Análise de eventos adversos em Unidade de Terapia Intensiva
Data
2015-10-28
Autores
Ortega, Daniela Benevides 
Orientadores
Bohomol, Elena
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Eventos adversos (EA) são ocorrências indesejáveis, porém preveníveis, de natureza danosa ou prejudicial que comprometem a segurança dos pacientes que se encontram sob os cuidados dos profissionais de saúde. Objetivos: Caracterizar a população internada na UTI e analisar EA gerenciados pela enfermagem por meio da avaliação da sua prevalência e correlação com características dos pacientes e parâmetros relacionados a equipe de trabalho como a carga de trabalho e as relações entre enfermeiro/paciente e técnico de enfermagem/paciente. Método: Estudo prospectivo, correlacional, com abordagem quantitativa, em uma UTI geral de um hospital privado do município de São Paulo, SP. Foram avaliados 286 pacientes que tiveram 304 internações no período de 01 de setembro a 31 de dezembro de 2013. Por meio de instrumento de coleta de dados confeccionado pela pesquisadora, foram coletados dados da admissão do paciente como as escalas de APACHE II, Glasgow, Braden, NAS e cálculo do risco de queda. Subsequentemente, dados da evolução dos pacientes foram anotados diariamente em planilha específica, focando no registro dos dispositivos inseridos no paciente e no registro dos EA que foram objeto de estudo: queda, úlcera por pressão e perda dos dispositivos cateter venoso central (CVC), tubo orotraqueal (TOT), cateter central de inserção periférica (CCIP) e sonda nasoenteral (SNE). Na ocasião de um EA, foram anotados os parâmetros semelhantes à admissão do paciente como as escalas de NAS, Glasgow, Braden, risco de queda e as relações entre enfermeiro/paciente e técnico de enfermagem/paciente. Resultados: Houve grande variação na idade da casuística (14 a 108 anos) sendo 70 anos a mediana de idade tendo sido maior no sexo feminino. Não houve predomínio de gênero, o prontoatendimento foi a procedência mais comum e a mediana de tempo de permanência foi de três dias tendo sido maior nas internações por motivos clínicos. Na admissão, os pacientes apresentaram escore médio de 13,9 na escala APACHE II, 14,4 na escala de Glasgow, 13,0 na escala de Braden, 65,6 no escore NAS e a maioria dos casos apresentou elevado risco de queda. Foram inseridos dispositivos em 55% das internações, tendo sido a instalação de CVC o mais prevalente. A taxa de ocorrência de pelo menos um EA por internação foi de 8% considerando os eventos que foram objeto de estudo, tendo ocorrido ao total 39 EA sendo a UP o mais comum, seguido de perda de SNE. Em relação à comparação entre os grupos que tiveram ou não EA, o grupo que apresentou EA teve mediana de idade maior, maior prevalência de internações por motivos clínicos, internações mais prolongadas e maior escala de APACHE II na admissão na unidade. Além disso, o grupo que apresentou EA teve maior pontuação do NAS, menor escore na escala de Braden e menor escala de Glasgow, aferidos no dia da ocorrência do EA, em comparação ao grupo sem EA. Por último, não houve diferença na relação paciente/enfermeiro ou paciente/técnico de enfermagem entre os grupos com e sem EA. Conclusões: As análises das ferramentas utilizadas neste estudo, ao demonstrarem diferença entre os grupos de pacientes que tiveram ou não algum EA, responderam a pergunta desta pesquisa de que a ocorrência de EA em UTI sofre influência de fatores como a gravidade dos pacientes e carga de trabalho.
