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No. of bitstreams: 2 Dissertação - Alessandra Nogueira de Sousa Santos - 2015.pdf: 912725 bytes, checksum: bdbd00162d2c8005c538a1728cfd0dfa (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-07-30 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Patient safety in health services is a priority issue at the World Health Organization. Understanding the importance of this approach, this study aimed to analyze the risks in the health care of patients seen in non-hospital units of emergency and urgency. It is a descriptive research with a qualitative approach. Fieldwork was carried out with the nursing team through semi-structured individual interviews and opted for the content analysis. Respondents reported several factors that endanger the patients like human resources, material and physical assistance and operational processes. On human resources, the nursing team mentioned: unpreparedness of the medical and nursing team in responding to emergencies and emergencies related to insufficient training and lack of Continuing Education in services; shortage of doctors, and nursing staff and work overload. They reported the need for team downsizing and continuing education, to minimize risks related to work overload and lack of technical and scientific preparation. The material and physical resources were considered inadequate and insufficient in all units. However, half of the units assessed showed better working conditions in relation to physical resources. As for the operational processes, it stands out the scarce filing within the emergency block; improper operation of Material and Sterilization Center and how to identify patients were listed as insufficient for safe care. They reported errors and incidents with patients in the labor process, with emphasis on: medication administration errors, damage without incident (falls) and the occurrence of adverse events such as death, aspiration, member of mutilation and traumatic brain injury. It was found that these are related to insufficient and inadequate human, material and physical and interaction between the entire systems. The results pointed to the need for risk management in the units, according to the current legislation, with a view to patient safety. / A segurança dos pacientes em serviços de saúde é questão prioritária na Organização Mundial de Saúde. Entendendo a importância desta abordagem, este estudo objetivou analisar os riscos no cuidado à saúde de pacientes atendidos nas Unidades Não Hospitalares de Atendimento às Urgências e Emergências. Trata-se de pesquisa descritiva com abordagem qualitativa. O trabalho de campo foi realizado com a equipe de enfermagem por meio de entrevistas individuais semiestruturadas e optou-se pela análise de conteúdo. Os entrevistados relataram vários fatores que colocam em risco os pacientes, estando relacionados aos recursos humanos, materiais e físicos e aos processos operacionais assistenciais. Sobre os recursos humanos, a equipe de enfermagem mencionou: despreparo da equipe médica e de enfermagem no atendimento às urgências e emergências, relacionado à insuficiência na formação e ausência da Educação Permanente nos serviços; déficit de médicos e da equipe de enfermagem e sobrecarga de trabalho. Relataram a necessidade de redimensionamento de pessoal e da educação permanente, para minimização de riscos relacionados à sobrecarga de trabalho e a falta de preparo técnico-científico. Os recursos materiais e físicos foram considerados inadequados e insuficientes em todas as unidades. Entretanto, a metade das unidades avaliadas apresentaram melhores condições de trabalho no que se refere aos recursos físicos. Quanto aos processos operacionais, destaca-se a escassa protocolização dentro do bloco de urgência; o inadequado funcionamento do Centro de Material e esterilização e a forma de identificação dos pacientes foram mencionados como insuficientes para o cuidado seguro. Relataram erros e incidentes com pacientes no processo de trabalho, com destaque aos: erros de administração de medicamentos, incidentes sem danos (quedas) e a ocorrência de eventos adversos como óbito, broncoaspiração, mutilação de membro e trauma crânio-encefálico. Verificou-se que estes se relacionam à insuficiência e inadequação dos recursos humanos, materiais e físicos e na interação entre todo o sistema. Os resultados apontaram para a necessidade de gerenciamento de riscos nas unidades, conforme a legislação vigente, com vistas à segurança dos pacientes.

