Ariane Ferreira Machado Avelar

Interruptions of nurses' activities and patient safety: an integrative literature review

Objetivos: identificar caracteristicas relacionadas a la interrupcion que sufren los enfermeros en su practica profesional, asi como evaluar las implicaciones para la seguridad del paciente. Metodo: fue realizada una revision de literatura de tipo integradora, con busqueda en las bases de datos Pubmed/Medline, LILACS, SciELO y Biblioteca Cochrane, utilizando los descriptores interruptions y patient safety. La fecha inicial no fue limitada y la fecha final fue 31 de diciembre de 2013, se identificaron 29 articulos que atendieran a los criterios de inclusion. Resultados: todos los articulos revisados describieron la interrupcion como un factor perjudicial a la seguridad del paciente. El analisis de estos estudios revelo tres categorias relevantes: caracteristicas de la interrupcion, implicaciones de la interrupcion para la seguridad del paciente e intervenciones para minimizar las interrupciones. Conclusion: la interrupcion favorece la ocurrencia de errores en la salud. Asi, se noto la necesidad de realizar nuevas investigaciones para comprender ese fenomeno y los efectos del mismo en la practica clinica.Descriptores: Enfermeria; Seguridad del Paciente; Ingenieria Humana.OBJECTIVES: to identify characteristics related to the interruption of nurses in professional practice, as well as to assess the implications of interruptions for patient safety. METHOD: integrative literature review. The following databases were searched: Pubmed/Medline, LILACS, SciELO and Cochrane Library, using the descriptors interruptions and patient safety. An initial date was not established, but the final date was December 31, 2013. A total of 29 papers met the inclusion criteria. RESULTS: all the papers included describe interruptions as a harmful factor for patient safety. Data analysis revealed three relevant categories: characteristics of interruptions, implications for patient safety, and interventions to minimize interruptions. CONCLUSION: interruptions favor the occurrence of errors in the health field. Therefore, there is a need for further studies to understand such a phenomenon and its effects on clinical practice.

Predisposing factors for peripheral intravenous puncture failure in children.

Objetivo: Verificar factores predisponentes para el fracaso de la puncion intravenosa periferica realizada en ninos. Metodo: Estudio de cohorte transversal realizado con 335 ninos internados en unidad pediatrica de un hospital universitario, despues de la aprobacion del merito etico. Se utilizaron testes Jue-cuadrado de Wald, Razon de Superioridad (RP) y procedimiento de backward (p≤0,05). Resultados: se evidencio exito de la puncion en 300 (89,5%) ninos e fracaso en 35 (10,4%). Influenciaron significantemente las proporciones de fracaso: presentar historia clinica para dificultad en la puncion, estar desnutrido, uso previo de cateter central de insercion periferica, uso previo de cateter venoso central y antecedentes de flebitis y de infiltracion. En el modelo multivariado, estar desnutrido y haber sido sometido antepasadamente a cateterizacion venosa central fueron los factores predisponentes para el fracaso. Conclusiones: La proporcion del 10,4% de fracaso en la puncion es analogo a la identificada en estudios sobre la tematica y fue influenciada por caracteristicas del nino y de la terapia. En asociacion, a las variables desnutricion y uso previo de cateter venoso central fueron a las caracteristicas mas importantes para el aumento de la proporcion de fracaso de la puncion intravenosa periferica. Este estudio trae nuevas evidencias sobre los factores de riesgo que aportan para el fracaso en la puncion intravenosa periferica de ninos, constituyendo aspecto a ser considerado en la planificacion y ejecucion de la practica asistencial de enfermeria pediatrica, con vistas a la obtencion de mejores resultados en la puncion intravenosa periferica y promocion de la seguridad del paciente.Descriptores: Enfermeria Pediatrica; Cateterismo Periferico; Seguridad del Paciente; Pediatria.OBJECTIVE To identify predisposing factors for peripheral intravenous puncture failure in children. METHODS Cross-sectional cohort study conducted with 335 children in a pediatric ward of a university hospital after approval of the ethics committee. The Wald Chi-squared, Prevalence Ratio (PR) and backward procedure (p≤0.05) tests were applied. RESULTS Success of peripheral intravenous puncture was obtained in 300 (89.5%) children and failure in 35 (10.4%). The failure rates were significantly influenced by: presence of clinical history of difficult venous access, malnourishment, previous use of peripherally inserted central venous catheter, previous use of central venous catheter, and history of phlebitis or infiltration. In the multivariate model, being malnourished and having previously been submitted to central venous catheterization were the predisposing factors for the failure. CONCLUSION The failure rate of 10.4% is similar to that identified in analogous studies and was influenced by characteristics of the children and intravenous therapy. In association with this, malnutrition and previous use of a central venous catheter were the most important variables influencing increase in peripheral intravenous puncture failure.

