Patient safety culture in times of the COVID-19 pandemic: a cross-sectional study in a hospital.

OBJECTIVES: to assess patient safety culture during the COVID-19 pandemic and identify the dimensions that need to be improved in hospital settings and which sector, open or closed, direct or indirect care, exhibits a higher level of safety culture. METHODS: a descriptive and cross-sectional study. The validated version for Brazil of the Hospital Survey on Patient Safety Culture instrument was applied to assess patient safety culture. Those dimensions with 75% positive responses were considered strengthened. RESULTS: all dimensions presented results lower than 75% of positive responses. Closed sectors showed a stronger safety culture compared to open ones. Indirect care sectors had a low general perception of patient safety when compared to direct care sectors. CONCLUSIONS: with the pandemic, points of weakness became even more evident, requiring attention and incisive interventions from the institution's leaders.

Development of Automated Triggers in Ambulatory Settings in Brazil: Protocol for a Machine Learning-Based Design Thinking Study.

BACKGROUND: The use of technologies has had a significant impact on patient safety and the quality of care and has increased globally. In the literature, it has been reported that people die annually due to adverse events (AEs), and various methods exist for investigating and measuring AEs. However, some methods have a limited scope, data extraction, and the need for data standardization. In Brazil, there are few studies on the application of trigger tools, and this study is the first to create automated triggers in ambulatory care. OBJECTIVE: This study aims to develop a machine learning (ML)-based automated trigger for outpatient health care settings in Brazil. METHODS: A mixed methods research will be conducted within a design thinking framework and the principles will be applied in creating the automated triggers, following the stages of (1) empathize and define the problem, involving observations and inquiries to comprehend both the user and the challenge at hand; (2) ideation, where various solutions to the problem are generated; (3) prototyping, involving the construction of a minimal representation of the best solutions; (4) testing, where user feedback is obtained to refine the solution; and (5) implementation, where the refined solution is tested, changes are assessed, and scaling is considered. Furthermore, ML methods will be adopted to develop automated triggers, tailored to the local context in collaboration with an expert in the field. RESULTS: This protocol describes a research study in its preliminary stages, prior to any data gathering and analysis. The study was approved by the members of the organizations within the institution in January 2024 and by the ethics board of the University of São Paulo and the institution where the study will take place. in May 2024. As of June 2024, stage 1 commenced with data gathering for qualitative research. A separate paper focused on explaining the method of ML will be considered after the outcomes of stages 1 and 2 in this study. CONCLUSIONS: After the development of automated triggers in the outpatient setting, it will be possible to prevent and identify potential risks of AEs more promptly, providing valuable information. This technological innovation not only promotes advances in clinical practice but also contributes to the dissemination of techniques and knowledge related to patient safety. Additionally, health care professionals can adopt evidence-based preventive measures, reducing costs associated with AEs and hospital readmissions, enhancing productivity in outpatient care, and contributing to the safety, quality, and effectiveness of care provided. Additionally, in the future, if the outcome is successful, there is the potential to apply it in all units, as planned by the institutional organization. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55466.

Polypharmacy and high-alert medications in patients with nasally placed feeding tube on admission and at hospital discharge: Multicenter cross-sectional study.

Background: Polypharmacy and the use of high-alert medications in patients with nasally placed feeding tube (NPFT) increase the risks of drug related problems. Objective: Characterize drugs prescribed to patients with NPFT and compare the rates of polypharmacy and high-alert medication use at admission and hospital discharge. Design and setting: Multicenter cross-sectional study with 327 participants. Methods: Data of patients with NPFT were obtained from the medical records and recorded in an electronic data collection tool. Mean number of drugs, polypharmacy and number of high-alert medications prescribed on admission and at discharge were compared using Wilcoxon or McNemar's tests. Generalized Estimating Equations analyzed the relationship between polypharmacy and high-alert medications according to age and time point. Primary reason for hospital admission, level of consciousness, severity of comorbid diseases and patient care complexity were also assessed. Results: Most patients were male, older people, hospitalized for circulatory system diseases and had at least one comorbidity. On admission, a significant number of patients were alert (59.9%), at high risk for death (43.1%) and high dependent on nursing care (35.4%). Additionally, 92% patients were on polypharmacy on admission, versus 84.7% at hospital discharge (p = 0,0011). The occurrence of polypharmacy was independent of age (p = 0.2377). >17% of all drugs prescribed were high-alert medications, with no statistically significant difference between admission and discharge (p = 0,3957). There was no statistical evidence that the use of high-alert medications increases with age (n = 0,5426). Conclusions: These results support the planning of multidisciplinary qualified actions for patients using NPFT.

