Cultura de segurança do paciente e prática dos cuidadores no âmbito do cuidado domiciliar: uma revisão de escopo

Abstract

INTRODUCTION: The home environment, as well as any healthcare establishment, presents specific risks and conditions that must be carefully observed to ensure patient safety. The common perception that the home environment constitutes a space of less vulnerability to unsafe practices is mistaken, but it is in this context that primary care is carried out most frequently and where a large part of health actions are developed. In this sense, it is essential to recognize the potential risks present at home and adopt appropriate behaviors to prevent them, promoting safe and effective care. The incorporation of a patient safety culture in the context of home care demands a careful look at the multiple dimensions of care, with special emphasis on the qualification and preparation of caregivers. OBJECTIVE: To map existing evidence in the literature on the patient safety culture with an approach to the caregiver and their practice, within the scope of home care. METHODOLOGY: This is a scoping review, conducted based on the Joanna Briggs Institute (JBI) methodological framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMAScR) checklist. To elaborate the research question, the mnemonic conceptual model Population, Concept and Context (PCC) was considered, in which “population” corresponded to caregivers; “concept”: patient safety and “context”: home care. The searches were carried out in six databases in September 2024 and the research protocol was registered on the Open Science Framework (OSF) platform. The publications found were exported to the Rayyan® software and duplicates were removed. A pilot test was performed before blind screening began in order to reduce bias. Then, the selection and inclusion of studies continued, being carried out independently in a double-blind screening according to the established eligibility criteria. The screening process was divided into two levels. In the second level of screening, the studies that were pre-selected by reading the title, abstract and keywords (108) were read in full by the reviewers, identifying their relevance to the research more precisely. The conflicts without consensus recorded between the reviewers were resolved by a third reviewer. Relevant data related to the included studies were independently extracted by pairs using a data extraction form according to the JBI template. The process of selection, eligibility and refinement of publications were referred to in a PRISMA flowchart. RESULTS: Of the 1,818 records found, 40 studies were included in the scoping review. The prevalence of female caregivers (formal and informal) corresponded to 72.5% of the selected publications. The United States (20%), Brazil (17.5%) and Canada (17.5%) had the highest number of publications. Regarding the type of care provided, professional or formal care predominated among the studies (42.5%), followed by the combination of professional/formal and informal care (35%) and only informal care (22.5%). Several risks were identified, covering: physical, economic, emotional and relational damages, which involved multiple dimensions: physical and environmental, social, mental/psychological and emotional, interpersonal, technological and functional of home care. As well as risks of a chemical, biological nature and related to violence. Regarding the difficulties perceived by caregivers, many challenges were identified regarding the organizational dimension of care, behavioral and cognitive limitations of patients and family members, as well as vulnerabilities in the management and safe administration of medications, structural difficulties and unsanitary home environments, which were highlighted by caregivers as significant barriers to continuity of care and patient safety. FINAL CONSIDERATIONS: Patient safety has gradually gained its space in this care scenario, which despite the expansion of home health care, many barriers and weaknesses permeate understanding the risks encountered and the predictive implementation of practical safety strategies and measures. The results of this study reveal the level of consolidation of the patient safety culture among caregivers, highlighting the importance of important investments in the training of caregivers, which also includes health professionals, as well as attention to elements inherent to the specificity of care in this scenario — such as ambience, delimitation of duties and responsibilities, in addition to adapting norms and routines to the particularities of the homes. Such factors are fundamental to guarantee the effectiveness of safety actions and the qualification of care provided in this context, directly reflecting on health work processes. The relevance and findings of this study are reaffirmed by its potential contribution to the formulation and strengthening of strategies that promote a more solid, effective and external safety culture in this care scenario, since the global panorama involving patient safety at home is recent and permeated by many institutional and political challenges.