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    Interrupções de atividades realizadas por enfermeiros de um hospital universitário: implicações para a segurança do paciente
    (Universidade Federal de São Paulo (UNIFESP), 2013-08-28) Monteiro, Cintia [UNIFESP]; Pedreira, Mavilde da Luz Goncalves Pedreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Exploratory and observational study that aimed to classify nursing activities, verify the occurrence and factors that associated with interruptions and also identify nurses walking distance. The sample was composed of 25 nurses from the day-shift, and pediatric and adult, surgical and intensive care units, of a university hospital in São Paulo. Data collection occurred between 15th March 2012 and 18th February 2013, after approval by the committee of ethics in research (0732/11). During 150 hours of observation, there were 2,295 activities classified, being 885 (38.6%) indirect care, 516 (22.5%) direct care, 421 (18.3%) care management, 244 (10.6%) personal activity and 229 (10.0%) unit management. The time spent according to the type of activity performed by the nurses was higher during the direct care (36.2%). There were 719 (31.3%) interrupted activities, however an average of 1.6 interruptions was observed in the same activity, resulting in 1,180 occurrences (7.9 interruptions per hour). The number of interruptions was higher during the indirect care (44.7%), and the most frequent sources were nursing staff (43.3%) and physicians and medical residents (16.5%), requiring more time for resolution of interruptions originated by the nursing staff (36.2%) and lack of supplies (16.4%). After interruptions, nurses did not return to the interrupted activity in 13.2% of the situations and, it was necessary to perform from one to ten activities before returning to the primary activity. From among the factors that correlated with interruption occurrence, it was noticed that professionals with less than five years of professional practice and work in the unit, as well as, without post graduation in the same area of practice, were more interrupted, without significant differences. The number of people present in the unit (p=0.002), the proportion of surgical patients of high dependency and semi-intensive care (p=0.017), the number of caregivers (p=0.003) and other health care professionals (p=0.001), had linear influences over the occurrence of interruptions. By analyzing data from pediatric sites (PS) and adult sites (AS), a greater number of interruptions could be noticed in the first group (p=0.009). On surgical care (SC) and intensive care (IC) sites, the interruptions higher in the SC (p=0.078). The number of patients (p=0.002), the total number of people in unit (p=0.002), the rate of patients per nurse (p=0.001), the rate per nursing assistants and technicians (p=0.003), and a higher number of caregivers (p<0.001), influenced the occurrence of interruptions in PS. In AS was observed a higher number of interruptions related with the presence of a higher number of other health care professionals in the unit (p=0.002). Regarding displacement, nurses walked 260.2 m/h and had to go out the unit in 2.1% of the activities observed, being the main reason the lack of supplies (55.1%). Besides, the highest the distance walked was associated with the greater the number of activities performed (p<0.001), without correlation with the number of interruptions (p=0.508). In conclusion interruptions were observed in all types of activities performed by investigated nurses, even those characterized as interventions more related to direct care, which can compromise patient safety.