Safety culture and communication about surgical errors from the perspective of the health team. / Cultura de segurança e comunicação sobre erros cirúrgicos na perspectiva da equipe de saúde.

OBJECTIVE: To analyze the safety culture related to the communication dimensions and event notification from the perception of the health team. METHOD: Survey carried out in a teaching hospital of Paraná through the application of the Survey on Patient Safety Culture questionnaire to 158 professionals working in surgical units from May to September 2017.The analysis of the data was done by descriptive and analytical statistics; dimensions with positive responses ≥75% represent strong areas for patient safety. RESULTS: No dimension or item/question were considered strong to surgical patient safety. There was a difference, with a less negative perception from nursing in relation to medicine, in the dimensions "Return of the information and communication about the error" and "Frequency of events reports" (p<0.001). CONCLUSION: The health team perceives that there is fragility in the patient safety in relation to the communication dimension, demanding actions that promote the patient safety.

Medication incidents in an outpatient emergency service: documental analysis. / Incidentes com medicamentos em unidade de urgência e emergência: análise documental.

OBJECTIVE: To characterize medication incidents occurred in an outpatient emergency service. METHOD: Descriptive, documental, retrospective and quantitative research. The International Classification for Patient Safety was the theoretical reference for the construction of the instrument used to collect and analyze the data from 119 notification and investigation forms of incidents occurred in 2014 in a teaching hospital. Data were collected twice, compared, corrected and transcribed to an Excel worksheet. The SPSS 19.0 Software and the non-parametric Mann-Whitney test were used in the analysis; p<0.05 indicated statistical significance. RESULTS: A total of 142 incidents were analyzed, most of them involving the nursing team; 93.7% were avoidable; one-third involved high-alert medications; the majority involved parenteral administration. Harm was rare but proportional to the time elapsed for error detection. Management failures prevailed, especially omission. CONCLUSION: Most of the incidents analyzed were characterized as potentially harmful and avoidable, with emphasis on personnel factors as contributors.

Construction and content validation of checklist for patient safety in emergency care. / Construção e validação de conteúdo de checklist para a segurança do paciente em emergência.

OBJECTIVE: To construct and validate a checklist for patient safety in emergency care. METHOD: This is methodological research conducted in Curitiba, in 2015, with construction and validation stages. The checklist was based on the guidelines of the Brazilian patient safety programme and validated online using the Delphi method, with a questionnaire, and with the participation of 23 Brazilian specialists in the first round and 20 in the second round. The data were analysed using the Content Validity Index (CVI), Cronbach's α, and Fisher's Exact Test. RESULTS: We produced a checklist with 18 valid and reliable items (94% of CVI, Cronbach's α = 0.91). CONCLUSIONS: The checklist comprises patient safety actions and items to predict risk situations, corrective actions, and promote safety in emergency services and other health-related contexts.

[The nurse in the management of materials in teaching hospitals]. / O enfermeiro no gerenciamento de materiais em hospitais de ensino.

OBJECTIVE: To present the nurse's integration within materials management of six teaching hospitals of Paraná - Brazil, and to describe the activities performed by nurses within this process. METHOD: A study of a qualitative approach and descriptive nature, conducted in teaching hospitals in Paraná, between June and August of 2013. The data collection was conducted through semi-structured interviews with eight nurses who worked in materials management; data were analyzed using content analysis. RESULTS: These showed that nurses perform ten categories of activities, distributed into four of the five steps of the materials management process. CONCLUSION: The nurse, in performing of these activities, in addition to favoring the development of participative management, contributes to the organization, planning, and the standardization of the hospital supply process, giving greater credibility to the work with professionals who use the materials, and to the suppliers.

[Adherence to the use of the surgical checklist for patient safety]. / Adesão ao uso de um checklist cirúrgico para segurança do paciente.