Atualmente, é uma preocupação a exposição dos pacientes de unidade de terapia intensiva (UTI) a situações da prática clínica que colocam suas vidas em risco. Um agravante para essa exposição são os múltiplos agentes farmacológicos que esses pacientes recebem, aliado ao seu desequilíbrio fisiológico. Entre os principais problemas relacionados à utilização de medicamentos na UTI, estão as interações medicamentosas (IM), que quando não prevenidas ou tratadas prontamente podem provocar danos irreparáveis no paciente. Considerando que o conhecimento sobre IM é uma importante ferramenta para otimização no cuidado em enfermagem, desenvolveu-se este estudo com o propósito de analisar o conhecimento sobre interações medicamentosas de enfermeiros que atuam em unidades de terapia intensiva de adultos de três hospitais públicos de Goiânia - GO. Trata-se de um estudo descritivo, não experimental, com delineamento transversal. A população foi composta por 64 profissionais e a amostra constituiu-se de 51 enfermeiros que aceitaram participar do estudo. Para a coleta de dados construiu-se um instrumento com perguntas de múltipla escolha sobre IM. As alternativas desse instrumento foram extraídas da base de dados do MICROMEDEX® Healthcare Series (1974- 2009). Os dados foram organizados e analisados usando Microsoft Excel 2002. A faixa etária dos enfermeiros variou de 25 a 55 anos, com média de 38,9 anos. O tempo de atuação na enfermagem variou entre 2 e 31 anos, com média de 12 anos. Sobre a formação em farmacologia, 29 (56,9%) enfermeiros informaram ter tido uma formação regular na graduação e 49 (96,1%) expressaram necessidade de capacitação em farmacologia. Quanto ao conhecimento sobre interações medicamentosas na UTI, houve uma relação de acertos e erros praticamente de 50%. Os itens que alcançaram maior número de respostas corretas foram os que abordaram as interações relativas a medicamentos com ação sedativa e analgésica como o caso da dupla fentanila + morfina (86,3%). Os itens que apresentaram maior número de respostas incorretas foram os que abordaram medicamentos de ação antiinfecciosa e anti-hipertensiva. Quanto ao conhecimento do manejo clínico sobre IM, observou-se que metade dos profissionais responderam corretamente em mais de 50% dos itens se destacando, também, os medicamentos de ação sedativa e analgésica. Os resultados evidenciaram a necessidade de melhorar as práticas de cuidados na utilização de medicamentos e chamam a atenção para a importância de atualização dos enfermeiros a respeito dos medicamentos comumente administrados na UTI. Por sua vez, é necessário fornecer apoio aos profissionais para que busquem conhecimentos que sustente a qualidade da prática. Espera-se que as universidades e demais instituições de saúde se sensibilizem quanto à necessidade de difundir e promover um conhecimento farmacológico, adequado aos profissionais de enfermagem tendo em vista que a segurança do paciente na terapia medicamentosa deve ser uma prioridade no contexto da saúde. / Nowadays there is a hard concern on the exposition of intensive care unit (ICU) patients to situations on clinical practice which can put their lives in risk. An aggravating factor for this exhibition is the multiple pharmacological given to these patients, allied to their physiologic disturbs. Among the main troubles related to using drugs in ICU shot out drug interactions (DI). When not prevented or promptly treated, they can cause irreparable damage to the patients. As the knowledge on DI is an important tool for nurse optimizing care, this study was done aiming to analyze information which nurses have on DI in adult ICU in three public hospitals in Goiania- GO, Brazil. It is a descriptive not experimental cross-sectional study. Population was formed by 64 professionals and the sample had 51 nurses who agreed to participate on it. Data collection used an instrument with multiple choice questions on DI. The instrument alternatives were picked up on MICROMEDEX® Healthcare Series (1974- 2009) database. These data were organized and analyzed by Microsoft Excel 2002. The participants ages ranged from 25 to 55 years, mean 38.9 years. The nursing working time ranged from 2 to 31 years, mean 12 years. Concerning to formation in pharmacology, 29 (56,9%) of the nurses informed that they had a regular formation on Graduation Course and 49 (96,1%) expressed need for training in pharmacology. There was a ratio of hits and misses nearly 50% on ICU DI. The items that reached most correct answers were those related to interactions due to sedative and analgesic drugs, as the pair fentanil + morphine (86,3%). Questions that showed most incorrect answers were related to anti infection and anti hypertension drugs. Concerning to clinical manage on DI, 50% of the professionals answered correctly more than 50% of the questions. Sedative and analgesic drugs stood out. The results showed the need of improving care practices on using drugs and they claim attention to the importance of training nurses on drugs commonly administrated on ICU. It is also necessary to support the professionals in order they can look for knowledge that give quality on the practice. One hopes that the universities and other institutions may be touched by the need of spreading and improving a nurse pharmacological knowledge aiming the patient insurance on drug therapy as a priority in health context.

