Avaliação da segurança do cuidado de enfermagem no uso de vacinas na atenção primária à saúde

Abstract

The importance of safety in Primary Health Care services raises the need for studies on the adverse events arising from medication errors, especially of the vaccines, frequently used in these places. The aim of this study was to evaluate the safety of nursing care in the use of vaccines in Primary Health Care. Methodological research, with a quantitative approach, divided into the following stages: 1) scoping review; 2) elaboration of a graphic protocol for the evaluation of nursing insurance care in the use of vaccines in Primary Health Care; 3) validation of content and appearance of the graphical protocol - which counted on the participation of twelve judges in the technique Delphi 1 and eight in Delphi 2, with completion of an electronic form made available by Google Forms. The relevance analysis of these items was by the Content Validity Coefficient (CVC) ≥ 0.78; 4) evaluation of vaccination rooms - occurred by the graphic protocol previously validated in its content and appearance, in 13 Health Units of the Family of Natal/RN/Brazil. The protocol was used in person, through the technique of non-participant observation, by two evaluators. The data collection period for all stages of the research was from November 2016 to August 2018. Data analysis regarding vaccine room evaluation was performed using the instructions of the protocol itself and the Kappa coefficient to inter-observer reliability. All the steps of the research followed the ethical precepts with approval under Certificate of Presentation and Ethical Appraisal (CAAE) nº 59962316.8.0000.5537. The valid protocol in its content and appearance reached General Content Validity Coefficient (0.83) in the Delphi 2 step. This value demonstrates that the instrument has reliability and trustworthiness, with a recommendation of 75% of the judges for the application of the instrument in practice health services. The results and discussion are organized into four topics: patient safety in Primary Health Care, which identified a variety of patient safety actions emphasizing the importance of improving the safety culture at this level of care; the role of the nursing team in vaccine care, which allowed the listing of important aspects for the actions in the vaccine room, with emphasis on the need for supervision by the nurse. The third, construction and validation of content and appearance of the graphic protocol, in which the evaluation of the judges considered the items of the instrument valid, with recommendation of its use in Primary Health Care services. The fourth, nursing care security assessment in the vaccine rooms, identified unsafe care in seven investigated settings and partially safe care in five vaccine rooms, results that point to fragilities that could compromise patient safety. It is concluded that the proposed instrument allows to evaluate the safety of nursing care in the use of vaccines, necessary to detect factors that may affect the proper conservation of vaccines and their potency and efficacy, with damages to the health of the population. Thus, the importance of training to professionals and the implementation of improvement cycles to qualify the services is emphasized.