Adverse events (AE), although preventable, are undesirable occurrences of a harmful or detrimental nature that compromise the safety of patients who are under the care of health professionals. Objectives: To characterize the hospitalized population in the Intensive Care Unit (ICU) and analyze AE managed by nursing by assessing its prevalence and correlation with patient characteristics and parameters related to work staff, such as workload and sizing of the nursing staff. Method: A prospective observational study with quantitative approach, in a general ICU of a private hospital in São Paulo, SP. We evaluated 286 patients who had 304 hospital admissions in the period from September 1 to December 31, 2013. Data relating to the scale of APACHE II, Glasgow, Braden, NAS and calculating the risk of falling were collected from patient admission data through a data collection instrument made by the researcher. Subsequently, data of patients' evolution were noted daily on a specific worksheet, focusing on registration of the devices inserted in the patient and recording the AE that were the object of study: fall, pressure ulcer and loss of central venous catheter (CVC) devices, orotracheal tube (OTT), peripherally inserted central catheter (PICC) and nasogastric tube (NGT). On the occasion of AE, the NAS, Glasgow and Braden scales, risk of fall and staff dimensioning parameters were noted in a manner similar to patient's admission. Results: There was wide variation in the age of the study population (14-108 years, median 70 years) and was higher in females. There was no predominance of gender, the emergency room was the most common origin and the median length of stay was three days and was higher in admissions for medical reasons. On admission, patients had a mean score of 13.9 on the scale APACHE II, 14.4 on the scale of Glasgow, 13.0 on the scale of Braden, 65.6 in the NAS score and most of the cases presented a high risk of falling. Devices were placed in 55% of hospitalizations, with CVC the most prevalent installation. The rate of occurrence of at least one AE per hospitalization was 8% considering the events studied. There was a total of 39 AEs, with pressure ulcer being the most common, followed by loss of NGT. Regarding the comparison between groups with or without AE, the group with AE had a higher median age, higher prevalence of hospitalizations for medical reasons, more prolonged hospitalization and greater scale of APACHE II on admission to the unit. Furthermore, the group with AE had a higher NAS score and a lower score in both the Braden and Glasgow scales, measured on the day of occurrence of the AE, compared to the group without AE. There was no difference in relation to the patient/ nurse and patient/nursing technician between the groups with and without AE. Conclusions: The analysis of the tools used in this study show differences between the groups of patients with or without AE, answering the question in this study whether the occurrence of AE in the ICU is influenced by factors such as the severity of patients and work load.
Adverse events (AE), although preventable, are undesirable occurrences of a harmful or detrimental nature that compromise the safety of patients who are under the care of health professionals. Objectives: To characterize the hospitalized population in the Intensive Care Unit (ICU) and analyze AE managed by nursing by assessing its prevalence and correlation with patient characteristics and parameters related to work staff, such as workload and sizing of the nursing staff. Method: A prospective observational study with quantitative approach, in a general ICU of a private hospital in São Paulo, SP. We evaluated 286 patients who had 304 hospital admissions in the period from September 1 to December 31, 2013. Data relating to the scale of APACHE II, Glasgow, Braden, NAS and calculating the risk of falling were collected from patient admission data through a data collection instrument made by the researcher. Subsequently, data of patients' evolution were noted daily on a specific worksheet, focusing on registration of the devices inserted in the patient and recording the AE that were the object of study: fall, pressure ulcer and loss of central venous catheter (CVC) devices, orotracheal tube (OTT), peripherally inserted central catheter (PICC) and nasogastric tube (NGT). On the occasion of AE, the NAS, Glasgow and Braden scales, risk of fall and staff dimensioning parameters were noted in a manner similar to patient's admission. Results: There was wide variation in the age of the study population (14-108 years, median 70 years) and was higher in females. There was no predominance of gender, the emergency room was the most common origin and the median length of stay was three days and was higher in admissions for medical reasons. On admission, patients had a mean score of 13.9 on the scale APACHE II, 14.4 on the scale of Glasgow, 13.0 on the scale of Braden, 65.6 in the NAS score and most of the cases presented a high risk of falling. Devices were placed in 55% of hospitalizations, with CVC the most prevalent installation. The rate of occurrence of at least one AE per hospitalization was 8% considering the events studied. There was a total of 39 AEs, with pressure ulcer being the most common, followed by loss of NGT. Regarding the comparison between groups with or without AE, the group with AE had a higher median age, higher prevalence of hospitalizations for medical reasons, more prolonged hospitalization and greater scale of APACHE II on admission to the unit. Furthermore, the group with AE had a higher NAS score and a lower score in both the Braden and Glasgow scales, measured on the day of occurrence of the AE, compared to the group without AE. There was no difference in relation to the patient/ nurse and patient/nursing technician between the groups with and without AE. Conclusions: The analysis of the tools used in this study show differences between the groups of patients with or without AE, answering the question in this study whether the occurrence of AE in the ICU is influenced by factors such as the severity of patients and work load.
Descrição
Citação
ORTEGA, Daniela Benevides. Análise de eventos adversos em unidade de terapia intensiva. 2015. 109 f. Dissertação (Mestrado em Enfermagem) - Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.