Patterns, appropriateness and outcomes of peripherally inserted central catheter use in Brazil: a multicentre study of 12 725 catheters.

BACKGROUND: Little is known about peripherally inserted central catheter (PICC) use, appropriateness and device outcomes in Brazil. METHODS: We conducted an observational, prospective, cohort study spanning 16 Brazilian hospitals from October 2018 to August 2020. Patients ≥18 years receiving a PICC were included. PICC placement variables were abstracted from medical records. PICC-related major (deep vein thrombosis (DVT), central line-associated bloodstream infection (CLABSI) and catheter occlusion) and minor complications were collected. Appropriateness was evaluated using the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). Devices were considered inappropriate if they were in place for <5 days, were multi-lumen, and/or were placed in patients with a creatinine >2.0 mg/dL. PICCs considered appropriate met none of these criteria. Mixed-effects logistic regression models adjusting for patient-level and hospital-level characteristics assessed the association between appropriateness and major complications. RESULTS: Data from 12 725 PICCs were included. Mean patient age was 66.4±19 years and 51.0% were female. The most common indications for PICCs were intravenous antibiotics (81.1%) and difficult access (62.7%). Most PICCs (72.2%) were placed under ultrasound guidance. The prevalence of complications was low: CLABSI (0.9%); catheter-related DVT (1.0%) and reversible occlusion (2.5%). Of the 12 725 devices included, a total of 7935 (62.3%) PICCs were inappropriate according to MAGIC. With respect to individual metrics for appropriateness, 17.0% were placed for <5 days, 60.8% were multi-lumen and 11.3% were in patients with creatinine >2.0 mg/dL. After adjusting for patient and hospital-level characteristics, multi-lumen PICCs considered inappropriate were associated with greater odds of major complications (OR 2.54, 95% CI 1.61 to 4.02). CONCLUSIONS: Use of PICCs in Brazilian hospitals appears to be safe and comparable with North America. However, opportunities to improve appropriateness remain. Future studies examining barriers and facilitators to improving device use in Brazil would be welcomed.

Near-miss analysis in a large hospital in southern Brazil: A 5-year retrospective study.

BACKGROUND: Near-miss analysis is an effective method for preventing serious adverse events, including never events such as wrong-site surgery. OBJECTIVE: To analyze all near-miss incidents reported in a large general hospital in southern Brazil between January 2013 and August 2017. METHOD: We performed a descriptive retrospective study of near-miss incidents recorded in the hospital's electronic reporting system in a large non-profit hospital (497 beds). The results are expressed as absolute (n) and relative frequencies (%). Pearson's chi-square test, Fisher's exact test (Monte Carlo simulation) and linear regression were used. RESULTS: A total of 12,939 near-miss incidents were recorded during the study period, with linear growth in the number of reports. Near-miss incidents were most frequent for medication, followed by processes unspecified in the International Classification for Patient Safety framework, followed by information control (patient chart and fluid balance data), followed by venous/vascular puncture. The highest prevalence of reports was observed in inpatient wards, in adult, pediatric, and neonatal intensive care units, and in the surgical center/post-anesthesia care unit. Pharmacists and nursing personnel recorded most of the reports during the day shift. CONCLUSION: The most frequent categories of near-miss incidents were medication processes, other institutional protocols, information control issues, and venous/vascular puncture. The significant number of reported near-miss incidents reflects good adherence to the reporting system.

Quality improvement strategy to enhance compliance with the World Health Organization Surgical Safety Checklist in a large hospital: Quality improvement study.

