Quality indicators: tools for the management of best practices in Health

Incidence and time until the first traction or obstruction of the nasoenteral tube in hospitalized adults

OBJECTIVE

To determine incidence and time until first traction or obstruction of nasoenteral tube in hospitalized adults.

METHODS

Prospective double cohort study that included 494 adults who were users of nasoenteral tubes as inpatients in two clinical units and two surgical units in a teaching hospital. The occurrence of tube tractions and obstructions was monitored daily between 2017 and 2019. The Kaplan-Meier method was used to estimate time until the first event.

RESULTS

Tube traction occurred in 33% of the sample, and the incidence of the event was higher on the first five days of tube use. Tube obstruction incidence was 3.4% and grew as tube use time increased.

CONCLUSION

Traction incidence was higher at the beginning of the period of use, whereas obstruction incidence grew as tube use time increased.

Indicadores de cuidado de enfermería hospitalario orientados por modelo de práctica profesional

Objetivo Diseñar y validar indicadores de cuidado de enfermería a partir de la orientación de un modelo de práctica profesional en un hospital universitario de Colombia, 2018 – 2021. Material y Método: Esta es una “Investigación metodológica en enfermería” desarrollada por fases: 1) revisión de los procesos de calidad institucional. 2) revisión de literatura sobre indicadores hospitalarios de enfermería. 3) propuesta de indicadores con orientación del modelo institucional de práctica profesional de enfermería 4) validación de los indicadores mediante criterio de expertos y 5) evaluación de la efectividad preliminar en campo durante 8 meses. Resultados: Los 21 indicadores de cuidado de enfermería propuestos presentaron alta comprensibilidad y validez facial, una razón de validez de contenido (RVC) entre .74 y .96, y un índice de validez de contenido (IVC) de 0.83. Conclusión: Los indicadores de cuidado de enfermería diseñados bajo la orientación de un modelo de práctica profesional y validados mediante el criterio de expertos, mostraron una efectividad preliminar positiva para medir y mejorar los procesos y resultado del cuidado de enfermería de acuerdo con las personas implicadas en la recepción y suministro de dicho cuidado.  Estos indicadores pueden ser empleados en hospitales con plataformas estratégicas similares.

Passagem de plantão, comunicação efetiva e o método SBAR, na percepção dos enfermeiros de uma unidade coronariana

Objetivo: Identificar as percepções dos enfermeiros de uma unidade coronariana sobre a relação entre a passagem de plantão, comunicação efetiva e o método SBAR. Método: Estudo descritivo exploratório com abordagem qualitativa que buscou identificar as percepções dos enfermeiros sobre a relação entre a passagem de plantão, a comunicação efetiva e o método SBAR na unidade de terapia intensiva no processo realizado entre os turnos de trabalho, com indicativos para a construção de um instrumento estruturado para orientar e conduzir a troca de turnos, com a participação de 12 enfermeiros de uma unidade intensiva coronariana. Os dados foram obtidos no período de janeiro a julho de 2020 por meio oficina presencial antes da pandemia, e questionários foram submetidos à análise temática. Resultados: Foram elencadas três categorias: Organização da passagem de plantão com enfermeiro e técnico de Enfermagem; Instrumentalização da passagem de plantão entre as equipes de Enfermagem; e Método SBAR na passagem de plantão, como base para a elaboração do instrumento de passagem de plantão. Evidenciou-se que a comunicação efetiva é um fator influenciador na passagem de plantão para a realização do cuidado de Enfermagem de forma continuada, evitando eventos adversos aos pacientes. Conclusão: Confirma-se que, estratégias envolvendo a gestão hospitalar, como instrumentalizar e capacitar a equipe que está na linha de frente da atividade do plantão, acrescentam e enriquecem o cuidado sistematizado e humanizado.

Evaluation of the Manchester Triage System quality indicator: service time

OBJECTIVE

to verify the conformity of the time interval between the end of the risk classification and the beginning of medical care with that recommended by the Manchester protocol and to relate the times of care and the risk categories with the outcome.

METHOD

Cross-sectional, retrospective, and analytical study. The t test, the analysis of variance and the generalized linear model were used.

RESULTS

The average time for medical care in the red and orange categories was 3 and 39.5 minutes, respectively. Death outcome was associated with the red category, with an average time to start the classification of 5.5 minutes and an average length of stay of 2.3 hours.

CONCLUSION

The waiting time for medical care in the high priority categories was longer than recommended, which suggests the need to continuously monitor the system. Shorter waiting times for classification and permanence were related to the red category and the outcome of death.

Content and layout validation of indicators to assess the degree of implementation of the Hearing Conservation Program

ABSTRACT Purpose: to validate indicators and parameters to construct an assessment instrument for the Hearing Conservation Program. Methods: methodological research to validate the content and layout of indicators to assess the Hearing Conservation Program, using the Delphi method, as well as the semantic validation of an assessment instrument for the program, in compliance with the procedures used by the European group DISABKIDS. A total of 20 speech-language-hearing therapists participated in the study, answering validation questionnaires. The answers were tabulated and analyzed considering descriptive statistical data, establishing the item content validity index, the scale content validity index, the percentage of absolute agreement, and the content analysis. Results: of the 64 items submitted for validation, two were not considered appropriate. The set of items was considered representative. The validated indicators and parameters provided the means to construct an assessment instrument of the degree of implementation of the Hearing Conservation Program, which proved to be semantically valid. Conclusion: the indicators were validated to meet and represent the functions of quality, control, and follow-up of the Hearing Conservation Program, aiding administrators to carry out their responsibilities and making it possible to construct evaluative instruments.

Fall prevention in hospitalized patients: Evaluation through the nursing outcomes classification/NOC

OBJECTIVE

To evaluate the nursing outcomes of hospitalized patients at high risk for falls through NOC and correlate NOC outcomes called Knowledge: Fall Prevention and Fall Prevention Behavior with patients' sociodemographic and clinical variables.

BACKGROUND

Falls represent one of the major safety incidents in the hospital setting. The role of nursing is fundamental in preventing these events, from risk assessment to outcome evaluation. One of the strategies for evaluating nursing outcomes is the use of Nursing Outcomes Classification (NOC).

METHODS

A cross-sectional study conducted with a sample of 68 adult patients at high risk for falls admitted to clinical and surgical units. The patients received three evaluations. Data collect was prospective with an instrument containing five results and 28 NOC indicators. Descriptive and analytical analysis considered the NOC 5-point Likert scale.

RESULTS

Evaluation of the Knowledge: Fall Prevention and Fall Prevention Behavior outcomes showed that patients have a limited level of knowledge and rarely demonstrated preventive behavior. Vital Signs (0802), Medication Response (2301) and Safe Health Care Environment (1934) pointed to the existence of adequate patient monitoring and safe environment.

CONCLUSION

The evaluation of patient outcomes supported by a standardized classification system such as the NOC highlights the patient's clinical evolution and produces data that support the planning of care and management interventions, providing more effective and safer practices.