Afin d’améliorer la santé maternelle, il est essentiel de mettre en œuvre des interventions qui agissent sur la période intrapartum, interventions qui consistent essentiellement en l’amélioration de l’accès aux soins obstétricaux et néonataux d’urgence (SONU). Néanmoins, plusieurs pays qui se sont tournés vers ce type d’interventions rencontrent d’importants défis au niveau de leur implantation et les taux élevés de mortalité maternelle persistent. Cette étude vise à identifier des caractéristiques de structure et de processus dans les centres de santé communautaire (CSCOM) où des décès maternels ont eu lieu et de comparer ces caractéristiques avec celles de CSCOM où aucun décès maternel n’a eu lieu. Nous avons opté pour une démarche exploratoire comparative des groupes de CSCOM qui diffèrent de par les issues des parturientes qui y ont été traitées ainsi que par leur configuration en termes de ressources humaines. La population à l’étude correspond à des CSCOM de la région de Kayes dans lesquels ont été prises en charge des femmes qui ont fait face à des urgences obstétricales. Les ressources humaines, les ressources matérielles, les ressources en pharmacie et les connaissances des prestataires de soins de ces établissements constituent les principaux objets à l’étude. L’analyse de nos données montre qu’il existe de grandes disparités au niveau des ressources disponibles dans les CSCOM, ressources pourtant nécessaires à une prise en charge adéquate des urgences obstétricales. Bien qu’aucune caractéristique des CSCOM ne puisse être associée aux issues défavorables des femmes qui y ont été traitées, l’accumulation de déficits au niveau des ressources matérielles et humaines ainsi que le faible niveau de connaissances de certaines catégories de personnel laissent penser que la prise en charge des parturientes est déficiente au point de menacer leur survie. / To improve maternal health, it is essential to implement interventions that act on the intrapartum period, interventions that consist essentially in improving access to obstetric and neonatal emergency care (EmOC). Nevertheless, several countries that have turned to such interventions encounter significant challenges in their implementation and the high rates of maternal mortality persist. This study aims to identify characteristics of structure and process in community health centers (CSCOM) where maternal deaths have occurred and to compare these characteristics with those of CSCOM where no maternal deaths have occurred. We opted for an exploratory comparative approach of CSCOM with patients with different outcomes and different human resources configuration. The study population corresponds to CSCOMs of Kayes region in which obstetric emergencies were managed. The main focus of this study is on human resources, availability of equipment, supply and medicine, and on the level of knowledge of health care providers in these health centers. Our data analysis revealed that there are large disparities in resources available at the CSCOM level. Yet, these resources are needed in order to adequately manage obstetric emergencies. Although none of the CSCOM characteristic can be associated with adverse outcomes, the accumulation of deficits in human and material resources as well as the lack of knowledge of certain categories of staff suggests that the poor quality of obstetric care may threaten the parturient survival.