Introduction: The field of patient safety has increased in prominence over the last decade in response to information about the harm that occurs to patients in their journeys through healthcare. Healthcare education has also responded with the introduction of patient safety into many undergraduate and postgraduate curricula. Understanding how to influence healthcare worker behaviours is key to these responses. A vital area is the influence that individual factors have on patient safety behaviours. A model of the influences on patient safety has been proposed (Jackson 2008). There is little research in undergraduates that explores this area. This thesis presents a longitudinal series of studies following a cohort of students through a medical curriculum to answer the primary question: which individual factors influence learning about patient safety? Additionally to this how could these factors be tested in relation to patient safety for medical students? Methods: The series of studies used the Medical Research Council’s framework for the evaluation of complex interventions together with Kirkpatrick’s framework to test a conceptual model of individual factors relevant to medical students in patient safety. Measurable outcomes relevant to medical students needed to be identified for each level in Kirkpatrick’s hierarchy. Study 1 used focus group data, when the students were in year 1 of the curriculum, to identify the conceptual model of the influences on patient safety for medical students at level Kirkpatrick’s level 1. Study 2 tested the conceptual model at level 2a when the cohort of students was in year 3. The study used validated questionnaires to test associations between reflective ability, and knowledge and attitudes to patient safety (Kember 1999, Patey 2007). Study 3 occurred in year five. This study identified associations between reflective ability, safe behaviours and error behaviours, in a standardised simulated ward setting. This was used to establish an association between individual factors and behaviours at level 3. Results: Pilot/Study 1: The interpretation of data from seven focus groups involving sixty students identified reflection and intellectual development as individual factors which influenced learning about error. Study 2: Sixty-one students participated and the questionnaires showed acceptable levels of reliability; Cronbach alpha for the reflection questionnaire was 0.71 and the patient safety questionnaire 0.90. The following significant associations were demonstrated: • Reflection and knowledge of actions to take for patient safety, correlation coefficient 0.44 (p=0.0002). • Critical reflection and intentions regarding patient safety, correlation coefficient 0.40 (p=0.0007) Study 3: Forty-eight students participated and the self-administered questionnaires showed acceptable levels of internal consistency, Cronbach alpha for reflection was 0.70 and for critical reflection was 0.78. The generalisability coefficient for the judgments about safe behaviour was 0.84 and for the error behaviours was 0.52. The following significant association was demonstrated: • Reflection and knowledge based errors, correlation coefficient r -0.30 (p=0.03) There were no significant correlations between critical reflection and error, and reflection and safe behaviour. Discussion: The results of these studies in a single cohort identify reflection as an individual factor that influences error behaviours as shown below add greater depth to Jackson’s model (Jackson 2008). The link between reflective thinking and a reduced rate of knowledge-based errors appears to be associated with thoughtful action with reflection rather than critical reflection transforming meaning frameworks. This series of studies identify an association between reflection and error and give a new perspective on the use of reflection in patient safety education.

