Avaliação da segurança do paciente no cuidado de enfermagem em Unidades de Terapia Intensiva Neonatais: uso de protocolo gráfico e checklist

Abstract

This study aimed to evaluate patient safety in nursing care through a graphic protocol and checklist in Neonatal Intensive Care Units. Evaluative research with a quantitative multimethod approach, conducted in six hospitals of the metropolitan region of Natal / RN / Brazil. The study was subdivided into three methodological steps: 1) Identification and mapping of patient safety in the neonatal intensive care unit, based on a scoping review; 2) Elaboration of a safe care evaluation instrument, with subsequent validation of content and appearance; 3) Evaluation of safe nursing care through a quasi-experimental study, before-after type, with intervention. In step 1, the essential elements for safe nursing care were listed. The construction of the instruments (graphic protocol and checklist) was based on the structure-process-result triad, with adaptations for neonatal care, supported by scoping review data. To validate the content and appearance of the instruments, the Delphi technique was used, divided into two steps (Delphi 1 and 2) and the relevance of the items was judged by the result of the Content Validation Coefficient. In step 3, the measurement of patient safety took place in the form of pre and post-test, interspersed by an intervention in neonatal units, from January to July 2019 through non-participant observation of two trained evaluators and no interaction between them. The results were analyzed by descriptive statistics; thus, the classification of care was performed based on the score listed in the graphics protocol. All ethical precepts were respected and the project received approval from the Research Ethics Committee of the Federal University of Rio Grande do Norte. Scoping review resulted in a total of 87 scientific productions, whose themes were subdivided into Adverse Event Investigation (49; 56.3%) and Assessment / Implementation of Safe Practices (38; 43.7%). The construction of the protocol was based on these results. A structured checklist script was elaborated, consisting of ten items and 111 sub-items about the elements "structure, process and result". The protocol was considered valid for content, with the Content Validity Coefficient of 0.97 in the second Delphi round. The overall estimate of the instrument for appearance validation was 0.99 at Delphi II. Besides, 100% of the judges recommended the use of the protocol after the inclusion of suggested changes. In step 3, the element process presented the best compliance percentage, above 50% for all neonatal units. The processing element varied so that those services that did not have an active patient safety center had their items considered inadequate (below 50% of compliance) in three services at the first evaluation. The result element had the highest number of inadequacies (below 50% compliance in three intensive care units). In the metropolitan region of Natal, prevailed the partially safe care, evidenced by 83.3% of NICUs with protocol scores between 7 and 13. In conclusion, in the services investigated, nursing care is partially safe. Moreover, the evaluation, through the graphic protocol, was essential to identify problems that impact the safety of newborns. Similarly, the intervention played an important role in achieving improvements. However, these actions must occur continuously to subsidize the practice of nursing professionals in the face of harm reduction.