INTRODUÇÃO: A legislação em enfermagem prevê o uso da Sistematização da Assistência de Enfermagem (SAE). As atitudes dos profissionais de enfermagem sobre o processo de enfermagem (PE) e o poder clínico que percebem ter para realizar mudanças são fatores potencialmente associados ao processo de implantação e manutenção da SAE. OBJETIVOS: Descrever as atitudes relacionadas ao PE (disposição sobre o PE e percepção de poder clínico) de auxiliares de enfermagem e enfermeiros; analisar associações entre atitudes relacionadas ao processo de enfermagem e variáveis selecionadas. MÉTODO: Estudo descritivo-exploratório de delineamento transversal, com amostra não probabilística de 973 auxiliares de enfermagem e 632 enfermeiros de 35 hospitais e ambulatórios vinculados à Secretaria de Estado da Saúde de São Paulo (86,9% do sexo feminino, idade média de 44,12 anos (DP= 9,55), 52,3% trabalhavam em hospitais gerais, cerca de 44 horas semanais, estavam nas instituições há 10 anos em média). Os dados foram coletados por meio de resposta ao instrumento de caracterização sociodemográfica e aos questionários padronizados Posições sobre o Processo de Enfermagem (PPE) adaptado para esse estudo e o Power as Knowing Participation in Change Tool- versão brasileira (PKPCT), que apresentaram boas estimativas de validade e confiabilidade. Testes não paramétricos foram usados para analisar associação entre as atitudes relacionadas ao PE e as variáveis selecionadas. RESULTADOS: O escore total médio no PPE foi de 112,37 (DP=22,28) e o escore total médio no PKPCT foi de 281,12 (DP= 38,72) para os 1605 respondentes. Houve associação entre as duas atitudes relacionadas ao PE e categoria profissional, a atitude dos enfermeiros sobre o PE foi mais favorável que a dos auxiliares de enfermagem (p=0,024) e a percepção de poder dos enfermeiros foi mais elevada que a dos auxiliares de enfermagem (p=0,004). Houve correlação positiva moderada entre os escores do PPE e do PKPCT para os auxiliares (r=0,480; p=0,000) e para os enfermeiros (r=0,460; p=0,000). Os auxiliares do sexo feminino tiveram disposição sobre o PE (111,93) mais favorável que os do sexo masculino (106,11) (p=0,018) e maior percepção de poder (279,75 vs 270,84) (p=0,020); na amostra de enfermeiros não houve associação entre essas variáveis. Apenas para os auxiliares de enfermagem ter pós-graduação associou-se significativamente a maiores médias de atitude sobre o PE (119,0, p=0,011). As enfermeiras que relataram ter cargo de chefia apresentaram escores de percepção de poder mais elevados (293,52) que as enfermeiras sem cargo de chefia (282,61 p=0,010), mas não houve associação entre cargo de chefia e atitude sobre o PE. As associações entre os escores do PPE e PKPCT e as variáveis idade, tempo de formado, atividade principal, satisfação com a carreira, satisfação com o local de trabalho, conhecimento e contato com a SAE foram de intensidade desprezível no caso das correlações ou não significantes ao nível de 5%. / INTRODUCTION: The Brazilian nursing legislation requires that the nursing process (NP) is documented in all health institution. Attitudes of nursing staff towards the nursing process (NP) and their perception on their own clinical power to make changes are factors potentially associated with implementation and maintenance of the NP. OBJECTIVES: To describe the attitudes towards NP (attitudes on NP and perception of clinical power) of auxiliary nurses and baccalaureate nurses; and to analyze associations between attitudes towards the NP and selected variables. METHODS: An exploratory descriptive study with cross-sectional design, with a non-probabilistic sample of 973 auxiliary nurses and 632 baccalaureate nurses from 35 health agencies linked to the Ministry of Health of São Paulo, Brazil (86.9% female, mean age = 44.12 years (SD = 9.55), 52.3% worked in general hospitals, about 44 hours per week, were in institutions for 10 years on average). Data were collected by self-report using a form for personal, educational and other social data, and the Positions on Nursing Process (PNP) tool, adapted for this study, and the Power as Knowing Participation in Change Tool-Brazilian version (PKPCT), which showed good estimates of validity and reliability. Nonparametric tests were used to test associations between attitudes towards the NP and the selected variables. RESULTS: The mean PNP total score was 112.37 (SD = 22.28) (possible range = 20-140) and the mean PKPCT total score was 281.12 (SD = 38.72) (possible range = 48-336) for 1605 subjects. There was an association between the two PNP-related attitudes and professional category; the attitude of baccalaureate nurses on the NP was more favorable than that of auxiliary nursing (p = 0.024) and perceived clinical power of the baccalaureate nurses was higher than that of the auxiliary nurses (p = 0.004). There was moderate positive correlation between the scores of the PNP and PKPCT for auxiliary nurses (r = 0,480, p = 0.000) and baccalaureate nurses (r = 0.460, p = 0.000). The female auxiliary nurses had higher scores on PNP (111.93vs 106.11; p = 0.018) and PKPCT (279.75vs. 270.84; p = 0.020) than the male ones. There were no associations between sex an attitudes towards NP among baccalaureate nurses. Only for auxiliary nurses sample attending a continuing education program was associated with higher NP scores (119.0, p = 0.011). Baccalaureate nurses serving in leadership positions had higher mean total score on PKPCT (293.52) than nurses serving in direct care (282.61 p = 0.010), but there was no association between leadership position and PNP scores. Association tests for scores of the PNP and PKPCT and the variables age, time since graduation, main activity, satisfaction with the career, satisfaction with the workplace, knowledge on NP and contact with the NP resulted in negligible correlation coefficients or non-significant coefficients at 5%.