BACKGROUND: The World Health Organization Surgical Safety Checklist is an effective tool to reduce morbidity, mortality, perioperative complications, and hospital length of stay. However, its implementation that involves complex social interaction is still challenging. OBJECTIVES: The aim was to increase use of the Surgical Safety Checklist to 100% of performed surgeries compared to current practice at Hospital Moinhos de Vento, in Porto Alegre, Brazil. METHODS: A quality improvement strategy was implemented based on the Plan, Do, Study, Act cycle. During the intervention, Surgical Safety Checklist structure and content were adjusted to the local context and surgeons were engaged in discussions of the medical and scientific basis of the Surgical Safety Checklist. Also, the surgery center nursing team was trained as well as empowered to use the Surgical Safety Checklist. RESULTS: As compared to baseline data, there was an increase in the use of the tool and data was monitored to evaluate sustainability of the strategy over 26 months. Mean compliance with the Surgical Safety Checklist after the intervention reached 89%. Compliance with the most critical phase - time out - began at 26%. After the intervention, an increase in time out compliance was noted, varying from 60% to 90%. CONCLUSION: The proposed quality improvement strategy, implemented at no additional cost to the institution, was effective to increase Surgical Safety Checklist compliance and produced sustainable results.

Navegação de enfermagem na atenção ao câncer de mama durante a pandemia: relato de experiência / Navegación de enfermería en la atención del cáncer de mama durante pandemia: informe de experiencia / Nursing navigation in breast cancer care during the pandemic: an experience report

Objetivo: descrever a atuação do navegador de enfermagem na atenção ao paciente com câncer de mama durante a pandemia do novo Coronavírus em um hospital privado de um município do sul do Brasil. Método: relato de experiência sobre medidas adotadas para garantir o início e/ou a continuidade do tratamento de câncer de mama, durante o distanciamento social enquanto recomendação sanitária pela pandemia do novo Coronavírus. Resultados: diversas medidas para auxiliar no enfrentamento da pandemia e propiciar ambiente seguro aos profissionais e pacientes foram adotadas. Conclusão: a atuação do enfermeiro navegador para pacientes com câncer de mama foi fundamental. As visitas hospitalares podem expor os pacientes a um risco maior e as medidas adotadas foram para assegurar o acesso das pacientes ao serviço com segurança, não permitindo que ficassem desassistidas em virtude da medida sanitária de distanciamento social.(au)

Objective: to describe the role of the nursing navigator in breast cancer care during the pandemic of the new Coronavirus in a private hospital in a municipality in southern Brazil. Method: experience report on measures taken to ensure the initiation and/or continuity of breast cancer treatment, during social distancing as a health recommendation for the new coronavirus pandemic. Results: several measures were taken to help fight the pandemic caused by the new Coronavirus and provide a safe environment for professionals and patients. Conclusion: the role of the nurse navigator for patients with breast cancer was essential. Hospital visits can expose patients to a greater risk and the measures adopted were to ensure patients' access to the service safely, not allowing them to be left unattended due to the sanitary measure of social distancing.(AU)

Objetivo: describir el papel de la navegadora de enfermería en la atención del cáncer de mama durante la pandemia del nuevo coronavirus en un hospital privado de un municipio del sur de Brasil. Método: informe de experiencia sobre las medidas tomadas para asegurar el inicio y/o continuidad del tratamiento del cáncer de mama, durante el distanciamiento social como recomendación de salud para la nueva pandemia de coronavirus. Resultados: se tomaron varias medidas para ayudar a combatir la pandemia y brindar un ambiente seguro para los profesionales y pacientes. Conclusión: el papel de la enfermera navegadora para los pacientes con cáncer de mama fue fundamental y las medidas adoptadas fueron para asegurar el acceso de los pacientes al servicio de forma segura, no permitiéndoles quedar desatendidos por la por la medida sanitaria, de distanciamiento social.(AU)

In-hospital falls in a large hospital in the south of Brazil: A 6-year retrospective study.