Alguns medicamentos são notórios por possuírem risco aumentado de causar danos significativos ou fatais em decorrência de falhas durante o uso, sendo identificados como medicamentos potencialmente perigosos. Conhecimento e informação são aliados na prevenção de tais falhas, contudo, o conhecimento apresentado pelos profissionais de saúde para evitá-las é incerto. Nesse contexto, almejando obter um panorama do conhecimento inerente aos profissionais enfermeiros e formular mecanismos para uma intervenção futura, pesquisadores de nacionalidade chinesa elaboraram e validaram o Questionário de Medicamentos Potencialmente Perigosos, destinado a mensurar o conhecimento pertinente à prática envolvendo estes medicamentos. Dessa forma, o objetivo deste trabalho foi traduzir para a língua portuguesa brasileira e adaptar culturalmente o Questionário de Medicamentos Potencialmente Perigosos, verificando sua aplicabilidade no contexto brasileiro. Tratou-se de uma pesquisa metodológica, cujo rigoroso processo de tradução e adaptação transcultural compreendeu as seguintes etapas: tradução do chinês para o português brasileiro por dois tradutores independentes; síntese das traduções; retrotradução para a língua de origem; avaliação por um comitê de cinco juízes, que verificaram as equivalências semântica, idiomática, conceitual e cultural dos itens, e propuseram alterações; e pré-teste, cuja função foi julgar a clareza e a pertinência do conteúdo dos itens e proceder à versão final do questionário, sendo realizado em uma amostra composta por 30 enfermeiros que exerciam suas atividades em tempo integral ou parcial em um hospital de ensino do interior do Estado de São Paulo. No processo de tradução houve pequenas variações entre as traduções independentes que foram solucionadas após argumentação e consenso entre os tradutores. Na etapa referente à avaliação pelo comitê de juízes, os especialistas consideraram que a versão traduzida para o português apresentou equivalência semântica, idiomática, cultural e conceitual, mas alguns itens necessitaram de ajustes para se tornarem culturalmente cabíveis. No pré-teste a população-alvo foi interrogada quanto à clareza da redação e pertinência dos itens. Na primeira parte do questionário (Administração dos Medicamentos), os percentuais médios relativos à clareza da redação e pertinência dos itens foram de 93,3% e 89,6%, respectivamente. No tocante à segunda parte do questionário (Procedimentos Clínicos), o percentual médio referente à clareza da redação foi de 93,3%, enquanto que, em média, 85,3% dos sujeitos concordaram com a pertinência dos itens. Desse modo, com base nos aspectos metodológicos adotados neste estudo, o resultado apresentado pelo processo de tradução e adaptação transcultural do instrumento investigado foi considerado satisfatório, havendo equivalência entre a versão original e a versão traduzida do questionário, a qual se apresenta facilmente compreensível e adequadamente adaptada para o contexto brasileiro. Além disso, assume-se que o estudo propiciou um embasamento indispensável para o prosseguimento do processo de validação do questionário investigado / Some medications are notorious for having an increased risk of causing significant harm or death due faults during their use, being identified as high-alert medications. Knowledge and information are allies in preventing such failures, however the knowledge presented by healthcare professionals to prevent them is uncertain. In this context, aiming to obtain an overview of the inherent knowledge to nurses and formulate mechanisms for a future intervention, researchers of Chinese nationality have developed and validated the Questionnaire of High-Alert Medications designed to measure the pertinent knowledge to the practice involving these medications. Thus, the aim of this study was to translate to Brazilian Portuguese and culturally adapt the Questionnaire of High-Alert Medications checking its applicability in the Brazilian context. It was a methodological study, in which the rigorous process of translation and cross-cultural adaptation included the following stages: translation from Chinese to Brazilian Portuguese by two independent translators; synthesis of translations; back translation into the source language; evaluation by a committee of five judges that verified the semantic, idiomatic, cultural and conceptual equivalence of the items, and have suggested changes; and pre-test, whose function was to judge the clarity and relevance of the content of the items and proceed to the final version of the questionnaire, which was conducted in a sample composed by 30 nurses who performed their activities in full or part time in a teaching hospital in the State of São Paulo. In the translation process there were minor variations between the independent translations that were resolved after argumentation and consensus among translators. In the stage related to the evaluation by the committee of judges, the experts considered that the translated version to Portuguese showed semantic, idiomatic, cultural and conceptual equivalence, but some items needed adjustments in order to become culturally appropriate. In the pre-test the target population was questioned about the clarity of writing and relevance of the items. In the first part of the questionnaire (Drug Administration) the average percentages for the clarity of writing and relevance of the items were 93.3% and 89.6%, respectively. In relation to the second part of the questionnaire (Clinical Procedures) the average percentage related to the clarity of writing was 93.3%, whereas, on average, 85.3% of the subjects agreed with the relevance of the items. Therefore, based on the methodological aspects adopted in this study, the result presented by the translation and cross-cultural adaptation process of the instrument was satisfactory and there was equivalence between the original and the translated version of the questionnaire, which presents itself easily understandable and properly adapted to the Brazilian context. In addition, it is assumed that the study provided an indispensable resource for the continuation of the validation process of the questionnaire investigated

No description available.

