Dificuldades na aplicação do checklist cirúrgico: estudo qualitativo de abordagem ecológica restaurativa

Resumo

Objetivo: analisar a aplicação do checklist da cirurgia segura, buscando descrever os principais fatores que podem afetar seu preenchimento e seguimento, segundo a percepção de técnicos de enfermagem. Método: estudo qualitativo, realizado com técnicos de enfermagem de um centro cirúrgico ambulatorial, do sul do Brasil. Os dados foram coletados por meio de grupos focais e métodos fotográficos, na perspectiva do pensamento ecológico e restaurativo. Resultados: do agrupamento das informações emergiram três categorias: Checklist para a segurança do paciente: ainda um desafio; Dificuldade de adesão ao checklist da cirurgia segura; e Etapas do checklist. Discussão: os dados indicam que algumas etapas desse processo ainda não são cumpridas e encontra-se dificuldade de adesão pelas equipes. Conclusões: entre as principais falhas levantadas, encontra-se a baixa adesão da equipe médica para realização do time out e para marcação de confirmação do local do procedimento. A abordagem ecológica restaurativa oportunizou o engajamento dos profissionais.
https://doi.org/10.17665/1676-4285.20175887
HTML (English)
HTML (Español (España))
HTML
EPUB
EPUB (English)
EPUB (Español (España))
PDF
PDF (English)
PDF (Español (España))

Referências

Spruce L. Back to basics: implementing the surgical checklist. [Internet]. AORN J. 2014; 100(5):465-73; quiz 474-6. [cited 2015 sep. 15]. Available from: http://www.aornjournal.org/article/S0001-2092%2814%2900877-1/pdf. doi: http://dx.doi.org/10.1016/j.aorn.2014.06.020

Wilson RM, Michel P, Olsen S, Gibberd RW, Vincent C, El-Assady R, Rasslan O, Qsous S, Macharia WM, Sahel A, Whittaker S, Abdo-Ali M, Letaief M, Ahmed NA, Abdellatif A, Larizgoitia I; WHO Patient Safety EMRO/AFRO Working Group. Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital. [Internet]. BMJ. 2012; 344:e832. [cited 2015 nov. 10]. Available from: http://www.bmj.com/content/344/bmj.e832.full.pdf. doi: 10.1136/bmj.e832

Haugen AS, Søfteland E, Almeland SK, Sevdalis N, Vonem B, Eide GE, et. al.

Effect of the World Health Organization Chekclist on Patient Outcomes- A stepped wedge cluster randomized controlled trial. [Internet]. Ann Surg. 2015;261(5):821-828. [cited 2016 oct. 30]. Available from: http://journals.lww.com/annalsofsurgery/toc/2015/05000. doi: 10.1097/SLA.0000000000000716

Borchard A, Schwappach DL, Barbir A, Bezzola P. A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery. [Internet]. Ann Surg. 2012; 256(6):925-33. [cited 2015 jun. 20]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22968074. doi: 10.1097/SLA.0b013e3182682f27

Joint commission international. National patient safety goals effective. 2013. [cited 2015 nov. 11]. Available from: http://www.jointcommission.org/hap_2014_npsgs

Walker A, Reschamwalla S, Wilson IH. Surgical safety checklists: do they improve outcomes? [Internet]. BrJAnaesth. 2012; 109(1):47-54. [cited 2015 jul. 11]. Available from: http://bja.oxfordjournals.org/content/109/1/47.full.pdf. doi:10.1093/bja/aes175

Cruz YL, Algonso PM, Pérez ACD. Seguridad del paciente en la cirugía refractiva con láser. [Internet]. Revista Cubana de Oftalmología. 2012; 25(1):57-64. [cited 2015 aug. 23] Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21762012000100008&lng=es.

Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, et. al. Safe Surgery Saves Lives Study Group. Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention. [Internet]. BMJ Qual Saf. 2011; 20(1):102-7. [cited 2015 mar. 8]. Available from: http://qualitysafety.bmj.com/content/20/1/102.full.pdf. doi:10.1136/bmjqs.2009.040022

BRASIL. Documento de referência para o Programa Nacional de Segurança do Paciente. [Internet]. Brasília: Ministério da Saúde, 2014. [cited 2015 oct 20]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/documento_referencia_programa_nacional_seguranca.pdf

Marck PB, Molzahn A, Berry-Hauf R, Hutchings LG, Hughes S. Exploring safety and quality in a hemodialysis environment with participatory photographic methods: a restorative approach. [Internet]. Nephrol Nurs J. 2014; 41 (1): 25-35. [cited 2015 mar. 15]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24689262

Ray JL, Smith AD. Using photographs to research organizations: evidence, considerations, and application in a field study. [Internet]. Organizational Research Methods. 2012; 15 (2): 288-315. [cited 2014 may. 13]. Available from: http://orm.sagepub.com/content/early/2011/12/19/1094428111431110.full.pdf. doi:10.1177/1094428111431110

Magalhães AMM, Dall’Agnol CM, Marck PB. Nursing workload and patient safety - a mixed method study with an ecological restorative approach. [Internet]. Rev. Latino-Am. Enfermagem. 2013; 21, Spec No: 146-154. [cited 2015 nov. 11]. Available from: http://www.scielo.br/pdf/rlae/v21nspe/19.pdf. doi.org/10.1590/S0104-11692013000700019

Minayo MC. [Qualitative analysis: theory, steps and reliability]. Cienc Saude Coletiva. 2012; 17(3):621-6. Portuguese.

BRASIL. Resolução nº 466/12. [Internet]. Brasília; 2012 [cited 2014 oct. 11]. Available from: http://conselho.saude.gov.br/resolucoes/2012/Reso466.pdf

Fourcade A, Blache JL, Grenier C, Bourgain JL, Minvielle E. Barriers to staff adoption of a surgical safety checklist. [Internet]. BMJ Qual Saf. 2011; 21(3):191-7. [cited 2015 mar. 15]. Available from: http://qualitysafety.bmj.com/content/early/2011/11/07/bmjqs-2011-000094.full.pdf. doi:10.1136/bmjqs-2011-000094

Maziero ECS, Silva AEBC, Mantovani MF, Cruz EDA. Adherence to the use of the surgical checklist for patient safety. [Internet]. Rev Gaúcha Enferm. 2015: 36(4):14-20. [cited 2015 dec. 10]. Available from: http://www.seer.ufrgs.br/RevistaGauchadeEnfermagem/article/viewFile/53716/35653. doi: http://dx.doi.org/10.1590/1983- 1447.2015.04.53716

Cullati S, Licker MJ, Francis P, Degiorgi A, Bezzola P, Courvoisier DS, et. al. Implementation of the Surgical Safety Checklist in Switzerland and Perceptions of Its Benefits: Cross-Sectional Survey. [Internet]. PLoS ONE. 2014, 9(7), e101915. [cited 2015 oct. 10]. Available from: http://journals.plos.org/plosone/article/asset?id=10.1371%2Fjournal.pone.0101915.pdf. doi:10.1371/journal.pone.0101915

Liza, S. Back to basics: implementing the surgical checklist. [Internet]. AORN J. 2014; 100(5):465-73. [cited 2015 nov. 18]. Available from: http://www.aornjournal.org/article/S0001-2092%2814%2900877-1/pdf. doi: http://dx.doi.org/10.1016/j.aorn.2014.06.020

Gimenes FR, Marck PB, Atila EG, Cassiani SH. Engaging nurses to strengthen medication safety: fostering and capturing change with restorative photographic research methods. [Internet]. Int J Nurs Pract. 2014. Epub ahead of print.[cited 2015 dez. 10]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24724623. doi:10.1111/ijn.12304

Papaconstantinou HT, Jo C, Reznik SI, Smythe WR, Wehbe-Janek H. Implementation of a Surgical Safety Checklist: Impact on Surgical Team Perspectives. [Internet]. The Ochsner Journal. 2013; 13(3), 299–309.[cited 2015 nov. 15]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776503/pdf/i1524-5012-13-3-299.pdf.