Este estudo de caso qualitativo busca compreender os significados atribuídos por enfermeiras assistenciais ao processo de implementação do diagnóstico de enfermagem no Sistema de Assistência de Enfermagem (SAE) do Hospital Universitário da Universidade de São Paulo. A coleta dos dados foi realizada por meio de entrevistas com oito enfermeiras da Unidade de Clínica Médica, que participaram de um teste piloto para a construção de um instrumento para implementação do diagnóstico de enfermagem como etapa do SAE. Os dados foram apresentados na forma de narrativa. Nos seus relatos as colaboradoras explicitaram ter percebido, inicialmente, a implementação do diagnóstico de enfermagem como uma imposição da chefia, o que gerou reações de resistência e sentimentos de desconforto. Evidenciaram que a capacitação teórico-prática e a possibilidade de participação, ao longo do processo, contribuíram para se tornarem agentes pró-ativas, em decorrência de uma transformação positiva em seus sentimentos a partir do desconforto inicial e da percepção desfavorável em relação ao processo. Relataram que os sentimentos compartilhados, durante a realização do teste piloto, foram trabalhados com mais facilidade uma vez que o grupo assumiu atitude pró-ativa em relação a eles, confiando que podiam lidar com esses sentimentos e superar as dificuldades. As colaboradoras revelaram, ainda, que o processo de implementação do diagnóstico de enfermagem, como etapa do SAE, continuava sendo um grande desafio a ser vivenciado. Entretanto, mostraram que a apropriação do processo permitiu além do compartilhamento das decisões e da responsabilidade pelos resultados, o desenvolvimento da crença de que serão capazes de superar as dificuldades quando forem vivenciar os acontecimentos. Fica evidente que o processo participativo é mais demorado, no entanto propicia a detecção das necessidades dos diferentes grupos, e de cada componente, fornecendo dados para que essas necessidades sejam atendidas. Dessa forma, proporciona autonomia aos participantes, gerando sentimentos de prazer e de auto-realização e, conseqüentemente, o resultado obtido é mais seguro e duradouro. / This qualitative case study searches for understanding the meanings attributed by nurses for the nursing diagnosis implementation process on the Nursing Care System (NCS) from the University Hospital at the University of Sao Paulo. Data collection was made through interviews with eight nurses from the Medical Clinic Unit, who attended a pilot test for building up an instrument for nursing diagnosis implementation as a stage of the NCS. Data was presented through a narrative way. The respondents told clearly on their reports having perceived initially the nursing diagnosis implementation as a management imposition, which generated resistance reaction and discomfort feelings. They evidenced that the theory-practice capability and the possibility of participation throughout the process helped them for being proactive agents, resulting from a positive transformation in their feelings starting from the initial discomfort and the unfavourable perception regarding to the process. They reported that shared feelings during the pilot test were worked up easier once the group assumed a proactive attitude for them. They trusted they could deal with these feelings and overcome difficulties. The respondents also revealed that the nursing diagnosis implementation process, as a NCS stage, keeps on being a big challenge to be lived. However, they showed that the appropriateness of the process allowed, besides the decision sharing and responsibility for the results, the development of a belief that they will be able to overcome difficulties when they face the facts. It becomes clear that the participative process takes longer; nonetheless, it offers the detection of needs from different groups and each of their components, providing data for meeting their needs. Thus, it gives autonomy for their participants, creating pleasure and self-satisfaction feelings and, consequently, the result obtained is safer and lasting.

