma center. Participants were injured in motor vehicle crashes (including an all-terrain vehicle), falls, by gunshot, trampoline and football trauma. Interview questions were framed by two themes from a study of adult recovery from physical injury, i.e., the event and fallout. Participants were interviewed within days of the injury, 2 weeks after returning home, and within one month of EFD removal. Data were coded from verbatim transcripts using NVIVO and organized into themes guided by the principles of qualitative analysis. An overarching theme of “old self no more; forever changed” emerged from 26 interviews. The participants’ experience affected all tasks of adolescence: independence from parents, accepting body image, peer relations, and forming an identity. Major themes included “what risk?”, regarding circumstances leading to the traumatic event, mastering the environment, was 2 part first, processing the event, where determining fault and realizing everything has changed, they were ambivalently lucky, and not invincible. Secondly “suck it up and deal with it”, where strategies to deal with traumatic injury emerged (i.e. medication, channeling outlets, and slow caution). EFD experience revealed “Space age robot” and “they’ll do it themselves” as emergent themes. EFDs were described as painless, robotic, no big deal and necessary. One draining pin-site was noted. Findings related to use of self-administered analgesics, information technology, recall of detail, and gender differences in coping may lead to future interventions. These findings lay the groundwork for future studies that may improve care of adolescents during acute recovery from traumatic injury.

The purpose of this study was to conduct an integrated review of the literature examining the use of non-pharmacologic pain management strategies in premature neonates and to explore the relationship between health outcomes and time to discharge from the neonatal intensive care unit (NICU). Non-pharmacologic pain management strategies include human touch, facilitated tucking, non-nutritive sucking, and kangaroo care. A systematic review of the literature was conducted from multiple online databases. Peer reviewed, English-language articles containing the keywords ‘pain management’, ‘neonatal intensive care unit’, and ‘non-pharmacologic’ were included for synthesis. Exclusion criteria included articles with a focus on infants not admitted to the NICU and infants with a gestational age greater than 37 weeks. Results revealed positive outcomes when alternative pain-relieving methods, rather than drug therapy, were used in the NICU. A majority of articles suggest facilitated tucking is very successful in lowering a preterm infant’s pain. However, facilitated tucking alone was significantly less effective in relieving procedural pain compared to facilitated tucking in combination with oral sucrose administration. Kangaroo care and gentle human touch also proved to reduce physiologic and behavioral signs of pain in neonates. The literature reveled an overall positive outcome when non-pharmacologic pain interventions are used in the NICU, with some behavioral interventions showing better efficacy than others at relieving neonatal pain. None of the reviewed articles explored the relationship between reduced length of stay and parameters assessing health outcomes based on pain control in neonates. The literature indicated nurses play a significant role in the use of pain-relieving methods in neonatal populations. Implications for future research that focuses on successful behavioral based pain management strategies that assists in refining neonatal pain relief would be of great benefit to improving health outcomes related to infant survival after discharge from the NICU.

Introduction: Acute respiratory distress syndrome (ARDS), seen in critically ill patients, is a disease process that affects the lungs and directly impacts a patient’s oxygenation. Despite treatment, patients often die of ARDS secondary to systemic complications. Prone positioning has been introduced as a treatment to improve the outcomes of ARDS patients. This thesis summarized and critiqued recent literature on the outcomes of prone positioning in ARDS patients. Methodology: An initial literature search was conducted using CINAHL Plus with Text, Medline, Cochrane Database of Systematic Reviews, and US National Library of Medicine National Institutes of Health. Multiple search terms were used. Inclusion criteria consisted of peer reviewed research articles, academic journal articles, and evidence-based research or practices published within the last ten years. All studies included adult subjects and were published in the English language. Studies that did not address patient outcomes such as mortality, length of stay, or hemodynamic oxygenation were excluded from the review. Results: The review of literature contains one meta-analysis and two studies. Data indicated that prone positioning was statistically significant in reducing mortality when performed in sessions of 12 hours or longer (p=0.05). Hemodynamic oxygenation improved significantly after at least 48 hours of implementing prone positioning. There was no trend in the length of stay or duration in mechanical ventilation whether supine or prone positioning was used. Complications such as endotracheal tube dislodgement, incidence of ventilator-associated pneumonia, and pressure ulcers were reported in both supine and prone position with an increased risk of pressure ulcers and endotracheal tube obstruction in the prone position groups. Conclusions: Findings support a benefit in patient outcomes in patients placed in prone position with ARDS. Mortality was reduced when prone sessions lasted longer than 12 hours possibly due to the improvement in patient oxygenation 48 hours after initiation of prone positioning intervention. Further research is needed to solidify these findings and establish guidelines and optimal procedural methods to maximize patient outcomes and lower the incidence of patient complications.

