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.

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.