Descriptive study of quantitative nature, which aimed to evaluate the quantitative and qualitative of the nursing staff of the Surgical Clinic of a teaching hospital in southern Brazil, composed of 52 beds. 465 patients participated in the study; the ethical precepts of Resolution 466/2012 were followed, under CAAE No. 52487116.6.0000.5346. Data were collected from April 12 to July 10, 2016, according to the methodological guidelines proposed by Gaidzinski (1998). To classify the patients, the instrument of Fugulin et al (2006) was used. For the hours of assistance and percentage distribution of each category, the standards of the COFEN Resolutions No. 293/2004 and 0527/2016 were followed. Inpatients were evaluated daily, with 4164 evaluations performed. Patients were classified in five levels of care dependency, being the majority, 35% (1442), with care profile corresponding to the intermediate care category; 30% (1263), with high dependency care; 21% (873) were classified with minimal care; 8% (331) with semi-intensive care and 6% (255) with intensive care. The technical safety index determined by the study for nurses was 40.50% and 37.83% for nursing technicians, being that among the absences foreseen by weekly rest days was 17%. Of the unforeseen absences, 6.65% were by nurses and 4.53% by assistants and technicians, being the majority due to medical licenses. The current frame of the nursing service is 16 nurses and 45 nursing technicians and assistants, during the period of data collection. According to the COFEN Resolution of 2004, the project is 27 nurses and 55 technicians and assistants, while in the Resolution of 2016 the project was 29 nurses and 57 technicians and nursing assistants. The proportion of the nursing staff is below what is recommended by the Resolutions, which may compromise the quality of care and patient safety, causing sickness in the nursing team and increasing absenteeism. This study made possible the dimensioning of the nursing team, which is part of the managerial action of the nurse, collaborates to achieve care, teaching and research in the surgical clinic, thus pointing out the necessary conditions for improving the quality of care with patient safety and team productivity. / Estudo descritivo de natureza quantitativa, que objetivou avaliar o quantitativo e qualitativo de pessoal de enfermagem da Clínica Cirúrgica de um hospital de ensino da região Sul do Brasil, composta por 52 leitos. Participaram do estudo 465 pacientes, e seguiram-se os preceitos éticos da Resolução 466/2012, com CAAE nº 52487116.6.0000.5346. Os dados foram coletados de 12 de abril a 10 de julho de 2016, de acordo com as orientações metodológicas propostas por Gaidzinski (1998), Para a classificação dos pacientes foi seguido o instrumento de Fugulin et al (2006). Para as horas de assistência e distribuição percentual de cada categoria foram seguidos os padrões da Resolução do Conselho Federal de Enfermagem nº293/2004 e nº 0527/2016. Os pacientes internados foram avaliados diariamente, sendo realizadas 4164 avaliações. Os pacientes apresentaram classificação nos cinco níveis de dependência de cuidados, sendo a maioria, 35% (1442), com perfil assistencial correspondente à categoria de cuidados intermediários; 30% (1263), com cuidados de alta dependência; 21% (873) foram classificados em cuidados mínimos; 8% (331), com cuidados assistência semi-intensivos e 6% (255), com cuidados intensivos. O índice de segurança técnica determinado pelo estudo para os enfermeiros foi de 40,50%, do nível médio 37,83%, sendo que entre as ausências previstas por folga semanal foi 17%. Das ausências não previstas 6,65% para enfermeiros e 4,53% para auxiliares e técnicos, sendo a maioria por licenças médicas. O quadro atual do serviço de enfermagem é de 16 enfermeiros e 45 de técnicos e auxiliares de enfermagem, no período de coleta de dados. De acordo com a Resolução do Conselho federal de Enfermagem/2004 o projetado é de 27 enfermeiros e 55 técnicos e auxiliares, enquanto que na Resolução de 2016 o projetado foi 29 enfermeiros e 57 técnicos e auxiliares de enfermagem. A proporção da equipe de enfermagem está aquém do preconizado pelas Resoluções, podendo comprometer a qualidade da assistência e a segurança do paciente, causando adoecimento na equipe de enfermagem e aumentando o absenteísmo. Este estudo possibilitou o dimensionamento da equipe de enfermagem, o qual faz parte da ação gerencial do enfermeiro, colabora para a concretização do cuidado, do ensino e da pesquisa na clínica cirúrgica, desta forma apontando as condições necessárias para a melhoria da qualidade do cuidado com segurança para o paciente e produtividade da equipe.

Made available in DSpace on 2010-04-20T20:15:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2000-04-05T00:00:00Z / A presente dissertação é um estudo de caso sobre as mudanças organizacionais ocorridas em hospital como conseqüência da implantação dos padrões da Joint Commission on Accreditation of Healthcare Organizations - JCAHO (Comissão Conjunta de Acreditação de Organizações de Assistência à Saúde) / Case Study on organizational changes that took place in a tertiary healthcare facility located in São Paulo, Brazil, as a result of the adoption of a comprehensive quality model, the implementation of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards for hospitals. Quality initiatives within the referred hospital are identified. The changes that ocurred due to this implementaion process are presented and discussed, as well as the organizational change estimulating and limitating factors. The main challenges faced are the development of the medical staff organization, the medical record improvement and the management of the environmente of care.

