Nearly 70 % of adverse events could be prevented. Observing of adverse events is one way for improving the quality of health services and patient safety. The adverse event reporting systems in České Budějovice hospital was mainly subject in the research portion. A mixed research method (qualitatively quantitative) was used for the research portion. The research results are interpreted using tables and graphs.

Submitted by Franciele Moreira (francielemoreyra@gmail.com) on 2018-08-14T13:52:56Z No. of bitstreams: 2 Dissertação - Valquíria Vicente da Cunha Barbosa - 2018.pdf: 3762835 bytes, checksum: e341255f1bca230b313e89cdd3117d07 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Rejected by Luciana Ferreira (lucgeral@gmail.com), reason: Essa dissertação é Saúde Coletiva on 2018-08-16T11:27:42Z (GMT) / Submitted by Franciele Moreira (francielemoreyra@gmail.com) on 2018-08-16T12:45:58Z No. of bitstreams: 2 Dissertação - Valquíria Vicente da Cunha Barbosa - 2018.pdf: 3762835 bytes, checksum: e341255f1bca230b313e89cdd3117d07 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-08-16T14:10:11Z (GMT) No. of bitstreams: 2 Dissertação - Valquíria Vicente da Cunha Barbosa - 2018.pdf: 3762835 bytes, checksum: e341255f1bca230b313e89cdd3117d07 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-08-16T14:10:11Z (GMT). No. of bitstreams: 2 Dissertação - Valquíria Vicente da Cunha Barbosa - 2018.pdf: 3762835 bytes, checksum: e341255f1bca230b313e89cdd3117d07 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-07-04 / Health facilities have sought to achieve improvements in their services through quality management, aiming at safer patient care. In this context, the accreditation process emerges as a method to evaluate the resources of these establishments, aiming to guarantee the quality of the assistance through pre- established standards. The objective of this research was to analyze nurses' perceptions about the accreditation process in public hospitals of a state in the Midwest region of the country, to verify the meaning of this process for nurses and to identify the potentialities and fragilities arising from this process from the perspective of the nurses. A descriptive, exploratory qualitative approach was carried out. Data were collected through focal groups in March 2018, with nurses from two public hospitals accredited by the National Accreditation Organization (levels I and III). The Bardin content analysis method was used, considering the following steps: pre-analysis, material exploration and treatment and interpretation of results. The following categories were apprehended, with their respective subcategories: meaning of the accreditation process - premises, organization and tools of this process; potentialities of the accreditation process - advantages of the process for the professional, institution and patient; weaknesses of the accreditation process - negative impact on the professional, for institution and deficient knowledge about this process. It was identified that the nurses had knowledge about the accreditation process; that the most outstanding potentialities were professional development, continuous improvement and safety for the patient and professional; and that the most mentioned weaknesses were an increase in the workload, a lack of professionals' insertion in the process, an increase in bureaucracy and a decrease in the quality of patient care due to this process itself. Another important finding was that, although the participants affirmed, on several occasions, that the accreditation process aims to offer patients more safety, more advantages were scored for the professionals and institution than for the patients themselves. It is concluded that the potentialities seized were more prominent than fragilities, evidencing that the accreditation process offers more benefits to the health sector, than harm. / Os estabelecimentos de saúde têm procurado o alcance de melhorias em seus serviços, por meio da gestão da qualidade, objetivando uma assistência mais segura aos pacientes. Nesse contexto, o processo de acreditação surge como um método de avaliação de recursos desses estabelecimentos, visando garantir a qualidade da assistência por meio de padrões pré estabelecidos. Objetivou-se com essa pesquisa analisar a percepção dos enfermeiros sobre o processo de acreditação em hospitais públicos de um estado da região Centro Oeste do país, verificar o significado desse processo para os enfermeiros e identificar as potencialidades e fragilidades advindas desse processo sob a ótica dos enfermeiros. Para tanto foi realizada uma pesquisa descritiva, exploratória de abordagem qualitativa, sendo os dados coletados por meio de grupos focais, em março