Patient safety culture in times of the COVID-19 pandemic: a cross-sectional study in a hospital / Cultura de seguridad del paciente en tiempos de la pandemia COVID-19: estudio transversal en un hospital / Cultura de segurança do paciente em tempos de pandemia de COVID-19: estudo transversal em hospital

ABSTRACT Objectives: to assess patient safety culture during the COVID-19 pandemic and identify the dimensions that need to be improved in hospital settings and which sector, open or closed, direct or indirect care, exhibits a higher level of safety culture. Methods: a descriptive and cross-sectional study. The validated version for Brazil of the Hospital Survey on Patient Safety Culture instrument was applied to assess patient safety culture. Those dimensions with 75% positive responses were considered strengthened. Results: all dimensions presented results lower than 75% of positive responses. Closed sectors showed a stronger safety culture compared to open ones. Indirect care sectors had a low general perception of patient safety when compared to direct care sectors. Conclusions: with the pandemic, points of weakness became even more evident, requiring attention and incisive interventions from the institution's leaders.

RESUMEN Objetivos: evaluar la cultura de seguridad del paciente en el contexto de la pandemia COVID-19 e identificar las dimensiones que necesitan ser mejoradas en el ambiente hospitalario y qué sector, abierto o cerrado, de asistencia directa o indirecta, exhibe un mayor nivel de cultura de seguridad. Métodos: estudio descriptivo y transversal. Para evaluar la cultura de seguridad del paciente se aplicó la version validada para Brasil del instrumento Hospital Survey on Patient Safety Culture. Se consideraron fortalecidas aquellas dimensiones con un 75% de respuestas positivas. Resultados: todas las dimensiones presentaron resultados inferiores al 75% de respuestas positivas. Los sectores cerrados mostraron una cultura de seguridad más fuerte en comparación con los abiertos. Los sectores de atención indirecta tenían una percepción general baja de la seguridad del paciente en comparación con los sectores de atención directa. Conclusiones: con la pandemia, los puntos de debilidad se hicieron aún más evidentes, requiriendo atención e intervenciones incisivas por parte de los líderes de la institución.

RESUMO Objetivos: avaliar a cultura de segurança do paciente no contexto da pandemia de COVID-19 e identificar as dimensões que precisam ser aprimoradas no ambiente hospitalar e qual setor, aberto ou fechado, de assistência direta ou indireta, exibe um nível mais elevado de cultura de segurança. Métodos: estudo descritivo e transversal. Aplicou-se a versão validada para o Brasil do instrumento Hospital Survey on Patient Safety Culture para avaliar a cultura de segurança do paciente. Foram consideradas dimensões fortalecidas aquelas com 75% de respostas positivas. Resultados: todas as dimensões apresentaram resultados menores que 75% de respostas positivas. Setores fechados mostraram cultura de segurança mais fortalecida em relação aos abertos. Setores de assistência indireta apresentaram baixa percepção geral de segurança do paciente, quando comparados aos de assistência direta. Conclusões: com a pandemia, os pontos de fragilidade tornaram-se ainda mais evidentes, exigindo atenção e intervenções incisivas por parte das lideranças da instituição.

Development and validity of audiovisual technology for medication preparation and administration via feeding tube / Desarrollo y validación de tecnología audiovisual para la preparación y administración de medicamentos vía sonda enteral / Desenvolvimento e validação de tecnologia audiovisual para preparo e administração de medicamentos via sonda enteral

ABSTRACT Objective: to develop and validate an audiovisual educational technology in the form of video to add scientific and practical knowledge to nursing professionals during oral medication preparation and administration via feeding tube. Method: this is a methodological study based on the theoretical framework of Fleming, Reynolds and Wallace, held in Ribeirão Preto, São Paulo, Brazil, from September 2022 to August 2023. The population was made up of seven experts, three nurses, two pharmacists and two nutritionists. The study was developed in three phases: "Pre-production" - literature review and script preparation; "Production" - script validity and video recording; and "Post-production" - video validity. Material appearance and content were validated using the Delphi technique and a Content Validity Index greater than or equal to 70% (CVI ≥0.7). Results: the video script/storyboard was developed and validated by seven experts, with 94.2% agreement. The video was validated and reached 99.2% agreement among experts in terms of functionality, usability, efficiency, audiovisual technique, environment and procedures. Experts suggested organizing the video into three parts, which involved general considerations related to feeding tubes (Video 1), nursing care related to preparation (Video 2) and medication administration in adult and elderly patients with a tube (Video 3). Conclusion: the audiovisual educational technology developed in this study in the form of video can contribute to training high school and higher education professionals as well as students of vocational training and undergraduate courses in nursing.

