Ligia Marcia Contrin

Eventos adversos na assistência de enfermagem em uma unidade de terapia intensiva

ABSTRACT Objective: The existence of adverse events may simplify the inquiry regarding the quality of nursing care, presuming a foregrounding role in evaluating health services. The aim of the study was to identify the adverse events in nursing care occurring at an intensive care unit. Methods: Data were collected using a proper form kno-wn as problem-oriented record (POR) over a 10-month pe-riod; patients were monitored throughout their intensive care unit stay. Results: Over the study period, 550 adverse events were recorded as follows: 26 concerned to the “five rights” related to the administration of drugs; 23 to non-administered me-dications; 181 to inappropriate medication recordings; 28 to failure in infusion pump assembly; 17 to inhalation not per-formed; 8 to incorrect handling of needles and syringes; 53 to nursing processes not performed; 46 to incorrect handling of therapeutic devices and diagnosis; 37 to alarms/warnings of devices used incorrectly; and 131 to failure in data recor-ding by nurses.

Tempo de chegada do paciente com infarto agudo do miocárdio em unidade de emergência

OBJECTIVES To characterize the profile of patients with acute myocardial infarction (AMI) treated at the emergency department and to verify the time of arrival of each patient (ΔT). Identify how the patient was transported and to correlate Delta-T (ΔT) with the treatment and the prognosis of each patient. METHODS Cross-sectional survey involving 52 patients with AMI admitted to the Emergency Department of a Teaching Hospital took part in the study from July to December 2010. Data collection was performed using medical records and interviews. RESULTS The majority of the patients were male with a mean age of 62.35 ± 14.66 years. The participants were married, with low education levels, family history of heart diseases, arterial hypertension, dyslipidemia, and a sedentary lifestyle. The symptoms presented were pains in the chest, epigastric region, or a chest discomfort associated to dyspnea and/or sudden sweating. The majority of the patients were transported by ambulance. They were submitted to cardiac catheterization followed by angioplasty. Delta-T found was 9h45min ± 18h9min. In this study, the overall lethality was 3.85%. CONCLUSIONS The perception of signs and symptoms of AMI by the patient was a decisive factor when seeking out specialized treatment. Those with the lowest Delta-T presented better prognosis.

Quality of Life of Severe Sepsis Survivors After Hospital Discharge

OBJETIVO: Evaluacion de la calidad de vida de los sobrevivientes de sepsis grave con los instrumentos EuroQol-5D y la Escala Analogica Visual (EQ-VAS). METODO: Estudio caso-control anidado en pacientes que recibieron alta de la unidad de cuidados intensivos (UCI) de un hospital de ensenanza despues de la admision con sepsis grave. La seleccion fue realizada a partir del registro de sepsis conteniendo 349 pacientes y cada paciente con sepsis fue considerado como un caso y el que fue hospitalizado inmediatamente despues fue seleccionado como control, desde que no tuviera sepsis y hubiera sobrevivido a la hospitalizacion en la UCI y la sepsis, totalizando 100 sujetos. RESULTADOS: El grupo de sepsis mostro una mayor mortalidad a 1 ano comparado con los pacientes en estado critico pero sin sepsis en el grupo control. Los pacientes ancianos (>60 anos) con sepsis tuvieron una prevalencia significativamente mayor de problemas. No hubo diferencias en EQ-VAS entre los entrevistados de ambos grupos. CONCLUSIONES: Despues del alta de la UCI, los pacientes que sobrevivieron a la sepsis tuvieron una tasa de mortalidad mas alta que los pacientes sin enfermedad critica. Pacientes ancianos con sepsis tuvieron problemas moderados y graves en todas las cinco dimensiones de calidad de vida evaluadas.AIMS to evaluate the quality of life in severe sepsis survivors, using specific QoL questionnaires: the EuroQol-5 Dimensions and the Visual Analogue Scale (EQ-VAS). METHOD This case-control study was performed in patients discharged from a teaching hospital after being admitted to the ICU with severe sepsis. Medical records from 349 patients were retrieved from the hospital sepsis registry. Each patient with sepsis was considered as a case. Patients who were admitted immediately after the sepsis episode were considered as controls, provided that they did not have sepsis and survived the ICU admission. This specific study population included 100 patients. RESULTS The sepsis group showed higher mortality at 1 year compared with critically ill patients. However, the control group showed no sepsis. Older patients (>60 years) in the sepsis group had a significantly higher prevalence of problems. There were no differences in EQ-VAS between respondents from both groups. CONCLUSIONS After discharge from ICU, sepsis survivors of sepsis had a higher mortality rate than critically ill patients without sepsis. Older patients with sepsis had more moderate and severe problems in all five quality of life dimensions evaluated.