O desenvolvimento de software pode contribuir com a padronização dos registros de enfermagem e facilitar a avaliação dos custos das ações desses profissionais nos serviços de saúde. Acresça-se a possibilidade de contribuir com a tomada de decisão para melhorar a qualidade da assistência nos diferentes pontos da Rede de Atenção à Saúde. Pesquisa teve como objetivo geral: Desenvolver um software para apoio à tomada de decisão na seleção de diagnósticos e intervenções de enfermagem a partir da nomenclatura de diagnósticos resultados e intervenções de enfermagem de um Hospital Universitário da Paraíba. Pesquisa metodológica do tipo aplicada, a qual seguiu os passos da engenharia de software proposto por Pressman, nas seguintes fases: construção do fluxograma; Conversão dos instrumentos de coleta de dados, diagnósticos e intervenções em telas (elaboração do protótipo); Inserção dos diagnósticos de enfermagem ao software (desenvolvimento de mapas conceituais e expressões funcionais) e a fase desenvolvimento técnico do sistema. O processo de desenvolvimento do software e implantação no servidor de rede ocorreu entre os meses de março de 2012 e janeiro de 2014. O fluxograma foi elaborado na Linguagem Unificada de Modelagem (UML -Unified Modeling Language), com auxílio do JUDE System Design Tool. Para o protótipo foram estruturadas, inicialmente, as telas de interface do software e para permitir a interação humano/sistema o protótipo foi estruturado utilizando o Programa Axure ®. A elaboração de mapas conceituais permitiu a visualização dos links para apresentação dos diagnósticos de enfermagem. O agrupamento dos indicadores conduziu a 28 mapas de diagnósticos de enfermagem para crianças 0- 5 anos e 29 mapas de diagnósticos para os adolescentes. Para inserção dos diagnósticos de enfermagem (DE) na programação foram elaboradas duas expressões funcionais para DE identificados nos dois grupos, resultando em 112 expressões para as crianças 0-5 anos e 124 para os adolescentes. Para o desenvolvimento do sistema foram utilizados os seguintes softwares de acesso livre (open source): Eclipse, um IDE (Integrated Development Environment), o Zend (conectividade com banco de dados e conectividade com Java). O MySQL workbench foi a ferramenta visual utilizada na arquitetura do banco de dados. O sistema foi desenvolvido com a linguagem PHP (hypertext preprocessor) + MySQL um sistema gerenciador de banco de dados que utiliza a linguagem SQL (Structured Query Language - Linguagem Estruturada para Consulta), juntamente com a linguagem P4A (php for application). Foram utilizados os software WampServer para instalar os softwares PHP 4.3.x/4.4.x/5.x.x, Apache 1.3.x/2.0.x e o MySQL e as configurações necessárias para os arquivos P4A. Após finalização para os testes em ambiente de simulação o software foi hospedado num servidor no endereço: http://143.107.193.26/sisped/applications/sica/. Para garantir a segurança das informações, o servidor dispõe de um módulo que utiliza a camada SSL (Secure Sockets Layers - camada de sockets protegida). A utilização de Tecnologia da Informação6 para auxiliar as ações de cuidado pode permitir aos profissionais de enfermagem realizar uma assistência baseada em conhecimentos validados contribuindo com a qualidade desse cuidado, o que pode levar a redução de erros e de custos, aumentando a eficiência da informação, a melhoria na continuidade e a segurança da informação / Software development can contribute to the standardization of nursing records and facilitate the cost assessment of the professionals\' actions in the health services. Also should add the possibility to contribute to the decision making to improve the quality of care in different points of the Health Care Network. The research had as general aim: Develop software to support decision making in the selection of nursing diagnoses and interventions from the nomenclature of nursing diagnoses, results and interventions from a University Hospital of Paraíba. Methodological research type, following the software engineering phases proposed by Pressman: flowchart construction; Conversion screens of instruments for data collection (prototype building); Insertion of nursing diagnoses to the software (development of concept maps and functional expressions) and technical development phase of the system. The software development process and implementation on the network server occurred between the months of March 2012 and January 2014. The flowchart was drafted in Unified Modeling Language (UML), with the aid of JUDE System Design Tool. For the prototype were structured at first the software interface screens and to allow human / system interaction the prototype was structured using Axure® Program. The development of concept maps allowed the visualization of links to display the nursing diagnoses. The grouping of indicators led to 29 maps of nursing diagnoses for children 0-5 years and 29 maps of nursing diagnoses for teens. To insert the nursing diagnoses in the system two functional programming expressions were prepared for nursing diagnoses identified in the two groups, resulting in 112 phrases for children 0-5 years and 124 for teens. To