de 2018, com enfermeiros de dois hospitais públicos acreditados pela Organização Nacional de Acreditação (níveis I e III). Utilizou- se o método de análise de conteúdo segundo Bardin contemplando as seguintes etapas: pré análise, exploração do material e tratamento e interpretação dos resultados obtidos. Foram apreendidas as seguintes categorias, com suas respectivas subcategorias: significado do processo de acreditação – premissas, organização e ferramentas desse processo; potencialidades do processo de acreditação – vantagens do processo para o profissional, instituição e paciente; fragilidades do processo de acreditação – impacto negativo para o profissional, para instituição e conhecimento deficiente sobre esse processo. Identificou-se que os enfermeiros possuíam conhecimento acerca do processo de acreditação; que as potencialidades mais destacadas foram desenvolvimento profissional, melhoria contínua e segurança para o profissional e paciente; e que as fragilidades mais mencionadas foram aumento de carga de trabalho, falta de inserção dos profissionais no processo, aumento da burocracia e diminuição da qualidade na assistência ao paciente em virtude desse próprio processo. Outro achado importante foi que, apesar dos participantes afirmarem, por várias vezes, que o processo de acreditação visa oferecer mais segurança aos pacientes, foram pontuadas mais vantagens para os profissionais e instituição do que para os próprios pacientes. Conclui-se que as potencialidades apreendidas foram mais destacadas que as fragilidades, evidenciando que o processo de acreditação oferece mais benefícios ao setor saúde, do que malefícios.

A relação da qualidade da prática médica assistencial com os indicadores de saúde tem sido objeto de controvérsia. A possibilidade de avaliar o estado de saúde do recém-nascido em função do cuidado recebido, facilita o estudo desta relação, principalmente na área perinatal onde a expectativa é o nascimento de um bebê saudável ao final de uma gestação sem fatores de riscos acompanhados segundo as normas obstétricas vigentes. Neste estudo, examina-se a adequação do acompanhamento do trabalho de parto em uma maternidade pública do Estado do Rio de Janeiro, sob a ótica de avaliação de qualidade pela abordagem de processos e resultados através de critérios explícitos supondo que os fatores selecionados como componentes do processo de assistência ao trabalho de parto determinariam o resultado. Observa-se tais relações através da metodologia epidemiológica optando por um estudo caso-referente ou um estudo caso-controle, com definição primária da base. Selecionou-se como determinantes da qualidade da prática obstétrica intraparto a duração do trabalho de parto, percepção de alterações durante o trabalho de parto, prontidão para intervenção, número de exames realizados e intervalo entre o último exame e hora do parto. O resultado neonatal adverso caracterizou-se por óbito intra-útero, óbito neonatal e presença de um conjunto de sinais clínicos anormais no período neonatal imediato, com alto valor preditivo para o futuro dano neurológico. O risco de um resultado adverso foi estimado pela razão dos produtos cruzados aodds ratio (OR) numa população de 34 casos e 124 controles. A duração do trabalho de parto maior que doze horas esteve associada a um OR igual a 3,48 (1,28-9,43), idade da gestante, dilatação cervical do colo uterino à admissão e peso ao nascer modificaram o efeito desta associação, que também foi confundida pela paridade e pelo uso da ocitocina contrariando hipótese inicial. A percepção de alterações resultou num OR= 14,73 (4.24-54,27) e, à medida que o tempo de intervenção se prolongava os riscos aumentavam obedecendo a uma tendência linear. Discutem-se as dificuldades de aplicação metodologia epidemiológica ao campo da avaliação da qualidade, essencialmente no que se refere as exigências quantitativas, para garantir precisão e confiabilidade. A observação da interação e o controle do confundimento apontam o cuidado necessário nos trabalhos desta natureza para alcançar consistência e validade. / The connection between the quality of health care practice and its outcomes has been a controversial matter in many different fields. Chiefly in the perinatal area, where at the end of a pregnancy without risk factors being monitored in accordance with valid obstetric standards, the birth of healthy babies is expected. The objective of this study has been to assess the relationship among the quality of obstetrical care in pregnancies free of risk factors during the intrapartum death, neonatal death and evidences of adverse clinical signs at an early neonatal period, with high predictive values for later neurological disability such as seizures and