Measuring quality and safety of epilepsy monitoring units in Brazil: Adoption of quality indicators.

PURPOSE: Drug-resistant epilepsy affects a substantial proportion (30-40 %) of patients with epilepsy, often necessitating video-electroencephalography (video-EEG) monitoring. In 2016, Sauro et al. introduced a set of measures aimed at improving the quality and safety indicators reported in video-EEG evaluations. This study aims to report our experience with the implementation of these measures. METHODS: We analyzed video-EEG data regarding quality and safty from a period spanning January 2016 to January 2018, involving a total of 101 patients monitored in our video-EEG unit. RESULTS: Among the patients included in the study, a definitive diagnosis was attainable for 92.1 %, with 36.6 % experiencing a change in diagnosis and 65.3 % undergoing a change in treatment as a result of the video-EEG evaluation. Additionally, the referral question was fully addressed in 60.4 % of admissions, and video-EEG was considered to be very useful or extremely useful in 66.4 % of cases. Adverse events were observed in 26.7 % of patients, with the most common being the progression of focal seizures to bilateral tonic-clonic seizures (11.9 %) and the occurrence of seizure clusters (5.9 %). CONCLUSION: Our findings support the implementation of Sauro et al.'s set of measures, as they provide valuable criteria for improving the reporting of video-EEG quality and safety indicators. However, challenges may arise due to variations in terminology across studies and the lack of standardized criteria for defining essential questions in video-EEG evaluations. Further research utilizing these measures is necessary to enhance their effectiveness and encourage consistent reporting of results from epilepsy monitoring units.

The environment of the nursing team's professional practice in inpatient units of a university hospital.

OBJECTIVE: To evaluate the environment of the professional practice of the nursing staff from inpatient units and to compare it according to professional and work characteristics. METHOD: A cross-sectional analytical study conducted in southern Brazil. Data was collected through the Brazilian version of the Nursing Work Index-Revised with a sample of (n=142) professionals, them being nurses (n=56; 34.9%) and nursing technicians/assistants (n=86; 60.6%). The analysis was performed by means of descriptive and analytical statistics. RESULTS: The professional practice environment was considered favorable in all the subscales. The subscale of relationships between physicians/nursing staff showed a significant difference among the professional categories, with better results for nurses. The afternoon shift stood out in the favorable assessment. Longer working time at the institution and unit tended to have worse assessments for autonomy and control, respectively. CONCLUSION: The assessment of the practice environment was favorable; however, the study signals opportunities for improvements for the nursing team.

Ambiente da prática profissional da equipe de enfermagem em unidades de internação: implicações na qualidade do cuidado e segurança do paciente / Professional practice environment of the nursing team in inpatient units: implications for the quality of care and patient safety

As características dos ambientes da prática de enfermagem têm sido estudadas a fim de uma melhor compreensão dos aspectos que podem favorecer ou restringir o exercício profissional. Os ambientes considerados favoráveis à prática profissional podem contribuir para a qualidade e segurança do paciente. Este estudo teve por objetivos avaliar o ambiente da prática profissional da equipe de enfermagem de unidades de internação clínica e cirúrgica adulto, descrevendo a percepção da equipe em relação ao seu ambiente de trabalho no que diz respeito à segurança do paciente, à qualidade do cuidado, à satisfação com o trabalho e à intenção de deixar o emprego, bem como verificar as relações entre os domínios do instrumento B-NWI-R e as variáveis demográficas da equipe de enfermagem, identificando o número de pacientes atribuídos por profissional da enfermagem em seu turno de trabalho. A coleta de dados foi mediante a aplicação versão brasileira resumida do Nursing Work Index ­ Revised para enfermeiros, auxiliares e técnicos de enfermagem, no período de agosto a dezembro de 2018. Os dados foram analisados por meio de estatística descritiva e analítica. Compuseram a amostra 142 profissionais, sendo 56 (39,4%) enfermeiros e 86 (60,6%) auxiliares e técnicos de enfermagem. Os achados do presente estudo demostram que a equipe de enfermagem percebe como favorável o seu ambiente de prática profissional evidenciando escores positivos (menores de 2,5, segundo ponto de corte da escala) para os quatro domínios do instrumento ­ autonomia (1,82 ± 0,54), controle sobre o ambiente (1,96 ± 0,50), boas relações médico/enfermeiro/equipe de enfermagem (2,05 ± 0,62) e suporte organizacional (1,91 ± 0,49). Apresentou elevada percepção de qualidade do cuidado, segurança do paciente e satisfação no trabalho, com medianas de oito a nove pontos, além de baixa intenção de deixar o emprego (md =1). Após o ajuste pelo modelo multivariado, os dados confirmam que a percepção de segurança do paciente está relacionada com um ambiente favorável. Para os domínios de autonomia, controle, suporte organizacional e escore total, os trabalhadores do turno da manhã apresentaram percepção menos favorável para o ambiente de prática, quando comparado ao trabalho no turno da tarde. O turno da noite também mostrou-se fator de risco para os domínios controle e escore total. Conclui-se que o ambiente da prática na amostra estuda mostra-se favorável, segundo a percepção dos profissionais de enfermagem. No entanto, identificou-se algumas possibilidades de reflexão e pontos de melhoria que poderiam contribuir para um ambiente mais favorável, saudável e seguro para os pacientes e profissionais de enfermagem. Ressalta-se a importância de novos estudos acerca dessa temática, principalmente com dados mais amplos relacionados não só a equipe de enfermeiros, mas também sobre a equipe de auxiliares e técnicos de enfermagem, visto que no Brasil a enfermagem é composta por mais de uma categoria profissional.

The characteristics of nursing practice settings have been studied aiming at better understanding the aspects that may favor or restrict the professional practice. Settings that are considered favorable to the professional practice may contribute for quality and patient safety. The present study aimed at assessing the professional practice environment of the nursing team at hospitalization and adult surgery units, describing the perception the team has of their work environment regarding patient safety, care quality, work satisfaction and intention of quitting their job. In addition, it also sought to verify the relations between the domains of the B-NWI-R instrument and the demographic variables of the nursing team, identifying the number of patients assigned per nursing practitioner in their work shift. Data collection was done through the application of a summarized Brazilian version of the Nursing Work Index ­ Revised for nurses, nursing assistants and technicians, from August to December 2018. Data were analyzed through descriptive and analytical statistics. The sample was composed by 142 professionals, being 56 (39.4%) nurses and 86 (60.6%) nursing assistants and technicians. The findings of the present study show that the nursing team sees their professional practice setting as favorable, highlighting positive scores (lower than 2.5, second cutoff point in the scale) for the four domains of the instrument ­ autonomy (1.82 ± 0.54), control over the environment (1.96 ± 0.50), good relations between physician/nurse/nursing team (2.05 ± 0.62) and organizational support (1.91 ± 0.49). A high perception of care quality, patient safety and work satisfaction was observed, with averages from eight to nine points, in addition to the low intention of quitting the job (md =1). After the adjustment by the multivariate model, data confirmed that the perception of patient safety is related to a favorable environment. For the domains of autonomy, control, organizational support and total score, the workers of the morning shift presented a less favorable perception for the setting of practice when compared to the work in the afternoon shift. The night shift also appeared as a risk factor for the domains of control and total score. It is concluded that the practice setting of the sample analyzed is favorable, according to the perception of nursing professionals. However, there are possibilities for reflection and points for improvement that could contribute to a safer, healthier and more favorable setting for patients and nursing professionals. The importance of new studies concerning this topic is emphasized, especially with broader data related not only to the nursing team, but also to nursing assistants and technicians, considering that in Brazil nursing is composed by more than one professional category.