develop the system the following open source software were used: Eclipse, an IDE (Integrated Development Environment), Zend (database connectivity and connectivity with Java). The MySQL workbench was visual tool used in the database architecture. The system was developed with PHP (hypertext preprocessor) language and MySQL a database system manager that uses SQL (Structured Query Language) along with P4A (php for application) language. It was used the software WampServer to install the software PHP 4.3.x/4.4.x/5.x.x, Apache 1.3.x/2.0.x, MySQL and the required settings for the files P4A. After finishing the tests in simulation environment the software was hosted on a server at the address: http://143.107.193.26/sisped/applications/sica/. To ensure the information security, the server has a module that uses the layer SSL (Secure Sockets Layers). The use of information technology to help care actions can enable the nursing professionals perform a care based on validated knowledge, contributing to the care quality, to reduce errors and costs, information efficiency, improving continuity and security of information

A emergência psiquiátrica é uma unidade complexa devido à demanda de pacientes com várias patologias psiquiátricas e clínicas associadas e distintas, com alta rotatividade. O objetivo deste trabalho foi analisar a percepção da equipe de enfermagem quanto à Sistematização da Assistência de Enfermagem em um serviço de emergência psiquiátrica, enfatizando os aspectos relacionados à sua implementação. O estudo foi desenvolvido utilizando o método qualitativa e a coleta de dados se deu através de entrevistas e grupo focal com os diferentes profissionais envolvidos no cuidado de enfermagem da Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Os resultados apontaram que a equipe percebe as contribuições da Sistematização da Assistência de Enfermagem (SAE) para o trabalho da equipe de enfermagem, no entanto uma série de dificuldades em relação à consolidação da Sistematização da Assistência de Enfermagem nesta unidade foram apontados, bem como propostas de melhorias e elementos essenciais que contribuiriam para a efetiva implementação da SAE na referida Unidade. Adequações nos instrumentos, treinamentos mais focados e estratégias participativas são descritos como elementos-chave para este processo / Psychiatric emergency is a complex unit due to the demand of patients with various psychiatric and medical conditions associated and distinct, with high turnover. The objective of this study was to analyze the perception of the nursing team about the systematization of nursing care in a psychiatric emergency service, emphasizing the aspects related to its implementation. The study was conducted using qualitative method and the data collection was carried out through interviews and focus groups with the different professionals involved in nursing care of the Emergency Unit of the Hospital of the Ribeirão Preto Medical School. The results showed that the team realizes the contributions of the Systematization Of Nursing Assistance (SNA) for the work of the nursing staff, however a number of difficulties in relation to the consolidation of systematization of nursing care in this unit were appointed and proposals improvements and essential elements that contribute to the effective implementation of SNA in that unit. Adjustments in the instruments, more focused training and participatory strategies are described as key elements to this process

Poor nursing documentation of patient care was identified in daily nurse visit notes in a health care setting. This problem affects effective communication of patient status with other clinicians, thereby jeopardizing clinical decision-making. The purpose of this evidence-based project was to determine the impact of a retraining program on the quality of documentation of patient care in nurses' notes in a home health agency in central Texas. A retrospective audit of quality of nursing documentation using the Nurse and Midwifery Content Audit Tool (NMCAT) was done. A pre- and posttest design was used. A convenience sample of de-identified nurses' notes (80 pre- and 80 post) was selected from active patient records in the agency (n = 160). Descriptive and inferential statistics from the project showed that there was improved quality for the 15 criteria representing quality nursing documentation. After the educational intervention, documentation of patient's status if changed or unchanged improved to 80%, and patient's response to treatment improved (57% to 85%), entries were written as incidents occurred improved (53% to 64%). The nurse refers to the patient by name improved (0% to 66%). These findings were an indication of practice change, validating the need for periodic audits of nurses' notes in the agency in order to demonstrate compliance with quality standards. Based on the project findings, a retraining program is recommended to improve structured nursing documentation in a home health agency. This project is likely to contribute to social change as it enhanced the information communicated to other health care providers, coordination of care, and patient outcomes.