Incidence of phlebitis in adult patients

ABSTRACT Objective: to verify the incidence of phlebitis in adult patients associated with sociodemographic characteristics, hospitalization and venous puncture. Method: quantitative, descriptive, retrospective study performed at a sentinel hospital, reporting adverse events in the electronic medical record, totaling 176. The mean and standard deviation for the quantitative variables were calculated. The incidence of phlebitis was calculated using absolute numbers and percentage. Opinion 1,050,829. Results: the mean incidence of phlebitis was 14.66 at 12 months. The majority of the patients were men aged between 61 and 80 years, white, married, with incomplete elementary school, retired, Catholic, of the Unified Health System, with hospitalization <15 days and peripheral venous puncture with time <72h of insertion. Most nurses did not specify the prescribed drug. Conclusion: phlebitis occurred in patients with time of hospitalization <15 days and venous puncture <72h. Most of the drugs were not specified but, when described, it was irritating. The procedure was to remove and replace the puncture and the patients were discharged. This study demonstrated the need for correct notification of phlebitis by nurses in order to assess risks to improve patient safety. Descritores : Notification; Phlebitis; Patient; Nursing: Hospitals, Teaching; Nursing Care. RESUMO Objetivo : verificar a incidencia de flebites em pacientes adultos associando com caracteristica sociodemografica, internacao hospitalar e puncao venosa. Metodo : estudo quantitativo, descritivo, retrospectivo, realizado em um hospital da rede sentinela, por meio da notificacao de eventos adversos no prontuario eletronico, totalizando 176. Foram calculados a media e o desvio padrao para as variaveis quantitativas. A incidencia de flebites foi calculada usando-se numeros absolutos e porcentagem. Parecer 1.050.829. Resultados : a incidencia media de flebite foi 14,66 em 12 meses. A maioria dos pacientes era de homens, entre 61 e 80 anos, branca, casada, com ensino fundamental incompleto, aposentada, catolica, do Sistema Unico de Saude, com internacao <15 dias e puncao venosa periferica com tempo <72h de insercao. A maioria dos enfermeiros nao especificou a droga prescrita. Conclusao : a flebite ocorreu em pacientes com tempo de internacao <15 dias e puncao venosa <72h. A maioria das drogas nao foi especificada, mas, quando descrita, era irritante. A conduta foi a retirada e a troca da puncao e os pacientes receberam alta hospitalar. Este estudo demonstrou a necessidade da notificacao correta de flebite pelos enfermeiros a fim de avaliar os riscos para melhorar a seguranca do paciente. Descritores : Notificacao; Flebite; Paciente; Enfermagem; Hospital de Ensino; Assistencia de Enfermagem. RESUMEN Objetivo: verificar la incidencia de flebitis en pacientes adultos asociando con caracteristica sociodemografica, internacion hospitalaria y puncion venosa. Metodo: estudio cuantitativo, descriptivo, retrospectivo, realizado en un hospital de la red centinela, por medio de la notificacion de eventos adversos en el prontuario electronico, totalizando 176. Se calcularon la media y la desviacion estandar para las variables cuantitativas. La incidencia de flebitis fue calculada, usando numeros absolutos y porcentaje. Dictamen 1.050.829 . Resultados : la incidencia media de flebitis fue 14,66 en 12 meses. La mayoria de los pacientes eran hombres, entre 61 y 80 anos, blancas, casadas, con ensenanza fundamental incompleta, jubilada, catolica, del Sistema Unico de Salud, con internacion <15 dias y puncion venosa periferica con tiempo <72h de insercion. La mayoria de las enfermeras no especifico la droga prescrita. Conclusion: la flebitis ocurrio en pacientes con tiempo de internacion <15 dias y puncion venosa <72h. La mayoria de las drogas no fueron especificadas, pero cuando se describian eran irritantes. La conducta fue retirada y el intercambio de la puncion y los pacientes recibieron alta hospitalaria. Este estudio demostro la necesidad de la notificacion correcta de flebitis por los enfermeros, a fin de evaluar los riesgos para mejorar la seguridad del paciente . Descritores : Notificacion; Flebitis; Paciente; Enfermeria; Hospitales de Ensenanza; Atencion de Enfermeria.