RESUMEN Objetivo: desarrollar y validar una tecnología educativa audiovisual en forma de video para agregar conocimientos científicos y prácticos a los profesionales de enfermería durante la preparación y administración de medicamentos orales vía sonda enteral. Método: se trata de un estudio metodológico, basado en el marco teórico de Fleming, Reynolds y Wallace. Realizado en Ribeirão Preto, São Paulo, Brasil, de septiembre de 2022 a agosto de 2023. La población estuvo compuesta por siete especialistas, tres enfermeros, dos farmacéuticos y dos nutricionistas. Estudio desarrollado en tres fases: "Preproducción" - revisión de literatura y preparación de guión; "Producción" - validación de guión y grabación de vídeo; y "Postproducción" - validación de vídeo. La apariencia y contenido del material fueron validados mediante la técnica Delphi y el Índice de Validez de Contenido mayor o igual al 70% (IVC ≥0,7). Resultados: el guión/script/storyboard del vídeo fue desarrollado y validado por siete expertos, con un 94,2% de acuerdo. El vídeo fue validado y alcanzó un 99,2% de acuerdo entre expertos en cuanto a funcionalidad, usabilidad, eficiencia, técnica audiovisual, entorno y procedimientos. Los expertos sugirieron organizar el video en tres partes, que involucraron consideraciones generales relacionadas con las sondas enterales (Video 1), cuidados de enfermería relacionados con la preparación (Video 2) y administración de medicamentos en pacientes adultos y ancianos portadores de sonda (Video 3). Conclusión: la tecnología educativa audiovisual desarrollada en este estudio en forma de video puede contribuir a la formación de profesionales de la educación secundaria y superior, así como de estudiantes de cursos técnicos y de pregrado en enfermería.

RESUMO Objetivo: desenvolver e validar uma tecnologia educativa audiovisual na forma de vídeo para agregar conhecimentos científicos e práticos aos profissionais de Enfermagem durante o preparo e a administração de medicamentos orais via sonda enteral. Método: trata-se de um estudo metodológico, alicerçado no referencial teórico de Fleming, Reynolds e Wallace. Realizado em Ribeirão Preto, São Paulo, Brasil, de setembro de 2022 a agosto de 2023. A população foi composta por sete especialistas, sendo três enfermeiras, duas farmacêuticas e duas nutricionistas. Estudo desenvolvido em três fases: "Pré-produção" - revisão da literatura e elaboração do roteiro; "Produção" - validação do roteiro e gravação do vídeo; e, "Pós-produção" - validação do vídeo. A aparência e o conteúdo do material foram validados pela técnica Delphi e pelo Índice de Validade de Conteúdo maior ou igual a 70% (IVC ≥0,7). Resultados: o roteiro/script/storyboard do vídeo foi desenvolvido e validado por sete especialistas, com 94,2% de concordância. O vídeo foi validado e atingiu 99,2% de concordância entre os especialistas nos quesitos funcionalidade, usabilidade, eficiência, técnica audiovisual, ambiente e procedimentos. Os especialistas sugeriram organizar o vídeo em três partes, as quais envolveram considerações gerais relacionadas às sondas enterais (Vídeo 1), cuidados de Enfermagem relacionados ao preparo (Vídeo 2) e à administração de medicamentos em pacientes adultos e idosos com sonda (Vídeo 3). Conclusão: a tecnologia educativa audiovisual desenvolvida neste estudo na forma de vídeo pode contribuir com a capacitação de profissionais de nível médio e superior, bem como de estudantes dos cursos técnicos e de graduação em Enfermagem.

Agreement Between Epigastric Auscultation and pH Measurement in the Confirmation of Nasoenteral Tube Placement.

AIM: This study aimed to evaluate the agreement between epigastric auscultation and pH measurement in the confirmation of nasoenteral tube placement. METHOD: A cross-sectional study carried out in a medium-sized private hospital in the interior of the state of São Paulo. Forty-nine patients who were submitted to ninety insertion procedures and confirmation of tube placement. aimed at evaluating the agreement of clinical methods used by nurses to confirm the positioning of a nasoenteral tube inserted blindly at the bedside, by measuring the parameters of sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: The epigastric auscultation was the method that presented the highest sensitivity (100.0%), but lower specificity (2.0%). The measurement of the pH presented lower sensitivity (63.0%) than the auscultation, however, higher specificity (58%). Moreover, the positive predictive value of the pH measurement was 55% and the negative predictive value was 66%. There was no agreement between the epigastric auscultation and the pH measurement with the radiography. CONCLUSION: The pH measurement did not allow for distinguishing between gastric and enteric positioning, due to the similarity of the esophageal and pulmonary pH with the pH of the intestine. Furthermore, external factors such as the use of medication and reduced fasting time may interfere with the pH value.

Impact of a quality improvement programme on the preparation and administration of medications via a nasoenteral feeding tube: 2014-2019 intervention study.

