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      Avaliação da segurança do doente no bloco operatório: perceção dos enfermeiros Translated title: Evaluación de la seguridad del paciente en el quirófano: percepción de los enfermeros Translated title: Assessment of patient safety in the operating room: nurses’ perceptions

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          Abstract

          Resumo Enquadramento: O bloco operatório constitui o local onde ocorre maior número de incidentes em cuidados de saúde. A implementação de políticas de segurança do doente torna-se fundamental. Objetivo: Caracterizar a perceção dos enfermeiros perioperatórios sobre a segurança do doente no bloco operatório. Metodologia: Estudo descritivo, com recurso a amostragem por clusters de hospitais. Inclui 1.001 enfermeiros de 46 blocos operatórios, e utiliza o Questionário de Segurança do Doente no Bloco Operatório. No tratamento de dados usa-se a aplicação IBM SPSS Statistics, versão 25.0. Resultados: A análise das percentagens de respostas positivas revelou que a maioria das dimensões de segurança do doente tem um baixo nível de implementação (<50%), destacando-se as dimensões relacionadas com as auditorias. Apenas as dimensões no âmbito das boas práticas na identificação inequívoca dos doentes e da prevenção e controlo de infeção e resistência aos antimicrobianos apresentam um nível de implementação elevado (≥75%). Conclusão: Os resultados indiciam oportunidades de melhoria na generalidade das dimensões de segurança do doente no bloco operatório.

          Translated abstract

          Resumen Marco contextual: El quirófano es el lugar donde se produce el mayor número de incidentes en la asistencia sanitaria. La implementación de políticas de seguridad del paciente es fundamental. Objetivo: Caracterizar la percepción de los enfermeros perioperatorios sobre la seguridad del paciente en el quirófano. Metodología: Estudio descriptivo, mediante muestreo por grupos de hospitales. Incluye a 1001 enfermeros de 46 quirófanos y utiliza el Cuestionario de Seguridad del Paciente en el Quirófano. Los datos se procesaron con la aplicación IBM SPSS Statistics, versión 25.0. Resultados: El análisis de los porcentajes de respuestas positivas mostró que la mayoría de las dimensiones de seguridad del paciente tienen un bajo nivel de implementación (<50%), en particular las relacionadas con las auditorías. Solo las dimensiones relacionadas con las buenas prácticas en la identificación inequívoca de los pacientes, así como de la prevención y del control de la infección y la resistencia a los antimicrobianos mostraron un alto nivel de implementación (≥75%). Conclusión: Los resultados indican oportunidades de mejora en la mayoría de las dimensiones de la seguridad del paciente en el quirófano.

          Translated abstract

          Abstract Background: Most healthcare incidents occur in the operating room. Thus, it is essential to implement patient safety policies. Objective: Characterize perioperative nurses’ perceptions of patient safety in the operating room. Methodology: Descriptive study using sampling by clusters of hospitals. The sample consisted of 1,001 nurses from 46 operating rooms. The Patient Safety in the Operating Room Questionnaire was applied and IBM SPSS Statistics software, version 25.0, was used for data processing. Results: The analysis of the percentages of positive answers revealed that most patient safety dimensions have a low level of implementation (<50%), particularly those regarding audits. Only the dimensions concerning good practices in unambiguous patient identification and antimicrobial resistance and infection control and prevention had high levels of implementation (≥75%). Conclusion: The results point to opportunities for improvement in the generality of dimensions of patient safety in the operating room.

