The need to establish a national patient safety program in Brazil

How Can Implementation of a Large-Scale Patient Safety Program Strengthen Hospital Safety Culture? Lessons From a Qualitative Study of National Patient Safety Program Implementation in Two Public Hospitals in Brazil

Large-scale (e.g., national) programs could strengthen safety culture, which is foundational to patient safety, yet we know little about how to optimize this potential. In 2013, Brazil's Ministry of Health launched the National Patient Safety Program, involving hospital-level safety teams and targeted safety protocols. We conducted in-depth qualitative case studies of National Patient Safety Program implementation in two hospitals, with different readiness, to understand how program implementation affected enabling, enacting, and elaborating processes that produce and sustain safety culture. For both hospitals, external mandates were insufficient for enabling hospital-level action. Internal enabling failures (e.g., little safety-relevant senior leadership) hindered enactment (e.g., safety teams unable to institute plans). Limited enactment and weak elaboration processes (e.g., bureaucratic monitoring) failed to institutionalize protocol use and undermined safety culture. Optimizing the safety culture impact of large-scale programs requires effective multi-level enabling and capitalizing on the productive potential of interacting national- and local-level influences.

Neonatal near miss in the intensive care unit

OBJECTIVE

To analyze near miss cases among newborns hospitalized in the Intensive Care Unit.

METHODS

An observational, cross-sectional, retrospective study using the STROBE guideline. Data were collected from 1,101 records of live births (newborns). Statistical analysis used the Epi-Info program 3.3.2 and Chi-square and Fisher's exact tests.

RESULTS

A total of 162 newborns were hospitalized, of which 63 had at least one criterion of near miss. The variables that remained associated with neonatal near miss were weight <1.750 g, gestational age <33 weeks and Apgar at 5 minutes <7, pragmatic criteria to identify cases of neonatal near miss morbidity.

CONCLUSION

Prematurity and low birth weight were the factors that contributed most to the near miss outcome among newborns hospitalized in intensive care, a rate two and a half times higher than the number of deaths, according to scientific evidence.

Perception of a multidisciplinary team on physical restraint use on older adults: care paradoxes

OBJECTIVE: To describe the perception of a multidisciplinary team on the use of physical restraint in older adults. METHODS: Qualitative research conducted with 58 health professionals in two long term care facilities for older adults located in the state of Rio de Janeiro, Brazil. Semi-structured interviews were further analyzed using thematic content analysis. The data was collected from November 2017 to June 2018. RESULTS: Twenty-one initial codes were identified and organized in three categories: team perception of the consequences and risks of a physical restraint (the patient’s safety paradox); implications of the decision of physical restraint of the older adults; and strategies to restrain and not restrain. CONCLUSIONS: The results reinforce the need for training of professionals on restraint-free alternatives of care, as part promoting a culture of care that respects the right to freedom and the dignity of people — especially the most vulnerable ones.

Perceptions of a group of hospital pharmacists and other professionals of the implementation of clinical pharmacy at a high complexity public hospital in Brazil

BACKGROUND

During the process of implementation of clinical pharmacy services, internal and external factors may favor or hinder the incorporation of care into the hospital routine. This study aimed to understand the perceptions of a group of hospital pharmacists and other professionals of the implementation of clinical pharmacy at a high complexity public hospital in Brazil.

METHODS

A focus group with 16 pharmacists and interviews with tree key stakeholders including managers in the pharmaceutical, medical, and nursing profession were conducted to understand their perceptions of the implementation clinical pharmacy services in a high complexity public hospital in Brazil. The service proposal was presented to the selected participants before conducting the focus group. Professionals with an overview of the hospital and influence on the relevant departments for the implementation of clinical pharmacy at the institution were selected. Data collected were transcribed and analyzed using the Bardin Content Analysis technique. Data analyzed were systematized into categories and registration units. The methodology involves the organization and analysis of reported content to make inferences.

RESULTS

The data obtained were divided into four categories: "Perception of the current situation", "Implementation expectations", "Barriers to implementation", "Implementation facilitators". Participants discussed the stagnation of clinical activities of the pharmaceutical profession in Brazil, a reality that results from a lack of clinical training in the country. Pharmacists expressed their expectations for changes in professional performance. According to the managers, such services would positively affect clinical outcomes for patients. Gaps in academic education, lack of knowledge, and poor communication skills were barriers reported in this study. Pharmacists' clinical experience has been reported to facilitate the provision of services.

CONCLUSIONS

This study highlights factors that may influence the implementation of clinical pharmacy services in the institution analyzed, such as resistance, fear, and frustration as barriers, as well the experience in clinical pharmacy of some pharmacists in the institution was one of the facilitators most cited by participants. This knowledge may aid future planning for the implementation of clinical pharmacy in hospitals.

Assistência de enfermagem e o enfoque da segurança do paciente no cenário brasileiro

RESUMO O objetivo deste estudo foi o de analisar a contribuição da enfermagem para a segurança do paciente no Brasil. O método de pesquisa eleito foi o da revisão integrativa da literatura. Pesquisaram-se as bases de dados Lilacs, Medline, BDENF, SciELO e PubMed por meio dos descritores 'segurança do paciente', 'cuidados de enfermagem' e 'Brasil'. Os artigos avaliados referem-se ao período 2009-2014, disponíveis em português, inglês e espanhol. Por fim, selecionaram-se 15 artigos. As publicações evidenciam a existência de ações positivas da enfermagem na segurança do paciente. Concluindo, a pesquisa reflete sobre a importância da identificação do erro e da utilização de ferramentas para melhoria da cultura de segurança nas instituições brasileiras.