BACKGROUND: Reporting falls in the hospital setting is a world-recognized strategy to prevent these incidents. OBJECTIVE: To describe in-hospital falls reported in a large hospital in the South of Brazil. METHOD: Retrospective, descriptive study of falls reported in the hospital's electronic reporting system. RESULTS: We analyzed 1071 fall incidents. The incidence of falls in inpatient units was 1.7 per 1000 patient days. Among the recorded falls, 95.3% occurred in patients who had been previously assessed as being at high or moderate risk of falls; 61.5% were using medications associated with increased risk of falls. Regarding age, 70.8% of the falls occurred in patients aged ≥60 years. Falls occurred mostly (72.6%) in inpatients units, and in 63.4% of the incidents the fall was witnessed by a family member/companion or a health team professionals. No injuries were recorded in 71.4% of the patients. Serious adverse events or sentinel events, such as fractures or head trauma occurred in 2.1% of the patients. Of these, 80% were in the group aged ≥60 years; 83% of the head traumas and 58% of the fractures occurred in patients who had been assessed as being at high risk of falls. Fractures were associated (p = 0.026) with age 70-79 years. CONCLUSION: At the hospital where the study was performed, new fall prevention strategies must focus on patients admitted to inpatient units, aged ≥60 years, assessed as being at high risk of falls, and using medications associated with increased risk of falls.

In hospital falls of a large hospital.

OBJECTIVES: The present database contains information on patient falls in the hospital setting. Data were collected in January 2018 with of describing in-hospital falls reported from 1st January 2012 to 31 December 2017 in a large hospital in the South of Brazil. Learning about the characteristics of these events and establishing a profile may contribute to the design of adequate prevention and improvement strategies that are effective to reduce the risk of falls. DATA DESCRIPTION: This data set encompasses 1.071 in-patients falls characterized by the follow variables: year, date, patient birth, weekday, shift, department/location of the incident, location, severity, presence of companion, age, sex, risk level, medication associated with fall risk, implemented fall prevention protocol, type of injury, reason, restraint prescription, physical therapy prescription.

Nurse Navigation Program: Outcomes From a Breast Cancer Center in Brazil.

BACKGROUND: Nurse navigators play a major role in the care provided to patients with cancer within the healthcare system. OBJECTIVES: This study aims describe the outcomes of a pioneering nurse navigation program established in a breast cancer center in a private, nonprofit hospital in Porto Alegre, Brazil. METHODS: This is a cross-sectional, retrospective, descriptive study based on electronic health records. Descriptive statistics were used for data analysis. FINDINGS: Data from 263 patients participating in the navigation program and hospital quality indicators showed a reduction in the time elapsed from diagnosis to the start of treatment from 24 days in 2014 to 18 days in 2017. Of 153 patients who responded to a patient satisfaction survey, 97% were satisfied or very satisfied with the care provided by the nurse navigator.

The uptake of safe infant sleep practices by Brazilian pediatricians: a nationwide cross-sectional survey.

OBJECTIVE: Sudden infant death syndrome (SIDS) is a major cause of death among children aged <1 year. Campaigns to educate physicians have been effective to reduce its incidence. We assessed the knowledge of Brazilian pediatricians' regarding risk factors for SIDS, their familiarity with the first Brazilian SIDS campaign launched in 2009, and self-reported changes in practices following this campaign. METHODS: Active members of the Brazilian Society for Pediatrics who had been in practice for at least two years at the time of the campaign were invited. Pediatricians answered an online survey including eight multiple-choice questions and one open-ended question. Invitees were chosen by chance draw to reflect the geographic distribution of pediatricians in the five regions of the country. RESULTS: The survey was answered by 1654 pediatricians (mean [SD] age: 46 [11.5] years; mean [SD] professional practice time: 20.2 [11.52] years). Bedding items (77.7%), prone sleeping position (72.9%), bed sharing (66.3%), and smoking (59.2%) were recognized as risk factors for SIDS. Most pediatricians (88.2%) were familiar with the campaign, and 84.7% were aware of the current recommendation of supine sleeping position to prevent SIDS. The effectiveness of the first Brazilian SIDS campaign could be measured by a change in practice; before the campaign, 67.5% recommended lateral position and 23.1% the supine, and after the campaign, 76.2% recommended supine and 10.4% lateral. However, 12.8% still recommend prone position. CONCLUSIONS: The majority of pediatricians changed their advice to parents after the educational campaign and became familiar with risk factors for SIDS. Continuous educational campaigns focusing on physicians resistant to changing practices should be provided.