Electronic Health Record (EHR) systems could make healthcare delivery safer by providing benefits such as timely access to accurate and complete patient information, advances in diagnosis and coordination of care, and enhancements for monitoring patient vitals. This study explored the nature of EHR adoption in U.S. hospitals and their patient safety performance in relation to one hospital acquired condition: postoperative sepsis – a condition that complicates hospitalizations, increases lengths of stay, and leads to higher mortality rates. Administrative data from several sources were utilized in order to obtain comprehensive information about the patient, organizational, and market characteristics of hospitals, their EHR adoption patterns, and the occurrence of postoperative sepsis among their patients. The study sample consisted of 404 general, short-term, acute care, non-federal, and urban hospitals based in six states, which provided longitudinal data from 2005 to 2009. Hospital EHR and the EHR’s sophistication level were measured by the presence of eight clinical applications. Econometric techniques were used to test six hypotheses that were derived from macro-organizational theories and frameworks. After controlling for potential confounders, the study’s key findings suggested that hospitals had a significant increase in the probability of having EHR as the percent of other hospitals having the most sophisticated EHR (i.e., EHRS3) in the market increased. Conversely, hospitals had a significant decrease in the probability of having EHR when the percent of Medicaid patients increased within a hospital or when the hospital belonged to centralized or moderately centralized systems. Also, the study findings suggested that EHR was associated with a higher rate of postoperative sepsis. Specifically, the intermediate EHR sophistication level (i.e., EHRS2) and the most sophisticated EHR level (i.e., EHRS3) were associated with a significantly higher rate of postoperative sepsis when compared to hospitals that did not have such EHR sophistication. The study results, however, did not support the hypotheses that higher degrees of fit between hospitals’ EHR sophistication level and specific structural dimensions were associated with greater reductions in postoperative sepsis outcomes vis-à-vis hospitals that did not have these types of fit.

Despite efforts to ensure patient safety in the United States, patients are being harmed by preventable errors. There is a gap in the literature from the nurse's perspective as to why medical errors continue to occur despite having evidence-based safety strategies available. The purpose of this constructivist grounded theory study was to develop a theory explaining nurses' perception of their role in patient safety and why medical errors are still occurring despite implementation of evidence-based safety strategies. The systems engineering initiative for patient safety (SEIPS) model provided the conceptual framework for the study. Data collection included interviews with 11 nurses who worked in a Magnet designated hospital. Data were sorted and analyzed using the constant comparative method. Three themes emerged: technology, work environment, and human factors. These themes aligned with components of the SEIPS model. An emphasis on how technology adds to the nurses' workload compounded with a busy work environment was noted as a contributing factor for bypassing safety systems. The bypass model theory was derived from the themes to describe the conditions that nurses work in that result in bypassing safety systems. Further research needs to go beyond engaging nurses with the implementation of health IT system by examining long-term impacts on workflow as changes are being made. Addressing the reasons why safety measures are bypassed can affect positive social change which will improve the quality and safety of patient care outcomes.

Studies have found links between physician relationships with nurses, patient safety culture, and patient outcomes, but less is known about a similar link between physician relationships with allied health professionals (AHPs), patient safety culture, and patient outcomes. The purpose of this exploratory quantitative, survey study was to investigate whether physician interactions with AHPs contribute to improved patient-safety culture, AHP empowerment, and self-efficacy. Based on a theoretical framework consisting of structural empowerment, psychological empowerment, and self-efficacy, it was hypothesized that self-efficacy is predicted by structural and psychological empowerment and self-efficacy predicts a positive patient safety culture. The AHP Survey of Physician Collaboration was constructed using psychometrically sound items from instruments that have studied similar phenomena. A purposive sample with 95 respondents consisted of occupational and physical therapists currently working in hospitals. Pearson Product-Moment correlation, standard multiple regression analysis, independent groups t-tests, and one-way between groups analyses of variance were employed. Although the survey results did not indicate a statistically significant relationship between psychological empowerment and patient-safety culture, findings in this study indicated that patient-safety culture has a significant positive correlation with structural empowerment and self-efficacy. Structural empowerment and self-efficacy were found to significantly predict patient-safety culture. The results did not show differences based on gender, profession, age, or years of service. By illustrating the nature of the relationship between physicians and AHPs, the results of this study can affect social change through enhancing the ability to reduce the number of preventable negative health outcomes in hospitals.

