Instrumentos para avaliação da cultura de segurança do paciente nos serviços de emergência: revisão integrativa

Torrente, Gisele; Barbosa, Sayonara de Fátima Faria

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Revista Brasileira de Enfermagem

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REVISÃO • Rev. Bras. Enferm. 74 (2) • 2021 • https://doi.org/10.1590/0034-7167-2019-0693 copiar

Instrumentos para avaliação da cultura de segurança do paciente nos serviços de emergência: revisão integrativa

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

identificar os instrumentos utilizados para a avaliação da cultura de segurança do paciente no cenário da emergência.

Método:

revisão integrativa da literatura referente ao período de 2000 a 2018.

Resultados:

foram identificados 13 instrumentos para avaliar a cultura de segurança do paciente em emergência hospitalar e pré-hospitalar, compreendendo de 12 a 50 questões, agrupadas de três a 12 dimensões, prevalecendo dimensões relacionadas ao trabalho em equipe, apoio e ações da gestão para a segurança do paciente e aquelas com foco na melhoria contínua dos processos e educação permanente. Destaca-se o Emergency Medical Service Safety Attitude Questionnaire, exclusivo para o atendimento pré-hospitalar.

Conclusões:

a escolha e a melhor decisão quanto ao instrumento estão atreladas aos objetivos, ao ambiente e à população a ser investigada, bem como à confiabilidade do instrumento.

Descritores:
Gestão de Segurança; Cultura Organizacional; Segurança do Paciente; Avaliação de Processos (Cuidados de Saúde); Serviços Médicos de Emergência

