Gestão da qualidade nos serviços de hemoterapia do interior do estado do Rio Grande do Norte

Abstract

Introduction: The Blood Sanitary Surveillance exercises the control of transfusion risks related to hemotherapy services and aims to minimize the health risks arising from the provision of these services, the production and use of blood components (hemotherapy), seeking the protection of collective health . Existing health legislation requires that such services have policies and actions that ensure the quality of products and services, ensuring that procedures and processes take place under controlled conditions and define the quality system as an organizational structure with responsibilities, policies, processes, procedures and resources established by the institution's executive board to achieve the quality policy. Objective: to carry out an external quality improvement cycle aimed at the development of quality management activities in the Hemotherapy Services of the interior of the State of Rio Grande do Norte, based on the evaluation and performance of the Sub-Coordinator of State Sanitary Surveillance (SUVISA), in accordance with current legislation. Methodology: The quantitative study conducted in the biennium 2017-2018 was almost experimental, before and after, without a control group, with the elaboration and evaluation of thirteen quality criteria, from causes classified as modifiable, observing the precepts of face, content and criterion validities. The intervention in the eight hemotherapy services in the interior of the NB, including two regional blood centers, two collection and transfusion units and four transfusion agencies, occurred in the period from 06/07 to 01/09/2017. After this stage, the reassessment of the quality criteria was carried out, from 11 to 10/24/2017, in order to visualize the effect of the improvement cycle and to enhance the remaining opportunities. Results: The results referred to the compliance and non-compliance levels of the thirteen criteria, based on their relative and accumulated absolute frequencies, which showed that the compliments increased from 44 (42.3%) to 66 (63.5% ), resulting in a decrease in non-compliances or quality defects from 60 to 38, after intervention in the hemotherapy services evaluated. Criteria 1, 2, 3, 4 and 11 maintained the same level of care after interventions in the improvement cycle, and presented compliance of more than 60%. However, a higher percentage of compliance was observed in criterion 6, referring to "established procedures and registered for the treatment of nonconformities and corrective measures", from 12.5% to 75%, showing an improvement of 62.5 %. Similarly, there was an increase in compliance with criteria 5, 7, 10, 13 (37.5%), criteria 8 and 9 (25%) and criterion 12 (12.5%), among which corresponding to the main quality defects identified in the 1st evaluation and which were prioritized in intervention actions and quality improvement in the hemotherapy services of the study. At the same time, the individual performance of each service was evaluated against the improvement cycle and the analysis of the spatial distribution of compliance and compliance levels according to the location of the services in the health regions of the state. Conclusions: When comparing the results of the two evaluations, the effectiveness of the improvement cycle in the eight hemotherapy services in the interior of the NB was demonstrated and demonstrated that the use of quality management strategies and tools was useful to identify priorities for improvement and improvement specific problems, with a view to the quality of hemotherapy products and processes, as well as transfusion safety. The Health Surveillance initiative as a regulatory and supervisory body in the hemotherapy services was fundamental to boost and monitor improvement processes, understanding that quality management and evaluation are mandatory requirements that must be met by such services, as determined by legislation sanitary legislation.