Administração segura de medicamentos via endovenosa: uma proposta para o hospital universitário / Safe intravenous drug administration: a proposal for the university hospital

Introdução: A assistência à saúde com qualidade e segurança é um tema atual e pertinente aos serviços de saúde, que tem se preocupado em aprimorar seus processos com base nos preceitos desta temática. Este estudo visa contribuir para qualidade e segurança na assistência aos pacientes no que concerne a administração de medicamentos. E também pretende contribuir com o ensino e pesquisa nesta área na medida em que trata um delineamento da realidade de uma Instituição de Ensino e busca propor uma uniformização do processo. Objetivos: Identificar a dinâmica de administração de medicamentos. Elaborar um Procedimento Operacional Padrão para administração de medicamentos via endovenosa. Elaborar Lista de Verificação (CheckList) com as etapas a serem seguidas para uma administração segura de medicamentos para avaliar adesão dos profissionais. Os produtos oriundos dessa pesquisa foram: Procedimento Operacional Padrão para administração de medicamentos via endovenosa e um CheckList com as etapas para administração segura de medicamentos.Método:Estudo descritivo com abordagem qualitativa para análise dos dados. Os participantes foram os membros da Equipe de Enfermagem da enfermaria de escolha, a coleta de dados foi realizada por meio da observação direta guiada por um roteiro de observação, no segundo semestre de 2015, de segunda a domingo, nos três turnos de trabalho após a assinatura do Termo de Consentimento Livre e Esclarecido, sendo a amostra não probabilística por conveniência. Este estudo foi aprovado pelo comitê de ética das instituições proponente e co-participante sob os pareceres n° 1.262.690 e 1.301.318. Resultados: Foi observado um total de 23 doses de medicamentos por via endovenosa. Foi observada adesão superior à 50% na maioria das etapas da administração de medicamentos. Porém ressaltou-se como pontos de atenção uma adesão de 17% ao uso de EPI durante a manipulação dos medicamentos, 17% à desinfecção das conexões antes da administração e 15% à higienização das mãos logo após o procedimento antes de retornar ao posto de enfermagem. Conclusão: Os achados desta pesquisa apontam para necessidade de intervenção em questões da prática dos profissionais como higienização das mãos e uso de EPI's. Esses dados corroboram a necessidade de uma uniformização da prática assistencial no que concerne a administração de medicamentos visando à qualidade e segurança da assistência de Enfermagem

Introduction: Health care with quality and safety is a current topic and pertinent to health services, which has been concerned with improving its processes based on the precepts of this theme. This study aims to contribute to quality and safety in patient care in drug administration. It also intends to contribute to teaching and research in this area insofar as it deals with a delineation of the reality of a teaching institution and seeks to propose a standardization of the process. Objectives: To identify the dynamics of drug administration. Elaborate a Standard Operating Procedure for intravenous drug administration. Elaborate Checklist with the steps to follow for safe administration of medications to assess adherence of professionals. The products that came from this research were: Standard Operating Procedure for intravenous drug administration and a CheckList with the steps for safe administration of drugs. Method: Descriptive study with qualitative approach for data analysis. Participants were members of the Nursing Team of the infirmary of choice, data collection was done through direct observation guided by an observation script, in the second half of 2015, from Monday to Sunday, in the three work shifts after the signature of the Free and Informed Consent Term, being the non-probabilistic sample for convenience. This study was approved by the ethics committee of the proposing institutions and co-participant under the reports no. 1,262,690 and 1,301,318. Results: A total of 23 intravenous drug doses were observed. Adherence was higher than 50% in most stages of drug administration. However, a 17% adherence to the use of PPE during the manipulation of medications, 17% to the disinfection of the connections before administration and 15% to the hygiene of the hands soon after the procedure before returning to the nursing station . Conclusion: The findings of this research point to the need for intervention in issues of professional practice such as hand hygiene and use of PPE. These data corroborate the need for a standardization of care practice regarding the administration of medicines aiming at the quality and safety of Nursing care

[The locations of mobile geriatric teams in France]. / Les équipes mobiles de gériatrie en France.

Mobile geriatric teams fulfil several missions in healthcare facilities. They work within and outside hospitals. A nationwide study was carried out in 2011 and a task force was created within the French geriatric and gerontology society (SFGG) to standardise the practices of these teams in France and emphasise their place at the heart of the health care pathway of the elderly.

[Perception of safety climate in outpatient pediatric care]. / Die Wahrnehmung des Sicherheitsklimas in der ambulanten Kinderkrankenpflege.

In ambulant pediatric care, patients situations are becoming increasingly complex, because the lenght of hospital stay is reduced since the introduction of Diagnosis Related Groups (DRG). Consequently, the patients' safety is constantly becoming more important. The patients' safety is closely associated with the nurses' awareness of risks and the safety climate within the institution. This study is investigating how nurses of a pediatric outpatient service estimate the patients' safety and how that can be optimized, if necessary. As part of a cross-sectional study, a total of 106 nurses of the pediatric outpatient service were interviewed with a modified German version of the "Patient Safety Climate Inventory (Patientensicherheitsklima-Inventar, PaSKI)". Data was analysed by a descriptive statistical method. The return rate was 80.2 percent. The results show a very high awareness of patients' safety issues as well as a high level of satisfaction concerning team collaboration. Both results have a positive influence on the safety-climate. Problems are associated mainly with the incident reporting system, e.g. with reporting critical incidents and communicating after reporting. This indicates the importance of a useable incident reporting system, which--in combination with staff training--may be an important step towards a structured risk management. Furthermore, it clarifies the importance of transparent communication after a reported incident, as also described in the literature.