OBJECTIVE: Evaluate adherence to the checklist of the Programa Cirurgias Seguras (safe surgery programme) at a teaching hospital. METHODS: Evaluative study conducted at a teaching hospital in the south of Brazil in 2012. Data were collected by means of non-participant observation in 20 hip and knee replacement surgeries and an instrument that was created for research based on the checklist and used by the institution. RESULTS: In the observed procedures (n=20) there was significant adhesion (p<0.05) to the instrument in relation to the verification of documentation, fasting, hair removal in the surgical site, absence of nail varnish and accessories, identification of the patient and surgical site on admission to the surgical unit, availability of blood and functionality of materials. However, there was no significant adherence to the checklist in the operating room in relation to patient identification, procedure and laterality, team introduction, surgical break and materials count. CONCLUSION: The results showed that the items on the checklist were verified nonverbally and there was no significant adherence to the instrument.

[Infrastructure and adherence to hand hygiene: challenges to patient safety]. / Infraestrutura e adesão à higienização das mãos: desafios à segurança do paciente.

Considering the importance of hands in the chain of transmission of microorganisms, this observational research investigated the material infrastructure and compliance of hand hygiene in an intensive care unit in the south of Brazil in 2010. The data was collected by direct non-participant observation and through the use of self-administered questionnaires to be completed by the 39 participants, which was analyzed with the assistance of the chi2 Test, descriptive statistics and quantitative discourse analysis. Although health professionals overestimate compliance rates, recognize the practice as relevant to the prevention of infection and refer there are no impeding factors, of the 1,277 opportunities observed, compliance was 26% and significantly lower before patient contact and the use of aseptic procedures than after patient contact: infrastructure was shown to be deficient. The results indicate risk to patient safety, and thus, the planning of corrective actions to promote hand washing is relevant.

Team-based learning in the internal medicine clerkship didactics.

BACKGROUND: Active-learning approaches, such as team-based learning, are infrequently used in internal medicine clerkship didactics even though there is increasing evidence to suggest medical students prefer it over traditional lecture-based learning. In this study, five team-based learning sessions were incorporated into three blocks of a 12-week internal medicine clerkship. METHODS: The goal of this quasi-experimental study was to compare learner engagement, satisfaction and preference between team-based learning and lecture-based learning in the internal medicine clerkship didactics. Outcomes were compared using the Classroom Engagement Survey, a satisfaction questionnaire and the Team-Based Learning Student Assessment Instrument (TBL-SAI). FINDINGS: There was a statistically significant difference in the classroom engagement scores between team- and lecture-based learning (P < 0.0001) with a median of 39.0 and 33.0 in the team-based learning and lecture-based learning groups. For learning preference, the median TBL-SAI score was substantially above neutral. Across all team-based learning sessions, 100% of students were satisfied or strongly satisfied with the learning style as a valuable experience and as a way to learn course material, and only one student was not satisfied or strongly satisfied with team-based learning to improve problem solving skills. DISCUSSION: The classroom engagement and learning style preference findings were consistent with previously published data in other clerkship settings. Student satisfaction was more consistent with team-based learning than with the lecture-based learning, which may be because of the consistent format whereas lecture-based learning style was faculty dependent. CONCLUSION: Students preferred team-based learning and had improved engagement and satisfaction when compared to lecture-based learning. This study provides evidence in favour of team-based learning as a strategy to incorporate active learning in clerkship didactics.

Impact of surgical checklists on the time of surgical processes: a cross-sectional study.

OBJECTIVES: to analyze the impact of the use of checklists on the mean time of the operative processes of patients undergoing hip and knee arthroplasties. METHOD: cross-sectional and analytical research conducted between November/2020 and March/2022 with retrospective consultation in a simple random sample of 291 medical records, distributed in three periods (2010/2013/2016). Descriptive and inferential statistics were used for data analysis; p=0.05 values indicated significance. RESULTS: there was a reduction in the time of entry-exit from the operating room (p=0.002), surgery (p<0.001) and between the onset-anesthesia and the beginning-incision (p=0.021). There was no difference in time between patients with and without the use of checklists (p=0.05) in relation to the variables onset-anesthesia, onset-incision, time of anesthesia and surgery. CONCLUSION: the implementation of checklists potentially contributed to reduce the time of use of the operating room. The nonassociation of its use with the increase in the mean time of the processes in the operating room shows that its application does not interfere negatively in this indicator.

Hospital admission and the occurrence of delirium in older adults with physical frailty: cross-sectional study.

