Efeito da implementação de checklist de enfermagem em anestesia no clima de segurança e trabalho em equipe: estudo quase-experimental.

Lemos, Cassiane de Santana; Poveda, Vanessa de Brito

Acessibilidade / Reportar erro

Brasil

Revista da Escola de Enfermagem da USP

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Brasil

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 56 • 2022 • https://doi.org/10.1590/1980-220X-REEUSP-2021-0471en copiar

Efeito da implementação de checklist de enfermagem em anestesia no clima de segurança e trabalho em equipe: estudo quase-experimental.

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

Avaliar o efeito da implementação de um checklist de segurança do paciente: enfermagem no procedimento anestésico sobre a percepção do clima de segurança e clima de equipe de enfermeiros e anestesiologistas de um centro cirúrgico.

Método:

Estudo quase experimental realizado no centro cirúrgico de um hospital do Brasil com uma amostra de enfermeiros e anestesiologistas. O desfecho foi avaliado por meio dos instrumentos “Safety Attitudes Questionnaire/Operating Room Version” e “Team Climate Inventory”, aplicados antes e após a implementação de um checklist de segurança do paciente: enfermagem no procedimento anestésico pelos enfermeiros. O modelo de regressão linear de efeitos mistos foi utilizado para analisar o efeito da implementação.

Resultados:

Ao todo, 19 (30,2%) enfermeiros e 44 (69,8%) anestesiologistas participaram do estudo, implementando o checklist de segurança do paciente: enfermagem no procedimento anestésico em 282 anestesias. O escore do Safety Attitudes Questionnaire/Operating Room mudou de 62,5 para 69,2, com modificação entre os anestesiologistas no domínio “Percepção da gestão” (p = 0,02). Entre os dois profissionais, o escore do Team Climate Inventory aumentou após a intervenção (p = 0,01).

Conclusão:

A implementação do Patient safety checklist: nursing in anesthetic procedure modificou o escore de percepção de clima de segurança e clima de trabalho em equipe, melhorando a comunicação e o trabalho colaborativo.

DESCRITORES
Enfermagem Perioperatória; Anestesia Geral; Segurança do Paciente; Lista de Checagem; Qualidade da Assistência à Saúde; Equipe de; Assistência ao Paciente

Domains	Position	Period		p-values
Domains	Position	Pre mean (SD*)	Post mean (SD)	Exposure period	Position	Interaction: period and position
Total SAQ	N	62.5 (14.1)	64.7 (12.5)	0.08	0.18	0.93
Total SAQ	A	66.6 (10.9)	69.2 (10.7)	0.08	0.18	0.93
Safety climate	N	77 (13.7)	80.3 (11.5)	0.36	0.97	0.69
Safety climate	A	78.3 (13.8)	80.2 (15.6)	0.36	0.97	0.69
Perception of management	N	62.8 (16.7)	62.9 (16.9)	0.0002	0.0007	0.02
Perception of management	A	68.5 (15.7)	79.3 (16.2)	0.0002	0.0007	0.02
Stress recognition	N	53.9 (31.3)	56.6 (29.2)	0.49	0.33	0.93
Stress recognition	A	61.6 (26.1)	64.3 (24.7)	0.49	0.33	0.93
Working conditions	N	64.5 (20.4)	73.7 (16.8)	0.36	0.82	0.08
Working conditions	A	72.6 (15.5)	74.6 (16.2)	0.36	0.82	0.08
Communication environment	N	80.3 (20.1)	85.1 (10.2)	0.23	0.14	0.55
Communication environment	A	87.5 (9.81)	90.1 (9.68)	0.23	0.14	0.55
Perception of professional performance	N	29.9 (28.2)	32.5 (27.1)	0.20	0.007	0.23
Perception of professional performance	A	18.8 (21.3)	15.4 (18.8)	0.20	0.007	0.23

SAQ total post-intervention	Period	β	95% CI*	p-value
SAQ total post-intervention	Period	β	95% CI*	Main	Interaction
		4.12	–1.44 − 9.68	0.04
Items executed of PSC/NAP	Pre	0.007	–0.005 − 0.02	0.10	0.02
Items executed of PSC/NAP	Post	–0.007	–0.02 − 0.005	0.10	0.02
Age of professional	Pre	0.52	0.17 − 0.87	<0.001	<0.001
Age of professional	Post	0.26	–0.12 − 0.63	<0.001	<0.001
Position: nurse	Pre	–4.27	–20.74 − 12.19	0.47	0.03
Position: nurse	Post	–2.11	–18.57 − 14.34	0.47	0.03
Professional experience	Pre	–0.27	–0.62 − 0.07	0.03	<0.001
Professional experience	Post	0.22	–0.15 − 0.59	0.03	<0.001
Sex: Male	Pre	–12.65	–27.82 − 2.52	0.02	<0.001
Sex: Male	Post	–3.62	–18.80 − 11.55	0.02	<0.001
Number of completed PSC/NAP	Pre	–0.16	–0.37 − 0.04	0.03	<0.001
Number of completed PSC/NAP	Post	–0.11	–0.32 − 0.09	0.03	<0.001
Anesthesiologist exposure to the PSC/NAP	Pre	0.36	–0.71 − 1.44	0.35	<0.001
Anesthesiologist exposure to the PSC/NAP	Post	–0.26	−1.33 − 0.82	0.35	<0.001

