Implicación de los acompañantes en la seguridad del paciente de unidades pediátricas y neonatales: revisión de alcance

Oliveira, Thayane Gusmão Pires de; Diniz, Catharine Galvão; Carvalho, Marina Peluci Malta; Corrêa, Allana dos Reis; Rocha, Patrícia Kuerten; Manzo, Bruna Figueiredo

doi:10.1590/0034-7167-2021-0504

Brasil

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REVIEW • Rev. Bras. Enferm. 75 (3) • 2022 • https://doi.org/10.1590/0034-7167-2021-0504 linkcopiar

Implicación de los acompañantes en la seguridad del paciente de unidades pediátricas y neonatales: revisión de alcance

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos: describir la evidencia científica sobre la implicación de los acompañantes en la seguridad del paciente, desde la perspectiva del susodicho y de los profesionales sanitarios de las unidades neonatales y pediátricas.

Métodos: es una revisión de alcance realizada entre 2011 y 2021 en ocho bases de datos, según las recomendaciones del Instituto Joanna Briggs y siguiendo la lista de verificación Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Resultados: se incluyeron 13 estudios que demuestran la importancia de la implicación en la seguridad del paciente y en la prevención de eventos adversos. Sin embargo, se han detectado grietas en la comunicación y fragilidad en la formación de los profesionales, lo que dificulta dicha implicación. El fortalecimiento de la educación en salud, las rondas multidisciplinares y las tecnologías educativas se destacaron como estrategias para ampliar el envolvimiento de los acompañantes.

Consideraciones Finales: Este estudio dirige elementos para que profesionales de la salud y gerentes reconsideren el papel de los acompañantes en la seguridad del paciente y desarrollo de estrategias colectivas.

Descriptores: Participacón del Paciente; Família; Seguridad del Paciente; Pediatría; Neonatología

Database (Number of studies)	Search Strategies	Included study
LILACS (22)	(“Patient Safety” OR “Seguridad del Paciente” OR “Segurança do Paciente”) AND (“Medical Chaperones” OR “Chaperones Médicos” OR “Acompanhantes Formais em Exames Físicos” OR “Acompanhante Formal do Paciente” OR “Acompanhante Médico” OR “Acompanhante de Paciente” OR “Acompanhantes Formais de Pacientes” OR “Acompanhantes de Pacientes” OR “Apoio Familiar de Paciente” OR “caregivers” OR “cuidadores” OR “cuidador” OR “Cuidador Familiar” OR “Cuidador de Família” OR “Cuidadores Familiares” OR “Cuidadores de Família” OR “Familiar Cuidador” OR “Familiares Cuidadores” OR “Participação da Família” OR “Participação Familiar” OR “Family Participation” OR “Envolvimento da Família” OR “Envolvimento Familiar” OR “Family Involvement” OR “Engajamento da Família” OR “Engajamento Familiar” OR “Family Engagement” OR “envolvimento” OR “involvement” OR “engajamento” OR “engagement” OR “acompanhante” OR “companion”) AND (“pediatrics” OR “pediatria” OR “pediatria” OR “child” OR “niño” OR “criança” OR “crianças” OR “Paciente Pediátrico” OR “Pediatric Patient”).	1
BDENF (10)	(“Patient Safety” OR “Seguridad del Paciente” OR “Segurança do Paciente”) AND (“Medical Chaperones” OR “ChaperonesMédicos» OR«Acompanhantes Formais em Exames Físicos” OR “Acompanhante Formal do Paciente” OR “Acompanhante Médico” OR “Acompanhante de Paciente” OR “Acompanhantes Formais de Pacientes” OR “Acompanhantes de Pacientes” OR “Apoio Familiar de Paciente” OR “caregivers” OR “cuidadores” OR “cuidador” OR “Cuidador Familiar” OR “Cuidador de Família” OR “Cuidadores Familiares” OR “Cuidadores de Família” OR “Familiar Cuidador” OR “Familiares Cuidadores” OR “Participação da Família” OR “Participação Familiar” OR “Family Participation” OR “Envolvimento da Família” OR “Envolvimento Familiar” OR “Family Involvement” OR “Engajamento da Família” OR “Engajamento Familiar” OR “Family Engagement” OR “envolvimento” OR “involvement” OR “engajamento” OR “engagement” OR “acompanhante” OR “companion”) AND (“pediatrics” OR “pediatria” OR “pediatria” OR “child” OR “niño” OR “criança” OR “crianças” OR “Paciente Pediátrico” OR “Pediatric Patient”).	2
MEDLINE via PubMed (908)	“patient safety AND medical chaperones OR caregivers OR family participation OR family involvement OR family engagement OR involvement OR engagement OR compa]nion AND pediatrics OR child OR pediatric patient ”.	6
COCHRANE (163)	“patient safety AND medical chaperones OR caregivers OR family participation OR family involvement OR family engagement OR involvement OR engagement OR companion AND pediatrics OR child OR pediatric patient”.	0
CINAHL (204)	“patient safety AND medical chaperones OR caregivers OR family participation OR family involvement OR family engagement OR involvement OR engagement OR companion AND pediatrics OR child OR pediatric patient”.	0
SCOPUS (459)	“patient safety AND medical chaperones OR caregivers OR family participation OR family involvement OR family engagement OR companion AND pediatric patient”.	2
WEB OF SCIENCE (15)	“patient safety AND medical chaperones OR caregivers OR family participation OR family involvement OR family engagement OR involvement OR engagement OR companion AND pediatrics OR child OR pediatric patient”.	0
EMBASE (711)	“patient safety AND family OR caregiver AND pediatric patient”.	0
*TOTAL^ * Total of studies found in each database.**		11

