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Dotações de enfermagem : impacto na segurança dos cuidados de saúde
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| 4.33 MB | Adobe PDF |
Advisor(s)
Abstract(s)
Introdução – Sabemos que um sistema complexo e dinâmico, como o contexto hospitalar, favorece o risco de ocorrência de eventos adversos. Questionando a segurança dos cuidados que são prestados, abordamos assim um dos principais valores e um domínio central das ciências da enfermagem, a segurança, com vista a contribuir para a sensibilização dos gestores e decisores políticos para as questões relacionadas com as dotações inadequadas das equipas de enfermagem e o seu reflexo na ocorrência de eventos adversos nos doentes. Objetivos - Descrever a dotação de enfermeiros nos serviços de medicina, cirurgia e ortopedia dos hospitais com SCD/E implementado; Identificar o défice de horas de cuidados prestados nos serviços de medicina, cirurgia e ortopedia dos hospitais com SCD/E implementado; Conhecer a associação entre o défice de horas de cuidados de enfermagem e a ocorrência de eventos adversos (complicações respiratórias, de UPP, de ITU, a demora média de internamento e a mortalidade) nos serviços de medicina, cirurgia e ortopedia dos hospitais com SCD/E implementado. Metodologia – O estudo assenta no paradigma quantitativo, exploratório, de uma amostra com 70.241 casos recolhidos nas bases de dados do Sistema de Classificação de Doentes em Enfermagem e Grupos de Diagnósticos Homogéneos, entre 1 de janeiro de 2011 e 31 de dezembro de 2013. No tratamento dos dados foi efetuada análise uni e bivariada dos dados com recurso a medidas de risco, com um intervalo de confiança de 95% e a modelos de regressão logística. Resultados – A amostra foi constituída na sua maioria por mulheres (52,8%), com média etária de 66 anos, internados nas unidades de cirurgia (40,2%), medicina (41,3%) e ortopedia (18,5%). A maioria estava em hospitais da região de saúde de Lisboa e Vale do Tejo (33,8%) e 63,4% em hospitais de nível II, e 71,9% dos doentes tiveram uma admissão urgente. Cerca de metade (50,8%) apresentaram um Indice de Comorbilidades de Charlson superior a 2. A matriz de distribuição dos efetivos da equipa de enfermagem é efetuada numa proporção média de 50% no turno da manhã, 30% no turno da tarde e 20% no turno da noite, independentemente do número de Horas de Cuidados Necessários identificadas. Existe um défice diário superior a duas horas de cuidados por doente e por dia de internamento, atingindo uma média superior a cinquenta horas negativas. Ficou demonstrada a existência de uma associação estatisticamente significativa entre o défice de horas de cuidados e a ocorrência de eventos adversos, sendo esta manifestamente mais elevada sempre que os doentes foram expostos a maior défice de horas de cuidados. Conclusões – Verificámos que o risco de ocorrência de eventos adversos é 2,9 vezes superior quando os doentes são expostos a dotações inadequadas, sendo de 2,4 vezes superior na ocorrência de complicações respiratórias, 3,5 vezes superior na ocorrência de infeções do trato urinário infeções do trato urinário e 3,7 vezes superior na ocorrência de úlceras por pressão e 1,2 vezes no aumento da demora média. Os resultados obtidos mostram uma associação estatisticamente significativa, entre o défice de horas de cuidados e a mortalidade, sendo que os doentes expostos a dotações inadequadas apresentam um risco de mortalidade 2,2 vezes mais elevado que os doentes expostos a dotações adequadas. Concluimos que é essencial a redefinição de estratégias que permitam a melhoria da organização e a adequação dos recursos humanos de enfermagem às necessidades indentificadas nos doentes.
