Bakgrund: Lex Maria är ett avvikelsehanteringssystem vars mål är främjandet av patientsäkerheten. All hälso- och sjukvårdspersonal har anmälningsskyldighet enligt Lex Maria. I samband med Lex Maria-anmälan ska händelseanalys genomföras och nya åtgärder tillämpas. Syfte: Studiens syfte var att sammanställa Lex Maria-anmälningarna från fyra akutsjukhus i södra Sverige mellan åren 2009-2011 och betydelsen för patientsäkerheten. Metod: Studien har en kvantitativ metod med retrospektiv inriktning. Datamaterial kom från Socialstyrelsen registerdatabas. Med hjälp av kvalitativ innehållsanalys delades anmälningar in i kategorier. Resultat: Resultatet sammanställer anmälningarna efter typ av anmälning. Antalet anmälningar mellan 2009-2011 inom Fördröjd diagnos ökade med 175 %, Fördröjd behandling ökade med 50 %, Komplikation vid operation minskade med 56 % ochMedicintekniskt handhavandefel minskade med 25 %. Diskussion: Orsak till ökning avFördröjd diagnos och Fördröjd behandling kopplas till överbeläggningar och hur detpåverkar patienter. Minskning av Komplikation vid operation förklaras med utveckladeoperationsrutiner och kunskap. Minskning av Medicintekniskt handhavandefel kopplas tillförbättrade rutiner vid läkemedelshantering. Lex Marias betydelse för patientsäkerhetendiskuterades tillsammans med åtgärdsförslagen. Slutsats: Lex Maria-anmälningar bidrar tillarbete där målet är säkrare patientvård. För att kunna förbättra vården och minska antaletvårdskador är det viktigt att hälso- och sjukvårdspersonal följer sin skyldighet och anmälerriskfyllda händelser. / Background: Lex Maria is a system that reports health care errors and increases patient safety. All health care professionals are obligated to report health care errors by Lex Maria. Reports from Lex Maria-complaints are analysed and new routines are presented to prevent further errors. Aim: The aim of this study was to compile Lex Maria-reports from four acute care hospitals in southern Sweden between the years of 2009-2011 and it’s importance for the patient safety. Method: The study was a quantitative method with a retrospective approach. Data were collected from records of the Swedish National Board of health and Welfare. Data was categorized with a qualitative content analysis. Results: The result compiles notifications by type of notification. The number of reports of Delayed diagnosis increased by 175%, Delayed treatment increased by 50%, Complication during surgery decreased by 56% and Medical Technical failure decreased by 25%. Discussion: Possible reasons for the increase in Delayed diagnosis and Delayed treatment may be linked to overcrowding and its effect on patients. Reduction of Complications during surgery can be explained by improved surgical procedures and increased treatment knowledge. Reduction of Medical Technical failure can in turn be linked to improved procedures when administrating medications. Lex Maria-reports importance for patient safety were discussed along with proposals of changes in routines. Conclusion: Lex Maria-reports contribute in process with the purpose to increase the patient safety. In order to improve care and reduce health damage, it is of importance that health care professionals follow their duty and report critical events.

