ABSTRACT
O objetivo deste estudo é analisar as características sociodemográficas, laboratoriais e farmacológicas de indivíduos que sofreram complicações e eventos adversos durante a hemodiálise. Trata-se de estudo descritivo, transversal e documental. Realizado em uma clínica de terapia renal substitutiva de uma regional de saúde do noroeste do Paraná. A população foi composta de 151 portadores de doença renal crônica em estágio 5 hemodialítico e seus respectivos prontuários, e que faziam tratamento financiado pelo Sistema Único de Saúde. A coleta de dados ocorreu por meio de um questionário semiestruturado nos meses de junho e julho de 2019. A análise dos dados foi por meio de estatística descritiva. Entre os resultados, evidenciou-se que dos 151 participantes, todos tiveram alguma complicação/eventos durante a hemodiálise. Destacaram-se o sexo masculino (61%), idosos (46,4%), residentes no Noroeste do Paraná (46%), trabalhador rural (23%), pardos (46,4%) e renda de até dois salários mínimos (53%). Foram identificados dados de 37 tipos de exames nos prontuários, com predominância (100%) de ureia, hemoglobina e hematócrito. 44 participantes relataram uso regular de medicação, os medicamentos mais utilizados são a eritropoietina humana recombinante (89%), anti-hipertensivos (70%), sacrato de hidróxido férrico (68%) e cloridrato de sevelâmer (n=98; 65%). Conclui-se que as características que contemplaram o estudo permitiu a identificação ampliada de complicações e eventos que comprometem a segurança do paciente. Assim, destaca-se a importância de compreender os fatores de risco e planejar ações para a melhoria do cuidado.
The objective of this study is to analyze the sociodemographic, laboratory and pharmacological characteristics of individuals who suffered complications and adverse events during hemodialysis. This is a descriptive, cross-sectional and documentary study. Performed at a renal replacement therapy clinic in a health district in northwestern Paraná. The population consisted of 151 patients with chronic kidney disease undergoing hemodialysis stage 5 and their respective medical records, who were receiving treatment financed by the Unified Health System. Data collection took place through a semi-structured questionnaire in June and July 2019. Data analysis was through descriptive statistics. Among the results, it was evidenced that of the 151 participants, all had some complication/events during hemodialysis. Males (61%), elderly (46.4%), residents of Northwest Paraná (46%), rural workers (23%), browns (46.4%) and income of up to two minimum wages stood out. (53%). Data from 37 types of tests were identified in the medical records, with a predominance (100%) of urea, hemoglobin and hematocrit. 44 participants reported regular use of medication, the most used drugs are recombinant human erythropoietin (89%), antihypertensives (70%), ferric hydroxide sacrate (68%) and sevelamer hydrochloride (n=98; 65%). It is concluded that the characteristics that contemplated the study allowed the expanded identification of complications and events that compromise patient safety. Thus, the importance of understanding risk factors and planning actions to improve care is highlighted.
El objetivo de este estudio es analizar las características sociodemográficas, de laboratorio y farmacológicas de individuos que sufrieron complicaciones y eventos adversos durante la hemodiálisis. Se trata de un estudio descriptivo, transversal y documental. Realizado en una clínica de terapia de reemplazo renal en un distrito de salud en el noroeste de Paraná. La población estuvo conformada por 151 pacientes con enfermedad renal crónica en hemodiálisis estadio 5 y sus respectivas historias clínicas, quienes recibían tratamiento financiado por el Sistema Único de Salud. La recolección de datos se realizó a través de un cuestionario semiestructurado en junio y julio de 2019. El análisis de datos se realizó mediante estadística descriptiva. Entre los resultados, se evidenció que, de los 151 participantes, todos tuvieron alguna complicación/eventos durante la hemodiálisis. Se destacaron hombres (61%), ancianos (46,4%), residentes en el Noroeste de Paraná (46%), trabajadores rurales (23%), pardos (46,4%) e ingresos de hasta dos salarios mínimos (53%). Se identificaron datos de 37 tipos de pruebas en las historias clínicas, con predominio (100%) de urea, hemoglobina y hematocrito. 44 participantes informaron el uso regular de medicamentos, los medicamentos más utilizados son la eritropoyetina humana recombinante (89%), los antihipertensivos (70%), el sacrato de hidróxido férrico (68%) y el clorhidrato de sevelámero (n=98; 65%). Se concluye que las características que contempló el estudio permitieron la identificación
ABSTRACT
Objective:To analyze the application of path quality inspection combined with "zero defect" service management in nursing quality management of orthopedic ward.Methods:From January 2018 to December 2019,196 patients admitted to the Department of Orthopaedics of Panzhihua Central Hospital, Sichuan Province. Ninety-eight patients from January to December 2018 were as control group, 98 patients from January to September 2019 were as observation group. The control group adopted the routine nursing management mode, while the observation group adopted the path type quality inspection combined with the "zero defect" service management mode. The differences in the incidence of nursing adverse events, quality of life scores and nursing satisfaction were compared between the two groups.Results:The incidence of nursing adverse events during hospitalization in observation group and control group was 6.12% (6/98) and 15.31% (15/98), the difference was statistically significant ( χ 2 value was 4.320, P<0.05). Mental score, sleep score, diet score, mental health score, total score were (94.38±8.36), (93.28±8.33), (95.37±8.43), (91.89±10.48), (377.12±20.08) points in observation group, significantly higher than (85.65±10.74), (81.01±9.48), (87.69±7.97), (85.47±12.02), (331.09±13.39) points in the control group, the difference between the two groups was statistically significant ( t value was 3.118-18.880, P<0.01). The nursing satisfaction of observation group and control group was 92.86% (91/98), 82.65% (81/98), the difference was statistically significant ( χ 2 value was 4.749, P<0.05). Conclusion:The application of path quality inspection combined with "zero defect" service management in the nursing quality management of orthopedic ward is conducive to reducing the incidence of nursing adverse events, improving the quality of life of patients after surgery, and improving patients' satisfaction with nursing services.