Medication safety initiative in reducing medication errors.

The purpose of the study was to evaluate whether a Medication Pass Time Out initiative was effective and sustainable in reducing medication administration errors. A retrospective descriptive method was used for this research, where a structured Medication Pass Time Out program was implemented following staff and physician education. As a result, the rate of interruptions during the medication administration process decreased from 81% to 0. From the observations at baseline, 6 months, and 1 year after implementation, the percent of doses of medication administered without interruption improved from 81% to 99%. Medication doses administered without errors at baseline, 6 months, and 1 year improved from 98% to 100%.

Network analysis of team structure in the neonatal intensive care unit.

OBJECTIVE: The goal was to examine nursing team structure and its relationship with family satisfaction. METHODS: We used electronic health records to create patient-based, 1-mode networks of nursing handoffs. In these networks, nurses were represented as nodes and handoffs as edges. For each patient, we calculated network statistics including team size and diameter, network centrality index, proportion of newcomers to care teams according to day of hospitalization, and a novel measure of the average number of shifts between repeat caregivers, which was meant to quantify nursing continuity. We assessed parental satisfaction by using a standardized survey. RESULTS: Team size increased with increasing length of stay. At 2 weeks of age, 50% of shifts were staffed by a newcomer nurse who had not previously cared for the index patient. The patterns of newcomers to teams did not differ according to birth weight. When the population was dichotomized according to median mean repeat caregiver interval value, increased reports of problems with nursing care were seen with less-consistent staffing by familiar nurses. This relationship persisted after controlling for factors including birth weight, length of stay, and team size. CONCLUSIONS: Family perceptions of nursing care quality are more strongly associated with team structure and the sequence of nursing participation than with team size. Objective measures of health care team structure and function can be examined by applying network analytic techniques to information contained in electronic health records.

The AWHONN Near-Term Infant Initiative: a conceptual framework for optimizing health for near-term infants.

In June 2005, the Association of Women's Health, Obstetric and Neonatal Nurses launched a multiyear initiative to address the unique physiologic and developmental needs of near-term infants (NTIs) defined as those born between 34 and 37 weeks post-menstrual age. The Optimizing Care for the Near-Term Infant Conceptual Model integrates the concepts of neonatal physiologic functional status, nursing care practices, care environment, and the essential role of the family both in the hospital and beyond. The elements of the model will serve to guide program and resource development within the Near-Term Infant Initiative. Goals of the initiative are to raise awareness of the NTI population's unique needs, emphasize the need for research, encourage development and adoption of evidence-based guidelines to promote safe care, and provide resources that assist nurses and other health care professionals in risk-based assessment of NTIs.

Using OASIS data to improve skin care.

Using the FOCUS-PDCA process, this article outlines an early intervention project focusing on improving patient interventions for skin care using OASIS data.

Skill mix literature review.

Administrators are currently being challenged to maintain high quality patient care in the face of shrinking health care resources. The introduction of different skill mix ratios has been suggested as one way to help manage health care costs. This paper briefly reviews the literature and research data on skill mix, discussing the relevant issues and identifying the positive and negative implications of this approach. It concludes with suggestions for further research.

Patient satisfaction with nursing care, evaluation before and after cutback in expenditure and intervention at a surgical clinic.

After a major cutback in the budget and staffing of a surgical clinic in southern Sweden there was intervention to improve the quality of nursing care and to evaluate the outcome. The intervention consisted of the implementation of: (1) nursing care organized in such a way that it would secure continuity of the nurse-patient relationship, (2) individually planned care by means of diagnostic reasoning, and (3) quality assurance for aspects believed to be connected with quality of care. Patient satisfaction before and after the intervention was assessed by means of a patient questionnaire survey (May 1991; n = 105 and May 1992; n = 137). Patient satisfaction improved significantly in variables related to nursing care viz. overall satisfaction and satisfaction with information and decision making; satisfaction with contact and staff-patient relationship; ward facilities and physical treatment or examinations; and satisfaction with physical nursing care. The results were interpreted to mean that the intervention may have counteracted any negative impact the reduced budget might have had such as the higher patient turn-over and the shorter in-patient periods, and thus seemed to have improved the quality of the nursing care in terms of patient satisfaction.

Qualified nurse and nursing auxiliary perceptions of their work environment in primary, team and functional nursing wards.

The way in which nursing work is organized has major implications for the role of different staff grades. This paper describes how qualified nurses and nursing auxiliaries perceived their work in primary, team and functional nursing wards. The Work Environment Scale was distributed to 12 qualified nurses and 12 nursing auxiliaries within each organizational mode, and a response rate of 97% was achieved. While differences were found between organizational modes, there was no difference in work perceptions between qualified nurses and nursing auxiliaries within organizational mode. It is argued that this is due to cultures existing within organizational types which transcend staff grade.

A summary of findings of a five-year comparison study of primary and team nursing.

This study compared primary and team nursing in three areas: quality of care, impact on nursing staff, and cost. Eight medical units in one hospital were evaluated. The study was conducted over a four-year period utilizing three phases: one preintervention phase and two postintervention phases. The study used multiple measures including two approaches to analysis of cost. The findings of this study confirm that primary nursing does result in a higher quality of nursing care than team nursing and that nurse retention is improved in primary nursing. In addition, this study shows that, both directly and indirectly, primary nursing reduces costs when compared to team nursing.