other signs of asphyxia constitute the neonatal adverse outcomes. The quality of obstetrical practice during the intrapartum period was gauged by the duration of labour, the observation of abnormalities during labour, the time elapsed between observation and intervention, the number of examinations performed and the time between the last obstetric visit and labour. Concerned with perinatal care in public maternities in the State of Rio de Janeiro, this study presumed that under the quality assessment view the selected factors, as components of the process of labour care, should be associated with their outcomes. This study was aimed at developing such comprehension, through epidemiological methodology, adopting a case referent or a case-control study with primary definition of the base where the above mentioned factors were determinant of neonatal adverse outcome occurrence and the odds ratio (OR) was the parameter of interest. A labour duration which exceeded 12 hours has been associated to a crude OR of 3.48 (CI: 1.28-9.43) for neonatal adverse outcome. The mothers age, the degree of cervical dilation admission and the birth weight modified the effect of such association which was expressed by an OR of 14.73 (CI; 4.23-54.27). As the time of intervention grew larger, the risk increased, following a linear tendency. Some studied factors could supply indicators for further investigations of the relationship between the quality of intrapartum care and neonatal adverse outcomes.

A relação da qualidade da prática médica assistencial com os indicadores de saúde tem sido objeto de controvérsia. A possibilidade de avaliar o estado de saúde do recém-nascido em função do cuidado recebido, facilita o estudo desta relação, principalmente na área perinatal onde a expectativa é o nascimento de um bebê saudável ao final de uma gestação sem fatores de riscos acompanhados segundo as normas obstétricas vigentes. Neste estudo, examina-se a adequação do acompanhamento do trabalho de parto em uma maternidade pública do Estado do Rio de Janeiro, sob a ótica de avaliação de qualidade pela abordagem de processos e resultados através de critérios explícitos supondo que os fatores selecionados como componentes do processo de assistência ao trabalho de parto determinariam o resultado. Observa-se tais relações através da metodologia epidemiológica optando por um estudo caso-referente ou um estudo caso-controle, com definição primária da base. Selecionou-se como determinantes da qualidade da prática obstétrica intraparto a duração do trabalho de parto, percepção de alterações durante o trabalho de parto, prontidão para intervenção, número de exames realizados e intervalo entre o último exame e hora do parto. O resultado neonatal adverso caracterizou-se por óbito intra-útero, óbito neonatal e presença de um conjunto de sinais clínicos anormais no período neonatal imediato, com alto valor preditivo para o futuro dano neurológico. O risco de um resultado adverso foi estimado pela razão dos produtos cruzados aodds ratio (OR) numa população de 34 casos e 124 controles. A duração do trabalho de parto maior que doze horas esteve associada a um OR igual a 3,48 (1,28-9,43), idade da gestante, dilatação cervical do colo uterino à admissão e peso ao nascer modificaram o efeito desta associação, que também foi confundida pela paridade e pelo uso da ocitocina contrariando hipótese inicial. A percepção de alterações resultou num OR= 14,73 (4.24-54,27) e, à medida que o tempo de intervenção se prolongava os riscos aumentavam obedecendo a uma tendência linear. Discutem-se as dificuldades de aplicação metodologia epidemiológica ao campo da avaliação da qualidade, essencialmente no que se refere as exigências quantitativas, para garantir precisão e confiabilidade. A observação da interação e o controle do confundimento apontam o cuidado necessário nos trabalhos desta natureza para alcançar consistência e validade. / The connection between the quality of health care practice and its outcomes has been a controversial matter in many different fields. Chiefly in the perinatal area, where at the end of a pregnancy without risk factors being monitored in accordance with valid obstetric standards, the birth of healthy babies is expected. The objective of this study has been to assess the relationship among the quality of obstetrical care in pregnancies free of risk factors during the intrapartum death, neonatal death and evidences of adverse clinical signs at an early neonatal period, with high predictive values for later neurological disability such as seizures and other signs of asphyxia constitute the neonatal adverse outcomes. The quality of obstetrical practice during the intrapartum period was gauged by