Within the health care, many medical professionals know about the critical time restraints for provisions of care within their discipline, but do not know the term "The Golden Hour". The Golden Hour is a term indicating the universal time restraint found within every area of health care and more specifically, every area of nursing. The term and concept represented by it should be recognized to better the outcomes of our patients. Although the Golden Hour typically indicates a 60-minute period of time, various settings recognize shorter and longer periods during which specific actions must be taken to assure positive patient outcomes. To meet this aim, this thesis will review studies related to outcomes as associated with time critical interventions that could be categorized by "The Golden Hour". To meet the goal, a search of CINAHL, MEDLINE, PsychINFO, and ScienceDirect databases was conducted. Findings of the search revealed that while the term is not widely used, the concept of time sensitive care is found in many areas of Health Care and, specifically, within multiple sub-disciplines of nursing.

Family Presence During Resuscitation (FPDR) remains controversial and is not consistently implemented during resuscitation events or invasive procedures. Evidence has demonstrated positive outcomes produced by implementation of FPDR; such as, decreased rates of post-traumatic stress symptoms, decreased symptoms of anxiety, and depressive symptoms were not significantly different. Unfortunately, use of FPDR in the acute care setting is not widely accepted or readily implemented. The primary purpose of this integrative literature review is to evaluate the use of FPDR in the acute care setting. The secondary purpose is to evaluate the health care professional's level of perceived value associated with the outcome of having family present during resuscitation. A systematic literature search was conducted using multiple databases for relevant articles in the English language between 2006 to 2017, including Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), Elton B. Stephens Co. Host (Ebsco Host), Medical Literature On-line (Medline), Psychological Information Database (PsychINFO), and PubMed. Search terms included 'family presence during resuscitation', 'family presence', 'pediatrics', 'nurse perceptions', and 'perceptions'. Ten of the nineteen articles suggest the use of FPDR leads to positive outcomes such as decreased post-traumatic symptoms, and decreased anxiety for family members. The use of FPDR can enhance family members' understanding of resuscitation efforts and involves them in their loved one's care. This integrative review indicates the implementation of FPDR can provide benefits for family members of those undergoing CPR and invasive procedures; although the perceptions of the healthcare team remain the barrier to its use.

In-patient deterioration is a global phenomena and timely recognition and action improves outcome. Intensive care facilities are scarce and expensive and therefore patient care must be optimal. A retrospective health record analysis was used for this study. The findings indicated that nursing personnel do not recognize patient deterioration timeuously. However, the implementation of an outreach team and clinical markers training program improved the recognition of patient deterioration in general wards with three hours and 40 minutes. It is recommended to implement a comprehensive hospital program that addresses the basic knowledge and skills of general ward personnel to observe, recognize, assess and intervene to patients with clinical deterioration. Together with an extensive training program, a basic physiological parameters guideline to activate a team of experts to the bedside, such as an Outreach team, assist nursing personnel to recognize and manage those patients timeuously and ensure treatment in an appropriate level of care. / Health Studies / M. A. (Health studies)