OBJECTIVE: To analyze the relationship between hospitalization and the occurrence of delirium in older adults with physical frailty. METHOD: Cross-sectional study carried out in a public hospital in southern Brazil. Hospitalized older adults aged ≥ 60 years participated. Sociodemographic and clinical data were collected, physical frailty phenotype tests were performed and the Confusion Assessment Method was used. Descriptive analyzes were carried out and odds ratio values were estimated for the frailty and delirium variables. RESULTS: Of the 320 older adults evaluated, 21.14% presented delirium, 49% were identified as pre-frail and 36.2% as frail. Of those affected by delirium, 71.6% were classified as frail and 28.3% as pre-frail (p < 0.001). An association was observed between the occurrence of delirium and frailty (OR 1.22; 95% CI 1.07 to 1.38), age ≥ 80 years (OR 1.14; 95% CI 1.01 to 1.32), epilepsy (OR 1.38; 95% CI 1.09 to 1.76), dementia (OR 1.58; 95% CI 1.37 to 1.82), and history of stroke (OR 1.14; 95% CI 1.03 to 1.26). CONCLUSION: There was a high frequency of pre-frail and frail older adults, and the occurrence of delirium in frail was significantly higher. Special attention should be paid to frail older adults to prevent the occurrence of delirium during hospitalization.

[Characteristics of victims and fatal accidents at the workplace]. / Caracterização das vítimas e dos acidentes de trabalho fatais.

This is a quantitative, descriptive, retrospective documental study on fatal accidents occurred during the period from o2006 to 2010, in which workers were treated at Hospital do Trabalhador, located in Curitiba/Parand. We selected 25 notifications for the outcome death. This study aimed to characterize victims and fatal occupational accidents. Fatal occupational accidents hit workers with a mean age of 35 years (SD = 13.0694), of the male sex, n = 23 (92%). Typical occupational accidents accounted for 52% (n = 13) of cases. One of the preventive measures proposed to reduce the number of fatal occupational accidents is the performance of educational and preventive work at the workplace by nurses. Moreover, it is necessary to rethink transit violence as a relevant factor for the cause of death of workers as well.

Translation, cross-cultural adaptation and content validation of the Global Trigger Tool surgical module.

OBJECTIVE: to translate, cross-culturally adapt and validate the Global Trigger Tool surgical module content for Brazil. METHOD: this is methodological research, carried out between March/2018 and February/2019, following the steps of translation, synthesis, back-translation, validation by the Delphi technique, pre-test and presentation to developers. Two translators, two back-translators, six professionals participated in the expert committee. A pre-test was carried out with a retrospective analysis of 244 medical records of adult patients. The content validity index and Cronbach's alpha were determined for data analysis. RESULTS: the translation and cross-cultural adaptation allowed adjustments of items for use in Brazil. The mean Content Validity Index was 1.38, and the degree of agreement among experts was 92.4%. Cronbach's alpha was 0.83 for the 11 surgical triggers and their guidelines. CONCLUSION: the module was translated, cross-culturally adapted for Brazil, with high reliability to identify surgical adverse events.

The Healthcare Failure Mode and Effect Analysis as a tool to evaluate care protocols.

OBJECTIVES: to identify, classify, and analyze modes of failure in the medication process. METHODS: evaluative research that used the Healthcare Failure Mode and Effect Analysis (HFMEA) in a service of bone marrow transplant from June to September 2018, with the participation of 35 health workers. RESULTS: 207 modes of failure were identified and classified as mistakes in verification (14%), scheduling (25.6%), administration (29%), dilution (16.4%), prescription (2.4%), and identification (12.6%). The analysis of risk showed a moderate (51.7%) and high (30.9%) need of intervention, leading to the creation of an internal quality assurance group and of continued education activities. CONCLUSIONS: the Healthcare Failure Mode and Effect Analysis showed itself to be a tool to actively identify, classify, and analyze failures in the process of medication, contributing for the proposal of actions aimed at patient safety.

Effect of a guide for clinical reasoning on Nursing students' diagnostic accuracy: A clinical trial. / Efeito de guia para raciocínio clínico na acurácia diagnóstica de estudantes de enfermagem: ensaio clínico.

