Mavilde da Luz Gonçalves Pedreira

Information technology and patient safety in nursing practice: an international perspective

Abstract When people become patients, they place their trust in their health care providers. As providers assume responsibility for their diagnosis and treatment, patients have a right to expect that this will include responsibility for their safety during all aspects of care. However, increasing epidemiological data make it clear that patient safety is a global problem. Improved nursing care may prevent many adverse events, and nursing must take a stronger leadership role in this area. Although errors are almost inevitable, safety can be improved, and health care institutions are increasingly making safety a top priority. Information technology provides safety benefits by enhancing communication and delivering decision-support; its use will likely be a cornerstone for improving safety. This paper will discuss the status of patient safety from an international viewpoint, provide case studies from different countries, and discuss information technology solutions from a nursing perspective.

Estudo dos acidentes na infância em um pronto socorro pediátrico

The aim of this study was identify cases of accidents victimizing children assisted at the emergence ward of a general hospital. Data were collected from January to March, 1999 through a protocol with variables related to the identification of the accidents as well as of the children. The sample in the study consisted of 890 children of whom 56.1% were males and 43.9% were females. The most prevalent accident was fall (46.9%), the age with a major incidence was between 7 and 11 years old, the parents were present to 43.4% of the cases. The children were discharged from hospital after being given care in 95.7% of the cases.The aim of this study was identify cases of accidents victimizing children assisted at the emergence ward of a general hospital. Data were collected from January to March, 1999 through a protocol with variables related to the identification of the accidents as well as of the children. The sample in the study consisted of 890 children of whom 56.1% were males and 43.9% were females. The most prevalent accident was fall (46.9%), the age with a major incidence was between 7 and 11 years old, the parents were present to 43.4% of the cases. The children were discharged from hospital after being given care in 95.7% of the cases.El objetivo de este estudio fue el de identificar los accidentes infantiles registrados en una unidad de Urgencias Pediatricas (UUP). Los datos fueron recolectados en el periodo de Enero a Marzo de 1999, utilizando un cuestionario que contenia datos sobre la identificacion del nino y del accidente. La poblacion estuvo conformada por 942 ninos y la muestra fue reducida para 890. Principales resultados: la faja etarea mas afectada fue la de 7 a 11 anos, siendo 56,1% del sexo masculino y 43,9% femenino; el tipo de accidente mas frecuente fue la caida (46,9%), los padres estaban presentes en 43,4% de los casos. En 95,7% de las ocurrencias, el nino recibio alta hospitalaria despues de ser tendido.

ADVERSE EVENTS RELATED TO THE USE OF PERIPHERAL INTRAVENOUS CATHETERS IN CHILDREN ACCORDING TO DRESSING REGIMENS

A randomized, controlled study was implemented to verify reasons to release and adverse events related to the use of peripheral intravenous catheters in children, according to the dressing regimens The sample was set at 150 peripheral intravenous catheters, randomly assigned to three groups: sterile gauze dressings, sterilized transparent film dressings, and non sterile hypoallergenic adhesive tape. The data was collected after consent had been obtained by the Ethics Committee, including children who had been submitted to catheterization with Teflon(R) over the needle catheters. Statistical tests were performed by applying the Pearson Chi-square test, significance level set at p < 0.05. The results showed that dressing regimens influenced the reasons for catheter removal and occurrence of adverse events, mainly due to infiltration (55.3%). The Sterile gauze showed the best performance (p=0.002) in comparison with the other studied groups, once 40.0% of the catheters were removed by release from treatment.Estudo randomizado e controlado que objetivou identificar motivos de retirada e eventos adversos relacionados ao uso de cateteres intravenosos perifericos em criancas segundo tipo de curativo. A amostra foi ajustada em 150 cateteres distribuidos em tres grupos, compostos por curativo com gaze esteril ou pelicula transparente e fixacao com fita adesiva hipoalergenica nao esteril. A coleta de dados ocorreu apos aprovacao do merito etico, incluindo-se no estudo criancas submetidas a puncao intravenosa periferica, com cateteres fora da agulha de Teflon®. Para analise de correlacao entre variaveis foi utilizado teste do Qui-quadrado de Pearson, sendo considerados significantes valores de p < 0,05. Os resultados evidenciaram que os curativos influenciaram os motivos de retirada do cateter e a ocorrencia de eventos adversos, destacando-se a infiltracao (55,3%). O curativo com gaze em comparacao com os outros grupos estudados apresentou menor proporcao de eventos adversos (p=0,002), sendo 40,0% dos cateteres retirados por alta do tratamento.

