Navegando por Palavras-chave "segurança do paciente"
Agora exibindo 1 - 3 de 3
Resultados por página
Opções de Ordenação
- ItemSomente MetadadadosComplicações nos períodos intra e pósoperatório de cirurgia de crânio eletiva e de urgência/emergência(Universidade Federal de São Paulo (UNIFESP), 2013-03-27) Pires, Ellen Maria de Campos [UNIFESP]; Diccini, Solange Diccini [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: To evaluate the incidence of neurological and systemic complications, adverse events and mortality among patients undergoing an elective cranial surgery and urgent/emergency surgery during the intra and post-operative periods. Methods: This was a prospective study in patients, who underwent elective cranial surgery and urgent/emergency surgery, aged equal to or above 18 years, of both genders and were followed daily from the surgical procedure until hospital discharge or death. Results: 127 patients were included in the elective group, with a mean age of 49,2 years with 45,7% being men and 75 patients were in the urgent/emergency group, with a mean age of 51,5 years and 64% being men. In the intraoperative period, the incidence of neurological complications was 12,7% in the elective group and 63.5% in the urgent/emergency group (p<0.0001) and systemic complications was 95,4% in the elective group and 82,7% in the urgent/emergency group (p=0,017). Patients in the urgent/emergency group presented more intracranial hypertension (ICH) (p=0,001) and arterial hypotension was more frequent in the elective group (p=0,001). In the immediate post-operative period (POI) the incidence of neurological complications was 45,5% in the elective group and 52,9% in the urgent/emergency group (p=0,402); systemic complications was 98,3% in the elective group and 98,5% in the urgent/emergency group (p=1,000) and adverse events was 19,7% in the elective group and 9,3% in the urgent/emergency group (p=0,071). The patients in the elective group had more vomiting (p=0,010), pain (p=0,003) and loss of arterial catheter (p=0,047) and patients in the urgent/emergency group showed more ICH (p=0,013), anisocoria (p=0,002), use of vasoactive drugs (DVA) (p=0,001), abnormal potassium (p=0,022) and hyperthermia (p=0,026). In the post-operatively mediate (POM) the incidence of neurological complications was 71,7% in the elective group and 79,7% in the urgent/emergency group (p=0,241), systemic complications was 99,2% in the elective group and 98,6% in the urgent/emergency group (p=1,000) and adverse events was 72,4% in the elective group and 81,3% in the urgent/emergency group (p=0,176). The patients in the elective group presented more pain (p<0.001) and patients in urgent/emergency group presented more ICH (p=0,001), vasospasm (p=0,043), pupils with no fotomotora reaction (p=0,006), re-operation (p=0,046), hypotension (p=0,001), use of vasoactive drugs (p<0,001), bradycardia (p=0,001), tachycardia (p=0,033), cardiopulmonary arrest (p=0,001), gastric reflux (p=0,001), acute renal failure (p=0,014), potassium electrolyte abnormalities (p=0,001), calcium (p=0,008) and sodium (p=0,001), hypoglycemia (p=0,001), hyperthermia (p=0,002), pulmonary infection (p<0,001), loss of arterial catheter (p=0,001), loss of gastric cateter (p=0,037), loss of enteral tube (p=0,001) and pressure ulcers (p=0,001). The mortality rate was 5,5% in the elective surgery group and 26,7% in the urgent/emergency surgery group (p<0,001). Conclusions: In the intra-operative period, the patients in the urgent/emergency surgery group presented more neurological complications such as ICH. In POI, patients in the elective surgery group presented more systemic complications and adverse events and neurological complications were more frequent in patients in the urgent/emergency surgery group. In POM, the patients of the urgent/emergency surgery group presented more neurological and systemic complications, adverse events than the patients in the elective surgery group. Mortality was higher among patients undergoing surgery of the cranium in the urgent/emergency surgery group.
- ItemSomente MetadadadosInterrupções 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.
- ItemSomente MetadadadosUso de estratégia multimodal para promover adesão à higienização das mãos em unidade de cuidados intensivos pediátricos(Universidade Federal de São Paulo (UNIFESP), 2013-12-20) Belela, Aline Santa Cruz [UNIFESP]; Pedreira, Mavilde da Luz Goncalves Pedreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Title: Multimodal strategy to promote hand hygiene compliance in a pediatric intensive care unit Introduction: Hand hygiene (HH) compliance has been regarded as unacceptably poor and the mean reported adherence rate is about 40%. Objectives: to verify Pediatric Intensive Care Unit (PICU) healthcare workers (HCW) previous knowledge about HH practices; to identify predictors of intention to perform the behavior HH during patient care in the PICU; to compare compliance to HH practices before and after interventions to promote adherence. Method: Quasi-experimental study that involved manipulation of the variable HH through the implementation of infrastructure and educational interventions. Descriptive method was adopted for knowledge and behavior intention studies. The research was carried out with 60 HCW of a PICU in a teaching hospital of São Paulo. Direct observation of a previous calculated sample, which consisted on 1261 HH opportunities, was conduct in three phases: Preintervention Phase (direct observation of HCW s HH compliance before intervention; 410 HH opportunities), Phase 1 - postintervention (preceded by infrastructure intervention, focused on knowledge verification; 405 HH opportunities), Phase 2 - postintervention (preceded by evaluation of predictors of HH intention behavior; 446 HH opportunities). Variables related to HH, HCW, knowledge about HH (measured by a validated instrument containing 10 care scenarios; HH knowledge being established in seven correct answers) and HH behavior (measured by a differential semantic scale validated by specialists, based on the Theory of Planned Behavior, studying the constructs intention, attitude, perceived social pressure and perceived behavior control) were also investigated. Descriptive and inferential data analysis were conducted (p<0.005). Results: The intervention promoted significant (p=0.010) improvement of the HH compliance rate ( Preintervention Phase 27.3%, Phase 1 - postintervention 33.1%, Phase 2 - postintervention 37.0%). It was verified a significant (p<0,001) increase in use of the alcoholic solution, without significant raise in handwashing, the most frequent HH procedure observed during the study. The indication after patient contact was related to the highest global HH rate (49.8%) and to higher levels of compliance in all the three study phases (p=0.005). Significant HH adherence increase was also observed to the indication after touching patient surroundings (p=0.005), without intervention influence on the other HH indications studied. Significant raise (p <0.001) in HH compliance was identified only among nursing technicians. 'Contact precautions' and 'g