Falls are a major public health concern and contribute significantly to mortality and morbidity in the older adult population. Each year, approximately 3 million older adults are treated in emergency departments for fall-related injuries and at least 300,000 older people are hospitalized for hip fractures. The purpose of this project was to improve the participants' knowledge and highlight interventions to reduce the incidence of falls and injuries as a result of falls. The project was developed using the Stop Accidents, Deaths and Injuries (STEADI) toolkit, the Iowa model of evidence-based practice to promote quality of care, and the Lewin's change theory. The practice-focused question related to whether fall prevention would improve following the implementation of a staff education project using the STEADI toolkit. Twenty-six nurses were assessed to determine their knowledge deficits. Pretest and posttest data were analyzed, and as a result of the staff education initiative, the nurses' knowledge increased by 99.25%. Prior to the session, the facility had not participated in a fall-prevention initiative. This project offered a practical solution to the educational gaps identified at the practice setting. Adopting the STEADI toolkit at the practice setting is expected to improve patient safety, reduce falls with injuries and prevent fall-related deaths.

Orientador: Silvana Andrea Molina Lima / Resumo: O presente estudo teve como objetivo analisar os indicadores de segurança do paciente em unidade coronariana de instituição privada. Método: Estudo descritivo, transversal, com abordagem quantitativa, realizado a partir de dados e anotações do processo de enfermagem do Hospital dos Fornecedores de Cana localizado na cidade de Piracicaba-SP. Foram avaliados os indicadores de segurança do paciente, sendo descritos: Parte 1- Cultura de Segurança dos hospitais na perspectiva da equipe de enfermagem, sendo aplicado questionário sobre segurança em hospitais (HSOPSC), que possui 42 dimensões; Parte 2- Incidentes relacionados à assistência à saúde: os dados foram coletados a partir dos registros contidos no processo de enfermagem e relatórios gerenciais do serviço. Foram incluídos todos os registros dos pacientes, que foram hospitalizados na unidade por doenças coronarianas agudas ou crônicas, do período de 01 de janeiro a 31 de dezembro de 2017. Produto: Elaborar um vídeo explicativo sobre a segurança do paciente com enfoque nas metas internacionais e como realizar as notificações ao núcleo de segurança do paciente. Resultados: Houve um maior percentual de respostas positivas nas dimensões relacionadas ao trabalho em equipe (37,5%), aprendizagem da organização (56,25%), percepção da segurança do paciente (81,25%), respostas não punitivas ao erro (62,50%), feedback e comunicação sobre erros (37,5%), abertura para comunicação (50,0%), apoio a gestão hospitalar (62,5%), frequência de e... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The present study aimed to analyze the safety indicators of the patient in a coronary unit of a private institution. Method: Descriptive study, with a quantitative approach, based on data and annotations of the nursing process of the Hospital dos Fornecedores de Cana (Suppliers Hospital of Cana) located in the city of Piracicaba-SP.The safety indicators of the patient were evaluated, being described: Part 1- Safety Culture of the hospitals from the perspective of the nursing team, being applied a questionnaire on safety in hospitals (HSOPSC), which has 42 dimensions, Part 2 - Incidents related to health care: data were collected from the records contained in the nursing process and management reports of the service. We included all records of the patients, who were hospitalized in the unit for acute or chronic coronary diseases, from January 1 to December 31, 2017. Results: There was a greater percentage of positive responses in the dimensions related to teamwork (37.5%), organizational learning (56.25%), perception of patient safety (81.25%), non-punitive responses to error (62.50%), feedback and communication about errors (37.5%), openness to communication (50.0%), hospital management support (62.5%), ) and shift (43.8%). There was a higher percentage of negative responses in the staff-related dimension (43.75%). Of the incidents that occurred in the patients admitted to the UCO, 100% were identified as adverse events, with 52% loss of peripheral venous access (PVA), 27% of... (Complete abstract click electronic access below) / Mestre