Made available in DSpace on 2011-05-04T12:36:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / As instituições de saúde são organizações com um alto potencial de risco tanto para pacientes, quanto para profissionais de saúde. Nessas instituições ocorrem diversos tipos de risco, o que torna muito complexo o gerenciamento dos mesmos por uma única estrutura organizacional, que no caso das instituições de saúde do Brasil é a Gerência de Risco Sanitário. Os riscos são tratados nas instituições de saúde de forma isolada por diversas estruturas organizacionais, o que não permite uma avaliação e um tratamento sistêmico dos mesmos. Diante desse problema consideramos necessária a execução de um estudo de revisão da literatura sobre gerenciamento de risco hospitalar objetivando contribuir para a ampliação da abrangência das ações desenvolvidas na Gerência de Risco do Instituto Nacional de Traumatologia e Ortopedia. Com base no conhecimento adquirido através da revisão da literatura, formulamos uma proposta para criação de um Comitê de Risco no Instituto Nacional de Traumatologia e Ortopedia que terá como o objetivo fazer uma gestão integrada dos diversos tipos de risco encontrados na instituição, identificando-os e tratando-os de forma proativa, bem como propondo açõespara redução ou mitigação dos mesmos. / Health institutions are organizations with a high potential risk for patients and for health professionals. In these institutions occur different kinds of risk, which makes very complex to manage them by a single organization structure, which, in the case of health institutions in Brazil, is the Sanitary Risk Management. Risks are treated in health institutions in isolation by several organization structures, which does not allow an evaluation neither a systemic treatment of these. In face of this problem we consider necessary to implement a study to review the literature about hospital risk management aiming to contribute to expand the scope of the actions developed in Risk Management from the National Institute of Traumatology and Orthopedy. Based on knowledge acquired through literature review, we formulate a proposal for creation a Risk Committee in the National Institute of Traumatology and Orthopedy that will aim to make an integrated management of various types of risk found in the institution, identifying them and treating them proactively, and proposing actions to reduce or mitigate them.

There is an increased need for complete medical device traceability in the healthcare industry. The two main reasons are the healthcare industry's global supply chain and decentralised adverse events reporting, where different laws apply for each country and where each country has their own database for incidents without international governance. The idea of improving traceability procedures in the surgical department at Karolinska University Hospital was formed in the light of a near miss event where guidelines regarding incident management of a Single-Use Medical Device (SUMD) were not followed properly. Hence, this thesis project will investigate the issue of finding an effective way to trace SUMDs at Karolinska University Hospital, in order to improve the incident management process and suggest improvements of patient safety at other Swedish hospitals as well. The collection of data consisted of different data sources; observations at the research site and interviews with relevant participants. By employing multiple sources to this study, a more holistic approach could be achieved. In addition to observing the current situation of device registration, it was of importance to ask individuals with competence and different perspectives on the issue of traceability of SUMDs. To answer the research questions, the acquired data was categorized into the different identified cornerstones of traceability of SUMDs. These were registration process, perioperative supply chain and incidents management. Each section was divided into an investigation of the current process, issues and suggested improvements, in order to clearly answer to the research questions. Furthermore, these acquired answers and insights, from observations and interviews, were translated and summarized to form a basis for the results. Based on the data acquisition and compilation from the different perspectives, key findings and themes are presented in the results. The thesis proposal include a visual representation that show the physical flow of a SUMD from the point of being delivered to the hospital by the distributor, through different entities where registration occur, until it is either discarded or saved for incidents reporting. In order to avoid many of the current issues and to realize the acquired suggestions from this thesis, interoperability between the systems within the healthcare organization as well as between the different entities throughout the entire supply chain is an essential part of the solution, which should be further studied.