Avaliação do estado de saúde pelo questionário de angina de seattle em pacientes com síndrome coronária aguda / Health status assessment by the seattle angina questionnaire in acute coronary syndromes

Introdução: Estudos que analisaram o estado de saúde não avaliaram diferenças entre pacientes com angina instável e infarto agudo do miocárdio com (IAMCST) e sem (IAMSST) elevação do segmento ST. Este estudo teve como objetivo comparar índices do estado de saúde, de acordo com o Questionário de Angina de Seattle (QAS), em pacientes com síndrome coronária aguda (SCA). Métodos: O QAS foi aplicado na admissão hospitalar e aos seis meses de acompanhamento em 391 pacientes com SCA. Foram analisados três domínios: limitação física (D1), frequência da angina (D3) e qualidade de vida (D5). Índices maiores em D1, D3 e D5 significam menor limitação física, menor frequência da angina e melhor qualidade de vida, respectivamente. Resultados: Na internação hospitalar, pacientes com angina instável apresentaram piores índices de frequência da angina e de qualidade de vida que os portadores de IAMSST, e piores índices de atividade física, frequência da angina e qualidade de vida que aqueles com IAMCST. Aos seis meses de seguimento, os pacientes com angina instável ainda apresentaram piores índices de atividade física, frequência da angina e qualidade de vida que os portadores de IAMCST, mas sem diferença significativa em relação aos pacientes com IAMSST. Pacientes com angina instável foram aqueles que apresentaram maior ganho em todos os domínios do QAS. Conclusões: No espectro da SCA, os pacientes com angina instável demonstraram pior estado de saúde, tanto na internação hospitalar como aos seis meses de acompanhamento, mas, por outro lado, foram os que apresentaram o maior ganho em cada um dos domínios avaliados pelo QAS.

Background: Studies assessing health status have not addressed differences among patients with unstable angina, non- ST elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI). This study was aimed at comparing health status scores according to the Seattle Angina Questionnaire (SAQ) in patients with acute coronary syndromes (ACS). Methods: SAQ was applied at hospitaladmission and at 6-month follow-up in 391 patients with ACS. Three domains were analyzed: physical limitation (D1),anginal frequency (D3) and disease perception (D5). Higher D1, D3 and D5 scores indicated less physical limitation,lower frequency of angina and better quality of life, respectively. Results: At hospital admission, patients with unstable angina presented significantly lower scores of anginal frequencyand disease perception than those with NSTEMI, and significantly lower scores of physical activity, anginal frequency and disease perception than those with STEMI. At the 6-month follow-up, patients with unstable angina still presented lower scores of physical activity, anginal frequency and disease perception than those with STEMI,but there were no significant differences when compared to those with NSTEMI. The SAQ domains increased to a greater extent in patients with unstable angina. Conclusions:Patients with unstable angina had worse health status at hospital admission and at the 6-month follow-up but, on the other hand, showed the largest improvements for each one of the SAQ domains analyzed.

Predictors of quality of life change after an acute coronary event.

BACKGROUND: The assessment of quality of life (QOL), identifying functional capacity and frequency of angina and other cardiac symptoms, are key issues in the treatment of chronic patients or in those with disease instability. OBJECTIVE: To identify predictors of quality of life (QOL) improvement in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). METHODS: Patients hospitalized in a cardiology reference hospital were assessed with the Seattle Angina Questionnaire (SAQ) at the time of admission and after 6 months. The analyzed outcome was the variation of the QOL score, resulting from the difference between the score after six months and the score at the time of admission. Differences between patients with or without 6-month QOL improvements regarding the demographic, clinical and therapeutic characteristics were assessed by univariate and multivariate analysis. RESULTS: Hypertensive patients presented lower improvement in QOL scores when compared to non-hypertensive ones [8.3(0-25) vs. 16.6(0-33.3); P=0.05], as well as patients with dyslipidemia, when compared to non-dyslipidemic ones [8.3(0-25) vs. 16.6(0-33.3); P=0.02]. Patients with unstable angina presented greater improvements in QOL in relation to those with NSTE myocardial infarction [16.6(0-33.3) vs. 8.3(-8.3-25); P=0.03]. By multivariate analysis, myocardial revascularization in the first 30-days was associated with the greater improvement in the QOL score (8.47 points; P=0.005). On the other side, the presence of dyslipidemia at the baseline evaluation was an independent predictor of worse QOL scores (-7.2 points; P=0.01). CONCLUSION: Myocardial revascularization was associated with improvement in the 6-month QOL scores, while dyslipidemia was associated with worse scores.

