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      CULTURA DE SEGURANÇA DO PACIENTE: AVALIAÇÃO PELOS PROFISSIONAIS DE ENFERMAGEM Translated title: CULTURA DE SEGURIDAD PARA EL PACIENTE: EVALUACIÓN REALIZADA POR LOS PROFESIONALES DE ENFERMERÍA Translated title: PATIENT SAFETY CULTURE: EVALUATION BY NURSING PROFESSIONALS

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          Abstract

          RESUMO Objetivo: avaliar a cultura de segurança do paciente das equipes de enfermagem no contexto hospitalar. Método: sob o ponto de vista da enfermagem foi realizado um estudo quantitativo, tipo survey, transversal. A coleta de dados ocorreu entre junho e julho de 2013. Foi utilizado o questionário Hospital Survey on Patient Safety Culture, respondido por 437 profissionais da equipe de enfermagem, com taxa de resposta de 100%. Resultados: entre as doze dimensões avaliadas, apenas seis apresentaram taxas de respostas positivas maiores que 50%, sendo frequência de relato de eventos (61,4%), aprendizado organizacional - melhoria contínua (60,5%), respostas não punitivas aos erros (58%), trabalho em equipe dentro da unidade (57,1%), passagem de plantão/turnos e transferências (53,1%) e retorno da informação e comunicação sobre erro (51,8%). Conclusão: para o alcance de cultura de segurança positiva são necessárias ações de melhoria que envolvam a gestão e as chefias no que se refere: percepção geral da segurança; expectativas sobre o supervisor/chefe e ações promotoras da segurança; abertura da comunicação; apoio da gestão hospitalar para a segurança do paciente e trabalho em equipe entre as unidades.

          Translated abstract

          RESUMEN Objetivo: evaluar la cultura de seguridad del paciente de los equipos de enfermería en el contexto hospitalario. Método: bajo el punto de vista de la enfermería fue realizado un estudio cuantitativo, tipo survey y transversal. La obtención de datos se realizó entre Junio y Julio del 2013. Se usó el cuestionario Hospital Survey on Patient Safety Culture que respondido por 437 profesionales del equipo de enfermería y con una taza de respuesta del 100%. Resultados: entre las doce dimensiones evaluadas apenas seis presentaron tazas de respuestas positivas mayores al 50%, siendo ellas la frecuencia del relato de eventos (61,4%), aprendizaje organizacional - mejora continua (60,5%), respuestas no punitivas a los errores (58%), trabajo en equipo dentro de la unidad (57,1%), pasaje de guardia/turnos y transferencias (53,1%) y proporcionar la información y comunicación sobre el error (51,8%). Conclusión: para llegar a la cultura de seguridad positiva son necesarias acciones de mejoramiento que incluyan la gestión y las jefaturas en lo que se refiere a la percepción general de la seguridad, expectativas sobre el supervisor/jefe y las acciones promotoras de la seguridad, abertura de la comunicación, apoyo de la gestión hospitalaria para la seguridad del paciente y el trabajo en equipo entre las unidades.

          Translated abstract

          ABSTRACT Objective: to evaluate the patient safety culture of nursing teams in the hospital context. Method: from a nursing point of view, a cross-sectional quantitative study, of the survey type, was performed. The data collection occurred between June and July 2013. The questionnaire Hospital Survey on Patient Safety Culture was used, answered by 437 professionals of the nursing team, with a response rate of 100%. Results: among the twelve dimensions evaluated, only six had positive response rates greater than 50%, being the frequency of event reporting (61.4%), organizational learning - continuous improvement (60.5%), non-punitive responses to errors (58%), teamwork within the unit (57.1%), shift/orderly and transfers (53.1%), and feedback of information and communication about error (51.8%). Conclusion: in order to reach a positive safety culture, improvement actions involving management and leadership are required: general perception of safety; expectations about the supervisor/boss and actions that promote safety; the opening of communication; support of hospital management for patient safety and teamwork between units.

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          Systematic review: impact of health information technology on quality, efficiency, and costs of medical care.

