Elaboración de un instrumento para evaluarlatransición segura del paciente al alta hospitalaria

Acosta, Aline Marques; Lima, Maria Alice Dias da Silva; Marques, Giselda Quintana; Zucatti, Paula Buchs; Silveira, Cristhiane de Souza; Oelke, Nelly Donszelmann

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Revista Gaúcha de Enfermagem

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Sumário

Original Article - Knowledge translation and advances in health and nursing practices • Rev. Gaúcha Enferm. 43 (spe) • 2022 • https://doi.org/10.1590/1983-1447.2022.20220222.en copiar

Elaboración de un instrumento para evaluarlatransición segura del paciente al alta hospitalaria

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Construir y validar el contenido de un instrumento de evaluación de la calidad de la transición de la atención y la seguridad del paciente en alta hospitalaria desde la perspectiva de los enfermeros.

Métodos:

Estudio metodológico, desarrollado en el sur de Brasil entre abril de 2019 y enero de 2022, en tres etapas: revisión integradora y entrevistas semiestructuradas con seis enfermeras para construir el instrumento; validación de contenido por un comité de 14 expertos; y pre-test con 20 enfermeras. Se empleó un Índice de Validez del Contenido superior a 0,80.

Resultados:

Instrumento desarrollado con 37 ítems organizados en seis dominios: estructura; planificación del alta; pautas de atención; derivación a la continuidad asistencial; cultura de seguridad, y resultado de la transición asistencial. El Índice de Validez de Conocimiento general fue de 0,93.

Conclusiones:

El instrumento presentó un valor de contenido y contribuyó a la comprensión de la transición del cuidado en el contexto nacional, proponiendo cambios para calificar y fortalecer la seguridad del paciente en el hospital de alta.

Palabras clave:
Alta del paciente; Continuidad de laatención al paciente; Seguridad del paciente; Transferencia de pacientes; Calidad de laatención de salud; Enfermería

Category	Subcategories
Positive elements of patient safety during care transition	Discharge preparation for the patient and the family
	Guidance to the patient and the family at discharge
	Monitoring of the patient after discharge
	Teamwork for better quality of hospital discharge
Negative elements of patient safety during care transition	Not addressing the patients' and family members' socioeconomic conditions
	Ineffective communication between the interprofessional team members
	Difficulty in the integration with the Primary Care services
	Absence of a discharge protocol
Patient safety assessment during and following care transition	Knowledge about the teamwork process for discharge
	Verification of hospital readmission as a quality indicator

Items	Content Validation			Pre-test
Items	Clarity CVI	Representativeness CVI	Assessment	Clarity CVI
Title of the instrument	0.93	NA	Maintained	NA
Format of the instrument	1.0	NA	Maintained	NA
Instructions for the instrument	0.83	NA	Modified	1.0
Structure domain
1 The space and the physical structure favor transitional care	0.71	0.86	Excluded	NA
2 There is a specific program or team to carry out transitional care at hospital discharge	0.93	1.0	Maintained	1.0
3 The specific program or team is available at any time	0.86	1.0	Maintained	1.0
4 Use of an electronic medical chart system shared across services	0.86	0.93	Modified	0.95
5 A specific provider coordinates the team during transitional care	0.93	1.0	Maintained	0.95
6 Staffing is adequate to develop transitional care actions	0.86	1.0	Modified	0.80
Discharge Planning domain
1 An instrument that identifies patients at a higher risk of readmission is used	1.0	1.0	Maintained	0.90
2 Transitional care actions for patients at risk of hospital readmission are prioritized	0.86	0.93	Maintained	0.95
3 Discharge planning is performed in advance	0.93	1.0	Modified	0.95
4 Discussion rounds or moments between the team members are implemented to plan and execute transitional care	0.93	1.0	Modified	0.95
5 The providers are informed about discharge of the patient in advance	1.0	1.0	Maintained	0.95
6 The team considers the patient/caregiver values and preferences when defining the care plan	0.93	1.0	Maintained	0.90
7 Medication reconciliation is performed	0.93	0.93	Modified	0.85
Care Education domain
1. Information is provided about the personal needs and the care measures after discharge	1.0	1.0	Maintained	1.00
2 Information is provided about care with the devices that will continue to be used in the patient's home	1.0	1.0	Maintained	1.00
3 Information is provided about medication use in the patient's home	1.0	1.0	Modified	0.95
4 The warning signs and symptoms that must be observed are explained	1.0	1.0	Maintained	1.00
5 Information is provided about the tests, consultations and/or monitoring to be performed after discharge	1.0	1.0	Maintained	0.95
6 Information is provided regarding which service/provider should be contacted in case of post-discharge health problems	0.78	0.93	Excluded	NA
7 The patient's and/or caregiver's questions are clarified while providing the discharge guidelines	1.0	1.0	Maintained	1.00
8 The patients and caregivers are asked if they understand the discharge guidelines provided	1.0	1.0	Modified	0.95
9 The discharge guidelines are provided in a short period of time on the day the patient is discharged from the hospital	0.86	0.93	Maintained	1.00
10 Educational material with diverse information about the care measures after discharge is handed to the patient/caregiver	1.0	1.0	Maintained	0.95
11 Educational and easy-to-understand material is provided with simple illustrations and language	1.0	1.0	Maintained	0.95
12. A discharge plan, report or letter is provided with the care recommendations, list of medications, tests and consultations to be performed after discharge	1.0	1.0	Maintained	0.95
Referral for Continuity of Care domain
1 Referral to services that provide necessary materials for the patient after hospital discharge is performed	0.93	1.0	Maintained	0.95
2 The Primary Care team attending to the patient is informed about their hospital admission and the home care plan	1.0	1.0	Modified	0.90
3 There are communication problems between this hospital unit and the Primary Care units	0.78	0.78	Excluded	NA
4 After discharge, the patient is contacted to verify adherence to the treatment, clarify questions and/or reinforce diverse information on post-discharge care	1.0	1.0	Maintained	0.90
Safety Culture domain
1 A number of instruments (scripts, checklists, protocols) are used for qualified discharge	1.0	0.93	Maintained	0.95
2 The team knows about the responsibilities and actions to be performed during transitional care	1.0	1.0	Modified	0.90
3 The transitional care processes of this institution are standardized	0.78	0.86	Excluded	NA
4 There is participation in regular meetings or training sessions	0.93	1.0	Modified	0.85
5 The management and leaders of this unit are committed to promoting the best quality in transitional care	0.86	1.0	Maintained	1.00
6 During the discharge process, it is common to miss important information about the care to be provided to the patient	0.86	0.78	Excluded	NA
7 Ways to prevent errors in transitional care are discussed	0.93	1.0	Maintained	0.85
Care Transitions Results domain
1 There are delays in hospital discharge due to avoidable reasons	1.0	0.93	Maintained	0.90
2 Patients and caregivers show that they are prepared to return home	1.0	1.0	Maintained	0.85
3. Some hospital readmissions might be avoided	0.93	1.0	Maintained	1.00
4 Patients seek emergency care after being discharged from this unit	1.0	1.0	Modified	0.95
5 There are errors that affect patient safety at hospital discharge from this unit	0.86	0.86	Maintained	0.90
6 I am satisfied with the quality of transitional care when discharging patients from this unit	1.0	1.0	Maintained	0.85

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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[1] Corresponding author:
Aline Marques Acosta E-mail: aline.acosta@gmail.com