Melhoria da qualidade nas práticas de segurança do paciente em serviço de diálise

Abstract

Introduction: Hemodialysis is a form of renal replacement therapy indicated for patients with kidney injury and a potential risk for adverse events. In this perspective, patient safety practices should be implemented and encouraged in order to improve quality using strategies such as improvement cycles. Objective: This study aimed to evaluate the effect of a quality improvement cycle on patient safety practices in a hemodialysis service. Methodology: This is a two-stage multimethod study conducted in the dialysis service of a public teaching hospital. The first stage of the multimethod study consisted of a quasi-experimental pre-test and post-test research without a control group, with quantitative approach, developed during an improvement cycle of patient safety practices in the hemodialysis service. The second stage was a crosssectional study with quantitative approach to assess the resilience safety culture. Both stages were carried out from April 2023 to April 2024. To develop the improvement cycle, renal dialysis patient care records, patient care records from the unit, the hemodialysis safety checklist, and incident reports were used to assess the level of quality, considered in eight criteria based on indicators adopted in the Assessment of Patient Safety Practices in Dialysis Services. After the reassessment, the Resilience Safety Culture translated and adapted for the Brazilian cultural context was applied to evaluate the resilience culture. Data from the pre-test and post-test assessments were presented in Pareto diagrams to demonstrate the level of improvement and its significance. A descriptive statistical analysis was performed on the data related to the resilience culture, with the results presented in tables. The Research Ethics Committee approved the study under CAAE No. 75601123.3.3001.5045. Results: The initial assessment revealed low levels of quality in all criteria, except for the one related to the presence of an intact, clean and identified dressing at the end of the procedure, which presented 100% compliance. In the reassessment, there was an absolute improvement of 73.95% in the other six criteria compared to the initial assessment. The analysis of the Resilience Safety Culture indicated a positive perception in most domains in a context of changes within the complex challenge of the dialysis unit. Conclusion: The improvement cycle proved to be effective in increasing quality and safety practices in the dialysis service.