Instrumentos		NoPesquisa/País/Ano	No de questões	No de dimensões	Cenário
1	HSOPSC⁽⁹9 Alquwez N, Cruz JP, Almoghairi AM, Al-Otaibi RS, Almutairi KO, Alicante JG, et al. Nurses' perceptions of patient safety culture in three hospitals in Saudi Arabia. J Nurs Scholarship. 2018;50(4):422-31. https://doi.org/10.1111/jnu.12394 https://doi.org/10.1111/jnu.12394... 10 Burström L, Letterstål A, Engström ML, Berglund A, Enlund M. The patient safety culture as perceived by staff at two different emergency departments before and after introducing a flow-oriented working model with team triage and lean principles: a repeated cross-sectional study. BMC Health Serv Res. 2014;14(1):296. https://doi.org/10.1186/1472-6963-14-296 https://doi.org/10.1186/1472-6963-14-296... 11 Cho SM, Choi J. Patient safety culture associated with patient safety competencies among registered nurses. J Nurs Scholarship. 2018;50(5):549-57. https://doi.org/10.1111/jnu.12413 https://doi.org/10.1111/jnu.12413... 12 Jang HE, Song Y, Kang HY. Nurses' perception of patient safety culture and safety control in patient safety management activities. J Korean Acad Nurs Adm. 2017;23(4):450. https://doi.org/10.11111/jkana.2017.23.4.450 https://doi.org/10.11111/jkana.2017.23.4... 13 Jones F, Podila P, Powers C. Creating a culture of safety in the emergency department: the value of teamwork training. J Nurs Adm. 2013;43(4):194-200. https://doi.org/10.1097/NNA.0b013e31828958cd https://doi.org/10.1097/NNA.0b013e318289... ^-¹⁴14 Tourani S, Hassani M, Ayoubian A, Habibi M, Zaboli R. Analyzing and prioritizing the dimensions of patient safety culture in emergency wards using the TOPSIS Technique. Glob J Health Sci. 2015;7(4):143-50. https://doi.org/10.5539/gjhs.v7n4p143 https://doi.org/10.5539/gjhs.v7n4p143... ⁾	Portugal (2011), Coréia (2017), Coréia do Sul (2018), Arábia Saudita (2018), Suécia (2013)	42	12	α
1	HSOPSC⁽¹⁴14 Tourani S, Hassani M, Ayoubian A, Habibi M, Zaboli R. Analyzing and prioritizing the dimensions of patient safety culture in emergency wards using the TOPSIS Technique. Glob J Health Sci. 2015;7(4):143-50. https://doi.org/10.5539/gjhs.v7n4p143 https://doi.org/10.5539/gjhs.v7n4p143... ⁾	Irã (2014)	42	12	β
2	SAQ⁽¹⁵15 Rigobello MCG, Carvalho REFL, Guerreiro JM, Motta APG, Atila E, Gimenes FRE. The perception of the patient safety climate by professionals of the emergency department. Int Emerg Nurs. 2017;33:1-6. https://doi.org/10.1016/j.ienj.2017.03.003 https://doi.org/10.1016/j.ienj.2017.03.0... ⁾	Brasil (2016)	41	6	α
3	AACN HWEAT e HSOPSC⁽¹⁶16 Connor JA, Ziniel SI, Porter C, Doherty D, Moonan M, Dwyer P, et al. Interprofessional use and validation of the AACN Healthy Work Environment Assessment Tool. Am J Crit Care. 2018;27(5):363-71. https://doi.org/10.4037/ajcc2018179 https://doi.org/10.4037/ajcc2018179... ⁾	EUA (2018)	20	6	α
4	RPPE⁽¹⁷17 Lambrou P, Papastavrou E, Merkouris A, Middleton N. Professional environment and patient safety in emergency departments. Int Emerg Nurs. 2015;23(2):150-5. https://doi.org/10.1016/j.ienj.2014.07.009 https://doi.org/10.1016/j.ienj.2014.07.0... ⁾	Chipre (2014)	39	8	α
5	PCQ-F⁽¹⁸18 Lindahl J, Elmqvist C, Thulesius H, Edvardsson D. Psychometric evaluation of the Swedish language Person-centred Climate Questionnaire: family version. Scand J Caring Sci. 2015;29(4):859-64. https://doi.org/10.1111/scs.12198 https://doi.org/10.1111/scs.12198... ⁾	Suécia (2015)	17	3	δ
6	Safety beliefs and practices conducted by the Air and Surface Transport Nurses Association ⁽ ¹⁹19 McNeill MM, Pierce P, Dukes S, Bridges EJ. En route care patient safety: thoughts from the field. Mil Med. 2014;179(8 Suppl):11-8. https://doi.org/10.7205/MILMED-D-13-00522 https://doi.org/10.7205/MILMED-D-13-0052... ⁾	EUA (2014)	15	4	Ω
7	ED Survey Colorado⁽²⁰20 Camargo Jr CA, Tsai CL, Sullivan AF, Cleary PD, Gordon JA, Guadagnoli E, et al. Safety climate and medical errors in 62 US emergency departments. Ann Emerg Med. 2012;60(5):555-63.e20. https://doi.org/10.1016/j.annemergmed.2012.02.018 https://doi.org/10.1016/j.annemergmed.20... ^-²¹21 Magid DJ, Sullivan AF, Cleary PD, Rao SR, Gordon JA, Kaushal R, et al. The safety of emergency care systems: results of a survey of clinicians in 65 US Emergency Departments. Ann Emerg Med. 2009;53(6):715-23. https://doi.org/10.1016/j.annemergmed.2008.10.007 https://doi.org/10.1016/j.annemergmed.20... ⁾	EUA (2012, 2009)	55	9	β
8	ED Survey Indianápolis⁽²⁰20 Camargo Jr CA, Tsai CL, Sullivan AF, Cleary PD, Gordon JA, Guadagnoli E, et al. Safety climate and medical errors in 62 US emergency departments. Ann Emerg Med. 2012;60(5):555-63.e20. https://doi.org/10.1016/j.annemergmed.2012.02.018 https://doi.org/10.1016/j.annemergmed.20... ^,²²22 Wright ER, Linde B, Rau NL, Gayman M, Viggiano T. The effect of organizational climate on the clinical care of patients with mental health problems. J Emerg Nurs. 2003 Aug;29(4):314-21. https://doi.org/10.1067/men.2003.103 https://doi.org/10.1067/men.2003.103... ⁾	EUA (2012, 2003)	67	10	β
9	EMS Safety Climate Scale⁽²³23 Eliseo LJ, Murray KA, White LF, Dyer S, Mitchell PA, Fernandez WG. EMS providers' perceptions of safety climate and adherence to safe work practices. Prehosp Emerg Care. 2012;16(1):53-8. https://doi.org/10.3109/10903127.2011.621043 https://doi.org/10.3109/10903127.2011.62... ⁾	EUA (2012)	20	6	Ω
10	EMS-SI⁽²⁴24 Weaver MD, Wang HE, Fairbanks RJ, Patterson D. The association between EMS workplace safety culture and safefy outcomes. Prehosp Emerg Care. 2012;16(1):43-52. https://doi.org/10.3109/10903127.2011.614048 https://doi.org/10.3109/10903127.2011.61... ⁾	EUA (2012)	44	6	Ω
11	Alberta Registered Nurse Survey ⁽ ²⁵25 Mallidou AA, Cummings GG, Estabrooks CA, Giovannetti PB. Nurse specialty subcultures and patient outcomes in acute care hospitals: a multiple-group structural equation modeling. Int J Nurs Stud. 2011;48(1):81-93. https://doi.org/10.1016/j.ijnurstu.2010.06.002 https://doi.org/10.1016/j.ijnurstu.2010.... ⁾	Canadá (2011)	20	12	α
12	Institute for Healthcare Improvement ⁽ ²⁶26 Shaw KN, Ruddy RM, Olsen CS, Lillis KA, Mahajan PV, Dean JM, et al. Pediatric Patient Safety in Emergency Departments: unit characteristics and staff perceptions. Pediatrics 2009;124(2):485-93. https://doi.org/10.1542/peds.2008-2858 https://doi.org/10.1542/peds.2008-2858... ⁾	EUA (2013)	19	4	β
13	EMS-SAQ⁽²⁷27 Patterson PD, Huang DT, Fairbanks RJ, Wang HE. The Emergency Medical Services Safety Attitudes Questionnaire. Am J Med Qual. 2010;25(2):109-15. https://doi.org/10.1177/1062860609352106 https://doi.org/10.1177/1062860609352106... ⁾	EUA (2016)	30	6	Ω