DIAGNÓSTICO DE SEPSE EM PACIENTES APÓS INTERNAÇÃO EM UNIDADE DE TERAPIA INTENSIVA

Introduction: Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Patients with sepsis (formerly called severe sepsis) should still be identified by the same organ dysfunction criteria (including lactate level greater than 2 mmol/L). Organ dysfunction may also be identified in the future using the quick Sepsis-Related Organ Failure Assessment (qSOFA). Currently, sepsis is one of the main causes of mortality in Intensive Care Units. In 2003, the Sepsis Surviving Campaign was created, elaborating a schedule of actions to reduce the incidence of sepsis, especially in intensive care units. Objective: To know the clinical characteristics and outcome of patients who developed sepsis during Intensive Care Units admission. Material and Methods: This is a retrospective, descriptive study using a quantitative approach performed at the Intensive Care Units. Data were obtained through an electronic medical record. The software Epi Info, version 7.2.1.0 was used to analyze data. Results: The largest number of patients hospitalized was male, aged from 51 to 70 years. The most common comorbidities were Systemic Hypertension, Diabetes Mellitus, alcoholism, smoking, and heart disease. The most analyzed post-sepsis outcome was discharge from Intensive Care Units, and the patients were considerably males. Conclusion: We conclude that the patients who most developed sepsis were men (62%), aged ranging from 51 to 70 years (36%). The main comorbidity was systemic hypertension (42%) and the most observed outcome was discharge from the Intensive Care Units (67%). Descriptors: Sepsis, Diagnosis, Intensive Care Units, Patients, Hospitalization.

