Segurança do paciente em Unidade de Terapia Intensiva: carga de trabalho de enfermagem e sua relação com a ocorrência de eventos adversos e incidentes

Abstract

An observational prospective study of an quantitative approach, aimed at analyzing the workload of nurses, according to the hours of care required by patients, and the allocation of the nursing staff, per patient a day, and its relationship with the occurrence of adverse events and incidents, in four intensive care units (ICUs) belonging to a university hospital, of a tertiary level, in São Paulo, Brazil. This research was performed in the ICU on the 4th floor (Emergency Room and Hematology) and the 6th floor (Pulmonary and Clinics). The sample consisted of 86 patients. To measure the hours of care required by patients, it was applied in a 40-day study, Nursing Activities Score. The data from this study was obtained from the daily analysis of patient charts, the daily monitoring of physician visits and nursing change of shifts on two shifts (morning and night). Patients in the ICU on the 4th floor demanded greater nursing care (15.7 hours) than patients in the ICU on the 6th floor (14.7 hours), with a significant difference (p = 0.008). The available nursing time in the ICU on the 4th floor (16.9 hours) were inferior to the one on the 6th floor (24.4 hours), also with a statistically significant result (p = 0.000). The average difference between the available hours and required ones on nursing care for ICU patients was higher on the 6th floor, compared to the ICU on the 4th floor (p = 0.000). In both ICUs there were 1082 adverse events and incidents, of which 865 (79.9%) were incidents and 217 (20.1%) adverse events. The increase in the difference between the available hours and the required ones on nursing care to patients resulted in increased frequency of adverse events and incidents per patient a day, only in the combined analysis of both ICUs, with an equal correlation of 0.444 (p = 0.000). Out of 1165 allocations of the nursing staff in both ICUs, 893 (76.7%) were adequate and 272 (23.3%) inadequate. The average number of incidents and adverse events was higher in the inadequate allocation of the nursing staff, compared to adequate allocation in both the 4th floor ICU (p = 0.004) and 6th floor ICU (p = 0.000), and when analyzed together both ICUs (p = 0.000). It was also observed that in both ICUs, when analyzed separately and together, the higher the difference between the available hours of nursing care and the required ones by patients, in the allocation of the nursing staff, the lower the frequency of adverse events and incidents was, these significant correlations. In conclusion, the results showed the importance of a proper distribution of the daily nursing staff per patient to ensure patient safety.

Retirada não planejada de dispositivos invasivos e suas implicações para a segurança do paciente crítico / Unplanned removal of invasive devices and their implications for the safety of the critical patient

“…Moreover, a study reveals that environmental factors such as noise and heat (due to a greater number of professionals and students acting in the unit), psychological as anxiety and stress of the professionals also contribute to the occurrence of errors. 6 The same author shows that the workload is one of the most important stressors among ICU nurses, interfering with the results of care. This statement is fully applicable to the reality of the ICU where this study was carried out.…”

Conhecimento de enfermeiros de Unidades de Terapia Intensiva acerca da notificação de eventos adversos

“…Em relação ao perfil encontrado entre os enfermeiros da pesquisa, verificou-se que em relação à idade média (35,7 anos, com variação entre 26 e 53 anos), tempo médio de Graduação (oito anos) e de experiência profissional (seis anos) e maior titulação obtida (Especialização), a amostra mostrou-se muito semelhante e consistente ao perfil encontrado na pesquisa nacional Perfil da Enfermagem no Brasil, realizada pelo Conselho Federal de Enfermagem (COFEN) em parceria com a FIOCRUZ em 2013 (12)(13) e dados divulgados pelo Conselho Regional de Enfermagem de São Paulo (COREN-SP).…”

Eventos adversos e carga de trabalho de enfermagem em pacientes submetidos ao transplante de células-tronco hematopoiéticas: estudo de coorte

“…No contexto atual, é fundamental a avaliação da carga de trabalho de enfermagem, categoria que representa 60,2% dos vínculos empregatícios dos profissionais de saúde e que é responsável por processos que visam à qualidade da assistência prestada (54) . Além disso, é a equipe de enfermagem que permanece maior tempo à beira do leito, para cuidar e realizar intervenções terapêuticas (55) .…”