Instrumentos de avaliação de segurança do paciente nos serviços de saúde: uma revisão integrativa / Patient safety assessment instruments in health services: an integrative review

Objectives The aim of the present study was to describe and compare organisational guidance documents related to recognising and responding to clinical deterioration across five health services in Victoria, Australia. Methods Guidance documents were obtained from five health services, comprising 13 acute care hospitals, eight subacute care hospitals and approximately 5500 beds. Analysis was guided by a specific policy analysis framework and a priori themes. Results In all, 22 guidance documents and five graphic observation and response charts were reviewed. Variation was observed in terminology, content and recommendations between the health services. Most health services’ definitions of physiological observations fulfilled national standards in terms of minimum parameters and frequency of assessment. All health services had three-tier rapid response systems (RRS) in place at both acute and subacute care sites, consisting of activation criteria and an expected response. RRS activation criteria varied between sites, with all sites requiring modifications to RRS activation criteria to be made by medical staff. All sites had processes for patient and family escalation of care. Conclusions Current guidance documents related to the frequency of observations and escalation of care omit the vital role of nurses in these processes. Inconsistencies between health services may lead to confusion in a mobile workforce and may reduce system dependability. What is known about the topic? Recognising and responding to clinical deterioration is a major patient safety priority. To comply with national standards, health services must have systems in place for recognising and responding to clinical deterioration. What does this paper add? There is some variability in terminology, definitions and specifications of physiological observations and medical emergency team (MET) activation criteria between health services. Although nurses are largely responsible for physiological observations and escalation of care, they have little authority to direct frequency of observations and triggers for care escalation or tailor assessment to individual patient needs. Failure to identify nurses’ role in policy is concerning and contrary to the evidence regarding nurses and MET activations in practice. What are the implications for practitioners? Inconsistencies in recommendations regarding physiological observations and escalation of care criteria may create patient safety issues when students and staff work across organisations or move from one organisation to another. The validity of other parameters, such as appearance, pain, skin colour and cognition, warrant further consideration as early indicators of deterioration that may be used by nurses to identify clinical deterioration earlier. A better understanding of the relationship between the sensitivity, specificity and frequency of monitoring of particular physiological observations and patient outcomes is needed to improve the predictive validity for identification of clinical deterioration.

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Patients’ experiences of eHealth in palliative care: an integrative review.

10.21203/rs.3.rs-37535/v1 ◽

2020 ◽

Author(s):

Cecilia Widberg ◽

Birgitta Wiklund ◽

Anna Klarare

Keyword(s):

Palliative Care ◽

Patient Safety ◽

Information And Communication Technology ◽

Communication Technology ◽

Integrative Review ◽

World Population ◽

Use Of Resources ◽

Individualized Care ◽

Information And Communication ◽

Health Applications

Abstract Background: With a growing world population, a longer life expectancy, and more deaths due to chronic diseases, the need for palliative care is increasing. E-Health involves the use of information and communication technology to provide care, and also to transmit health information through the Internet and related technologies. E-Health can be an effective way of supporting communication between patient and healthcare providers, but it is unclear to how patients regard information and communication technology (ICT) within palliative careMethods: The aim of this study was to describe patients’ experiences of eHealth in palliative care. An integrative review with a systematic literature search of six databases: Cinahl Complete; MEDLINE with Full Text; PubMed; Psychology and Behavioral Sciences Collection; Nursing and Allied Health; and PsycINFO generated 12 scientific articles. The articles were evaluated, data extracted, analyzed and synthesized, according to the aim.Results: The results are presented in the main theme: E-health applications – promoting communication on patients’ and families’ terms, and three sub- themes: usability and feasibility of eHealth applications; symptom control and individualized care promoted through eHealth applications; and use of eHealth applications increased sense of security and patient safety. Patients described ease of use, usability and feasibility of eHealth applications. Equal and individualized care, security, better symptom management, participation through increased accessibility and increased patient safety were described.Conclusions: E-Health applications promoted equal, individualized care, and may be a tool to promote accessibility and patient participation in palliative care settings. Furthermore, care transparency increased with eHealth communication when patients and families received more information, and experiences were that patient safety and feelings of security also were promoted. At organizational and societal levels, eHealth may contribute to sustainable development and more efficient use of resources in palliative care.

