O enfermeiro recém-formado na condição de segunda vítima / El enfermero recién graduado en condición de segunda víctima / The newly graduated nurse as a second victim

Resumo Objetivo Descrever a prevalência de enfermeiros recém-formados como segundas vítimas de eventos adversos e conhecer as condições de apoio recebidas nas instituições de saúde. Métodos Estudo transversal, descritivo e de abordagem quantitativa, cuja população foi constituída por enfermeiros recém-formados, que aceitaram responder ao questionário online, com perguntas relacionadas à admissão na instituição, envolvimento em eventos adversos e gerenciamento da condição de segunda vítima, contatados por e-mail, intermediado pelo Conselho Regional de Enfermagem de São Paulo. Foi realizada a análise descritiva dos dados e teste de igualdade de proporções. Resultados A amostra final foi de 138 enfermeiros, 54,3% desconheciam o termo segunda vítima, 44,9% desconheciam a existência de protocolos institucionais para apoio emocional aos profissionais e 26,8% estiveram envolvidos em eventos adversos. Destes, 94,6% apresentaram como desfecho diante do evento o sofrimento emocional, frustração, culpa, tristeza, estresse, incapacidade, constrangimento e insegurança para realizar suas funções no trabalho; 59,5% receberam algum tipo de apoio e 21,6% receberam punição institucional. Conclusão A prevalência de enfermeiros recém-formados envolvidos em eventos adversos foi de 26,8%, e, entre os que vivenciaram esse incidente, a maioria apresentou como desfecho, sentimentos negativos e de insegurança na condução do trabalho. Após o evento, o apoio recebido partiu, na maioria das vezes, de colegas de trabalho e pessoas significativas, e, quanto ao apoio institucional, destaca-se ainda a necessidade de programas para suporte emocional, a fim de que esses profissionais superem quando se encontram na condição de segunda vítima.

Resumen Objetivo Describir la prevalencia de enfermeros recién graduados como segundas víctimas de eventos adversos y conocer las condiciones de apoyo recibidas en las instituciones de salud. Métodos Estudio transversal, descriptivo y de enfoque cuantitativo, cuya población estuvo compuesta por enfermeros recién graduados, que aceptaron responder un cuestionario digital con preguntas relacionadas con la admisión en la institución, la participación en eventos adversos y la gestión de la condición de segunda víctima, contactados por correo electrónico e intermediado por el Consejo Regional de Enfermería de São Paulo. Se realizó el análisis descriptivo de los datos y prueba de igualdad de proporciones. Resultados La muestra final fue de 138 enfermeros. El 54,3 % desconocía el término segunda víctima, el 44,9 % desconocía la existencia de protocolos institucionales para apoyo emocional a profesionales y el 26,8 % estuvo involucrado en eventos adversos. De estos, el 94,6 % presentó, como consecuencia del evento, sufrimiento emocional, frustración, culpa, tristeza, estrés, incapacidad, vergüenza e inseguridad para realizar sus funciones en el trabajo; el 59,5 % recibió algún tipo de apoyo, y el 21,6 % recibió sanción institucional. Conclusión La prevalencia de enfermeros recién graduados involucrados en eventos adversos fue del 26,8 % y, de los que pasaron por estos incidentes, la mayoría presentó, como consecuencia, sentimientos negativos y de inseguridad en la conducción de su trabajo. Después del evento, el apoyo recibido, la mayoría de las veces, surgió de compañeros de trabajo y personas importantes. Respecto al apoyo institucional, también se observa la necesidad de programas para apoyo emocional para que estos profesionales se sobrepongan cuando se encuentren en condición de segunda víctima.

Abstract Objective To describe the prevalence of newly graduated nurses as second victims of adverse events and to know the conditions of support received in health institutions. Methods Cross-sectional, descriptive, quantitative study. The population consisted of newly graduated nurses who agreed to answer the online questionnaire with questions related to being hired at the institution, involvement in adverse events and management of the second victim condition. Contacted was by email, intermediated by the Regional Nursing Council of São Paulo. Descriptive data analysis and the test of equality of proportions were performed. Results The final sample consisted of 138 nurses, 54.3% were unaware of the term 'second victim', 44.9% were unaware of the existence of institutional protocols for emotional support to professionals and 26.8% were involved in adverse events. Of these, 94.6% presented emotional distress, frustration, guilt, sadness, stress, inability, embarrassment and insecurity to perform their duties at work as an outcome of the event; 59.5% received some type of support and 21.6% received institutional punishment. Conclusion The prevalence of newly graduated nurses involved in adverse events was 26.8%, and among those who experienced this incident, the majority presented negative feelings and insecurity in performing their work as an outcome. After the event, most of the time, the support received came from work colleagues and significant others. Regarding institutional support, the need for programs for emotional support is also highlighted, so that these professionals can overcome when finding themselves in the place of the second victim.