AIMS: Evaluate the impact of a quality improvement programme on the reduction of feeding tube obstruction frequencies, analyse the predictive variables of this safety incident, and estimate the economic costs related to the quality improvement programme during the period from 2014 to 2019. METHODS: Plan-Do-Study-Act cycles were performed to test the changes in drug preparation and administration processes via a nasoenteral feeding tube and to evaluate the outcome, process and balance measures. Statistical control charts were elaborated, and the bottom-up direct costing methodology was used to estimate the costs of the improvement programme. The impact of the programme on the monitoring measures was evaluated using logistic regression analysis. INTERVENTIONS: The following changes were tested in the hospital participating in the study: acquisition of the Easy Crush equipment for tablet crushing, use of appropriate packaging to crush hard tablets, standardise procedures for scheduling administration times and/or substitution of the pharmaceutical form, educational activities for the nursing team and elaboration and availability of infographics for the nursing team, patients and/or family/caregivers. RESULTS: There was a significant improvement in the frequency of tube obstructions, from 41.1% in 2014 to 57.9% in 2015-2017 and 9.6% in 2018-2019 (p=0.0010). After the execution of the improvement programme, it was estimated that the cost of dose preparation was reduced from R$1067.50 in 2014 to R$719.80 in 2015-2017 and R$433.10 in 2015-2019. CONCLUSION: By re-establishing the processes of drug preparation and administration via a nasoenteral feeding tube, through the acquisition of appropriate equipment for crushing hard tablets, together with educational activities for the nursing team, we could observe a reduction in tube obstructions and the cost of processes.

Nursing interventions to prevent corneal injury in critically ill sedated and mechanically ventilated patients: A systematic review of interventions.

OBJECTIVE: To identify the effectiveness of interventions to prevent corneal injury in critically ill, sedated, and mechanically ventilated patients. RESEARCH METHODOLOGY: A systematic review of intervention studies was conducted in the following electronic databases: Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Embase, Latin American and Caribbean Literature in Health Sciences, LIVIVO, PubMed, Scopus and Web of Science, and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Study selection and data extraction were performed by two independent reviewers. Quality assessment of the randomized and non-randomized studies was performed using the Risk of Bias (RoB 2.0) and ROBINS-I Cochrane tools, respectively, and the Newcastle-Ottawa Scale for cohort studies. The certainty of the evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. RESULTS: 15 studies were included. Meta-analysis showed that the risk of corneal injury in the lubricants group was 66% lower (RR = 0.34; 95 %CI: 0.13-0.92) than in the eye-taping group. The risk of corneal injury in the polyethylene chamber was 68% lower than in the eye ointment group (RR = 0.32; 95 %CI 0.07-1.44). The risk of bias was low in most of the studies included and the certainty of the evidence was evaluated. CONCLUSIONS: The most effective interventions to prevent corneal injury in critically ill sedated mechanically ventilated, who have compromised blinking and eyelid closing mechanisms, are ocular lubrication, preferably gel or ointment, and protection of the corneas with a polyethylene chamber. IMPLICATIONS FOR CLINICAL PRACTICE: Critically ill, sedated, and mechanically ventilated patients who have compromised blinking and eyelid closing mechanisms must receive interventions to prevent corneal injury. Ocular lubrication, preferably gel or ointment, and protection of the corneas with a polyethylene chamber were the most effective interventions to prevent corneal injury in critically ill, sedated, and mechanically ventilated patients. A polyethylene chamber must be made commercially available for critically ill, sedated, and mechanically ventilated patients.

Resilience of Healthcare Systems in the face of COVID-19: an experience report.

OBJECTIVE: to report the professional experience of a nurse manager facing the challenges of restructuring a hospital service in the face of the COVID-19 pandemic. METHOD: this is an experience report, based on the perspective of system resilience in a public hospital. RESULTS: the challenges faced were: internal service flow reorganization to assist suspected cases of COVID-19; institution of structural changes and adaptations, from entry into the emergency room to the wards and intensive care unit; equipment and supply acquisition for patient care with a focus on their quality and functionality; staff training, with the restructuring of work processes; staff sizing, considering the time of exposure to the virus; staff's professional qualification, absenteeism, stress, physical and psychological illness, with a view to safe and quality care; nursing staff leadership to deal with conflicts generated by professionals' stress and illness. CONCLUSION: healthcare service resilience is critical for hospital restructuring in the COVID-19 pandemic; however, patient care and healthcare professionals' physical and mental health must be considered.

Reporting Rates of Opioid-Related Adverse Events Since 1965 in Canada: A Descriptive Retrospective Study.

BACKGROUND: Patients with chronic or acute/postoperative pain frequently use opioids. However, opioids may cause considerable adverse reactions (ARs), such as respiratory depression, which could be lethal. Unfortunately, only 5% of drug-related ARs (including those to opioids) are reported to health authorities. Therefore, little is known regarding the occurrence of opioid-related ARs at the population level. OBJECTIVE: The aim of this study was to investigate how the rates of reported opioid-related ARs have changed in Canada since 1965. METHODS: Our retrospective study examined trends of reported opioid-related ARs occurring in hospitalized and outpatients. Data on opioid-related ARs and mortality between 1965 and 2019 were obtained from the Canada Vigilance and Statistics Canada databases. Descriptive and Joinpoint regression analyses were performed. RESULTS: Oxycodone and normethadone were the most and least involved opioid agents, respectively, among the 18,407 reported ARs. The highest rate of reported opioid ARs (3.8 per 100,000 person-years) was recorded in 2012, whereas the lowest was recorded in 1965 (0.1 per 100,000 person-years). Between 1965 and 2019, annual rates climbed by 4.2% (95% confidence interval [CI] 3.1-5.2), and many fluctuations were observed: 1965-1974: +22.3% (95% CI 12.0-33.6); 1974-2000: - 4.1% (95% CI - 5.3 to - 2.9); 2000-2008: +30.3% (95% CI 22.6-38.4); 2008-2014: +4.1% (95% CI - 1.5 to 10.1); 2014-2017: -26.0% (95% CI - 44.7 to - 0.9); and, finally, 2017-2019: +35.4% (95% CI 3.8-76.7). CONCLUSION: Reported opioid-related ARs have increased since 1965, although fluctuations were observed in recent decades. The absolute number of opioid-related ARs might be seriously underestimated. Future studies should look into how to close this gap.