Risk Factors for Ventilator-Associated Pneumonia in Infants and Children: a Cross-sectional Cohort Study

BACKGROUND The epidemiology of ventilator-associated pneumonia is well described for adults, but little information is available on risk factors for this disease in children. OBJECTIVE To identify predisposing factors for ventilator-associated pneumonia in children. METHODS A cross-sectional prospective cohort study of 96 patients in a 9-bed pediatric intensive care unit was performed. Variables examined were demographic characteristics, inpatient care, medications, nutrition, invasive procedures, and characteristics of mechanical ventilation. Data were analyzed by using Pearson χ(2) analysis, Fisher exact and Mann-Whitney tests, odds ratios, and forward stepwise logistic regression. RESULTS Occurrence of ventilator-associated pneumonia correlated positively with use of nasoenteral tubes (odds ratio, 5.278; P < .001), intermittent administration of nutritional formula (odds ratio, 6.632; P = .005), emergency reintubation (odds ratio, 2.700; P = .02), use of vasoactive drugs (odds ratio, 5.108; P = .009), duration of mechanical ventilation (P < .001), and length of stay in the pediatric intensive care unit (P < .001) and in the hospital (P = .01). CONCLUSION Use of vasoactive drugs, presence of a nasoenteral tube, and duration of stay in the pediatric intensive care unit were independent risk factors for ventilator-associated pneumonia.

Compreensão de alunos de cursos de graduação em enfermagem e medicina sobre segurança do paciente

OBJECTIVE: Prospective and exploratory study in order to identify the comprehension of nursing and medicine students from a public university of Sao Paulo regarding human error and patient safety. METHODS: It was investigated variables concerning the characterization of students and, attitudinal and conceptual aspects. The study sample was composed by 109 students who answered an electronic form. RESULTS: The majority of students answered that they had had formal learning about patient safety and show actions that demonstrate uncertainty about what would be correct in some practices. CONCLUSION: It is concluded that students understand and associate some aspects from formal learning about the theme patient safety to experiences during curricular stages.

Assessment of phlebitis, infiltration and extravasation events in neonates submitted to intravenous therapy

O objetivo deste estudo foi descrever a ocorrencia de flebite, infiltracao e extravasamento em recem-nascidos internados na unidade de terapia intensiva neonatal de uma maternidade publica do Rio de Janeiro. Trata-se de um estudo quantitativo descritivo com 36 recem-nascidos em uso de terapia intravenosa e com indicacao de remocao do dispositivo intravenoso periferico. Foram avaliados 50 sitios de puncao imediatamente apos a remocao de cateteres perifericos originando uma media de 1,40 puncoes venosas por neonato. As complicacoes foram responsaveis por 48% da remocao dos cateteres, antes da alta do tratamento, com predominio de infiltracao (79,2%), seguida por flebite (16,7%) e extravasamento (4,2%). A fim de se evitar os agravos e promover a seguranca dos recem-nascidos submetidos a terapia intravenosa, a equipe de enfermagem deve avaliar periodicamente o acesso venoso periferico e obter conhecimento acerca das intervencoes necessarias quando detectados sinais de complicacoes.

Capacitação de enfermeiros para uso da ultrassonografia na punção intravascular periférica

Este articulo relata la estrategia de capacitacion de enfermeros en el uso de la ultrasonografia vascular en la obtencion del acceso vascular periferico. El programa estuvo compuesto por intervenciones educacionales teoricas y practicas desarrolladas en un periodo de seis meses. Las estrategias fueron elaboradas e implementadas por dos enfermeros especialistas en terapia intravascular, un medico especialista en ultrasonografia vascular y, un ingeniero biomedico. Ocho enfermeros participaron de la capacitacion. Al final, los conocimientos, las competencias y habilidades adquiridas en la identificacion de arterias, venas, flujo sanguineo y posicion de cateteres, fueron evaluados. La estrategia posibilito que los enfermeros pediatras adquiriesen competencias capaces de promover intervenciones innovadoras en la puncion intravascular periferica.

Flebite associada a cateteres intravenosos periféricos em crianças: estudo de fatores predisponentes