OBJECTIVE: to evaluate the effect of the Self-Instructional Guide for Clinical Reasoning on the diagnostic accuracy of undergraduate Nursing students. METHOD: a randomized, parallel and double-blind (researchers and outcome evaluators) clinical trial, carried out with undergraduate Nursing students. Validated case studies were applied in two phases to identify the patient's Nursing diagnosis/problem, etiology and clues, using the Guide with the intervention group in the second phase. The outcomes - diagnostic and etiological accuracy and number of clues - were evaluated using validated rubrics. Descriptive statistics were used to analyze demographic data; Fisher's exact test for similarities in prior education and confidence; Mann-Whitney's test for age; and non-parametric ANOVA test in the evaluation of the hypothesis of differences in performance. RESULTS: final sample composed of 24 students in the control group and 27 in the intervention group; no difference as to gender, age and schooling. There was a difference in diagnostic (p=0.041) and etiological (p=0.0351) accuracy in the intervention group, showing a negative effect of using the Guide. CONCLUSION: the one-time self-instruction was not effective in impacting the diagnostic accuracy of students solving case studies. Repeated application of the Guide as a teaching tool can be effective in improving such outcome. REBEC: RBR-4bhr78.

Novel duplex RT-qPCR for animal rabies surveillance.

Rabies is a lethal zoonosis affecting mammals worldwide. Diagnosis of rabies follows international standard protocols, primarily relying on direct immunofluorescence (DI) followed by mouse inoculation test (MIT). WHO recommends molecular biology techniques such as RT-qPCR for replacing MIT to diagnose rabies in animal samples. Recently, a real-time PCR protocol that detects all rabies virus variants identified worldwide was validated. This assay is a pan-Lyssavirus TaqMan quantitative RT-PCR called LN34. A modified LN34 assay protocol was tested at the Paraná State Reference Laboratory (Lacen/PR) using animal samples previously tested by DI and MIT, the gold standard (GS). This method has been changed to a RT-qPCR duplex format to better fit the diagnostic routine. The new assay was called duplex LN34 and ß-actin RT-qPCR. All the 88 samples evaluated using the GS test, modified pan-Lyssavirus TaqMan RT-qPCR and duplex LN34 and ß-actin RT-qPCR showed 100% agreement with each other. This novel duplex RT-qPCR protocol has shown adequate diagnostic performance and may be used in research and surveillance purposes, replacing the standard MIT and ending mice use for rabies diagnosis.

Cross-cultural adaptation for Brazil and validity of a guide to assist nursing students' clinical reasoning.

PURPOSE: To assess the validity of a Written Clinical Reasoning Prompt (WCRP) to help nursing students' clinical reasoning (CR). METHOD: This is a methodological study of translation and cross-cultural adaptation into Brazilian Portuguese of instruments that aim to promote CR improvement, composed of (1) WCRP; (2) two case studies; (3) a questionnaire about students' perceptions during decision-making in case studies; (4) a scoring rubric for correcting case studies. For translation and cross-cultural adaptation, stages 1-8 of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Consortium Network were adopted. Agreement values among experts >80% and content validity coefficient (CVC) > 0.8 were considered satisfactory. For the pretest, a randomized clinical trial was carried out with 24 nursing students (intervention group, n = 14, using the WCRP to solve case studies; control group, n = 10, without using the WCRP). FINDINGS: The WCRP was translated and adapted into Brazilian Portuguese, requiring minimal adjustments to obtain agreement among the judges above 80% and CVC above 0.80. Regarding face validation, an adequate agreement was obtained in the assessment by students. There was no difference in the accuracy of nursing diagnoses between the intervention and control groups in the pretest. CONCLUSION: The WCRP was translated and adapted into Brazilian Portuguese and had adequate face and content validity estimates; however, there was no association with improving nursing students' diagnostic accuracy. IMPLICATIONS FOR NURSING PRACTICE: The translated and adapted versions of all instruments into Brazilian Portuguese had adequate evidence of content and face validity. The use of WCRP was not associated with a significant improvement in nursing students' diagnostic accuracy. New studies with larger samples, a sample power of at least 80%, and a level of significance of 5% are needed.

Association between professional qualification and adverse events in neonatal and pediatric intensive treatment units.

