Relación de las distracciones, las características sociodemográficas y contextuales con las prácticas seguras de inyecciones durante la práctica clínica del enfermero / Relationship of distractions, sociodemographic and contextual characteristics with safe injection practices during nurses' clinical practice

Objetivo: Analizar la relación entre las distracciones, las características sociodemográficas y contextuales con la realización de las prácticas seguras de inyecciones realizadas por el enfermero durante la preparación y administración de los medicamentos en los servicios de hospitalización y terapia intensiva de adultos. Método: Estudio cuantitativo, transversal y correlacional que utilizó la observación estructurada guiada por listas de chequeo, con un muestreo no probabilístico a propósito de 446 prácticas de inyecciones. Se realizó un análisis univariado y bivariado según el nivel de medición de las variables (correlación de Spearman, punto biserial y coeficiente Eta) en el paquete estadístico IBM SPSS Statistics 24.0 y un análisis de covarianza en el paquete estadístico Statgraphic XVII. Resultados: Se observaron 448 prácticas de inyecciones ejecutadas por 26 enfermeros con 5 años de experiencia, una mediana de 4 pacientes por turno y 3 medicamentos por ronda de medicación. Las distracciones fueron más frecuentes en la fase de preparación (67,9%), siendo las comunicaciones profesionales y sociales las más comunes con relevancias opuestas según la fase del proceso de medicación. La estrategia de manejo más usada fue "multitareas". Las prácticas de inyecciones conservaron la regla "un medicamento, una aguja, una jeringa, un solo diluyente por única vez" por paciente. El porcentaje total de ítems realizados de la lista de chequeo osciló entre el 47,3% y el 84,2%. Las variables de género (femenino p=0,028, IC 95%=0,051; 0,895), familia del medicamento (antiinfectivos: p=0,000, IC 95%=3,711; 5,568; preparaciones hormonales: p=0,000, IC 95%=1,197; 5,050 y sistema musculoesquelético: p=0,000, IC 95%=-2,046; 2,822), tipo de inyección (intravenosa: p=0,000, IC 95%=-0,749; 2,060), día de la semana (fin de semana: p=0,000, IC 95%=0,358; 1,404), servicio (hospitalización: p=0,001, IC 95%=6,613; 7,925) y turno (mañana: p=0,003, IC 95%=-0,227; 0,885) explicaron en un 81,67% la práctica segura de inyecciones. Conclusiones: Las distracciones (p=0,567, IC 95%=-0,742; 0,567) no fueron una variable que explicara la práctica segura de inyecciones a diferencia de las ocho características sociodemográficas y contextuales (turno, procedimiento e insumos) del enfermero.

Objective: Analyze the relationship between distractions, sociodemographic and contextual characteristics with the accomplishment of safe injection practices performed by the nurse during the preparation and administration of medications in hospitalization and adult intensive care services. Method: Quantitative, cross-sectional, correlational study that used structured observation guided by checklists, with a non-probabilistic sampling of 446 injection practices. A univariate and bivariate analysis was performed according to the level of measurement of the variables (spearman correlation, biserial point and eta coefficient) in the IBM SPSS Statistics 24.0 statistical package and an analysis of covariance in the Statgraphic XVII statistical package. Results: 448 injection practices were observed, carried out by 26 nurses with 5 years of experience, a median of 4 patients per shift and 3 medications per round of medication. Distractions were more frequent in the preparation phase (67.9%), the professional and social communications are the most common with opposite relevance according to the phase of the medication process and the most used management strategy was "multitasking". The injection practices kept the rule "one medicine, one needle, one syringe, one diluent at a time" per patient. The total percentage of items made from the checklist ranged between 47.3% and 84.2%. Gender variables (female p=0.028, 95% CI=0.051; 0.895), drug family (anti-infectives: p=0.000, 95% CI=3.711; 5.568, hormonal preparations: p=0.000, 95% CI=1.197; 5.050 and system musculoskeletal: p=0.000, 95% CI =-2.046; 2.822), type of injection (intravenous: p=0.000, 95% CI=-0.749; 2.060), day of the week (weekend: p=0.000, 95% CI=0.358; 1.404), service (hospitalization: p=0.001, 95% CI =6.613; 7.925) and shift (morning: p=0.003, 95% CI =-0.227; 0.885) explained the safe practice of injections by 81.67%. Conclusions: Distractions (p=0.567, 95% CI =-0.742; 0.567) were not a variable that explained the safe practice of injection, unlike the eight sociodemographic and contextual characteristics (shift, procedure, and supplies) of the nurse.