Syftet med den här uppsatsen har varit att undersöka hur personer som är hemlösa och missbrukar blir behandlade i sjukvården. Hur tycker de att de har blivit bemötta och har de fått den hjälp de har efterfrågat? Utifrån detta resultat har jag tittat på vilka förutsättningar vården har att utveckla en bra behandling och bemötande. Jag har intervjuat 25 hemlösa personer med kvalitativ metod. Den innebär att alla har fått samma frågor så att svaren går att jämföra. Samtidigt har det funnits utrymme för egna reflektioner och berättelser. De flesta menar att de blir både bra och dåligt behandlade, men att de sällan får den hjälp de efterfrågar. Inom vården har enskilda sköterskor och läkare fått beröm för sina insatser, men flera intervjupersoner vittnar om att personalen har ont om tid och missar allvarliga diagnoser. Över 80 procent anser att hemlösa och missbrukare behandlas sämre som grupp. Intervjupersonerna berättar om missade diagnoser, att de hamnar efter i kön på akuten och att de får höra nedsättande kommentarer på sjukhusen. De menar att utseende, dagsform och social status spelar in i bemötandet. Utifrån dessa svar har jag intervjuat experter på vård av hemlösa personer och missbrukare. Experterna bekräftar personernas berättelser. De säger att bristerna i bemötande och hjälp kan bero på att personalen har ont om tid och kan för lite om målgruppen. Jag har jämfört resultatet med stämplingsteorin och organisationsteorin. Stämplingsteorin visar att det ofta uppstår en motsättning mellan de som känner sig som avvikare och det etablerade samhället. Organisationsteorin visar att det byggs upp en intern gruppkultur i slutna organisationer som sjukhus och att det sättet att jobba ibland krockar med verkligheten. Den tidigare forskningen visar att det finns mycket att förbättra när det gäller hemlösa personers möte med vården: Överdödligheten är två till sex gånger högre i gruppen. Många dör i behandlingsbara sjukdomar som lunginflammation. Forskningen bekräftar också personernas ovilja att gå till läkare. Till sist visar forskningen att man kan uppnå betydligt bättre resultat i sjukvården genom andra sätt att jobba.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-01-30T11:07:42Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Elisete R R de B Sant'Ana - 2014.pdf: 2400788 bytes, checksum: 5e93bcef0e0d0f530a49c9776a2ba245 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-30T14:20:15Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Elisete R R de B Sant'Ana - 2014.pdf: 2400788 bytes, checksum: 5e93bcef0e0d0f530a49c9776a2ba245 (MD5) / Made available in DSpace on 2015-01-30T14:20:15Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Elisete R R de B Sant'Ana - 2014.pdf: 2400788 bytes, checksum: 5e93bcef0e0d0f530a49c9776a2ba245 (MD5) Previous issue date: 2014-02-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The human resources formation in the health care area has been suffering from a series of reconstructions with the purpose of supplying the failures related to solving the population health problems. One of the current challenges is the competent formation of the health care staff, in a way that they are able to act in emergency and urgency situations. And in this scenario, the training hospitals are of utmost importance as they receive a great number of students to be trained. In this context, there was an option to develop a case study with a qualitative approach, with the objective of analyzing the tutorship in the perspective of fifteen doctors who worked in and emergency and urgency health care system from a Federal Teaching Institution in Goiânia-Goiás. The data were collected from January 2013 to March 2013, through very close questionnaires and also semi-structured interviews, followed by a guide with open questions. For the analysis of the data collected in the interviews, Bardin (2009) technique of content analysis was used. From the data analysis, it was established that doctors consider tutoring a key element in the learning process in a practical way and it was also established that being a tutor means provide students the knowledge but also be responsible for their future formation. There were many tutoring activities mentioned, most ofthem related to clinic and surgery cases. Another outcome was that the tutoring enables the tutor to continue developing his or her studies, learning through their pupilswho also can be benefited in becoming well-trained professionals. The interest, a good formation in theories, and a good rapport between the staff was also highlighted as a key to help achieve the goal. On the other hand, the lack of structure, the little time awarded to procedures, the teachers’ lack of communication among themselves, tutors and students, the double-shift involving teaching and preceptor and the lack of tutor training were reported as negative