Contributions of healthcare staff to promote patient safety in intensive care

Minuzzi, Ana Paula; Salum, Nádia Chiodelli; Locks, Melissa Orlandi Honório; Amante, Lúcia Nazareth; Matos, Eliane

doi:10.5935/1414-8145.20160017

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RESEARCH • Esc. Anna Nery 20 (1) • Jan-Mar 2016 • https://doi.org/10.5935/1414-8145.20160017 copy

Contributions of healthcare staff to promote patient safety in intensive care

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

Presenting the recommendations of health professionals from an Intensive Care Unit for the improvement of patient safety culture.

Methods:

Descriptive-exploratory study, with a quantitative approach, resulting from the application of the Survey about Patient Safety in Hospitals, 59 professional staff participated between November 2013 and January 2014.

Results:

Were obtained 124 recommendations, which were categorized according to aspects of the instrument. Highlighting recommendations related to the support of the hospital management to patient safety, in particular, the supply of material resources; and also to organizational learning and continuous improvement, with suggestions for training and implementation of protocols aimed at standardizing the assistance.

Conclusion:

The study permitted to list significant recommendations for improvements in patient safety, and made it possible to identify the dimensions of safety culture that have more vulnerabilities.

Keywords:
Culture; Patient Safety; Intensive Care Units

Sociodemographic Data	Nurses (9)	Doctors and Physiotherapists (13)	Technicians and Nursing Assistants (19)	Total (41)
Age Group
Until 20 years	0	0	1 (5.26%)	1 (2.43%)
21 to 30 years	1 (11.11%)	2 (15.38%)	4 (21.05%)	7 (17.07%)
31 to 40 years	5 (55.55%)	5 (38.46%)	10 (52.63%)	20 (48.78%)
41 to 50 years	1 (11.11%)	4 (30.76%)	2 (10.52%)	7 (17.07%)
> 50 years	2 (22.22%)	2 (15.38%)	2 (10.52%)	6 (14.63%)
Gender
Female	7 (77.77%)	7 (53.84%)	15 (78.94%)	29 (70.73%)
Male	2 (22.22%)	6 (46.15%)	4 (21.05%)	12 (29.26%)
Working time in hospital
Less than 1 year	2 (22.22%)	4 (30.76%)	7 (36.84%)	13 (31.70%)
1 to 5 years	1 (11.11%)	3 (23.07%)	1 (5.26%)	5 (12.19%)
6 to 10 years	2 (22.22%)	2 (15.38%)	8 (42.10%)	12 (29.26%)
11 to 15 years	1 (9.99%)	0	0	1 (2.43%)
16 to 20 years	1 (9.99%)	2 (15.38%)	2 (10.52%)	5 (12.19%)
> 21 years	2 (22.22%)	2 (15.38%)	1 (5.26%)	5 (12.19%)
Working time in ICU
Less than 1 year	2 (22.22%)	5 (38.46%)	7 (36.84%)	14 (34.14%)
1 to 5 years	2 (22.22%)	2 (15.38%)	3 (15.78%)	7 (17.07%)
6 to 10 years	2 (22.22%)	2 (15.38%)	8 (42.10%)	12 (29.26%)
11 to 15 years	0	0	0	0
16 to 20 years	1 (11.11%)	2 (15.38%)	1 (5.26%)	4 (9.75%)
> 21 years	2 (22.22%)	2 (15.38%)	0	4 (9.75%)
Weekly hours
< 30 h/week	1 (9.99%)	7 (53.84%)	2 (10.52%)	10 (24.39%)
30-40 h/week	6 (66.66%)	2 (15.38%)	12 (63.15%)	20 (48.78%)
40-60 h/week	1 (9.99%)	4 (30.76%)	5 (26.31%)	10 (24.39%)
> 60 h/week	1 (9.99%)	0	0	1 (2.43%)
Working time in the profession
1 to 5 years	2 (22.22%)	3 (23.07%)	4 (21.05%)	9 (21.95%)
6 to 10 years	3 (33.33%)	3 (23.07%)	5 (26.31%)	11 (26.82%)
11 to 15 years	1 (9.99%)	1 (7.69%)	5 (26.31%)	7 (17.07%)
16 to 20 years	0	3 (23.07%)	3 (15.78%)	6 (14.63%)
> 21 years	3 (33.33%)	3 (23.07%)	2 (10.52%)	8 (19.51%)
Level of Education
Complete High School	0	0	10 (52.63%)	10 (24.39%)
Incomplete College	0	0	4 (21.05%)	4 (9.75%)
Complete College	1 (11.11%)	2 (15.38%)	3 (15.78%)	6 (14.63%)
Postgraduate studies	8 (88.88%)	11 (84.61%)	2 (10.52%)	21 (51.21%)
Employing links
1 link	4 (44.44%)	2 (15.38%)	13 (68.42%)	19 (46.34%)
2 links	3 (33.33%)	5 (38.46%)	6 (31.57%)	14 (34.14%)
> 3 links	2 (22.22%)	6 (46.15%)	0	8 (19.51%)

