O objetivo foi revisar a literatura sobre os incidentes, eventos adversos e seus fatores contribuintes no cuidado hospitalar, descritos segundo a perspectiva do paciente. Foi realizada revisão em artigos publicados nas bases MEDLINE, Scopus e LILACS entre os anos de 2008 e 2019. Dentre 2.686 estudos inicialmente levantados, 167 foram pré-selecionados para leitura, 24 selecionados e categorizados de acordo com a análise temática de conteúdo. Na síntese das informações extraídas dos 24 artigos emergiram quatro categorias: terminologia usada para definir incidentes e eventos adversos, destacando-se diferentes nomenclaturas como erro e erro médico; incidentes e eventos adversos identificados pelos pacientes, familiares e cuidadores relacionados ao processo de medicação, cirurgia, infecções relacionadas à assistência à saúde, quedas e lesão por pressão; percepção do paciente quanto os fatores contribuintes para o cuidado inseguro, destacando-se problemas relacionados à comunicação, higienização das mãos e identificação do paciente; sugestões dos pacientes para prevenir a ocorrência de incidentes e eventos adversos, incluindo treinamento de profissionais, elaboração de listas de verificação, escuta do paciente e adequação do ambiente. Pacientes foram capazes de identificar incidentes, eventos adversos e fatores contribuintes na prática do cuidado, que aliados às informações oriundas dos profissionais de saúde podem potencialmente contribuir para a prestação do cuidado em saúde mais seguro.
1 January 2020 in Revista Brasileira de Enfermagem
Objectives: to identify the perception of nursing professionals on human errors in nursing care at a Neonatal Intensive Care Unit and to assess Best Practices strategies proposed by these professionals for patient safety in nursing care. Methods: this is a quantitative-qualitative, descriptive study. Setting: Neonatal Intensive Care Unit. Participants: 22 nursing professionals. Data collection was performed through interviews and sent to the thematic analysis. Results: human errors in nursing care, such as wasted catheters; errors in the medication process; causes for error in nursing care, with a focus on work overload; Best Practices for patient safety in nursing care, such as professional training and improved working conditions. Conclusions: it is of utmost importance to invest in Best Practices strategies for Patient Safety, aimed at consolidating the culture of organizational safety and encouraging an adequate environment to manage errors.
20 December 2018 in Revista da Escola de Enfermagem da USP
Objective: To analyze the active failures and the latent conditions related to errors in intensive nursing care and to discuss the reactive and proactive measures mentioned by the nursing team. Method: Qualitative, descriptive, exploratory study conducted at the Intensive Care Unit of a general hospital. Data were collected through interviews, participant observation and submitted to lexical analysis in the ALCESTE® software and to ethnographic analysis. Results: 36 professionals of the nursing team participated in the study. The analysis originated three lexical classes: Error in intensive care nursing; Active failures and latent conditions related to errors in the intensive care nursing team; Reactive and proactive measures adopted by the nursing team regarding errors in intensive care. Conclusion: Reactive and proactive measures influenced the safety culture, in particular, the recognition of errors by professionals, contributing to their prevention, safety and quality care.
1 January 2021 in Revista Brasileira de Enfermagem
Objective: To reflect on the safe care exercised by the pre-hospital care team by emergency ambulance in times of coronavirus infection. Method: A reflection and description of how to provide safe care to the patient and the professional during pre-hospital care in times of coronavirus infection. Results: To ensure the health of all those involved in the care, health professionals who work in pre-hospital care by emergency ambulance should use the recommended Personal Protective Equipment (PPE), such as the use of surgical masks and N95, N99, N100, PFF2 or PFF3, the use of an apron or overall, goggles and face shield, gloves and a hat. The entire team must receive training and demonstrate the ability to use PPE correctly and safely. Final considerations: The professional working in the pre-hospital care by ambulance is exposed to a series of occupational risks that need to be discussed and minimized through professional training.
Objectives: to identify situations of violence in the daily work of the health professionals of the Family Health Strategy and to describe the conducts adopted by these professionals in relation to the situations of violence identified. Method: a qualitative, descriptive and exploratory study whose scenario was a Family Clinic of the city of Rio de Janeiro. Eighteen health professionals participated. Data was collected through semi-structured interviews and subjected to content analysis. Results: three thematic categories emerged: Situations of workplace violence in the Family Health Strategy; Consequences of workplace violence on the Family Health Strategy; The nurse's role as leader of the Family Health Team and the strategies adopted in the face of workplace violence. Conclusions: situations of interpersonal violence and collective violence were identified, exemplified by the contact with armed violence in the territory, racial discrimination, peer violence and violence suffered by the user, such as domestic violence, directly affecting the professional. The importance is highlighted of the nurse's role as leader of the Family Health Strategy team, envisioning the management of violence situations, often neglected.
1 January 2020 in Revista Brasileira de Enfermagem
Objectives: to analyze, according to the scientific literature, communication strategies in the transfer of cases between pre-hospital and in-hospital services and their contributions to patient safety. Methods: this is a literature review study, that is, one that aims to gather and synthesize research results on the subject in a systematic and orderly manner. Results: ten articles were published, published between 2010 and 2018, and two points of discussion emerged: use of mnemonics; and barriers to transferring a case. Conclusions: studies point to the need to standardize the case transfer process, as well as integrative training of professionals, regular assessment of the teams involved in emergency medical services and the need for research on the subject.