Assessment of the safety of injection practices and injection related procedures in Family Health Units and centers in Alexandria

The Safe Injection Global Network [SIGN] developed an intervention strategy for reducing overuse of injections and promoting the administration of safe injections. Tool C - Revised is designed to assess the safety of the most common procedures that puncture the skin within health services. The aim of the study was to assess injection safety within the primary healthcare facilities in Alexandria using Tool C - Revised. Study setting: A total of 45 family health units and centers in Alexandria were selected by proportional allocation from the eight regions of Alexandria. Data collection: The Tool C - Revised of the WHO was used for observation of the entire facility, injection practices and injection-related procedures, and sterilization practices. Interview of different health providers and immediate supervisor of injections was carried out. Indicators that reflect risk included: deficiency of alcohol-based hand rub for cleansing hands [13.3%], compliance with hand wash before preparing a procedure [56.9% before injection practices, 61.3% before phlebotomy, and 67.6% before lancet puncture], and wearing a new pair of gloves before new procedures [48.6% before injection practices, 9.7% for phlebotomy, 11.8% for lancet puncture, and 80% for both intravenous injections and infusions]. Enough disposable equipment in all facilities for at least 2 weeks dependent on the statement of the average numbers of procedures per week was shown. Only 38% of the providers had received training regarding injection safety in the last 2 years and 62.5% had completed their three doses of hepatitis B vaccine. Only 42.2% of staffs who handled healthcare waste had access to heavy gloves. Indicators related to injection and injection-related practices that reflect risk to patients include deficiency of alcohol-based hand rub tools, nonadherence to hand hygiene before preparing an injection, and inadequate adherence to using a clean barrier when opening a glass ampule and use of gloves. Indicators that may reflect risk to patients and providers include inadequate injection safety training and incomplete hepatitis B vaccination of healthcare providers. Indicators that may reflect risk to providers include nonadherence to safety precautions related to injection practices, such as inadequate access to heavy gloves by staff handling healthcare waste

Lesión del nervio ciático: aproximación médico legal / Sciatic nerve injury: medical legal correlation

Esta descripción reporta la revisión de peritajes realizados en el Centro de Estudio en Derecho y Salud (CENDES) sobre lesión del nervio ciático. El análisis de los hallazgos mostróque el 57,1 % de las causas de lesión del nervio ciático —con compromiso en todos los casos del nervio peroneo común, principalmente su rama peroneo superficial— se derivaron de la prestación de un servicio de salud. En la valoración de los pacientes se observó que el daño encontrado no essolo estructural, sino que involucra también los órdenes estético, funcional, psicológico y social que alteran, en su conjunto, el estado bio-sico-social y económico del individuo. Al igual puede implicar consecuencias de orden jurídico para el prestador de servicios de salud.

This paper reports the expert review conductedat the Center for Law and Health Study (CENDES)on sciatic nerve injury. Analysis of findings showed that 57.1% of the causes of the sciatic—nerve injury with involvement in all cases of common peroneal nerve, superficial peronealbranch mainly his— were derived from the provision of a health service. In the evaluation of patients showed that the damage found is notonly structural but also involves the aesthetic, functional, psychological and social alter, overall, the state bio-psycho-social and economicindividual. It may involve legal implications for the health care provider.

Best practice techniques for administration of injections: impact of lecture based interactive workshops on training of nurses

To determine if a structured workshop on best practice technique for the administration of injections for nurses results in an improvement in knowledge on the subject. Nurses attended an interactive lecture-based workshop on best practice technique for the administration of injections. Participants had to accept an invitation to the presentation prior to the training event. They completed a multiple choice question [MCQ] test, derived from topics covered in the presentation, prior to the lecture. The MCQ test was repeated after the lecture to assess retention and application of knowledge. Thirty-eight nurses participated in the workshop. There was a significant improvement in mean test scores after the lecture when compared with pre-lecture scores [Mean=16.5, SD=3.7 vs. Mean=7.8, SD=1.9, p<0.001]. Lecture based workshop on best practice techniques of administration of injections helps improve nurses knowledge. It also helps in overcoming deficiencies in nurses training

O processo de comunicaçäo na administraçäo de medicamentos injetáveis em crianças sob a perspectiva da interaçäo entre mäe-criança e auxiliares de enfermagem / The communication process in the administration of injection medication to children undert the perspective of interaction between mother/children and nursing auxiliaries

Neste estudo, de caráter qualitativo, foi analisada a comunicaçäo estabelecida entre mäe-criança-auxiliares de enfermagem durante as situaçöes de aplicaçöes de medicamentos injetáveis em crianças. Foi utilizada a técnica de observaçäo näo participante com anotaçöes de campo em onze situaçöes. Os dados foram categorizados segundo o Modelo Teórico de Forrest. Constatou-se o predomínio das categorias bloqueadoras Desaprovaçäo, Depreciaçäo, Tranquilizando a Mäe com "Clichês" ou Comentários Estereotipados. As categorias facilitadoras apresentaram as subcategorias Reconhecendo os sentimentos e presença da criança e esclarecendo e orientando a mäe ou responsável. Concluiu-se que houve predomínio no uso das categorias bloqueadoras, quando näo foram utilizados recursos de comunicaçäo verbal para interagir com a mäe e criança, näo estabelecendo um relacionamento de amizade e confiança e tornando o relacionamento ineficiente.