OBJECTIVE: to verify the association between the qualification of nursing professionals and the occurrence of adverse events in neonatal and pediatric intensive care units. METHOD: Cross-sectional and evaluation study conducted in six intensive care units of five public hospitals in the state of Paraná, Brazil. Data was collected from April/2017 to January/2018 through the use of a questionnaire to be completed by 143 nursing professionals and retrospective analysis of 79 medical records using the Neonatal Trigger Tool and Pediatric Trigger Tool instruments. The prognostic factors were professional training and the existence, or not, of a continuing education service; analysis was performed by logistic regression. RESULTS: Detected 30 adverse events in 22 medical records analyzed. There was a prevalence of infection (n = 12; 40%) and skin damage (n = 9; 30%). Among the prognostic factors, continuing education was identified as a protective factor against adverse events (p≤0.05). CONCLUSION: Continuing education was associated with the prevention of adverse events in neonatal and pediatric intensive care units.

Effects of Clinical Reasoning Prompts on Nursing Students' Clinical Judgment for a Patient Experiencing Respiratory Distress.

PURPOSE: To test the effects of clinical reasoning prompts on students' clinical judgment of a written case study. METHODS: An experimental pre- and posttest study with second semester nursing students (N = 163). FINDINGS: The intervention was insufficient to significantly improve clinical judgment. Students identified that the prompts would help them "narrow… down the problem" and "slow… the decision-making process" to improve analysis. The most accurate patient problem was identified by 28% of students in pretest and 35% in posttest. CONCLUSIONS: This study provides evidence of variations in nursing students' clinical judgment and students' desire to use decision-making algorithms. NURSING IMPLICATIONS: Nurse educators should provide students with additional education and practice to identify and solve these types of problems.

Methicillin resistant Staphylococcus aureus: knowledge and factors related to the nursing teams adherence to preventive measures.

This study evaluated the knowledge of a nursing team from a public hospital in the state of São Paulo, Brazil concerning preventive measures recommended in the care delivered to patients colonized with Methicillin Resistant Staphylococcus Aureus (MRSA) and, through the Health Beliefs Model, identified the factors influencing adherence or non-adherence to preventive measures. A total of 318 professionals from different units participated in the study. According to the analysis, the nursing teams knowledge and perception of MRSA susceptibility was limited, which indicates the need for actions to improve the understanding of preventive measures employed in the care delivered to patients colonized or infected by this microorganism.

Indicators of effectiveness of nursing care in the dimension of patient safety.

OBJECTIVES: to validate nursing care effectiveness indicators of patient safety dimension. METHODS: quantitative survey, using the electronic Delphi sampli, with 52 participants selected by the Snowball sampling. Eight indicators were evaluated regarding the attributes: availability, reliability, simplicity, representativeness, sensitivity, comprehensiveness, objectivity, cost, utility, stability and timeliness. For validation, the minimum agreement criterion was 70%. RESULTS: Cronbach's alpha (0.942) evidenced the high internal consistency among the attributes. The indicators fall with damage, hip fracture, and postoperative hip fracture, incidents related to equipment, incidents due to failures in patient identification, and pressure injury were validated in all attributes, and those of medication error and hand Hygiene were not validated. CONCLUSIONS: the validated indicators allow assessment of the effectiveness of hospital nursing care. Unavailability of data is an obstacle to monitoring patient safety.

Multimodal strategy for hand hygiene in field hospitals of COVID-19.

OBJECTIVE: Reflect and propose adaptations to the Multimodal Hand Hygiene Strategy for field hospitals, in the context of the COVID-19 pandemic. METHOD: Reflective study, carried out in April 2020, based on the recommendations of the World Health Organization and the guide for the implementation of the five components of the Multimodal Strategy: system change related to infrastructure; training/education; evaluation and feedback; reminders in the workplace; and institutional security climate. RESULTS: The Multimodal Strategy, proposed for hospitals in general, can be adapted for field hospitals in order to reduce the transmission of the SARS-CoV-2 virus. Investments to adapt the infrastructure and education of workers require foresight and speed and are of special relevance to promote hand hygiene in this care context. FINAL CONSIDERATIONS: Adjusting the Multimodal Strategy, especially for the reduced time in the execution of each component, is necessary for field hospitals with a view to preventing COVID-19.