Preditores de mudança na qualidade de vida após um evento coronariano agudo / Predictors of quality of life change after an acute coronary event

FUNDAMENTO: A verificação de desfechos complementares torna-se relevante para os pacientes com instabilização da doença coronariana e tratamento farmacológico crônico. OBJETIVO: Identificar preditores de melhora na qualidade de vida relacionada à saúde em pacientes com síndrome coronariana aguda (SCASST) sem supradesnivelamento. MÉTODOS: Pacientes consecutivamente internados em um hospital de referência cardiológica foram prospectivamente avaliados com o Seattle Angina Questionnaire (SAQ) na internação e em seis meses. O desfecho analisado foi a variação do escore SAQ - qualidade de vida, resultante da diferença entre o escore em seis meses e o da internação. Verificaram-se as características demográficas, clínicas e terapêuticas associadas à melhora da qualidade de vida (análise univariada), assim como seus preditores (multivariada). RESULTADOS: Os hipertensos apresentaram uma variação do escore SAQ - qualidade de vida menor quando comparados aos não-hipertensos [8,3(0-25) vs 16,6(0-33,3); P=0,05], assim como pacientes com dislipidemia, quando comparados aos não-dislipidêmicos [8,3(0-25) vs 16,6(0-33,3); P=0,02]. Pacientes com angina instável apresentaram uma variação maior no escore em relação aos pacientes com infarto agudo do miocárdio (IAM) sem supradesnivelamento de ST [16,6(0-33,3) vs 8,3(-8,3-25); P=0,03]. Ajustada para as características clínicas e demográficas, a revascularização do miocárdio em até 30 dias após a SCASST, está associada com maior variação no escore SAQ - qualidade de vida (+8,47 pontos; P=0,005) e, a dislipidemia com piora (-7,2 pontos; P=0,01). CONCLUSÃO: A revascularização miocárdica está associada à melhora da qualidade de vida relacionada à saúde, mais pronunciada naqueles pacientes submetidos à cirurgia. A dislipidemia está associada à piora desse desfecho em seis meses.

BACKGROUND: The assessment of quality of life (QOL), identifying functional capacity and frequency of angina and other cardiac symptoms, are key issues in the treatment of chronic patients or in those with disease instability. OBJECTIVE: To identify predictors of quality of life (QOL) improvement in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). METHODS: Patients hospitalized in a cardiology reference hospital were assessed with the Seattle Angina Questionnaire (SAQ) at the time of admission and after 6 months. The analyzed outcome was the variation of the QOL score, resulting from the difference between the score after six months and the score at the time of admission. Differences between patients with or without 6-month QOL improvements regarding the demographic, clinical and therapeutic characteristics were assessed by univariate and multivariate analysis. RESULTS: Hypertensive patients presented lower improvement in QOL scores when compared to non-hypertensive ones [8,3(0-25) vs. 16,6(0-33,3); P=0,05], as well as patients with dyslipidemia, when compared to non-dyslipidemic ones [8,3(0-25) vs. 16,6(0-33,3); P=0,02]. Patients with unstable angina presented greater improvements in QOL in relation to those with NSTE myocardial infarction [16.6(0-33.3) vs. 8.3(-8,3-25); P=0,03]. By multivariate analysis, myocardial revascularization in the first 30-days was associated with the greater improvement in the QOL score (8.47 points; P=0,005). On the other side, the presence of dyslipidemia at the baseline evaluation was an independent predictor of worse QOL scores (-7.2 points; P=0.01). CONCLUSION: Myocardial revascularization was associated with improvement in the 6-month QOL scores, while dyslipidemia was associated with worse scores.