Thesis (MPhil (Curriculum Studies))--Stellenbosch University, 2008. / Background to the study: The Critical Care nursing programme at the Faculty of Health Sciences (Stellenbosch University) is a one-year programme. The practical component consists of practical procedures and case presentations. Students have limited time available in the clinical areas to reach competency in the practical skills. Students tend to use the majority of the clinical teaching time available to reach competency in these practical procedures, rather than discussing the patient and learning the skills to integrate and understand the patient’s condition and treatment, which they can acquire by doing case presentations. The end result of this misuse of clinical contact time is that some of the students, by the end of their programme, still have difficulty to integrate a patient’s diagnosis and treatment regime, although they have managed to complete the expected practical procedures. Summary of the work: A case study design was used. I wanted to investigate whether one could make use of simulation and the Clinical Skills Centre (CSC) to complete the majority of the practical procedures so that more time would be available in the clinical areas for the students to do case presentations. The study focuses on describing how the tutors and students involved experienced the use of simulation, as well as how it impacted on the available teaching time in the clinical areas. Conclusions and recommendations: Some of the most important issues that were highlighted in the study and needs to be mentioned are the following: · The students highly valued supervision by a Critical Care tutor when practising their skills in the CSC. · Students indicated that they valued the opportunity to practise some of the more risky procedures in simulation, because it presents no risk to patients. · Case presentations seem important to be added to the CSC’s practical sessions in order to attempt making the practical simulated scenarios even more realistic. · The teaching at the bedside in the clinical areas used to be done somewhat ad hoc. With the teaching in the CSC now being much more structured, this necessitates the teaching at the bedside to be revisited and to be structured to a certain extent. Summary of the results: The information obtained from the Critical Care tutors and the students indicated that these two groups were largely in agreement that simulation seems to be valuable and can effectively be used in a Critical Care nursing programme.

Introdução: Os pacientes críticos necessitam de um acesso venoso central (AVC) para realização de terapia intravenosa (TIV) prolongada. Dentre as opções de AVC, o cateter central de inserção periférica (CCIP) vem conquistando espaço, progressivamente, nas organizações hospitalares brasileiras. A passagem de CCIP requer recursos humanos especializados, materiais, medicamentos e soluções específicas tornando-se fundamental a apuração dos custos envolvidos para subsidiar a eficiência alocativa destes insumos. Objetivo: Identificar o custo direto médio (CDM) do procedimento de passagem de CCIP, realizado por enfermeiros, em uma Unidade de Terapia Intensiva Pediátrica e Neonatal (UTIPN). Método: Trata-se de pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso único. O procedimento objeto de estudo foi estruturado em três fases: pré-inserção do cateter, inserção do cateter e pós-inserção do cateter. A amostra constituiu-se da observação não participante de 101 passagens de CCIP na UTIPN. O CDM foi calculado multiplicando-se o tempo (cronometrado) despendido por enfermeiros e técnicos de enfermagem pelo custo unitário da mão de obra direta (mob), somando-se ao custo dos materiais e soluções. A moeda brasileira real (R$), utilizada originalmente nos cálculos, foi convertida para a moeda norte-americana dólar (US$). Resultados: Obteve-se o CDM do procedimento ( ) de passagem de CCIP correspondente a US$ 226.60 (DP=82.84), variando entre US$ 99.03 e US$ 530.71, com mediana de US$ 313.21. O CDM com material, US$ 138.81(DP=75.48), e o CDM com mob de enfermeiro, US$ 78.80 (DP=30.75), foram os valores mais expressivos para a composição do . Os kits de cateteres corresponderam aos itens de maior impacto na composição do CDM com material e de maior custo unitário, com destaque para cateter epicutâneo + introdutor, kit - 2FR/duas vias (US$ 208.82/unidade); cateter epicutâneo + introdutor, kit - 2FR (US$ 74.09/unidade) e cateter epicutâneo + introdutor, kit - 3FR (US$ 70.37/unidade). O CDM com mob da equipe de enfermagem foi mais elevado na Fase 2: inserção do cateter (US$ 43.26 - DP=21.41) e na Fase 1 pré-inserção do cateter (US$ 37.96 - DP=14.89). Houve predomínio do CDM com mob de enfermeiro, especialmente pelo protagonismo dos enfermeiros executantes, US$ 40.40 (DP=20.58) e US$ 34.05 (DP=15.03), respectivamente. Conclusão: Este estudo de caso além de propiciar a mensuração do de passagem de CCIP, conferiu visibilidade aos insumos consumidos na perspectiva de contribuir com o seu uso racional. Favoreceu inclusive a proposição de estratégias visando incrementar a TIV prolongada, por meio do CCIP, e, consequentemente, auxiliar na contenção/minimização de custos e na diminuição de custos intangíveis aos pacientes. / Introduction: Critical patients require central venous access (CVA) for prolonged intravenous (IVT) therapy. Among the AVC options, the peripherally inserted central catheter (PICC) has been progressively gaining a position into the Brazilian hospital organizations. The passage of PICC requires specialized human resources, materials, medicines and specific solutions, being crucial to calculate the costs involved to subsidize the allocative efficiency of these inputs. Objective: To identify the average direct cost (ADC) of the PICC procedure performed by nurses, in a Pediatric and Neonatal Intensive Care Unit (PNICU). Method: This is a quantitative, exploratory-descriptive single-case study. The procedure was arranged into three phases: \"pre-insertion of the catheter\", \"insertion of the catheter\" and \"post-insertion of the catheter\". The sample consisted of the non-participant observation of 101 PICC passages in the PNICU. The average was calculated by multiplying the time (measured) spent by nurses and nursing technicians by the unit cost of direct labor (dl), adding up to the cost of materials and solutions. The Brazilian Real currency (R $), originally used in the calculations, was converted to the US dollar currency (US $). Results: The ADC of the PICC procedure ( )) corresponded to US $ 226.60 (SD = 82.84), ranging from US $ 99.03 to US $ 530.71, with a median of US $ 313.21. ADC regarding material was US $ 138.81 (SD = 75.48), and ADC regarding nurse dl was US $ 78.80 (SD = 30.75) which were the most significant values for the ( ) composition. The catheter kits corresponded to the items with the highest impact in the composition of the ADC regarding material and with a higher unit cost, with emphasis on epicutaneous catheter + introducer, kit - 2FR / two tracks (US $ 208.82 / unit); Epicutaneous catheter + introducer, \"kit\" - 2FR (US $ 74.09 / unit) and epicutaneous catheter + introducer, \"kit\" - 3FR (US $ 70.37 / unit). The ADC regarding dl of the nursing team was higher in Phase 2: \"insertion of the catheter\" (US $ 43.26 - SD = 21.41) and in Phase 1 \"pre-insertion of the catheter\" (US $ 37.96 - SD = 14.89). There was a predominance of the ADC regarding nurse dl, especially due to the leading role of the nurse practitioners, US $ 40.40 (SD = 20.58) and US $ 34.05 (SD = 15.03), respectively. Conclusion: This case study, besides providing the measurement of the PICC passage, allowed visibility to the inputs consumed from the perspective of contributing to its rational use. It also favored the proposition of strategies aimed at increasing the prolonged IVT through PICC and, consequently, to contain / minimize costs and reduce intangible costs to patients.

Introdução: A incompatibilidade de medicamento resulta de um fenômeno físico-químico causado pela combinação de dois ou mais medicamentos na mesma solução ou misturados em um mesmo recipiente. Pode ser considerado um erro de medicação pelo potencial de comprometer negativamente o tratamento. Objetivo: Estimar a incidência de incompatibilidades potenciais de medicamentos administrados por via intravenosa e fatores associados em pacientes críticos. Método: Coorte retrospectiva conduzida com pacientes internados nas Unidades de Terapia Intensiva e Semi-intensiva do Hospital Universitário da Universidade de São Paulo. A amostra foi composta por 110 indivíduos adultos hospitalizados, por pelo menos 72 horas, nessas unidades e submetidos à terapia intravenosa. A incompatibilidade potencial de medicamento foi analisada em duplas de medicamentos, utilizando-se a ferramenta Trissel´s TM 2 Compatibility IV, através da base de dados Micromedex 2.0®. A variável dependente foi a ocorrência de incompatibilidade. As variáveis independentes foram idade, sexo, procedência, tipo de internação, tempo de permanência, SAPSII, índice de Charlson, carga de trabalho de enfermagem, condição de alta, modo de infusão, número de medicamentos prescritos e de