Cirurgia segura em pediatria: elaboração e validação de checklist de intervenções pré-operatórias
Data
2014-09-24
Autores
Pires, Maria Paula de Oliveira 
Orientadores
Peterlini, Maria Angelica Sorgini
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A segurança do paciente é definida como a ausência de danos ou de lesões acidentais durante a prestação de assistência à saúde. Uma vez que o erro humano é inevitável, a utilização de checklists pode se constituir numa ferramenta relativamente simples e que garanta que todas as etapas do processo sejam cumpridas e, consequentemente, falhas sejam evitadas. Em junho de 2008, a Organização Mundial da Saúde publicou o Surgical Safety Checklist, instrumento desenvolvido a partir de revisões de práticas baseadas em evidências, que identificaram as causas mais comuns de danos ao paciente no período perioperatório. O instrumento referiu apenas o período intra-operatório, porém, sabe-se da importância do pré-operatório para segurança do paciente cirúrgico. Além disso, a população pediátrica pode ser caracterizada como vulnerável para a ocorrência de eventos adversos na área da saúde e uma das formas de minimizar o estresse consiste no preparo para a intervenção por meio da transmissão de informações às crianças, sendo a forma lúdica, um dos recursos utilizados pelos enfermeiros. Os objetivos desse estudo foram elaborar, validar e aplicar na prática clínica um instrumento que contenha intervenções pré-operatórias, relacionadas à segurança do paciente, a ser preenchido pela criança e família. O tipo de estudo foi metodológico, exploratório e de validação de construto e conteúdo, que ocorreu numa unidade de cirurgia pediátrica de um hospital universitário da cidade de São Paulo, entre 2011 e 2013. Vale ressaltar que o estudo foi iniciado após parecer de aprovação do projeto pelo Comitê de Ética em Pesquisa da instituição, sob o número 2114/11. O checklist foi elaborado pelas pesquisadoras, sendo um instrumento no formato de folder e apresentação lúdica, simulando o caminho a ser percorrido pela criança durante o período pré-operatório, denominando-o de ?Checklist Pediátrico para Cirurgia Segura?. Esse foi submetido à validação, por meio da técnica Delphi, com participação de cinco profissionais especialistas na área, fixando-se nível de consenso de 80%. Em seguida, utilizou-se o checklist na unidade em estudo, sendo a amostra constituída por 60 crianças pré-escolares a adolescentes e 60 familiares. Para análise de associação utilizou-se o Teste Exato de Fisher e o Teste t para duas amostras, com nível de significância de 5%. O checklist foi composto por 11 itens que foram validados por meio de duas rodadas da técnica Delphi, obtendo consenso, tanto para o conteúdo como construto. Quanto à aplicação na prática, identificou-se consecução de 65,3% itens preenchidos, porém, 30,0% não foram preenchidos devido a não execução da equipe. Verificou-se ainda, que crianças com idade superior preencheram mais o item da retirada de adornos do que as crianças menores, porém esse foi o único item que demonstrou diferença estatística (p=0,008). Os familiares relataram satisfação no uso do instrumento como ótimo (63,3%) e bom (36,7%), e acreditaram reduzir níveis de ansiedade na criança por meio da orientação e pintura. Sendo assim, o checklist pode constituir instrumento capaz de colaborar para que etapas do preparo e promoção de cirurgia segura sejam realizadas, ao se identificar a presença ou ausência das ações necessárias para a promoção da segurança do paciente, garantindo a satisfação dos clientes.