Author Title	Year Country	Objective	Study design Sample Scenario	Results	Level of evidence
Biasibetti et al.(²²) “Comunicação para a segurança do paciente em internações pediátricas”	2019 Brazil	To analyze the perception of health professionals and companions/family members regarding the development of communication for patient safety in pediatric hospitalizations.	Type of study: Qualitative. Sample: 44 health professionals and 94 companions. Scenario: Pediatric clinical-surgical inpatient units.	Participants identified problems in the academic training of health professionals, failures in institutional organization, lack of professional commitment and lack of integration between the health team and companions. As for the tools to qualify communication, the participants pointed out strategies such as the organization and compliance with standardized, computerized and bureaucratic processes, as well as the participation of all actors involved in care for the development of improvements related to pediatric patient safety through of effective communication.	6
Corbaly et al.(²³) “Parental involvement in the preoperative surgical safety checklist is welcomed by both parents and staff”	2014 Ireland	To establish how the surgical team and parents accept parental involvement during the Safe Surgery Checklist.	Type of study: Qualitative. Sample: 42 parents and 42 professionals. Scenario: Mother and child hospital.	Parents feel that family participation during the safe surgery checklist should be mandatory. The healthcare team recognized that parental participation is important to promote patient safety.	6
Gonçalves et al.(²⁴) “Estratégia lúdica para promoção do engajamento de pais e acompanhantes na segurança do paciente pediátrico”	2020 Brazil	To evaluate a playful strategy developed to promote the engagement of parents and companions in pediatric patient safety actions.	Type of study: Qualitative. Sample: 17 parents and companions. Scenario: Pediatric inpatient unit.	Participants evaluated the game as a playful, innovative, informative and educational resource regarding the process of family involvement in patient safety. Furthermore, they highlighted the change in behavior in favor of patient safety after experiencing the game.	6
Hoffman et al.(²⁵) “Identificação de incidentes de segurança do paciente pelos acompanhantes de crianças hospitalizadas”	2019 Brazil	Describe the security incidents identified by the companions of hospitalized children.	Type of study: Qualitative. Sample: 40 companions. Scenario: Pediatric Inpatient Units.	The incidents identified by the companions were related to falls, identification, dietary errors, medication errors, hygiene and communication failures.	6
Hoffman et al.(²⁶) “Patient safety incidents reported by relatives of hospitalized children”	2020 Brazil	To know the main safety incidents reported by family members of patients admitted to pediatric units.	Type of study: Qualitative. Sample: 91 family members. Scenario: Intensive care unit Pediatrics and Pediatric Emergency Room.	Family members recognized incidents related to medication administration, communication failures, incorrect hand hygiene, incorrect use of Personal Protective equipment, failures in patient identification and monitoring of visits.	6
Khan et al.(²⁷) “Families as partners in hospital error and adverse event surveillance”	2017 United States	Perform comparison of adverse events records: 1)With the presence and report of the family and without the family; 2)Reported by family and physicians; 3)Reported by the family and rate established by the hospital.	Type of study: Quantitative. Sample: 717 companions and 77 nursing and medical residents. Scenario: Pediatric units.	1)The rates of adverse events reported in the presence of family members were 1.1 times higher than rates without family members. 2) Families and physicians reported similar error rates (10.0 vs 12.8 per 1000 patient-days; and AEs (8.5 vs 6.2 per 1000 patient-days). 3) Family-reported error rates were 5.0 times higher than adverse events rates reported by hospital incident reports.	4