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          The impact of a standardized incident reporting system in the perioperative setting: a single center experience on 2,563 ‘near-misses’ and adverse events

          Background The reduction of perioperative harm is a major priority of in-hospital health care and the reporting of incidents and their causes is an important source of information to improve perioperative patient safety. We explored the number, nature and causes of voluntarily reported perioperative incidents in order to highlight the areas where further efforts are required to improve patient safety. Methods Data from the Hospital Incident Management System (HIMS), entered in the period from July 2009 to July 2012, were analyzed in a Dutch university hospital. Employees in the perioperatve field filled out a semi-structured digital form of the reporting system. The risk classification of the reported adverse events and ‘near misses’ was based on the estimated patient consequences and the risk of recurrence, according to national guidelines. Predefined reported incident causes were categorized as human, organizational, technical and patient related. Results In total, 2,563 incidents (1,300 adverse events and 1,263 ‘near-miss’ events) were reported during 67,360 operations. Reporters were anesthesia, operating room and recovery nurses (37%), ward nurses (31%), physicians (17%), administrative personnel (5%), others (6%) and unmentioned (3%). A total of 414 (16%) adverse events had patient consequences (which affected 0,6% of all surgery patients), estimated as catastrophic in 2, very serious in 34, serious in 105, and marginally serious in 273 cases. Shortcomings in communication was the most frequent reported type of incidents. Non-compliance with Standard Operating Procedures (SOPs: instructions, regulations, protocols and guidelines) was reported with 877 (34%) of incident reports. In total, 1,194 (27%) voluntarily reported causes were SOP-related, mainly human-based (79%) and partially organization-based (21%). SOP-related incidents were not associated with more patient consequences than other voluntarily reported incidents. Furthermore ‘mistake or forgotten’ (15%) and ‘communication problems’ (11%) were frequently reported causes of incidents. Conclusions The analysis of voluntarily reported perioperative incidents identified an association between perioperative patient safety problems and human failure, such as SOP non-compliance, mistakes, forgetting, and shortcomings in communication. The data suggest that professionals themselves indicate that SOP compliance in combination with other human failures provide room for improvement.
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            Prevention and Treatment of Pressure Ulcers Clinical Practice Guideline

            (2014)
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              A Nurse-Initiated Perioperative Pressure Injury Risk Assessment and Prevention Protocol.

              Pressure injuries negatively affect patients physically, emotionally, and economically. Studies report that pressure injuries occur in 69% of inpatients who have undergone a surgical procedure while hospitalized. In 2012, we created a nurse-initiated, perioperative pressure injury risk assessment measure for our midwestern, urban, adult teaching hospital. We retrospectively applied the risk assessment to a random sample of 350 surgical patients which validated the measure. The prospective use of the risk assessment and prevention measures in 350 surgical patients resulted in a 60% reduction in pressure injuries compared with the retrospective group. Our findings support the use of a multipronged approach for the prevention of health care-associated pressure injuries in the surgical population, which includes assessment of risk, implementation of evidence-based prevention interventions for at-risk patients, and continuation of prevention beyond the perioperative setting to the nursing care unit.
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                Author and article information

                Journal
                ref
                Revista de Enfermagem Referência
                Rev. Enf. Ref.
                Escola Superior de Enfermagem de Coimbra - Unidade de Investigação em Ciências da Saúde - Enfermagem (Coimbra, , Portugal )
                0874-0283
                2182-2883
                April 2021
                : serV
                : 6
                : e20134
                Affiliations
                [1] Coimbra orgnameEscola Superior de Enfermagem de Coimbra orgdiv1Unidade de Investigação em Ciências da Saúde: Enfermagem Portugal
                [4] Porto orgnameEscola Superior de Enfermagem do Porto Portugal
                [2] Coimbra orgnameCentro Cirúrgico de Coimbra Portugal
                [3] Porto orgnameUniversidade do Porto orgdiv1Instituto de Ciências Biomédicas Abel Salazar Portugal
                Article
                S0874-02832021000200003 S0874-0283(21)00000600003
                10.12707/rv20134
                00e36cb0-aabb-4f4f-82e4-79dc1df3e3f7

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 23 August 2020
                : 27 January 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 0
                Product

                SciELO Portugal

                Categories
                Artigo de Investigação (Original)

                nursing,health policy,operating rooms,patient safety,enfermería,política de salud,quirófanos,segurança do paciente,seguridad del paciente,enfermagem,política de saúde,salas cirúrgicas

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