          Experts consider health information technology key to improving efficiency and quality of health care. To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care. The authors systematically searched the English-language literature indexed in MEDLINE (1995 to January 2004), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects, and the Periodical Abstracts Database. We also added studies identified by experts up to April 2005. Descriptive and comparative studies and systematic reviews of health information technology. Two reviewers independently extracted information on system capabilities, design, effects on quality, system acquisition, implementation context, and costs. 257 studies met the inclusion criteria. Most studies addressed decision support systems or electronic health records. Approximately 25% of the studies were from 4 academic institutions that implemented internally developed systems; only 9 studies evaluated multifunctional, commercially developed systems. Three major benefits on quality were demonstrated: increased adherence to guideline-based care, enhanced surveillance and monitoring, and decreased medication errors. The primary domain of improvement was preventive health. The major efficiency benefit shown was decreased utilization of care. Data on another efficiency measure, time utilization, were mixed. Empirical cost data were limited. Available quantitative research was limited and was done by a small number of institutions. Systems were heterogeneous and sometimes incompletely described. Available financial and contextual data were limited. Four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. Whether and how other institutions can achieve similar benefits, and at what costs, are unclear.
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            A new, evidence-based estimate of patient harms associated with hospital care.

            Based on 1984 data developed from reviews of medical records of patients treated in New York hospitals, the Institute of Medicine estimated that up to 98,000 Americans die each year from medical errors. The basis of this estimate is nearly 3 decades old; herein, an updated estimate is developed from modern studies published from 2008 to 2011. A literature review identified 4 limited studies that used primarily the Global Trigger Tool to flag specific evidence in medical records, such as medication stop orders or abnormal laboratory results, which point to an adverse event that may have harmed a patient. Ultimately, a physician must concur on the findings of an adverse event and then classify the severity of patient harm. Using a weighted average of the 4 studies, a lower limit of 210,000 deaths per year was associated with preventable harm in hospitals. Given limitations in the search capability of the Global Trigger Tool and the incompleteness of medical records on which the Tool depends, the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm. The epidemic of patient harm in hospitals must be taken more seriously if it is to be curtailed. Fully engaging patients and their advocates during hospital care, systematically seeking the patients' voice in identifying harms, transparent accountability for harm, and intentional correction of root causes of harm will be necessary to accomplish this goal.
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              Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records.

              Despite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention. To examine the effects of hospital-wide nurse staffing levels (patient-to-nurse ratios) on patient mortality, failure to rescue (mortality risk for patients with complicated stays) and nurse job dissatisfaction, burnout and nurse-rated quality of care. Cross-sectional analysis combining nurse survey data with discharge abstracts. Nurses (N=3984) and general, orthopaedic, and vascular surgery patients (N=118752) in 30 English acute trusts. Patients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient-to-nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing. Patients in the hospitals with the highest patient to nurse ratios had 26% higher mortality (95% CI: 12-49%); the nurses in those hospitals were approximately twice as likely to be dissatisfied with their jobs, to show high burnout levels, and to report low or deteriorating quality of care on their wards and hospitals. Nurse staffing levels in NHS hospitals appear to have the same impact on patient outcomes and factors influencing nurse retention as have been found in the USA.
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                Author and article information

                Journal
                tce
                Texto & Contexto - Enfermagem
                Texto contexto - enferm.
                Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem (, SC, Brazil )
                0104-0707
                1980-265X
                2018
                : 27
                : 3
                : e2670016
                Affiliations
                [3] Ribeirão Preto orgnameUniversidade de São Paulo orgdiv1Escola de Enfermagem de Ribeirão Preto orgdiv2Departamento de Enfermagem Geral e Especializada Brazil cgabriel@ 123456eerp.usp.br
                [2] Ribeirão Preto orgnameUniversidade de São Paulo orgdiv1Escola de Enfermagem de Ribeirão Preto orgdiv2Programa de Pós-Graduação em Enfermagem Brazil danidsramos@ 123456yahoo.com.br
                [1] Londrina Paraná orgnameUniversidade do Norte do Paraná Brazil danielebernardi@ 123456hotmail.com
                [4] Ribeirão Preto orgnameUniversidade de São Paulo orgdiv1Escola de Enfermagem de Ribeirão Preto orgdiv2Departamento de Enfermagem Geral e Especializada Brazil adreab@ 123456eerp.usp.br
                Article
                S0104-07072018000300303 S0104-0707(18)02700300303
                10.1590/0104-070720180002670016
                dcc9b1d9-7a5f-4dd3-8649-0620fb03b583

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

                History
                : 16 September 2016
                : 11 October 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 24, Pages: 0
                Product

                SciELO Brazil


                Serviços hospitalares,Seguridad del paciente,Qualidade da assistência à saúde,Enfermagem,Segurança do paciente,Hospital services,Quality of health care,Nursing,Patient Safety,Cualidad de la asistencia para la salud,Servicios hospitalarios,Enfermería

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