prescritores. Na análise dos dados utilizaram-se os testes qui-quadrado de Pearson, Exato de Fisher, Kruskal-Wallis, modelo de análise de variância ANOVA e regressão logística, com significância de p 0,05. Resultados: A incidência de incompatibilidade potencial de medicamentos foi de 2,7%. Foram prescritos 72 tipos diferentes de medicamentos que formaram 565 duplas, destas, 44,9%, foram compatíveis e 8,8%, incompatíveis. O aparecimento de precipitação (50,0%) foi a alteração físico-química mais identificada, após as combinações via dispositivo em Y. Na frequência de aparecimento, as duplas de medicamentos incompatíveis formadas por fenitoína (32,0%), diazepam (14,0%), midazolam (10,0%) e dobutamina (8,0%) foram as mais identificadas. Cerca de 70% dos pacientes receberam medicamentos prescritos a critério médico, principalmente durante o período noturno. Os fatores de riscos associados à incompatibilidade foram procedência (RC: 1,506; IC: 0,327 - 6,934); tempo de permanência prolongado nas unidades (RC: 1,175; IC: 1,058 - 1,306); maior número de medicamentos prescritos (RC: 1,395; IC: 1,091 -1,784) e carga elevada de trabalho de enfermagem (RC: 1,060; IC: 1,010 -1,113). Conclusão: O número de medicamentos prescritos aos pacientes críticos, em decorrência da gravidade clínica, aumenta exponencialmente a ocorrência de incompatibilidade e, os expõe a graves consequências. Embora haja outros estudos que identifiquem as incompatibilidades potenciais, observa-se, no cotidiano das unidades críticas, a repetição de rotinas que comprometem a segurança do paciente. A incompatibilidade poderá ser teoricamente diminuída, quando houver ênfase nas medidas preventivas e na contínua educação da equipe multidisciplinar. / Introduction: Drug incompatibility results from a physicochemical phenomenon caused by the combination of two or more drugs in the same solution or mixed in a single container. It can be considered a medication error due to its potential to compromise the treatment. Objective: To estimate the incidence of potential incompatibilities of drugs administered intravenously and associated factors in critically ill patients. Methods: Retrospective cohort study conducted with patients in Intensive and Semi-intensive Care Units at the University Hospital of the University of São Paulo. The sample consisted of 110 adults hospitalized for, at least 72 hours, in these units and submitted to intravenous therapy. The potential drug incompatibility was analyzed in pairs of drugs, using the TM Trissel\'s 2 Compatibility IV tool through Micromedex 2.0® database. The dependent variable was the occurrence of incompatibility. The independent variables were age, gender, origin, type of admission, length of stay, SAPSII, Charlson index, nursing workload (NAS), discharge condition, infusion mode, number of prescription drugs and prescribers. To analyze the data we used the chi-squared Pearson tests, Fisher Exact test, Kruskal-Wallis, ANOVA model and logistic regression, with significance p 0.05. Results: The incidence of potential incompatibility of drugs was 2.7%. Seventy-two 72 different types of drugs were prescribed forming 565 pairs of which 44.9% were compatible and 8.8%, incompatible. The precipitation onset (50.0%) was most identified physical-chemical change after the combinations via device Y. In frequency of appearance, the pairs of drugs formed by phenytoin (32.0%), diazepam (14.0%), midazolam (10.0%) and dobutamine (8.0%) were the most identified. About 70% of the patients received prescription drugs to medical criteria, especially during the night. Risk factors associated with the incompatibility were origin (OR: 1.506; CI: 0.327 to 6.934); prolonged length of stay in the units (OR: 1.175; CI: 1.058 to 1.306); greater number of prescribed medications (OR: 1.395; CI: 1.091 -1.784) and high nursing workload (OR: 1.060; CI: 1.010 -1.113). Conclusion: The number of prescription drugs to critically ill patients, due to the clinical severity, exponentially increases the occurrence of incompatibility and exposes them to serious consequences. Although there are other studies that identify the potential incompatibilities, we observe, in the daily life of critical units, repeating routines that compromise patient safety. Incompatibility can be theoretically reduced when there is emphasis on preventive measures and continuous education of the multidisciplinary team