Calidad de vida de sobrevivientes de sepsis grave después del alta hospitalar

OBJETIVO: Evaluacion de la calidad de vida de los sobrevivientes de sepsis grave con los instrumentos EuroQol-5D y la Escala Analogica Visual (EQ-VAS). METODO: Estudio caso-control anidado en pacientes que recibieron alta de la unidad de cuidados intensivos (UCI) de un hospital de ensenanza despues de la admision con sepsis grave. La seleccion fue realizada a partir del registro de sepsis conteniendo 349 pacientes y cada paciente con sepsis fue considerado como un caso y el que fue hospitalizado inmediatamente despues fue seleccionado como control, desde que no tuviera sepsis y hubiera sobrevivido a la hospitalizacion en la UCI y la sepsis, totalizando 100 sujetos. RESULTADOS: El grupo de sepsis mostro una mayor mortalidad a 1 ano comparado con los pacientes en estado critico pero sin sepsis en el grupo control. Los pacientes ancianos (>60 anos) con sepsis tuvieron una prevalencia significativamente mayor de problemas. No hubo diferencias en EQ-VAS entre los entrevistados de ambos grupos. CONCLUSIONES: Despues del alta de la UCI, los pacientes que sobrevivieron a la sepsis tuvieron una tasa de mortalidad mas alta que los pacientes sin enfermedad critica. Pacientes ancianos con sepsis tuvieron problemas moderados y graves en todas las cinco dimensiones de calidad de vida evaluadas.AIMS to evaluate the quality of life in severe sepsis survivors, using specific QoL questionnaires: the EuroQol-5 Dimensions and the Visual Analogue Scale (EQ-VAS). METHOD This case-control study was performed in patients discharged from a teaching hospital after being admitted to the ICU with severe sepsis. Medical records from 349 patients were retrieved from the hospital sepsis registry. Each patient with sepsis was considered as a case. Patients who were admitted immediately after the sepsis episode were considered as controls, provided that they did not have sepsis and survived the ICU admission. This specific study population included 100 patients. RESULTS The sepsis group showed higher mortality at 1 year compared with critically ill patients. However, the control group showed no sepsis. Older patients (>60 years) in the sepsis group had a significantly higher prevalence of problems. There were no differences in EQ-VAS between respondents from both groups. CONCLUSIONS After discharge from ICU, sepsis survivors of sepsis had a higher mortality rate than critically ill patients without sepsis. Older patients with sepsis had more moderate and severe problems in all five quality of life dimensions evaluated.

Qualidade de vida de sobreviventes de sepse grave após alta hospitalar

OBJETIVO: Evaluacion de la calidad de vida de los sobrevivientes de sepsis grave con los instrumentos EuroQol-5D y la Escala Analogica Visual (EQ-VAS). METODO: Estudio caso-control anidado en pacientes que recibieron alta de la unidad de cuidados intensivos (UCI) de un hospital de ensenanza despues de la admision con sepsis grave. La seleccion fue realizada a partir del registro de sepsis conteniendo 349 pacientes y cada paciente con sepsis fue considerado como un caso y el que fue hospitalizado inmediatamente despues fue seleccionado como control, desde que no tuviera sepsis y hubiera sobrevivido a la hospitalizacion en la UCI y la sepsis, totalizando 100 sujetos. RESULTADOS: El grupo de sepsis mostro una mayor mortalidad a 1 ano comparado con los pacientes en estado critico pero sin sepsis en el grupo control. Los pacientes ancianos (>60 anos) con sepsis tuvieron una prevalencia significativamente mayor de problemas. No hubo diferencias en EQ-VAS entre los entrevistados de ambos grupos. CONCLUSIONES: Despues del alta de la UCI, los pacientes que sobrevivieron a la sepsis tuvieron una tasa de mortalidad mas alta que los pacientes sin enfermedad critica. Pacientes ancianos con sepsis tuvieron problemas moderados y graves en todas las cinco dimensiones de calidad de vida evaluadas.AIMS to evaluate the quality of life in severe sepsis survivors, using specific QoL questionnaires: the EuroQol-5 Dimensions and the Visual Analogue Scale (EQ-VAS). METHOD This case-control study was performed in patients discharged from a teaching hospital after being admitted to the ICU with severe sepsis. Medical records from 349 patients were retrieved from the hospital sepsis registry. Each patient with sepsis was considered as a case. Patients who were admitted immediately after the sepsis episode were considered as controls, provided that they did not have sepsis and survived the ICU admission. This specific study population included 100 patients. RESULTS The sepsis group showed higher mortality at 1 year compared with critically ill patients. However, the control group showed no sepsis. Older patients (>60 years) in the sepsis group had a significantly higher prevalence of problems. There were no differences in EQ-VAS between respondents from both groups. CONCLUSIONS After discharge from ICU, sepsis survivors of sepsis had a higher mortality rate than critically ill patients without sepsis. Older patients with sepsis had more moderate and severe problems in all five quality of life dimensions evaluated.