Objective: To identify risk factors for phlebitis related to peripheral intravenous catheters (PIC) in children. Methods: A retrospective cohort study conducted in 338 children submitted to intravenous. The variables related to the children and intravenous therapy were investigated, after approval of the ethical merit. Results: From 338 children, nine (2.7%) developed phlebitis. None of the demographic characteristics influenced significantly the development of phlebitis. Regarding to the therapy, there were significant: the use of the PIC for more than five days (p = 0.001), intermittent maintenance (p = 0.001) and greater time permanence of the PIC (p = 0.006). The risk factors were: the presence of predisposing conditions to puncture failure (p = 0.041, OR = 4.645), history of complications (p < 0.001, OR = 40.666); administration of drugs or solutions with extreme pH and osmolarity (p = 0.004, OR = 7.700). Conclusion: The occurrence of the phlebitis did not showed association with demographic characteristics and therapy aspects that represent risk factors, were predisposing conditions for puncture failure, previous complications, drugs administration and solutions with pH extremes and osmolarity.Objetivo: Identificar los factores de riesgo para flebitis relacionada con cateteres venosos perifericos (CVP) en ninos. Metodos: Estudio de cohorte, retrospectivo, realizado en 338 ninos sometidos a puncion venosa. Fueron investigadas variables relacionadas con los ninos y con la terapia intravenosa, despues de aprobacion etica. Resultados: De los 338 ninos, nueve (2,7%) tuvieron flebitis. Ninguna caracteristica demografica influencio significantemente el desarrollo de flebitis. Cuanto a la terapia, fueron significativas: uso de CVP por mas de cinco dias (p = 0,001); mantenimiento intermitente (p = 0,001); y permanencia mas larga (p = 0,006). Representaron factores de riesgo: condiciones que predisponen el fracaso de la puncion (p = 0,041, OR = 4,645); e historico de complicaciones (p < 0,001, OR = 40,666); administracion de farmacos o soluciones de pH y la osmolaridad altos (p = 0,004, OR = 7,700). Conclusion: Las caracteristicas demograficas no influenciaron la ocurrencia de flebitis y los factores de riesgo fueron la presencia de condiciones predisponentes para el fracaso de la puncion, complicaciones anteriores, la administracion de medicamentos y soluciones con pH extremos y osmolaridad.

Higienização das mãos e a segurança do paciente: perspectiva de docentes e universitários

Quantitative exploratory study with the objective to identify the perspectives of professors and undergraduate students on aspects regarding hand hygiene and healthcare associated infections in their daily care practice. The study instrument was a questionnaire with seven statements related to the studied theme, which was answered by 109 undergraduate students and 53 professors at a public university in Sao Paulo, Brazil. Significant disagreement between the two groups was observed in regard to the statement that internship settings make supplies available at points that promote hand hygiene practices (p=0.02), while significant agreement (p<0.01) was observed in regard to the unavailability of alcohol-based handrub preparation for hand hygiene. Practical activities developed by the professors and undergraduate students take place at locations where there is not proper infrastructure for recommended hand hygiene practices, which may contribute to lapses in the care process and compromise patient safety.

Avaliação polissonográfica do sono e vigília de recém-nascidos prematuros

OBJECTIVE to describe the total sleep time and its stages, total wake time, heart rate values and oxygen saturation shown by premature infants, and the influence of the periods of the day on sleep and physiological parameters. METHOD a descriptive study was conducted of 13 hospitalized premature infants. Data collection was performed using polysomnography and unstructured observation for 24 uninterrupted hours. RESULTS the newborns remained asleep for 59.6% of the day, predominantly in quiet sleep, with a higher mean heart rate during wakefulness (p<0.001). No difference was found between the variables related to sleep, physiological parameters and periods of the day, but in the morning a predominance of quiet sleep was observed (p=0.002). CONCLUSION the preterm newborn presented more total sleep time than wakefulness; quiet sleep was the predominant stage, and heart rate was higher during wakefulness.

Interrupções de atividades de enfermeiros e a segurança do paciente: revisão integrativa da literatura

Objetivos: identificar caracteristicas relacionadas a la interrupcion que sufren los enfermeros en su practica profesional, asi como evaluar las implicaciones para la seguridad del paciente. Metodo: fue realizada una revision de literatura de tipo integradora, con busqueda en las bases de datos Pubmed/Medline, LILACS, SciELO y Biblioteca Cochrane, utilizando los descriptores interruptions y patient safety. La fecha inicial no fue limitada y la fecha final fue 31 de diciembre de 2013, se identificaron 29 articulos que atendieran a los criterios de inclusion. Resultados: todos los articulos revisados describieron la interrupcion como un factor perjudicial a la seguridad del paciente. El analisis de estos estudios revelo tres categorias relevantes: caracteristicas de la interrupcion, implicaciones de la interrupcion para la seguridad del paciente e intervenciones para minimizar las interrupciones. Conclusion: la interrupcion favorece la ocurrencia de errores en la salud. Asi, se noto la necesidad de realizar nuevas investigaciones para comprender ese fenomeno y los efectos del mismo en la practica clinica.Descriptores: Enfermeria; Seguridad del Paciente; Ingenieria Humana.OBJECTIVES: to identify characteristics related to the interruption of nurses in professional practice, as well as to assess the implications of interruptions for patient safety. METHOD: integrative literature review. The following databases were searched: Pubmed/Medline, LILACS, SciELO and Cochrane Library, using the descriptors interruptions and patient safety. An initial date was not established, but the final date was December 31, 2013. A total of 29 papers met the inclusion criteria. RESULTS: all the papers included describe interruptions as a harmful factor for patient safety. Data analysis revealed three relevant categories: characteristics of interruptions, implications for patient safety, and interventions to minimize interruptions. CONCLUSION: interruptions favor the occurrence of errors in the health field. Therefore, there is a need for further studies to understand such a phenomenon and its effects on clinical practice.