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Objective To investigate the effect of the application of nursing quality sensitive indicators on the nursing care of burn patients and their satisfaction with nursing care. Methods A total of 90 cases of burn patients admitted from January 2015 to December 2016 were selected as study subjects. They were divided into pre- implementation group (January 2015- December 2015) and implementation group (January 2016-December 2016) for 45 cases each based on sensitive indicators of care quality. The traditional quality management control method was adopted before implementation. The quality-sensitive indicators of nursing quality were used for quality management after the implementation. The quality monitoring indicators, nursing adverse events, and nursing satisfaction were compared before and after implementation. Results After the implementation, the implementation rate of graded nursing, the accuracy of patient identification, the qualified rate of qualified nurses, the passing rate of risk assessment, and the passing rate of high-risk drugs were 97.78%(44/45), 93.33%(42/45), 95.56%(43/45), 97.78% (44/45), and 97.78% (44/45), which were significantly higher than those before implementation 84.44%(38/45)、77.78%(35/45), 82.22%(37/45), 82.22%(37/45), and 84.44%(38/45), respectively, and the difference was statistically significant (χ2= 4.050-, 6.049, P<0.05). After the implementation, drug errors and other adverse events were used. The incidence rate of 0.22%(1/450)was significantly lower than the pre-implementation rate of 1.78%(8/450), and the difference was statistically significant (χ2=5.499, P<0.05). After implementation, patient satisfaction with service attitude, basic nursing, professional skills, and comprehensive nursing service quality was 95.56%(43/45), 97.78%(44/45), 95.56%(43/45), 97.78%(44/45), and 95.56%(43/45), which were significantly higher than those before implementation 88.89%(40/45), 84.44%(38/45), 82.22%(37/45), 80.00%(36/45)and 82.22% (37/45), and the difference was statistically significant (χ2= 4.050-7.200, P <0.05). Conclusion The application of sensitive indicators of nursing quality can help improve the care quality of burn patients, reduce the occurrence of adverse care events, and enhance patient satisfaction.
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Objective To explore nursing safety management path of patients treat with modified electroconvulsive therapy(MECT) to improve the quality of nursing and reduce the adverse events. Methods According to the theory of Hazard Analysis and Critical Control Point(HACCP)and the SBAR standard communicative model, design and apply nurses handover check list for patients who treat with MECT(the following are referred to as MECT form).The nurses used MECT form to evaluate and manage the risk of patients before and after MECT treatment. This was also help to control the standardization criterion of nursing before and after treatment,meanwhile reduce the risk of treatment.Analyze the data of adverse event before and after applied this MECT form. Results After applied this form for one year,the number of above levle-0 adverse events decreased from 3.51% (191/5 441) to 1.05% (61/5 817) (x2=77.856, P 0.05). Conclusion The application of MECT form improves the nursing quality of MECT treatment in psychiatric department and secure the nursing safety.
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Objective To share for the nursing adverse events resources in the region, which would provide scientific data for nursing security management. Methods The form of nursing adverse events reporting was first designed by researchers. Then with the help of computer engineers the module on regional collaborative information platform was constructed. Preliminary running was used to modify and improve. Through continuous improvement the module function of adverse events reporting, query and statistics was finally made out. Results The module on regional collaborative information platform for nursing adverse events reporting and analysis was constructed, and it worked well. Conclusions The module realizes the sharing of nursing adverse events resources in the region. It can improve the level of nursing safety management in each hospital, which helps to reduce the incidence of nursing adverse events.
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Objective To compare and analyze the causes that occurred in psychiatric and general department using SHEL models, in order to provide evidence of preventing nursing adverse events.Methods We analyzed causes of 136 nursing adverse events using SHEL models, and compared the classification, causes, incidence of nursing adverse events between psychiatric and general departments. Results The first three nursing adverse events in psychiatric department were medication error,going outside, suicide and self harm, and those in general department were medication errors, specimens being wrong, improper operation and pipeline off. 91.18% of nursing adverse events accounted for quality of nursing services, 43.38% accounted for nursing environment, 41.18% accounted for clinical environment,and 57.35% accounted for parties and others. Incidence of nursing adverse events in psychiatric department were higher than that in general department. Conclusions SHEL model can objectively and comprehensively analyze the causes of nursing adverse events, and make nursing managers take the appropriate management strategy and the best safeguard against the risk of development of response.