	Dimensões / Domínios	Instrumentos
1	Frequência de eventos adversos notificados	HSOPSC; PSCS
2	Trabalho em equipe	HSOPSC; PSCS; SAQ-EMS; SAQ; RPPE; ED; EMS-SI
3	Expectativas e ações da direção/supervisão da unidade/serviço que favorecem a segurança	HSOPSC; PSCS
4	Aprendizagem organizacional/melhoria continuada	HSOPSC; PSCS
5	Apoio da gerência do hospital para a segurança do paciente	HSOPSC; PSCS
6	Percepção de segurança	HSOPSC; PSCS; SAQ-EMS; SAQ; EMS-SI
7	Feedback e comunicação sobre erros	HSOPSC; PSCS
8	Abertura para comunicações	HSOPSC; PSCS
9	Trabalho em equipe entre unidades	HSOPSC; PSCS
10	Dimensionamento de pessoal	HSOPSC; PSCS; AACN HWEAT
11	Problemas em mudança de turno e transições entre unidades/serviços	HSOPSC; PSCS
12	Resposta não punitiva aos erros	HSOPSC; PSCS
13	Satisfação no trabalho	SAQ-EMS; SAQ; EMS-SI; Alberta Registered Nurse Survey
14	Clima de segurança	SAQ-EMS; SAQ; PCQ-F; EMS-SI; Institute for Healthcare Improvement
15	Stress	SAQ-EMS; SAQ; EMS-SI
16	Condições de trabalho	SAQ-EMS; SAQ; EMS-SI
17	Colaboração verdadeira (true collaboration)	AACN HWEAT
18	Comunicação especializada (skilled communication)	AACN HWEAT
19	Tomada de decisão efetiva (effective decision-making)	AACN HWEAT
20	Reconhecimento significativo (meaningful recognition)	AACN HWEAT
21	Liderança autêntica (authentic leadership)	AACN HWEAT
22	Clima de cotidiano (climate of everydayness)	PCQ-F
23	Clima de hospitalidade (climate of hospitality)	PCQ-F
24	Lidar com desacordo e conflito (handling disagreement and conflict)	RPPE
25	Liderança e autonomia na prática clínica (leadership and autonomy in clinical practice)	RPPE
26	Motivação interna de trabalho (internal work motivation)	RPPE
27	Controle sobre a prática (control over pratic)	RPPE
28	Comunicação sobre o paciente (communication about patient)	RPPE
29	Relações da equipe com os médicos (staff relationships with physicians)	RPPE
30	Ambiente físico (physical environment)	ED
31	Pessoal (staffing)	ED
32	Enfermagem (nursing)	ED
33	Cultura (culture)	ED
34	Triagem e monitoramento (triage and monitoring)	ED
35	Coordenação e consulta de informação (information coordination and consultation)	ED
3	Coordenação de internação (inpatient coordination)	ED
6	Disponibilidade de equipamento de proteção individual (availability of personal protective gear)	EMS
37	Suporte da gestão (management support)	EMS
38	Ausência de impedimentos no emprego (absence of job hindrances)	EMS
39	Feedback e treinamentos (feedback/training)	EMS
40	Limpeza do ambiente de trabalho (cleanliness of workspace)	EMS
41	Conflito mínimo e boa comunicação (minimal conflict/good communication)	EMS
42	Aglomeração (crowding)	Institute for Healthcare Improvement
43	Comunicação e coordenador de cuidados (communication/coordination of care)	Institute for Healthcare Improvement
44	Segurança dos medicamentos (medicationsafety)	Institute for Healthcare Improvement
45	Qualidade do cuidado (quality of care)	Alberta Registered Nurse Survey
46	Eventos adversos com paciente (adverse patient events)	Alberta Registered Nurse Survey
47	Trabalho integral ou parcial (experience full time/part time)	Alberta Registered Nurse Survey
48	Salário (salary)	Alberta Registered Nurse Survey
49	Educação continuada (continuing education)	Alberta Registered Nurse Survey
50	Programa de garantia de qualidade (quality assurance program)	Alberta Registered Nurse Survey
51	Preceptoria (preceptorship)	Alberta Registered Nurse Survey
52	Autonomia (autonomy)	Alberta Registered Nurse Survey
53	Controle sobre a prática clínica (control over practice)	Alberta Registered Nurse Survey
54	Relação entre enfermeiros e médicos (RN-MD relationships)	Alberta Registered Nurse Survey
55	Exaustão emocional (emotional exhaustion)	Alberta Registered Nurse Survey
56	Segurança da equipe (staff crew safety)	Safety beliefs and practices conducted by the Air and Surface Transport Nurses Association
57	Segurança do paciente (patient safety)	Safety beliefs and practices conducted by the Air and Surface Transport Nurses Association
58	Condição de voo (flying status)	Safety beliefs and practices conducted by the Air and Surface Transport Nurses Association
59	Fechamento de chamadas, quase erros e incidents na segurança (close calls, near misses, or safety incidents)	Safety beliefs and practices conducted by the Air and Surface Transport Nurses Association

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[1] Autor Correspondente: Gisele Torrente E-mail: torrentegisele@gmail.com