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Patient Safety Assessment at Primary Health Care Centers in Cairo, Egypt

Journal of Family Medicine and Health Care ◽

10.11648/j.jfmhc.20160204.26 ◽

2016 ◽

Vol 2 (4) ◽

pp. 132

Author(s):

Alaa Abdelwahed Shams-Eldin

Keyword(s):

Health Care ◽

Patient Safety ◽

Primary Health Care ◽

Safety Assessment ◽

Primary Health ◽

Primary Health Care Centers ◽

Health Care Centers

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Nursing performance in robotic surgeries: integrative review

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2018-0426 ◽

2019 ◽

Vol 72 (3) ◽

pp. 795-800

Author(s):

Raísha Costa Martins ◽

Denilse Damasceno Trevilato ◽

Marielli Trevisan Jost ◽

Rita Catalina Aquino Caregnato

Keyword(s):

Patient Safety ◽

Perioperative Period ◽

The United States ◽

National Institutes Of Health ◽

Integrative Review ◽

Specific Knowledge ◽

Electronic Library ◽

Role Of Nursing ◽

Robotic Surgeries

ABSTRACT Objective: To know the scientific production on the performance of the nursing staff in robotic surgeries, identifying the role of the nurse in the three perioperative periods. Methods: Integrative review, search in the databases National Library of Medicine, National Institutes of Health, Scientific Electronic Library Online and Biblioteca Virtual em Saúde, performed from June to September, 2017; 17 selected articles met the inclusion criteria. Results: Most articles were published in foreign journals in English, nine in the United States, classified with evidence level of 4 and 5. The role of nursing in the perioperative period was identified, related mainly to patient safety. The most mentioned perioperative period in the articles was the intraoperative, with greater concern in the positioning of the patient. Conclusion: The nursing performance and patient safety in robotic surgeries are similar to the ones in major surgeries, requiring from the patient a specific knowledge on the setting and preparation of the robot.

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An integrative review of patient safety in studies on the care and safety of patients with communication disabilities in hospital

Patient Education and Counseling ◽

10.1016/j.pec.2015.10.022 ◽

2016 ◽

Vol 99 (4) ◽

pp. 501-511 ◽

Cited By ~ 13

Author(s):

Bronwyn Hemsley ◽

Andrew Georgiou ◽

Sophie Hill ◽

Megan Rollo ◽

Joanne Steel ◽

...

Keyword(s):

Patient Safety ◽

Integrative Review ◽

Communication Disabilities

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Validity, reliability and accuracy of oscillometric devices, compared with Doppler ultrasound, for determination of the Ankle Brachial Index: an integrative review

Jornal Vascular Brasileiro ◽

10.1590/jvb.2014.006 ◽

2014 ◽

Vol 13 (1) ◽

pp. 27-33

Author(s):

Rita de Cassia Gengo e Silva ◽

Vanessa Ferreira Amorim de Melo ◽

Maria Aparecida de Medeiros Lima

Keyword(s):

Health Services ◽

Literature Review ◽

Doppler Ultrasound ◽

Conventional Method ◽

Ankle Brachial Index ◽

Integrative Review ◽

Predictive Values ◽

Methodological Procedures ◽

Sensitivity Specificity

INTRODUCTION: The conventional method for measuring the ankle-brachial index (ABI) requires a vascular Doppler machine and a trained professional, which is a barrier to the examination becoming more widely adopted across health services. For this reason, the possibility of substituting Doppler monitors for other types of device has been investigated. The objective of this study was to assess the validity, reliability and accuracy of taking ABI measurement using oscillometric devices and compare them to vascular Doppler.METHODS: This is an integrative literature review of four articles.RESULTS: There was very little uniformity between the four studies in terms of ample populations or the methodological procedures used to measure systolic pressures. The results for sensitivity, specificity and positive and negative predictive values varied and so did measures of reliability.CONCLUSIONS: The results of these studies do not provide a basis from which conclusions can be drawn on the validity, reliability or accuracy of employing oscillometric devices as a substitute for Doppler for determination of ABI.