Lydon et al.(²⁸) “Parents’ perspectives on safety in neonatal intensive care: a mixed-methods study”	2014 United States	To examine parents’ perspectives regarding the safety of the patient in the Neonatal Intensive Care Unit.	Type of study: Qualitative and quantitative. Sample: 46 parents responded to the questionnaires and 14 of these parents also participated in 10 interviews. Scenario: Neonatal Intensive Care.	Parents showed little concern about the safety of the procedures. Therefore, participants suggested engagement strategies that address clinical treatment articulated to the domains of physical, developmental and emotional safety, which may result in safety improvements.	6
Massa et al.(²⁹) “Condiciones de seguridad percibidas por cuidadores familiares en atención pediátrica”	2020 Colombia	To identify the perception of caregivers about the safety conditions of care in a pediatric hospital.	Type of study: Quantitative. Sample: 163 caregivers. Scenario: Pediatric Units.	86% of caregivers perceived safety in the child’s hospitalization and, according to them, 60.2% of professionals explained the procedures to caregivers. Communication is clear for 70% of caregivers, 58.3% of them are alert to detect possible risks, 75.5% follow the recommendations given and 70.5% of caregivers trust the professionals.	6
Peres et al.(³⁰) “Percepção de familiares e cuidadores quanto à segurança do paciente em unidades de internação pediátrica”	2018 Brazil	To recognize the perceptions of family members and companions regarding patient safety in a pediatric inpatient unit.	Type of study: Qualitative. Sample: 24 companions. Scenario: Pediatric Inpatient Units.	Several respondents have never heard of patient safety. Family members believe that their main role is to provide emotional support for the child, but they recognize that they can help to prevent mistakes. Adverse events related to medication, procedure and lack of communication are the most worrying of parents.	6
Rodrigues et al.(³¹) “Segurança do paciente em unidade neonatal: preocupações e estratégias vivenciadas por pais”	2018 Brazil	To analyze how parents identify patient safety in a neonatal unit.	Type of study: Qualitative. Sample: 23 family members. Scenario: Neonatal inpatient unit.	The parents spoke about patient safety, mentioning their concerns regarding the flow of people, inefficient communication, problems with patient identification, the risk of infection, the risk of falling and injury due to the use of a medical device, and strategies that could prevent these incidents.	6
Rosenberg et al.(³²) “Provider perspectives on partnering with parents of hospitalized children to improve safety”	2017 United States	To explore the perspectives and experiences of pediatric professionals regarding family participation in pediatric patient safety.	Type of study: Qualitative. Sample: 20 health professionals. Scenario: Pediatric teaching hospital.	Professionals believe that parental involvement should not be mandatory, but that it helps to reduce errors. They presented, as facilitating aspects for patient safety, the clear definition of roles, the gain of trust, sympathy and effective communication. As barriers, they mentioned role conflicts, the lack of skill and time to put parents in safety, in addition to the concern with overloading the family.	6
Silva et al.(³³) “Segurança da criança hospitalizada na UTI: compreendendo os eventos adversos sob a ótica do acompanhante”	2014 Brazil	To describe the adverse events identified by the family member/caregiver in a Pediatric Intensive Care Unit.	Type of study: Qualitative. Sample: 13 companions. Scenario: Pediatric Intensive Care Unit.	The family member/caregiver realized that many of the adverse events were related to a lack of scientific knowledge on the part of the nursing team to safely perform some procedures. Regarding the medical team, there were problems related to communication with family members/caregivers, especially the form and content of the information received.	6
Sousa et al.(³⁴) ‘’A participação da família na segurança do paciente em unidades neonatais na perspectiva do enfermeiro”	2017 Brazil	To understand family participation in patient safety in Neonatal Intensive Care Units from the perspective of nurses.	Type of study: Qualitative. Sample: 14 nurses. Scenario: Intermediate Care and Neonatal Intensive Care Unit.	Nurses recognize the importance of family participation in neonatal patient safety, as well as in the prevention of incidents. However, they highlighted the lack of preparation to deal with the family member in their daily work. They also highlighted that the welcoming and guidance of family members are important strategies for family involvement in patient safety actions.	6