<p>The purpose of this thesis was to study different aspects of nursing content in patient records with special reference to nursing home care. The thesis focused on the content, comprehensiveness, accuracy and auditing of records, as well as the practice and perceptions of nurses in relation to recording. A national sample of nurses was asked to complete a questionnaire. The effects on recording and nurses' practice and perceptions in nursing homes following educational intervention were studied. Accuracy was examined through record reviews and interviews with nurses and patients. A literature review of record auditing methods was performed and findings from this search were applied in the assessment of a set of records.</p><p> The results indicate that the VIPS model, as a structure for nursing recording, is widespread and shows validity across various areas in Swedish health care. After the educational intervention program, documentation in nursing home care improved significantly in the study group concerning notes on nursing history, nursing status, nursing diagnoses, interventions and discharge notes. Systematic and comprehensive assessment grounded in research-based criteria were not used in the records. Accuracy varied considerably and was significantly better for some areas in the study group. After intervention, the nurses in the study group indicated that they recorded assessments of patients with greater frequency, showed greater satisfaction with their documentation and spent less time on oral reports. Procedures in auditing patient records were found to encompass four approaches: formal structure, process comprehensiveness, knowledge based and accuracy. </p><p> In conclusion, the evidence suggests that there are serious flaws in the nursing content of nursing home records though improvements can be achieved through educational means. Presently, there are serious limitations in using the patient record as the sole source of data for care delivery, quality assessment and evaluation of care.</p>

To ensure the provision of good and safe nursing care in the ward, the nursing needs of each patient should be established and clearly documented in the form of care plans in his/her medical record. There is a lack of scientific evidence of the benefits of this method of working as well as why this part of the nursing process is not always successful. The main aim of this thesis was to describe the assessment and decision-making process pertaining to nursing needs performed by nurses, to evaluate the consequences of planned, process oriented nursing care and to identify the factors and conditions that have had an impact on the implementation of individual care plans (ICP) and standardized care plans (SCP).   In studies I and III, qualitative methods were used. In study I, data collection and analysis were carried out by means of Grounded theory. Study III was conducted by means of directed content analysis and guided by “The Promoting Action on Research Implementation in Health Services framework”. In studies II and IV, quantitative methods were employed.   The benefits of a planned, process oriented method of working involving documentation of care plans have been investigated from the perspective of both the patient and the nurse. Nurses who applied the process oriented method adopted a nursing perspective in the assessment of and decision making pertaining to the patient’s nursing needs, which was not the case with nurses who did not work in this way and who instead exhibited a more medical approach (I). Patients cared for in wards where care plans were documented reported being more involved and that the care was more tailored to their individual needs compared to those not cared for in this manner (II). Leadership that prioritises the development of nursing care is essential for the implementation and continued use of ICPs and SCPs. Another important factor was the presence of internal facilitators in the ward in the form of nurses with a clear mandate to work with these issues. The nurses reported that they did not discuss scientific evidence as a basis for performing planned process oriented nursing care and that they did not listen to patient experiences to any great extent (III, IV).   The conclusion is that structured, process oriented nursing care based on written care plans probably promotes the nursing perspective and enables patient participation. Leadership as well as facilitators with a clear role and mandate are important factors in the implementation of this method of working and scientific evidence is of less importance.

The purpose of this thesis was to study different aspects of nursing content in patient records with special reference to nursing home care. The thesis focused on the content, comprehensiveness, accuracy and auditing of records, as well as the practice and perceptions of nurses in relation to recording. A national sample of nurses was asked to complete a questionnaire. The effects on recording and nurses' practice and perceptions in nursing homes following educational intervention were studied. Accuracy was examined through record reviews and interviews with nurses and patients. A literature review of record auditing methods was performed and findings from this search were applied in the assessment of a set of records. The results indicate that the VIPS model, as a structure for nursing recording, is widespread and shows validity across various areas in Swedish health care. After the educational intervention program, documentation in nursing home care improved significantly in the study group concerning notes on nursing history, nursing status, nursing diagnoses, interventions and discharge notes. Systematic and comprehensive assessment grounded in research-based criteria were not used in the records. Accuracy varied considerably and was significantly better for some areas in the study group. After intervention, the nurses in the study group indicated that they recorded assessments of patients with greater frequency, showed greater satisfaction with their documentation and spent less time on oral reports. Procedures in auditing patient records were found to encompass four approaches: formal structure, process comprehensiveness, knowledge based and accuracy. In conclusion, the evidence suggests that there are serious flaws in the nursing content of nursing home records though improvements can be achieved through educational means. Presently, there are serious limitations in using the patient record as the sole source of data for care delivery, quality assessment and evaluation of care.