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Methodologies Used in Nursing Research Designed to Improve Patient Safety

Annual Review of Nursing Research ◽

10.1891/0739-6686.24.1.273 ◽

2006 ◽

Vol 24 (1) ◽

pp. 273-292 ◽

Cited By ~ 3

Author(s):

Elizabeth Merwin ◽

Deirdre Thornlow

Keyword(s):

Patient Safety ◽

Health Services Research ◽

Health Services ◽

Doctoral Programs ◽

Survey Design ◽

Improve Patient Safety ◽

Secondary Data ◽

Nursing Research ◽

Services Research ◽

Methodological Challenges

Nursing research studies of patient safety for 2002-2005 were reviewed to determine methods used and methodological challenges within this field of research. Methods used in traditional clinical research and in health services research were often combined or adapted in innovative research designs to advance knowledge regarding nursing care and patient safety outcomes. This relatively new focus of complex research posed methodological challenges in areas such as measurement and the availability and analysis of data. The most frequent methods used included survey research, analysis of secondary data, and observational studies. This review points to the need to increase the incorporation of complex methodological training, including health services research, the analysis of secondary data and complex survey design in our doctoral programs, and to provide opportunities for researchers to gain further methodological training. Increased use of multi-site and multi-level studies is also needed.

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Safety Assessment of a Noninvasive Respiratory Protocol for Adults with COVID-19

Journal of Hospital Medicine ◽

10.12788/jhm.3548 ◽

2020 ◽

Vol 15 (12) ◽

pp. 734-738

Author(s):

William E Soares III ◽

Elizabeth M Schoenfeld ◽

Paul Visintainer ◽

Tala Elia ◽

Venkatrao Medarametla ◽

...

Keyword(s):

Patient Safety ◽

Respiratory Distress ◽

Healthcare System ◽

Safety Assessment ◽

Chart Review ◽

Retrospective Chart Review ◽

High Flow ◽

Adult Patients ◽

Do Not Resuscitate ◽

High Flow Nasal Cannula

As evidence emerged supporting noninvasive strategies for coronavirus disease 2019 (COVID-19)–related respiratory distress, we implemented a noninvasive COVID-19 respiratory protocol (NCRP) that encouraged high-flow nasal cannula (HFNC) and self-proning across our healthcare system. To assess safety, we conducted a retrospective chart review evaluating mortality and other patient safety outcomes after implementation of the NCRP protocol (April 3, 2020, to April 15, 2020) for adult patients hospitalized with COVID-19, compared with preimplementation outcomes (March 15, 2020, to April 2, 2020). During the study, there were 469 COVID-19 admissions. Fewer patients underwent intubation after implementation (10.7% [23 of 215]), compared with before implementation (25.2% [64 of 254]) (P < .01). Overall, 26.2% of patients died (24% before implementation vs 28.8% after implementation; P = .14). In patients without a do not resuscitate/do not intubate order prior to admission, mortality was 21.8% before implementation vs 21.9% after implementation. Overall, we found no significant increase in mortality following implementation of a noninvasive respiratory protocol that decreased intubations in patients with COVID-19.

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Quality junior doctor training, improved workforce outcomes and patient safety

Australian Health Review ◽

10.1071/ah07s106 ◽

2007 ◽

Vol 31 (5) ◽

pp. 106 ◽

Cited By ~ 3

Author(s):

Louis I Landau

Keyword(s):

Medical Education ◽

Patient Safety ◽

Health Service ◽

Health Services ◽

Junior Doctor ◽

Service Needs ◽

Critical Part

The intern year is a critical part of medical education and pivotal in provision of health services, especially in tertiary facilities. Training must be integrated with health service needs, as our health service is not well served if junior doctor training creates confidence without competence.

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