Resilience of Healthcare Systems in the face of COVID-19: an experience report / Resiliencia de los Sistemas de Salud frente al COVID-19: relato de experiencia / Resiliência de Sistemas de Assistência à Saúde no enfrentamento da COVID-19: relato de experiência

ABSTRACT Objective: to report the professional experience of a nurse manager facing the challenges of restructuring a hospital service in the face of the COVID-19 pandemic. Method: this is an experience report, based on the perspective of system resilience in a public hospital. Results: the challenges faced were: internal service flow reorganization to assist suspected cases of COVID-19; institution of structural changes and adaptations, from entry into the emergency room to the wards and intensive care unit; equipment and supply acquisition for patient care with a focus on their quality and functionality; staff training, with the restructuring of work processes; staff sizing, considering the time of exposure to the virus; staff's professional qualification, absenteeism, stress, physical and psychological illness, with a view to safe and quality care; nursing staff leadership to deal with conflicts generated by professionals' stress and illness. Conclusion: healthcare service resilience is critical for hospital restructuring in the COVID-19 pandemic; however, patient care and healthcare professionals' physical and mental health must be considered.

RESUMEN Objetivo: relatar la experiencia profesional de una enfermera gestora frente a los desafíos de la reestructuración de un servicio hospitalario frente a la pandemia de la COVID-19. Método: relato de experiencia, basado en la perspectiva de resiliencia del sistema en un hospital público. Resultados: los desafíos enfrentados fueron: reorganización del flujo interno de atención para la atención de casos sospechosos de COVID-19; institución de cambios y adaptaciones estructurales, desde el ingreso al departamento de urgencias y emergencias hasta las salas y unidad de cuidados intensivos; adquisición de equipos e insumos para la atención de pacientes con enfoque en su calidad y funcionalidad; formación de equipos con la reestructuración de los procesos de trabajo; dimensionamiento del personal, considerando el tiempo de exposición al virus, cualificación profesional, ausentismo, estrés, enfermedad física y psíquica del equipo, con miras a un cuidado seguro y de calidad y liderazgo del equipo de enfermería para el enfrentamiento de los conflictos generados por el estrés y la enfermedad de los profesionales. Conclusión: la resiliencia del servicio de salud es fundamental para la reestructuración hospitalaria en la pandemia del COVID-19, sin embargo, se debe considerar la atención al paciente y la salud física y mental de los profesionales de la salud.

RESUMO Objetivo: relatar a experiência profissional de um enfermeiro gestor frente aos desafios da reestruturação de um serviço hospitalar diante da pandemia da COVID-19. Método: relato de experiência, baseado na perspectiva da resiliência do sistema em um hospital público. Resultados: os desafios enfrentados foram: reorganização do fluxo de serviço interno para atender os casos suspeitos de COVID-19; instituição de mudanças e adaptações estruturais, desde a entrada na urgência e emergência, até nas enfermarias e unidade de terapia intensiva; aquisição de equipamentos e insumos para o atendimento dos pacientes com foco na qualidade e funcionalidade destes; treinamento das equipes, com a reestruturação dos processos de trabalho; dimensionamento de pessoal, considerando o tempo de exposição ao vírus; qualificação profissional, absenteísmo, estresse, adoecimento físico e psicológico da equipe, com vistas à uma assistência segura e de qualidade; liderança da equipe de Enfermagem para lidar com os conflitos gerados pelo estresse e adoecimento dos profissionais. Conclusão: a resiliência do serviço de saúde é fundamental para a reestruturação hospitalar na pandemia da COVID-19, no entanto, devem-se considerar o cuidado dos pacientes e a saúde física e mental dos profissionais de saúde.