Domains	Position	Period		p-values
Domains	Position	Pre mean (SD*)	Post mean (SD)	Exposition period	Position	Interaction: period and position
Total TCI score	N	150 (28.1)	160 (22.2)	0.01	0.08	0.93
Total TCI score	A	162 (25.8)	172 (25.5)	0.01	0.08	0.93
Participation in the team	N	38.3 (6.97)	41.8 (6.9)	0.004	0.06	0.75
Participation in the team	A	42.4 (6.77)	45.5 (7.11)	0.004	0.06	0.75
Support for new ideas	N	24.9 (5.85)	26.8 (4.81)	0.14	0.07	0.75
Support for new ideas	A	28.1 (5.12)	29.6 (5.57)	0.14	0.07	0.75
Team goals	N	55.2 (11.8)	56.1 (8.04)	0.19	0.27	0.63
Team goals	A	56.6 (9.52)	59.1 (9.97)	0.19	0.27	0.63
Task orientation	N	31.6 (8.94)	36.1 (7.15)	0.04	0.11	0.51
Task orientation	A	34.9 (6.33)	38 (6.77)	0.04	0.11	0.51

	Period	p-value		Main	Interaction
	Period	β	95% CI*	Main	Interaction
TCI total post-intervention		60.09	42.40–77.79	<0.001
Items executed of PSC/NAP	Pre	0.02	–0.01 − 0.06	0.09	0.02
Items executed of PSC/NAP	Post	–0.02	–0.06 − 0.01	0.09	0.02
Age of professional	Pre	–1.26	–2.38– −0.14	0.002	<0.001
Age of professional	Post	–2.28	–3.46 − −1.09	0.002	<0.001
Position: nurse	Pre	–31.74	–79.17 − 15.69	0.07	<0.008
Position: nurse	Post	–40.35	–87.73 − 7.03	0.07	<0.008
Professional experience	Pre	–0.48	–1.58 − 0.62	0.22	<0.04
Professional experience	Post	–0.12	–1.29 − 1.04	0.22	<0.04
Sex: Male	Pre	–6.54	–50.20 − 37.12	0.68	0.94
Sex: Male	Post	–6.30	–49.98 − 37.38	0.68	0.94
Number of completed PSC/NAP	Pre	–0.17	–0.76 − 0.42	0.41	0.31
Number of completed PSC/NAP	Post	–0.17	–0.75 − 0.42	0.41	0.31
Anesthesiologist exposure to the PSC/NAP	Pre	0.05	–3.04 − 3.13	0.41	0.001
Anesthesiologist exposure to the PSC/NAP	Post	–0.48	–3.57− 2.60	0.41	0.001
Domain: participation in the team
Post-intervention		27.75	23.20 − 32.30	<0.001
Items executed of PSC/NAP	Pre	0.003	–0.006 − 0.01	0.36	0.18
Items executed of PSC/NAP	Post	–0.003	–0.01 − 0.006	0.36	0.18
Workers’ age	Pre	0.19	–0.09− 0.47	0.06	<0.001
Workers’ age	Post	–0.47	–0.77 – −0.18	0.06	<0.001
Position: nurse	Pre	–5.26	–14.58 − 4.06	0.12	<0.001
Position: nurse	Post	–9.99	–19.29 − −0.68	0.12	<0.001
Professional experience	Pre	–0.32	–0.60 − −0.05	0.001	<0.001
Professional experience	Post	0.18	–0.11 − 0.46	0.001	<0.001
Sex: Male	Pre	–3.94	–12.50 − 4.62	0.20	0.05
Sex: Male	Post	–2.43	–11.00 − 6.14	0.20	0.05
Number of completed PSC/NAP	Pre	–0.05	–0.16 − 0.07	0.26	0.04
Number of completed PSC/NAP	Post	–0.04	–0.16 − 0.07	0.26	0.04
Anesthesiologist exposure to the PSC/NAP	Pre	0.20	–0.41 − 0.80	0.36	<0.001
Anesthesiologist exposure to the PSC/NAP	Post	–0.25	–0.85 − 0.35	0.36	<0.001
Domain: Task orientation
Post-intervention		7.42	3.17 − 11.68	<0.001
Items executed of PSC/NAP	Pre	0.002	–0.007 − 0.01	0.60	0.46
Items executed of PSC/NAP	Post	–0.002	–0.01 − 0.007	0.60	0.46
Workers’ age	Pre	–0.29	–0.56 − −0.02	0.003	<0.001
Workers’ age	Post	–0.55	–0.83 − −0.26	0.003	<0.001
Position: nurse	Pre	–9.23	–20.54 − 2.07	0.03	<0.001
Position: nurse	Post	–5.38	–16.68 − 5.91	0.03	<0.001
Professional experience	Pre	–0.03	–0.29 − 0.24	0.79	<0.001
Professional experience	Post	0.21	–0.07 − 0.49	0.79	<0.001
Sex: Male	Pre	–3.26	–13.66 − 7.15	0.38	<0.001
Sex: Male	Post	0.20	–10.21 − 10.61	0.38	<0.001
Number of completed PSC/NAP	Pre	–0.09	–0.23 − 0.05	0.08	<0.001
Number of completed PSC/NAP	Post	–0.05	–0.19 − 0.10	0.08	<0.001
Anesthesiologist exposure to the PSC/NAP	Pre	–0.12	–0.85 − 0.62	0.65	0.60
Anesthesiologist exposure to the PSC/NAP	Post	–0.10	–0.83 – 0.64	0.65	0.60

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author:
Cassiane de Santana Lemos Rua José Debieux, 282, Santana 02038-030 – São Paulo, SP, Brazil cassilemos@usp.br