With the advances in technology, the change of the healthcare environment, and the need for users, the use of computerized support systems or expert systems are able to cut down costs for unnecessary procedures, achieve higher levels of efficiency and productivity. Applied to the nursing department, it may provide good quality of care, decrease the time that nurses duplicate patient history, reduce nurses¡¦ burden and enhance the abilities to solve problems. The topic of this research mainly focused on the nursing department in the pediatric ward. I propose a framework for nursing knowledge management by using subjective data, objective data, assessment, and care plan (SOAP), which is used by the nursing staffs as a way of decision-making processes. The method is to collect subjective and objective data, read relevant clinical practice guidelines, make clinical judgments about patients¡¦ actual or potential problems and provide applicable nursing plans and interventions. The staffs review and make final decision to accept or reject these judgments, nursing plans and related interventions. If the staffs reject any judgment, nursing plan and intervention, the system should have inquiry-signs to ask physician and nursing staff. Then the staffs correct the inappropriateness. These clear and easy-to-follow processes help student nurses or beginning nurses cultivate their abilities to care and hope it can provide as a guide to nursing teaching and clinical patient care.

Vårdprocessen beskriver patientens väg genom vården där utgångspunkten är patientens behov och slutpunkten är då behovet av vård upphör och patienten är färdigbehandlad. Ett grundläggande kvalitetskrav är att vården är säker och att patienten inte riskerar att skadas i vårdprocessen. Den mycket uppmärksammade rapporten "To err is human", som kom i slutet av 1990-talet, visade att ett stort antal dödsfall och medicinska felbehandlingar orsakades av hälso- och sjukvården. Rapporten blev startskottet i en världsomspännande debatt om patientsäkerhet som påverkat säkerhets- och systemsyn. Idag ses felhandlingar inte längre som ett hinder utan som en möjlighet till lärande och ny kunskap. Begreppet patientsäkerhet har lyfts fram och vikten av att vårdprocesserna leder till goda resultat tydliggörs allt mer. Inom alla verksamheter inträffar oförutsedda händelser som får oönskade effekter, något som avviker från det förväntade. En avvikelse definieras som en händelse som inte följer normal rutin och förväntade vårdförlopp. Några av dessa händelser rapporteras och analyseras avseende bakomliggande orsak och allvarlighetsgrad av det inträffade samt sannolikhet för upprepning bedöms. Det saknas dock en övergripande riskvärdering av avvikelser i vårdprocessen och kunskap om var i de olika processerna som de allvarligaste riskerna förekommer. Syftet med studien var att belysa riskvärderade avvikelser i vårdprocessen. Studien bygger på empirisk retrospektiv analys av insamlad data i form av inkluderade data från elektroniskt avvikelsehanteringsverktyg under en period av tolv månader vid ett sjukhus som bedriver elektiv kirurgisk vård. Varje avvikelse riskvärderades, där grad av allvar (gradering 1-4) multiplicerades med sannolikhet för upprepning (gradering 1-4). Ett riskvärde, större eller lika med åtta, klassificerades som avvikelser med hög risk och mindre än åtta som avvikelser med låg risk. Därefter analyserades rapportörens berättelse av vad som inträffat och händelsen relaterades till var i huvud- eller stödprocess den inträffat. Avvikelser med hög risk i huvudprocessen, 67 procent, förekom vid vårdplanering och inskrivning och 33 procent vid utskrivning. Avvikelser med låg risk förekom vid vårdplanering, operation/behandling/omvårdnad samt vid postoperativ vård på uppvakningsavdelning, 67 procent. Av avvikelser med hög risk i stödprocesserna förekom 67 procent i den fysiska arbetsmiljön och 17 procent inom HR/personal och 17 procent inom sterilprocessen. Avvikelser med låg risk i stödprocesserna förekom företrädesvis i den fysiska arbetsmiljön, 54 procent. En systematisk riskvärdering av avvikelser visar vilka områden i vårdprocessen som kräver förbättringsåtgärder och skulle kunna skapa förutsättningar för en säkrare väg för patienten, samt skulle kunna stärka medarbetarnas riskmedvetenhet. Inledning och avslutning av vårdprocessen är områden som ur patientsäkerhetsperspektiv kan förbättras