Melhoria da qualidade do protocolo sepse pediátrico em um hospital terciário do Ceará

Abstract

Introduccion: Sepsis is characterized as a systemic response to an infectious disease whether it is caused by bacteria, viruses, fungi or protozoa, manifesting as different clinical stages of the same pathophysiological process. It is currently, in Brazil, the leading cause of death in Intensive Care Units (ICUs) and one of the leading causes of late hospital mortality, surpassing myocardium infarction and cancer. This health problem also reflects the reality of the hospital in study, corresponding to the primary cause of mortality of admitted patients, especially in the pediatric services. Objective: To improve the application and effectiveness of the sepsis protocol in the pediatric axis in a tertiary hospital in Ceará. Methodology: Based on a quality improvement cycle, a study quasi-experimental design developed, before and after, without a control group, following the SQUIRE guidelines. The research was carried out in the pediatric axis of a tertiary hospital in the interior of the state of Ceará between 2017 and 2018. Quality criteria was defined according to evidence for the adequate management of sepsis. The interventions were planned and implemented in a participatory manner with the objective of improving adherence to the quality criteria evaluated. After the interventions, the criteria were reassessed in order to measure their effects and identify the improvement opportunities that could guide the continuity of local actions. We calculated the point estimate of the criteria in each evaluation, the absolute and relative improvement after the intervention and the statistical significance of the improvement with unilateral Z hypothesis test. The ethical precepts of resolution 510/16. Results: Eight quality criteria related to the pediatric sepsis protocol were evaluated and compliance levels in the first evaluation ranged from 56.9% to 97.1%. After the interventions, the criteria oscillated from 62.8% to 93.8%. There was improvement in 6 evaluated criteria and a reduction in compliance of 2 criteria that were more than 90% compliant in the initial evaluation. Conclusions: The quality criteria based on scientific evidence and the results obtained by assessing their level of compliance before and after the intervention demonstrated that the internal quality improvement cycle was useful to ensure a better quality of the pediatric sepsis protocol through systematic procedures and safe care.