Programa de melhoria da qualidade na administração de medicamentos via sonda nasoenteral / Programa de mejora de la calidad en la administración de medicamentos por sonda nasoenteral / Quality improvement program in medication administration through nasogastric tube

Resumo Objetivo Avaliar o impacto de um programa de melhoria da qualidade relacionado aos indicadores de frequência de sondas nasoenterais obstruídas, do tempo despendido pela equipe de enfermagem no preparo e na administração de medicamentos orais por essa via, e dos custos associados ao incidente. Método Estudo de intervenção voltado para a comparação pré (Fase I) e pós (Fase II) implementação de um Programa Melhoria da Qualidade, proposto pelo Institute for Healthcare Improvement . Foram observadas 92 doses de medicamentos na Fase I e 66 doses na Fase II. Foram necessários quatro ciclos Plan-Do-Study-Act (PDSA) para atingir a meta proposta para o programa de melhoria. Resultados Houve redução no tempo médio gasto pelo profissional no preparo e na administração de medicamentos sólidos via sonda nasoenteral em ambas as fases. As frequências de sondas obstruídas reduziram de 33,3% (Fase I) para 7,4% (Fase II) e nenhuma sonda apresentou-se obstruída durante os ciclos 1, 2 e 4. O custo médio da obstrução por paciente foi de R$ 1.251,05 ao mês na Fase I e de R$ 23,31 na Fase II. Após as mudanças testadas, foi verificada economia de tempo para a equipe de enfermagem e de custo para a instituição. Conclusão Os ciclos PDSA foram eficazes na redução de não conformidades no preparo e na administração de medicamentos via sonda nasoenteral. Tal melhoria impactou a frequência de obstrução, os custos relacionados e o tempo médio gasto pelo profissional de enfermagem durante o preparo e a administração das doses.

Resumen Objetivo Evaluar el impacto de un programa de mejora de la calidad relacionado con los indicadores de frecuencia de sondas nasoenterales obstruidas, del tempo invertido por el equipo de enfermería en la preparación y en la administración de medicamentos orales por esa vía y de los costos asociados con el incidente. Métodos Estudio de intervención direccionado para la comparación previa (Fase I) y posterior (Fase II) a la implementación de un Programa Mejora de la Calidad, propuesto por el Institute for Healthcare Improvement . Se observaron 92 dosis de medicamentos en la Fase I y 66 dosis en la Fase II. Se necesitaron cuatro ciclos Plan-Do-Study-Act (PDSA) para alcanzar la meta propuesta para el programa de mejora. Resultados Hubo reducción del tiempo promedio consumido por el profesional en la preparación y en la administración de medicamentos sólidos por sonda nasoenteral en ambas fases. La frecuencia de la obstrucción de las sondas se redujo del 33,3 % (Fase I) para el 7,4 % (Fase II) y ninguna sonda presentó obstrucción durante los ciclos 1, 2 y 4. El costo promedio de la obstrucción por paciente fue de R$ 1.251,05 al mes en la Fase I y de R$ 23,31 en la Fase II. Después de someter a pruebas los cambios, se verificó un ahorro de tiempo para el equipo de enfermería y de costo para la institución. Conclusión Los ciclos PDSA fueron eficaces en la reducción de no conformidades en la preparación y en la administración de medicamentos por sonda nasoenteral. Esa mejora impactó la frecuencia de obstrucción, los costos relacionados y el tiempo promedio consumido por el profesional de enfermería durante la preparación y la administración de las dosis.

Abstract Objective Evaluate the impact of a quality improvement program related to the frequency indicators of obstructed nasogastric tubes, the time the nursing team spent on oral medication preparation and administration through this route, and the costs associated with the incident. Method Intervention study aimed at comparing pre (Phase I) and post (Phase II) implementation of a Quality Improvement Program, proposed by Institute for Healthcare Improvement . Ninety-two medication doses were observed in Phase I and 66 doses in Phase II. Four Plan-Do-Study-Act (PDSA) cycles were needed to achieve the proposed target for the improvement program. Results The average time the professional spent on solid medication preparation and administration through nasogastric tube decreased in both phases. Frequencies of obstructed tubes dropped from 33.3% (Phase I) to 7.4% (Phase II) and no probe was obstructed during cycles 1, 2, and 4. The average cost of the obstruction per patient was R$ 1,251.05 per month in Phase I and R$ 23.31 in Phase II. After testing the changes, time savings for the nursing team and cost savings for the institution were verified. Conclusion The PDSA cycles were effective in reducing non-conformities in medication preparation and administration via nasogastric tube. This improvement influenced the obstruction frequency, related costs, and the average time the nursing professional spent on the preparation and administration of the medication doses.

Factors associated with bronchopulmonary aspiration: a national-based study / Factores asociados con la aspiración broncopulmonar: estudio de base nacional / Fatores associados à aspiração broncopulmonar: estudo de base nacional

ABSTRACT Objectives: to determine the prevalence of bronchopulmonary aspiration in the Brazilian scenario, the factors associated with the incident and the variables associated with death. Methods: a cross-sectional and analytical study, carried out from analysis of notifications of incidents related to bronchopulmonary aspiration of the Health Surveillance Notification System, from January 2014 to December 2018. Results: of the 264,590 notifications, 553 referred to aspiration, whose prevalence rate was 0.21%. There was an association between the event and age, ethnicity, main medical diagnosis, country region, service type, health unit and consequences for patients. Furthermore, four independent predictor variables for death were found: living in the North or South regions, being elderly and receiving healthcare at night. Conclusions: the prevalence rate of bronchopulmonary aspiration was small, but with a negative impact on patients.