points that hinder the process. In conclusion, in the doctors’ point of view, the tutoring contributes in the formation of the future professional. However, there are many difficulties facing this area. Some structural changes have been developed in order to make the process more efficient such as applying more time. But, there is also a great need of improvement in the emergency and urgency areas, and there is also a search for projects focused on training tutors allied to the Institutions for Graduation Courses related to the health care area. / A formação de recursos humanos na área da saúde tem sofrido ao longo dos anos uma série de reestruturações com o objetivo de suprir as carências relacionadas à resolução dos problemas de saúde da população. Um dos desafios atuais é a formação de profissionais da saúde competentes para atuarem em emergência e urgência, daí a importância dos hospitais de ensino que recebem anualmente grande número de estudantes neste cenário. Nestecontexto, optou-se por desenvolver um estudo de caso com abordagem qualitativa com o objetivo de analisar a preceptoria na perspectiva de quinze médicos em um serviço de emergência e urgência hospitalar de uma Instituição Federal de Ensino Superior em Goiânia, Goiás. Os dados foram coletados de janeiro a março de 2013, por meio de questionário fechado e de entrevista semiestruturada, guiada por umroteiro com perguntas abertas. Para a análise dos dados obtidos nas entrevistas foi utilizada a técnica da análise de conteúdo proposta por Bardin (2009). A partir da análise dos dados, constatou-se que os médicos consideram a preceptoria fundamental para o processo de ensinoaprendizagem na prática e referiram que ser preceptor significa transmitir conhecimentos e se responsabilizar pela formação de futuros profissionais. Foram descritas inúmeras atividades de preceptoria, sendo a discussão de casos clínicos e cirúrgicos a mais citada. Relataram também que a preceptoria contribui para o preceptor continuar estudando e aprendendo e também para o estudante na formação de profissionais qualificados. Destacaram, como facilidades, o interesse e a boa formação teórica do estudante e o bom relacionamento com a equipe multiprofissional. Como dificuldades, assinalaram a falta de infraestrutura e de tempo, a pouca comunicação entre docentes, preceptores e estudantes, a dupla atividade de assistência e docência durante o turno de trabalho e a ausência de capacitação para a preceptoria, com consequências negativas e prejuízo na formação do estudante. Conclui-se que na perspectiva de médicos a preceptoria contribui na formação dos futuros profissionais. Entretanto, muitas dificuldades são enfrentadas no exercício desta função. Sugeriram melhorias na infraestrutura e nas condições de trabalho, em especial mais tempo para exercer a função e capacitação.Verificou-se que há necessidade de melhorias na infraestrutura do serviço de emergência e urgência, bem como de elaboração de projetos para capacitação pedagógica dos preceptores em articulação com as instituições formadoras de ensino superior e o serviço de saúde.

Made available in DSpace on 2014-12-17T14:46:41Z (GMT). No. of bitstreams: 1 RodrigoAND_DISSERT.pdf: 4123762 bytes, checksum: 769cd7b343d86a0d219577a0a3bf4575 (MD5) Previous issue date: 2009-10-30 / Exploratory descriptive study, with a quantitative approach and prospective data, performed in Pronto Socorro Cl?vis Sarinho (PSCS), in Natal/RN, aiming to analyze care given by the nursing and medical staff to victims of violence attended to in an emergency hospital in Natal/RN; to identify care given by the nursing and medical staff as viewed by the victims; to compare data observed during the process of care with the victim s view on the care given by the nursing and medical staff; to identify the existing knowledge on violence and the process of caring for victims and its relation with prejudice; to identify obstacles and perspectives for prevention during the process of caring for victims in the emergency services. The population consisted of 97 physicians, 16 nurses, 75 nursing technicians and assistants and 365 victims of violence, with data collected from April to May 2009. Out of 188 professionals, 52.1% are female; 32% were aged 41 to 50; 99.5% had given care to a victim of violence; 90.4% reported to have given care to patients under custody; among these, 17.3% felt prejudice; 55.3% stated they don t provide different care for assaulted victims and assailants, however 44.7% stated they do; 86.7% feel their workplace is unsafe; 61.7% denied the existence of any obstacle and 38.3% reported the existence of obstacles; among these, 26.1% referred to inadequate facilities; 37.8% believe reinforcing security and professional training are the main solutions. Among the 365 researched violence victims, 82.2% were assaulted; male (69.6%); aged 18 to 24 (24.9%); hailing from the Greater Natal area (89.9%); on 19.7% the event happened on Saturday; during the night (48.8%); victim of physical assault (61.4%); produced by body force (27.7%); 24.4% were injured in the head and neck. 57% had used some drug, among which alcohol was predominant (75.5%). On 621 observations performed during the victim care process, when compared to the report of assaulted victims, there was a statistical difference, at 5% significance level, regarding reception, resistance from the professionals, questioning about the violent event, providing of guidance, interaction with the patient and the understanding of receiving proper care, and care resolution. In comparisons involving the observed and the assailant victims reports, there was a statistical difference regarding the resence of resistance from the professionals, performance of necessary procedures and the nteraction with the patient and the understanding of receiving proper care and 58.1% reported the nursing team was the one that provided the best care. We conclude that professionals had lready given care to assailant patients, acknowledge the importance of knowing how the vent took place and acquired this preparation during their practice. The most often referred bstacles that hinder assistance were: inadequate facilities, material deficit and lack of rofessional preparation. As solutions for these problems, they cited the reinforcement of ecurity and professional training / Estudo explorat?rio descritivo, com abordagem quantitativa e dados prospectivos, realizado no Pronto Socorro Cl?vis Sarinho (PSCS), em Natal/RN, com vistas a analisar o cuidado prestado pela equipe de enfermagem e m?dica, ?s v?timas de viol?ncia atendidas em um hospital de urg?ncia em Natal/RN; identificar na vis?o das v?timas o cuidado prestado pela equipe de enfermagem e m?dica; comparar os dados observados durante o processo de cuidar com a vis?o da v?tima sobre o cuidado prestado pela equipe de enfermagem e m?dica; identificar o conhecimento existente sobre viol?ncia e o processo de cuidar ?s v?timas e sua rela??o com o preconceito; identificar os obst?culos e as perspectivas de preven??o durante o processo de cuidar ?s v?timas nos servi?os de urg?ncia. A popula??o constou de 97 m?dicos, 16 enfermeiros, 75 t?cnicos e auxiliares de enfermagem e 365 v?timas de viol?ncia, com dados coletados de abril a maio de 2009. Dos 188 profissionais, 52,1% s?o do sexo feminino; 32% tinham entre 41 e 50 anos; 99,5% haviam cuidado de alguma v?tima de viol?ncia; 90,4% afirmaram j? ter cuidado de paciente custodiado; dentre estes, 17,3% sentiram preconceito; 55,3% afirmaram que n?o cuidam de uma v?tima agredida diferente de uma agressora, por?m 44,7% afirmaram que sim; 86,7% acham seu local de trabalho inseguro; 61,7% negaram a exist?ncia de algum obst?culo e 38,3% afirmaram a exist?ncia de obst?culo; dentre estes, 26,1% referiram-se ao espa?o f?sico inadequado; 37,8% acham que o refor?o na seguran?a e a capacita??o dos profissionais, s?o as principais solu??es. Das 365 v?timas de viol?ncia pesquisadas, 82,2% foram agredidas; do sexo masculino (69,6%); tinham entre 18 a 24 anos de idade (24,9%); procedentes da Grande Natal (89,9%); em 19,7% o evento ocorreu no s?bado; no hor?rio noturno (48,8%); v?tima de agress?o f?sica (61,4%); produzida por for?a corporal (27,7%); 24,4% sofreram les?es na cabe?a e pesco?o; 57% haviam usado alguma droga, destes, predominando o ?lcool (75%). Das 621 observa??es feitas durante o processo de cuidar das v?timas, quando comparadas ao relato das v?timas agredidas, houve diferen?a estat?stica, ao n?vel de signific?ncia de 5%, em rela??o ao acolhimento, presen?a de resist?ncia por parte dos profissionais, questionamento sobre o evento violento, fornecimento de orienta??es, intera??o com o paciente e entendimento de ser bem atendido, e resolutividade do atendimento. Nas compara??es entre o observado e o relato das v?timas agressoras, houve diferen?a estat?stica, quanto ? presen?a de resist?ncia por parte dos profissionais, realiza??o dos procedimentos necess?rios e quanto a intera??o com o paciente e entendimento de ser bem atendido e 58,1% das v?timas relataram que a equipe de enfermagem foi a que melhor atendeu. Conclu?mos que os profissionais j? haviam cuidado de pacientes agressores, reconhecem a import?ncia de conhecer como se deu o evento e adquiriram esse preparo em suas pr?ticas. O cuidado durante as observa??es e no relato das v?timas, este sofre interfer?ncia dos sentimentos de medo ou preconceito em rela??o as v?timas agressoras e isto foi percebido por elas. Os obst?culos mais referidos que dificultam a assist?ncia, foram: o espa?o f?sico inadequado, o d?ficit de materiais e o despreparo dos profissionais. Como solu??es desses problemas, citaram o refor?o na seguran?a e capacita??o dos profissionais