Elementos clave en la implantación de sistemas de notificación de eventos adversos hospitalarios en América Latina / Key elements in implementing adverse event notification systems in Latin American hospitals

OBJETIVO: Elaborar recomendaciones para diseñar e implantar sistemas de notificación (SN) de eventos adversos en base a las experiencias de los países latinoamericanos. MÉTODOS: Mediante la metodología cualitativa Metaplán se recogieron propuestas a partir de la experiencia de 17 expertos nacionales en SN (de Argentina, Brasil, Chile, Colombia, Cuba, México y Perú) y 3 expertos de la Organización Panamericana de la Salud. Se analizaron las características, el alcance, las barreras y las limitaciones, el método de registro de datos, el tipo de análisis y el retorno de la información relacionada con los SN, y se discutió cómo involucrar a los profesionales en este proceso. Mediante el análisis de las respuestas y el discurso y la ponderación colectiva se priorizaron las propuestas. RESULTADOS: Se recogieron 73 recomendaciones sobre las características que deben poseer los SN y 90 sobre las barreras y limitaciones. Existió acuerdo en que la seguridad jurídica de los profesionales, la cultura de seguridad del establecimiento de salud, los incentivos, un sistema ágil para proporcionar resultados a los profesionales y una taxonomía unificada son temas clave para implantar con éxito un SN. Los SN deben dirigirse a generar mecanismos de seguridad para mejorar la atención sanitaria. CONCLUSIONES: Los SN deben ajustarse a las necesidades de cada centro. La oportunidad para aprender de la propia experiencia es la razón de ser de los SN. La confidencialidad, el anonimato, la voluntariedad, la taxonomía unificada y la seguridad jurídica de los profesionales son elementos cruciales de los SN.

OBJECTIVE: To develop recommendations for the design and implementation of adverse event notification systems based on the experiences of the Latin American countries. METHODS: Employing the qualitative Metaplán methodology, proposals were obtained from 17 experts on adverse event notification systems from Argentina, Brazil, Chile, Colombia, Cuba, Mexico, and Peru and three from the Pan American Health Organization. The characteristics, scope, barriers and constraints, data entry method, type of analysis, and information feedback on adverse event notification systems were reviewed and how to involve professionals in this process was discussed. The proposals were prioritized through an analysis of the responses, debate, and collective deliberation. RESULTS: A total of 73 recommendations were obtained on the characteristics that adverse event notification systems should have and 90 on barriers and constraints. There was agreement that legal security for professionals, a culture of safety in health facilities, incentives, a nimble system for providing professionals with results, and a single taxonomy are key to the successful implementation of adverse event notification systems, which must endeavor to protect patient safety in order to improve health care. CONCLUSIONS: Adverse event notification systems must be tailored to the needs of each health center. They exist to enable the health system to learn from experience. Confidentiality, anonymity, voluntary participation, a single taxonomy, and legal security for professionals are critical elements of adverse event notification systems.

Elementos clave en la implantación de sistemas de notificación de eventos adversos hospitalarios en América Latina / Key elements in implementing adverse event notification systems in Latin American hospitals

Objetivo. Elaborar recomendaciones para diseñar e implantar sistemas de notificación (SN) de eventos adversos en base a las experiencias de los países latinoamericanos. Métodos. Mediante la metodología cualitativa Meta-plán se recogieron propuestas a partir de la experiencia de 17 expertos nacionales en SN (de Argentina, Brasil, Chile, Colombia, Cuba, México y Perú) y 3 expertos de la Organización Panamericana de la Salud. Se analizaron las características, el alcance, las barreras y las limitaciones, el método de registro de datos, el tipo de análisis y el retorno de la información relacionada con los SN, y se discutió cómo involucrar a los profesionales en este proceso. Mediante el análisis de las respuestas y el discurso y la ponderación colectiva se priorizaron las propuestas. Resultados. Se recogieron 73 recomendaciones sobre las características que deben poseer los SN y 90 sobre las barreras y limitaciones. Existió acuerdo en que la seguridad jurídica de los profesionales, la cultura de seguridad del establecimiento de salud, los incentivos, un sistema ágil para proporcionar resultados a los profesionales y una taxonomía unificada son temas clave para implantar con éxito un SN. Los SN deben dirigirse a generar mecanismos de seguridad para mejorar la atención sanitaria. Conclusiones. Los SN deben ajustarse a las necesidades de cada centro. La oportunidad para aprender de la propia experiencia es la razón de ser de los SN. La confidencialidad, el anonimato, la voluntariedad, la taxonomía unificada y la seguridad jurídica de los profesionales son elementos cruciales de los SN.

