Avaliação de boas práticas assistenciais para segurança do paciente em unidade de terapia intensiva

Abstract

Assessing good care practices regarding allergy, risk of sepsis, need for bed restraint, risk of bronchial aspiration, risk of infection through invasive devices and risk of phlebitis according to the daily assessment of the patient´s safety managed by nurses in Intensive Care Units. METHODS: Cross-sectional study, with descriptive design and quantitative approach, carried out in seven Intensive Care Units of a school hospital in the interior of São Paulo state. Data collection was performed by auditing medical records of six protocols, according to the daily patient´s safety assessment managed by nurses, in the period from September 2018 to July 2019; weekly; on all days of the week, consecutively; totaling 4,001 assessments. Two statistical analysis functions were performed: descriptive and inferential, and Mann-Whitney U-test was applied to compare the compliances or non-compliances of the six items of the daily safety assessment. The study was approved by CEP/FAMERP, Approval number 2.713.068. RESULTS: Overall, differences in compliance were observed among the six items checked in the daily assessment of the patient ´s safety managed by nurses in all seven units. The individual analysis of each item has also pointed out significant differences among the seven units. The ICU that had the care of lower complexity as a characteristic, that is, less critically ill patients, has presented the best results. The ICU that cares for supplementary health patients, with more complex and more serious patients in several medical specialties, has presented the worst results in relation to the others. Among the six items, bed restraint has presented the best results; 95.13% of compliance of the nurse management for the patient´s safety and sepsis risk, 87.75%, showing to be the best practice with the lowest compliance, i.e., with the worst results, in all intensive care units. CONCLUSION: Significant differences among the seven units were observed. On individual analysis, from the six assessed items: sepsis risk, need for bed restraint, Broncho-aspiration risk, risk of infection through invasive devices and phlebitis risk, there were significant differences identified on all days of the week, according to each unit. We have concluded that there is a need for intervention to improve the daily patient´s safety assessment that should be managed by nurses in its full extent, according to the goals set by the Nursing service of the institution. Safety is an essential factor in the dimension of care, therefore, to evaluate good practices managed by nurses; to identify failures and to know the reality of care should create reflection among professionals, pointing out the need for an action plan for each Intensive Care Unit.