RESUMEN Objetivos: determinar la prevalencia de broncoaspiración en el escenario brasileño, los factores asociados al incidente y las variables asociadas a la muerte. Métodos: estudio transversal y analítico, realizado a partir del análisis de notificaciones de incidentes relacionados con la aspiración broncopulmonar del Sistema de Notificación de Vigilancia Sanitaria, de enero de 2014 a diciembre de 2018. Resultados: de las 264.590 notificaciones, 553 se refirieron a aspiración, cuya tasa de prevalencia fue del 0,21%. Hubo asociación entre el evento y la edad, etnia, diagnóstico médico principal, región del país, tipo de servicio, unidad de salud y consecuencias para el paciente. Además, se encontraron cuatro variables predictoras independientes de muerte: vivir en la región Norte o Sur, ser anciano y recibir atención médica por la noche. Conclusiones: la tasa de prevalencia de aspiración broncopulmonar fue pequeña, pero con impacto negativo en los pacientes.

RESUMO Objetivos: determinar a prevalência de aspiração broncopulmonar no cenário brasileiro, os fatores associados ao incidente e as variáveis associadas ao óbito. Métodos: estudo transversal e analítico, realizado a partir da análise das notificações de incidentes relacionados à aspiração broncopulmonar do Sistema de Notificações em Vigilância Sanitária, no período de janeiro de 2014 a dezembro de 2018. Resultados: das 264.590 notificações, 553 se referiam à aspiração, cuja taxa de prevalência foi de 0,21%. Houve associação entre o evento e idade, etnia, diagnóstico médico principal, região do país, tipo de serviço, unidade de saúde e consequência para o paciente. Ainda, verificaram-se quatro variáveis preditoras independentes para o óbito: residir na Região Norte ou Sul, ser idoso e receber atendimento à saúde no período noturno. Conclusões: a taxa de prevalência de aspiração broncopulmonar foi pequena, mas com impacto negativo para os pacientes.

Construção e validação de cartilha para cuidados paliativos domiciliares após alta hospitalar / Elaboración y validación de cartilla para cuidados paliativos domiciliarios después del alta hospitalaria / Construction and validation of a booklet for home palliative care after hospital discharge

Resumo Objetivo Construir e validar cartilha educativa para cuidados paliativos domiciliares após a alta hospitalar. Métodos Estudo metodológico desenvolvido em três etapas: levantamento bibliográfico, construção da cartilha educativa e validação do material por especialistas em cuidados paliativos e cuidadores de pacientes. O processo de validação foi realizado por 8 especialistas e 12 representantes do público-alvo, selecionados por conveniência. Considerou-se o Índice de Validade de Conteúdo mínimo de 0,80, para validação de conteúdo e concordância mínima de 75% para validação de aparência. Resultados A cartilha intitulada "Eu cuido, nós cuidamos - cuidados domiciliares a pacientes em cuidados paliativos" é composta por 28 páginas. Na validação de conteúdo pelos especialistas, o IVC global obtido foi 1,0 e a cartilha foi aprovada por unanimidade pelos representantes do público-alvo, com índice de concordância 1,0. Conclusão A cartilha educativa foi validada quanto ao conteúdo e aparência, podendo ser utilizada por cuidadores na realização de cuidados paliativos domiciliares e por enfermeiros para as orientações na alta hospitalar.

Resumen Objetivo Elaborar y validar cartilla educativa para cuidados paliativos domiciliarios después del alta hospitalaria. Métodos Estudio metodológico desarrollado en tres etapas: recopilación bibliográfica, elaboración de cartilla educativa y validación del material por especialistas en cuidados paliativos y cuidadores de pacientes. El proceso de validación fue realizado por ocho especialistas y 12 representantes del público destinatario, seleccionados por conveniencia. Se consideró el Índice de Validez de Contenido mínimo de 0,80 para la validación de contenido, y concordancia mínima de 75 % para validación de apariencia. Resultados La cartilla titulada "Yo cuido, nosotros cuidamos: cuidados domiciliarios a pacientes en cuidados paliativos" está compuesta por 28 páginas. En la validación de contenido por los especialistas, el IVC global obtenido fue 1,0 y la cartilla fue aprobada por unanimidad por los representantes del público destinatario, con un índice de concordancia de 1,0. Conclusión La cartilla educativa fue validada respecto al contenido y apariencia y puede ser utilizada por cuidadores en la realización de cuidados paliativos domiciliarios y por enfermeros para dar instrucciones en el alta hospitalaria.