Dimensions	Recommendations	Mentions	Total of mentions - (%)
Organizational learning and continuous improvement	- Conduct regular training on patient safety;	13	25 (20.16%)
	- Develop and implement standard operating protocols and checklist for standardization routines;	7
	- Improve training for new staff, with accountability of nurses in the transfer of routines;	3
	- Develop manual on patient safety;	1
	- Correct bad practice in service, preventing its adoption by newly hired professionals.	1
Personal	- Expand the amount of professionals;	7	15 (12.10%)
	- Reduce weekly work hours;	2
	- Avoid duty shifts shorter than 6 hours and greater than 12 uninterrupted hours;	2
	- Reduce the turnover of professionals;	1
	- Improve the rate of pay of professionals;	1
	- Promote equality of rights and duties between the professionals;	1
	- Create regulations that govern the behavior of professionals in the workplace.	1
Opening for communications	- Intensify the communication/dialogue between the team;	4	10 (8.06%)
	- Conduct regular meetings with the entire team;	3
	- Promote interdisciplinary discussions of clinical cases;	2
	- Conduct discussions regarding the AE on risk situations for patient safety.	1
Teamwork in the unit	- Commit to the team, cooperate, take responsibility and respect among professionals;	4	09 (7.26%)
	- Improve the hierarchical relationships internally in nursing;	2
	- Promote good communication between professionals and harmony in the workplace;	2
	- Assegurar, através da supervisão a implementação dos cuidados prescritos pelo enfermeiro.	1
Expectations and actions to promote patient safety supervisor/manager	- Expand the supervision of nurses and nursing leadership to technical team;	2	07 (5.65%)
	- Value the professionals who care about patient safety;	2
	- Being able to take the supervisor post;	1
	- Review the guidelines as to the rules and routines to other professionals;	1
	- Support the implementation of measures related to patient safety.	1
Feedback and communication	- Report adverse events;	1	02 (1.61%)
Feedback and communication	- Perform feedback of occurrences.	1	02 (1.61%)
Non-punitive responses to errors	- Do not punish the professionals due to the reporting of adverse events.	2	02 (1.61%)

Dimensions	Recommendations	Mentions	Total of mentions - (%)
Support of hospital management for patient safety	- Improve working conditions, providing permanent and consumption material with appropriate quality and in sufficient quantity;	10	28 (22.58%)
	- Provide hospital beds to ensure patient safety;	8
	- Exchange of infusion pumps used for better quality and security model for patients;	3
	- Promote regular maintenance of equipment;	1
	- Acquire more secure transport brand;	1
	- Create multidisciplinary Commission of patient safety in ICU;	1
	- Extend the distance between the beds in the unit;	1
	- Facilitate the handling and preparation of medications directly into the patient's bathroom;	1
	- Permanently train the professionals who occupy positions of leadership, direction and management;	1
	- Approach the hospital direction to the ICU, in order to become familiar with the problems of the unit.	1
Internal transfers and shift changes	- Perform a quality shift on call;	3	06 (4.83%)
	- Provide safe care in transferring patients between sectors;	2
	- Perform the shift change of nursing technicians on call together with the nurses.	1
Teamwork between units	- No recommendations	--	0

Dimensions	Recommendations	Mentions	Total of mentions - (%)
General perception of patient safety	- Pay attention to the five certainties in medication administration, noting the time, dilution and infusion time of these;	2	14 (11.29%)
	- Performing safe procedures to the patient;	1
	- Have focused primarily on the patient and not the server;	1
	- Take safety measures based on evidence and with the support of management;	1
	- Educate professionals concerning patient exposure to contamination;	1
	- Take care of hygiene and cleaning the environment, with special attention to the patient's bathroom;	1
	- Keep care as the exchange of gloves and cleaning of hands on withdrawal of urine, to each patient;	1
	- Perform changing decubitus at the indicated times;	1
	- Perform tracheal suctioning the patient whenever necessary;	1
	- Standardize the obligation to keep the grids of high beds;	1
	- Establish Protocol for weaning patients from mechanical ventilation;	1
	- Establish hygiene criteria of multiple trauma patients and/or intracranial hypertension;	1
	- Reduce the flow of visitors in the hospital.	1
Frequency of reported events	- Elaborate printed communication of adverse events: clear, specific and easy to fill;	3	06 (4.84%)
	- Stimulate and guide multidisciplinary team for reporting adverse events;	2
	- Notify all adverse events that occurred in the ICU.	1

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[1] Corresponding author: Ana Paula Minuzzi. E-mail: annaminuzzi@yahoo.com.br