Patient safety is defined as the absence of damage or accidental injury while rendering health care. Since human error is unavoidable, the use of checklists can be a relatively simple tool ensuring that all process steps are fulfilled and, consequently, failures are avoided. In June 2008, the World Health Organization Surgical Safety Checklist published instrument developed from a review of evidence-based practices, which identified the most common causes of damage to the patient in the perioperative period. The instrument mentioned only the intraoperative period, however, is known of the importance of safety for preoperative surgical patient. In addition, the pediatric population can be characterized as vulnerable to the occurrence of adverse events in health care and one of the ways to minimize stress is to prepare for intervention through the provision of information to children, with a playful way, a resources used by nurses. The objectives of this study were to develop, validate and apply in clinical practice an instrument that contains preoperative related to patient safety interventions, to be completed by the child and family. The type of study was methodological, exploratory and validation of the construct and content, which occurred in a pediatric surgery unit of a university hospital in São Paulo between 2011 and 2013. Importantly, the study was initiated after approval of the opinion project by the Institutional Research Ethics Committee, under number 2114/11. The checklist was developed by the researchers, being an instrument in the folder and playful presentation format, simulating the path to be taken by the child during the preoperative period, terming it a "Pediatric Checklist for Safe Surgery". This was subjected to validation by means of the Delphi technique, with participation of five specialists in the area, settling consensus level of 80%. Then we used the checklist in the unit under study, the sample consisted of 60 preschool children and 60 adolescents family. For association analysis used the Fisher's exact test and the t test for two samples, with a significance level of 5%. The checklist consisted of 11 items that have been validated through two rounds of the Delphi technique, obtaining consensus, for both content and construct. As for practical application, we identified achieving 65,3% completed items, however, 30,0% were not completed due to non-performance of the team. It was also found that children filled over the item the withdrawal of loud than younger children, but this was the only item that showed statistical difference (p=0.008). Family members reported satisfaction with using the instrument as great (63,3%) and good (36,7%), and believed to reduce levels of anxiety in children through the guidance and painting. Thus, the checklist can be an instrument able to collaborate so that steps of the preparation and promotion of safe surgery are performed to identify the presence or absence of the necessary actions to promote patient safety, ensuring customer satisfaction.
Patient safety is defined as the absence of damage or accidental injury while rendering health care. Since human error is unavoidable, the use of checklists can be a relatively simple tool ensuring that all process steps are fulfilled and, consequently, failures are avoided. In June 2008, the World Health Organization Surgical Safety Checklist published instrument developed from a review of evidence-based practices, which identified the most common causes of damage to the patient in the perioperative period. The instrument mentioned only the intraoperative period, however, is known of the importance of safety for preoperative surgical patient. In addition, the pediatric population can be characterized as vulnerable to the occurrence of adverse events in health care and one of the ways to minimize stress is to prepare for intervention through the provision of information to children, with a playful way, a resources used by nurses. The objectives of this study were to develop, validate and apply in clinical practice an instrument that contains preoperative related to patient safety interventions, to be completed by the child and family. The type of study was methodological, exploratory and validation of the construct and content, which occurred in a pediatric surgery unit of a university hospital in São Paulo between 2011 and 2013. Importantly, the study was initiated after approval of the opinion project by the Institutional Research Ethics Committee, under number 2114/11. The checklist was developed by the researchers, being an instrument in the folder and playful presentation format, simulating the path to be taken by the child during the preoperative period, terming it a "Pediatric Checklist for Safe Surgery". This was subjected to validation by means of the Delphi technique, with participation of five specialists in the area, settling consensus level of 80%. Then we used the checklist in the unit under study, the sample consisted of 60 preschool children and 60 adolescents family. For association analysis used the Fisher's exact test and the t test for two samples, with a significance level of 5%. The checklist consisted of 11 items that have been validated through two rounds of the Delphi technique, obtaining consensus, for both content and construct. As for practical application, we identified achieving 65,3% completed items, however, 30,0% were not completed due to non-performance of the team. It was also found that children filled over the item the withdrawal of loud than younger children, but this was the only item that showed statistical difference (p=0.008). Family members reported satisfaction with using the instrument as great (63,3%) and good (36,7%), and believed to reduce levels of anxiety in children through the guidance and painting. Thus, the checklist can be an instrument able to collaborate so that steps of the preparation and promotion of safe surgery are performed to identify the presence or absence of the necessary actions to promote patient safety, ensuring customer satisfaction.
Descrição
Citação
PIRES, Maria Paula de Oliveira. Cirurgia segura em pediatria: elaboração e validação de checklist de intervenções pré-operatórias. 2014. 73 f. Dissertação (Mestrado) - Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, 2014.