Abstract Objective To construct and validate an educational booklet for home palliative care after hospital discharge. Methods This is a methodological study developed in three stages: bibliographic survey, booklet construction and material validation by palliative care experts and patient caregivers. The validation process was carried out by 8 experts and 12 target audience representatives, selected for convenience. The Minimum Content Validity Index of 0.80 was considered for content validation and minimum agreement of 75% for appearance validation. Results The booklet "Eu cuido, nós cuidamos - cuidados domiciliares a pacientes em cuidados paliativos" consists of 28 pages. In the content validation by experts, the global CVI obtained was 1.0 and the booklet was unanimously approved by the target audience representatives, with agreement index of 1.0. Conclusion The educational booklet was validated regarding content and appearance, and can be used by caregivers in the performance of home palliative care and by nurses for guidance at hospital discharge.

Factors associated with bronchopulmonary aspiration: a national-based study.

OBJECTIVES: to determine the prevalence of bronchopulmonary aspiration in the Brazilian scenario, the factors associated with the incident and the variables associated with death. METHODS: a cross-sectional and analytical study, carried out from analysis of notifications of incidents related to bronchopulmonary aspiration of the Health Surveillance Notification System, from January 2014 to December 2018. RESULTS: of the 264,590 notifications, 553 referred to aspiration, whose prevalence rate was 0.21%. There was an association between the event and age, ethnicity, main medical diagnosis, country region, service type, health unit and consequences for patients. Furthermore, four independent predictor variables for death were found: living in the North or South regions, being elderly and receiving healthcare at night. CONCLUSIONS: the prevalence rate of bronchopulmonary aspiration was small, but with a negative impact on patients.

Adherence to safety barriers in medication administration: patients' perception.

OBJECTIVE: to analyze the perception of patients about health professionals' adherence to safety barriers in medication administration. METHOD: cross-sectional and correlational study carried out in a hospital in the countryside of São Paulo, with a total of 249 adult patients admitted to the medical clinic. An electronic form developed by the researcher was used. Quantitative variables were analyzed in mean, median and standard deviation. Likert-type variables were calculated according to the perception score and the Bayesian Information criterion was used. The cutoff point for positive assessment of the patients' perception was 0.75. RESULTS: the average perception score was 0.29 and, of the 15 barriers analyzed, eight are never adhered by professionals, in the opinion of most patients. Also, age was the only variable with statistical significance. CONCLUSION: the younger the patient, the better their perception of health professionals' adherence to safety barriers in medication administration.

Factors influencing the patient safety climate in intensive care units: cross-sectional study.

BACKGROUND: Measuring the patient safety climate of a health service provides important information about the safety status at a given time. This study aimed to determine the factors influencing the patient safety climate in Intensive Care Units. METHODS: An analytical and cross-sectional study conducted in 2017 and 2018 in two adult Intensive Care Units of a Brazilian Teaching Hospital. The Safety Attitudes Questionnaire instrument was applied with the multidisciplinary teams to determine the factors influencing the patient safety climate. Data were double entered into a database and processed using the R (version 3.5.0) statistical software. Position, central tendency and dispersion measures were taken and absolute and relative frequencies, mean and confidence intervals were calculated for the quantitative variables. Linear regression was performed to verify the effect of variables on the SAQ domains. Variables with a p-value of less than 0.25 were selected for multivariate analysis. RESULTS: A total of 84 healthcare providers participated in the study. The mean Safety Attitudes Questionnaire score was 59.5, evidencing a negative climate. The following factors influenced the safety climate: time since course completion, professional category, type of employment contract, complementary professional training, and weekly workload. CONCLUSIONS: The factors identified indicate items for planning improvements in communication, teamwork, work processes, and management involvement, aiming to ensure care safety and construct a supportive safety climate.

Risk factors for death due to COVID-19, in the state of Acre, Brazil, 2020: a retrospective cohort study. / Fatores de risco para óbito por COVID-19 no Acre, 2020: coorte retrospectiva.

OBJECTIVE: To analyze risk factors for death in individuals with severe acute respiratory syndrome due to COVID-19. METHODS: This was a retrospective cohort study, comprised of adult individuals with COVID-19, from March to September 2020, notified by the Epidemiological Surveillance System in the state of Acre, Brazil. Cox regression was used. RESULTS: Among 57,700 individuals analyzed, the incidence was 2,765.4/100,000 inhabitants, and mortality was, 61.8/100,000 inhabitants. The risk factors for death were: being male (HR=1.48 -95% CI 1.25;1.76), age ≥60 years (HR=10.64 -95% CI 8.84;12.81), symptom of dyspnea (HR=4.20 -95% CI 3.44;5.12) and multimorbidity (HR=2.23 -95% CI 1.77;2.81), with emphasis on heart disease and diabetes mellitus. 'Sore throat' and 'headache' were symptoms present in mild cases of COVID-19. CONCLUSION: Being male, elderly, having heart disease, diabetes mellitus and dyspnea were characteristics associated with death due to COVID-19.