the duration of labour, the observation of abnormalities during labour, the time elapsed between observation and intervention, the number of examinations performed and the time between the last obstetric visit and labour. Concerned with perinatal care in public maternities in the State of Rio de Janeiro, this study presumed that under the quality assessment view the selected factors, as components of the process of labour care, should be associated with their outcomes. This study was aimed at developing such comprehension, through epidemiological methodology, adopting a case referent or a case-control study with primary definition of the base where the above mentioned factors were determinant of neonatal adverse outcome occurrence and the odds ratio (OR) was the parameter of interest. A labour duration which exceeded 12 hours has been associated to a crude OR of 3.48 (CI: 1.28-9.43) for neonatal adverse outcome. The mothers age, the degree of cervical dilation admission and the birth weight modified the effect of such association which was expressed by an OR of 14.73 (CI; 4.23-54.27). As the time of intervention grew larger, the risk increased, following a linear tendency. Some studied factors could supply indicators for further investigations of the relationship between the quality of intrapartum care and neonatal adverse outcomes.

The current thesis deals with the issue of adverse events. However, it does not concern the number of described and recorded adverse events in healthcare facilities or their spectrum. I am particularly interested in the attitude of the staff at the University Hospital Pilsen and how to respond to the requirements of the TOP management in the recording of adverse events. The theoretical part will concentrate on explaining the concept "adverse event", the description of influences which cause such events to arise and also to summarize the current situation concerning the approach to adverse events in the Czech Republic. The empirical part of the thesis describes the implementation of qualitative research, its results and recommendations for future practice. I am interested in researching the perspective of employees and their level of cooperation and openness in the approach to the reporting of adverse events in the provision of therapeutic, diagnostic and nursing care in inpatient health care facilities. The respondents in my research are employees of the University Hospital in Pilsen. I researched their views using a structured interview. I've contacted 14 employees who are employed in various functional and professional positions at the University Hospital in Pilsen. I believe that the role of...

In Tanzania laboratory services were observed to be not providing the quality of services required. It is assumed that the perceived discrepancy between malaria diagnosis and confirming laboratory result might be attributed to incompetence of health personnel. Objective The objective of this research was to explore the competence and extend to which health personnel in Muhimbli hospital comply with procedural norms in malaria diagnosis. Methodology A quantitative approach of explorative descriptive design was used. A survey was done using observation guidelines based on existing policies and norms. Actual practice of malaria diagnosis compared with the policies and procedural norms. Result The data revealed that health personnel are not competence in malaria diagnosis. Conclusion Competence of health personnel is important in malaria diagnosis, a special guideline should be developed and in-service training be implemented to minimize errors in reporting for malaria investigation. / Health Studies / M. A. (Public Health)

In Tanzania laboratory services were observed to be not providing the quality of services required. It is assumed that the perceived discrepancy between malaria diagnosis and confirming laboratory result might be attributed to incompetence of health personnel. Objective The objective of this research was to explore the competence and extend to which health personnel in Muhimbli hospital comply with procedural norms in malaria diagnosis. Methodology A quantitative approach of explorative descriptive design was used. A survey was done using observation guidelines based on existing policies and norms. Actual practice of malaria diagnosis compared with the policies and procedural norms. Result The data revealed that health personnel are not competence in malaria diagnosis. Conclusion Competence of health personnel is important in malaria diagnosis, a special guideline should be developed and in-service training be implemented to minimize errors in reporting for malaria investigation. / Health Studies / M. A. (Public Health)