Perception about the involvement of companions in patient safety
Perspective of companions	Perspective of health professionals
Companion as a barrier to the occurrence of adverse events(²³,²⁵,²⁹); Participation of companions contributes to patient safety and should be mandatory(²⁴); Participation of companions does not predispose to increased anxiety(²⁴).	The involvement of companions depends on the professional’s attitude(³³); The involvement of companions should not be mandatory(³³).
Facilitating aspects for the involvement of companions in patient safety
Perspective of companions	Perspective of health professionals
Receive explanations about the rules and procedures offered by the team(³⁰); Having clear communication with the health team(³⁰); Receive information about risks, complications and procedures performed(³⁰); Receive support and attention from the team when identifying risks for adverse events(³⁰); Trust professionals(²⁹-³⁰); Be aware of the responsibility of companions in monitoring the care provided to their children(²⁹,³¹); Enable companions to identify risks and adverse events(²⁶-²⁷,³⁰-³²).	Participation of companions in the safe surgery checklist does not change the procedure time(²⁴); Recognition of the importance of the participation of companions during the safe surgery checklist(²⁴); Family recognition as a barrier to preventing adverse events(²³).
Hindering aspects for the involvement of companions in patient safety
Perspective of companions	Perspective of health professionals
Realize that there are difficulties in reporting patient safety incidents in a form or computerized system(²³); Ineffective communication between all those involved in child care(²³,²⁷,²⁹,³²); Lack of sufficient materials and equipment, as well as the precariousness of the hospital structure(²⁶); Impact of the Neonatal Intensive Care Unit environment on the bonding process between the child and companions(²⁹); Lack of knowledge of how to help prevent health risks(³⁰); Unfamiliarity of the patient/companion’s rights and duties(³⁰); Companions feel excluded from the child’s treatment, diagnosis and prognosis, becoming more anxious and insecure(³⁴); Unfamiliarity about the term patient safety(³¹).	Ineffective communication between everyone involved(²³,³³); Feeling of incapacity on the part of professionals to deal with companions(³³); Absence or distraction of some companions(³³); Concern of professionals with overloading companions(³³).
Strategies for the involvement of companions in patient safety
Perspective of companions	Perspective of health professionals
Games and playful activities that address the subject of patient safety(²⁵); Effective communication between everyone involved in child care(²³,³²); Adoption of practices against adverse events with the participation of companions(²⁶,²⁹,³¹); Professional qualification through continuing education and encouraging research in the area of patient safety(³¹,³⁴).	Exchange of information between professionals through systematic shift change, multidisciplinary rounds, transfer of care between sectors and regular team meetings with the inclusion of companions(²³); Integration of the care team with companions(²³); Practice of double checking information with companions(²³); Creation of training and ongoing education to train the team in the process of including companions in patient care and safety(²³).

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Total of studies found in each database.