Introduction – We know that a complex and dynamic system, such as the hospital context, favors the risk of adverse events. Questioning the safety of the care provided, we approach one of the core values and a central domain of nursing sciences, the safety, in order to contribute to raising awareness among managers and policy makers of issues related to inadequate staffing of nursing teams and its reflection on the occurrence of patients adverse events. Objectives – To determine if there is an association, and the strength of this association, between exposure to a nursing care deficit hours and the occurrence of an adverse event, increase in the mean delay in hospitalization and hospital mortality. Methodology – The study been based on the quantitative, exploratory paradigm of a sample with 70,241 cases collected in tthe databases of the System for Classification of Patients in Illness and Homogeneous Diagnostic Groups, between January 1, 2011 and December 31, 2013. The data been treated using a univariate and bivariate analysis and it was performed using risk measures, with a confidence interval of 95% logistic regression models. Results – The sample consisted mostly of women (52.8%), with a mean age of 66 years, hospitalized in the surgical (40.2%), medical (41.3%) and orthopedic units (18.5%). Most of them in Lisboa e Vale do Tejo Health Region hospitals (33.8%), and 63.4% was admitted to level II hospitals, and 71.9% of patients received urgent admission. About half (50.8%) have a Charlson Comorbidity Index greater than 2. The distribution matrix of the nursing staff was performed in an average proportion of 50% in the morning shift, 30% in the afternoon shift, and 20% % on night shift, regardless of the number of Nursing hours per Patient and day identified. There is a daily deficit greater than two hours of care per patient per day of hospitalization, reaching an average of more than fifty negative hours. The existence of a statistically significant association between the hours of care deficit and the occurrence of adverse events was showed to be significantly higher when patients was exposed to a greater deficit of hours of care Conclusions - We conclude that the risk of occurrence of adverse events is 2 times more when patients was exposed to inadequate staffing, being 2.4 times higher in the occurrence of respiratory complications, 3.5 times higher in the occurrence of Urinary tract and 3.7 times higher in the occurrence of pressure ulcers and in the increase in mean delay. The results obtained show a statistically significant association between hours of care and mortality, and patients exposed to inadequate staffing present a mortality risk 2.2 times higher than patients exposed to adequate staffing. We conclude that it is essential to redefine strategies that allow the improvement of the organization and the adequacy of nursing human resources to the needs identified in the patients.
Introduction – We know that a complex and dynamic system, such as the hospital context, favors the risk of adverse events. Questioning the safety of the care provided, we approach one of the core values and a central domain of nursing sciences, the safety, in order to contribute to raising awareness among managers and policy makers of issues related to inadequate staffing of nursing teams and its reflection on the occurrence of patients adverse events. Objectives – To determine if there is an association, and the strength of this association, between exposure to a nursing care deficit hours and the occurrence of an adverse event, increase in the mean delay in hospitalization and hospital mortality. Methodology – The study been based on the quantitative, exploratory paradigm of a sample with 70,241 cases collected in tthe databases of the System for Classification of Patients in Illness and Homogeneous Diagnostic Groups, between January 1, 2011 and December 31, 2013. The data been treated using a univariate and bivariate analysis and it was performed using risk measures, with a confidence interval of 95% logistic regression models. Results – The sample consisted mostly of women (52.8%), with a mean age of 66 years, hospitalized in the surgical (40.2%), medical (41.3%) and orthopedic units (18.5%). Most of them in Lisboa e Vale do Tejo Health Region hospitals (33.8%), and 63.4% was admitted to level II hospitals, and 71.9% of patients received urgent admission. About half (50.8%) have a Charlson Comorbidity Index greater than 2. The distribution matrix of the nursing staff was performed in an average proportion of 50% in the morning shift, 30% in the afternoon shift, and 20% % on night shift, regardless of the number of Nursing hours per Patient and day identified. There is a daily deficit greater than two hours of care per patient per day of hospitalization, reaching an average of more than fifty negative hours. The existence of a statistically significant association between the hours of care deficit and the occurrence of adverse events was showed to be significantly higher when patients was exposed to a greater deficit of hours of care Conclusions - We conclude that the risk of occurrence of adverse events is 2 times more when patients was exposed to inadequate staffing, being 2.4 times higher in the occurrence of respiratory complications, 3.5 times higher in the occurrence of Urinary tract and 3.7 times higher in the occurrence of pressure ulcers and in the increase in mean delay. The results obtained show a statistically significant association between hours of care and mortality, and patients exposed to inadequate staffing present a mortality risk 2.2 times higher than patients exposed to adequate staffing. We conclude that it is essential to redefine strategies that allow the improvement of the organization and the adequacy of nursing human resources to the needs identified in the patients.
Description
Keywords
Eventos adversos Dotações Rácios enfermeiro-doente Segurança Cuidados de enfermagem Adverse events Staffing Client-staff ratio Health safety Nursing care