Objective. To develop recommendations for the design and implementation of adverse event notification systems based on the experiences of the Latin American countries. Methods. Employing the qualitative Metaplán methodology, proposals were obtained from 17 experts on adverse event notification systems from Argentina, Brazil, Chile, Colombia, Cuba, Mexico, and Peru and three from the Pan American Health Organization. The characteristics, scope, barriers and constraints, data entry method, type of analysis, and information feedback on adverse event notification systems were reviewed and how to involve professionals in this process was discussed. The proposals were prioritized through an analysis of the responses, debate, and collective deliberation. Results. A total of 73 recommendations were obtained on the characteristics that adverse event notification systems should have and 90 on barriers and constraints. There was agreement that legal security for professionals, a culture of safety in health facilities, incentives, a nimble system for providing professionals with results, and a single taxonomy are key to the successful implementation of adverse event notification systems, which must endeavor to protect patient safety in order to improve health care. Conclusions. Adverse event notification systems must be tailored to the needs of each health center. They exist to enable the health system to learn from experience Confidentiality, anonymity, voluntary participation, a single taxonomy, and legal security for professionals are critical elements of adverse event notification systems.

Frecuencia de errores de los pacientes con su medicación / Frequency of medication errors by patients

OBJETIVO: Analizar la frecuencia de errores de medicación que son cometidos e informados por los pacientes. MÉTODOS: Estudio descriptivo basado en encuestas telefónicas a una muestra aleatoria de pacientes adultos del nivel primario de salud del sistema público español. Respondieron un total de 1 247 pacientes (tasa de respuesta, 75 por ciento). El 63 por ciento eran mujeres y 29 por ciento eran mayores de 70 años. RESULTADOS: Mientras 37 pacientes (3 por ciento, IC 95 por ciento: 2-4) sufrieron complicaciones asociadas a la medicación en el curso del tratamiento, 241 (19,4 por ciento, IC 95 por ciento: 17-21) informaron haber cometido algún error con la medicación. Un menor tiempo de consulta (P < 0,01) y una peor valoración de la información proporcionada por el médico (P < 0,01) se asociaron al hecho de que en la dispensación en la farmacia le indicaran al paciente que el tratamiento prescrito no era apropiado. CONCLUSIONES: A los riesgos conocidos de sufrir un evento adverso, fruto de la intervención sanitaria por error del sistema o del profesional, hay que sumar los asociados a los errores de los pacientes en la autoadministración de la medicación. Los pacientes insatisfechos con la información proporcionada por el médico informaron un mayor número de errores.

OBJECTIVE: Analyze the frequency of medication errors committed and reported by patients. METHODS: Descriptive study based on a telephone survey of a random sample of adult patients from the primary care level of the Spanish public health care system. A total of 1 247 patients responded (75 percent response rate); 63 percent were women and 29 percent were older than 70 years. RESULTS: While 37 patients (3 percent, 95 percent CI: 2-4) experienced complications associated with medication in the course of treatment, 241 (19.4 percent, 95 percent CI: 17-21) reported having made some mistake with their medication. A shorter consultation time (P < 0.01) and a worse assessment of the information provided by the physician (P < 0.01) were associated with the fact that during pharmacy dispensing the patient was told that the prescribed treatment was not appropriate. CONCLUSIONS: In addition to the known risks of an adverse event due to a health intervention resulting from a system or practitioner error, there are risks associated with patient errors in the self-administration of medication. Patients who were unsatisfied with the information provided by the physician reported a greater number of errors.

El punto de vista de los pacientes sobre la seguridad clínica de los hospitales: Validación del Cuestionario de Percepción de Seguridad / Hospital clinical safety from the patient's point of view: Validation of a safety perception questionnaire

Background: Approximately 10 percent of hospitalized patients suffer an adverse event during their hospital stay. An important proportion of subjects also feel that they have a high risk of suffering such an event during an eventual hospitalization. Aim: To determine the perception on clinical safety among patients discharged from a hospital. Material and methods: A questionnaire about hospital safety was mailed to 1300 patients discharged from a hospital. The questionnaire was analyzed using construct validity predictive validity and Cronbach Alpha for internal consistency Results: The questionnaire was answered by 384 patients, yielding a response rate of 29 percent. Of these, 77 incomplete answers were discarded. Thirty-one subjects (10 percent) reported a possible adverse event. In 19 cases (5.8 percent), it was due to medication errors and in 19 (6.1 percent), to surgical procedures. In seven cases (2.3 percent), both errors coincided (2.3 percent). According to the predictive validity of the questionnaire, if a patient reports an adverse event, the confidence in the hospital and in the professionals is reduced (p <0.001), communication with the physician is considered inappropriate (p =0.0001) and risk perception increases (p =0.003). Unsatisfied patients are those that believe that they have higher risks of suffering a medical error (p =0.005). Conclusions: Risk perception for adverse events increases after having suffered such an event. Patient satisfaction minimizes the effects of adverse events on their confidence and attitude.