Oral Care Interventions and Oropharyngeal Colonization in Children Receiving Mechanical Ventilation

BACKGROUND Recent progress in identification of oral microorganisms has shown that the oropharynx can be a site of origin for dissemination of pathogenic organisms to distant body sites, such as the lungs. OBJECTIVE To compare the oropharyngeal microbiological profile, duration of mechanical ventilation, and length of stay in the intensive care unit of children receiving mechanical ventilation who had pharmacological or nonpharmacological oral care. METHODS A randomized and controlled study was performed in a pediatric intensive unit in São Paulo, Brazil. A total of 56 children were randomly assigned to an experimental group (n=27, 48%) that received oral care with use of 0.12% chlorhexidine digluconate or a control group (n=29, 52%) that received oral care without an antiseptic. Oropharyngeal secretions were collected and cultured on days 0, 2, and 4, and at discharge. RESULTS The 2 groups had similar demographic characteristics, preexisting underlying diseases, and pharmacological, nutritional, and ventilatory support. Gram-negative bacteria were the predominant pathogens: Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enter-obacter species. The 2 groups did not differ significantly in the colonization of normal (P= .72) or pathogenic (P= .62) flora, in the duration of mechanical ventilation (P= .67), or in length of stay in the intensive care (P= .22). CONCLUSION Use of chlorhexidine combined with nonpharmacological oral care did not decrease the colonization profile, duration of mechanical ventilation, or length of stay in critically ill children receiving mechanical ventilation.

Noise level in a pediatric intensive care unit

OBJECTIVE The purpose of this study was to verify the noise level at a PICU. METHODS This prospective observational study was performed in a 10 bed PICU at a teaching hospital located in a densely populated district within the city of São Paulo, Brazil. Sound pressure levels (dBA) were measured 24 hours during a 6-day period. Noise recording equipment was placed in the PICU access corridor, nursing station, two open wards with three and five beds, and in isolation rooms. The resulting curves were analyzed. RESULTS A basal noise level variation between 60 and 70 dBA was identified, with a maximum level of 120 dBA. The most significant noise levels were recorded during the day and were produced by the staff. CONCLUSION The basal noise level identified exceeds International Noise Council recommendations. Education regarding the effects of noise on human hearing and its relation to stress is the essential basis for the development of a noise reduction program.

Nível de ruídos em uma unidade de cuidados intensivos pediátricos

OBJETIVO: Verificar o nivel de ruidos em uma unidade de cuidados intensivos pediatricos. METODOS: Estudo observacional e prospectivo realizado em uma unidade de cuidados intensivos pediatricos de 10 leitos de um hospital universitario da cidade de Sao Paulo, Brasil. Os niveis de ruidos foram medidos por meio de equipamento instalado no corredor de acesso a unidade de cuidados intensivos pediatricos, posto de enfermagem, duas salas com tres e cinco leitos, bem como nas unidades de isolamento. O equipamento utilizado foi calibrado para registrar a pressao do som em dBA, durante 24 horas, por 6 dias. Os dados foram analisados de acordo com as curvas graficas registradas pelo equipamento. RESULTADOS: Foi identificado um nivel basal de ruidos de 60 a 70 dBA, com pico de 120 dBA. Os niveis mais elevados foram identificados no periodo diurno, decorrentes da atividade e comunicacao dos profissionais. CONCLUSAO: Os niveis de ruidos identificados excederam as recomendacoes do International Noise Council, da Organizacao Mundial da Saude. A educacao sobre os efeitos prejudiciais de ruidos na audicao humana e sua relacao com o estresse constituem as bases para a implementacao de programas de reducao de ruidos.

Estudo prospectivo, randomizado e controlado sobre o tempo de permanência de cateteres venosos periféricos em crianças, segundo três tipos de curativos

Estudo prospectivo, randomizado e controlado, que verificou a influencia de tres tipos de curativos, sobre o tempo de permanencia de cateteres venosos perifericos (CVP) em criancas. Os grupos de estudo foram compostos por curativos com gaze esteril (GE 1), pelicula transparente esteril (GE 2) e fita adesiva hipoalergenica (GC). Foram selecionadas variaveis para o controle de caracteristicas referentes as criancas, profissionais executantes dos procedimentos e terapia intravenosa. Compuseram os grupos 150 CVP, instalados em 68 criancas, predominantemente pre-escolares, sexo masculino, cor da pele parda, eutroficas com patologias do sistema gastrointestinal. A maioria dos CVP foi instalada por auxiliares de enfermagem, em veias do arco dorsal da mao. Verificamos que o tipo de curativo influenciou significantemente (p=0,022) o tempo medio de permanencia dos CVP estudados: GE 1 (46,12 horas), GE 2 (29,53 horas) e GC (38,18 horas), e o curativo com gaze esteril manteve o cateter por mais tempo.This prospective, randomized and controlled study verified the influence of three dressing regimens on the dwell time of peripheral intravenous catheters (PIC) in children. The study groups were composed of dressings with sterile gauze (EG 1), with sterile transparent film (EG 2) and with hypoallergenic adhesive tape (CG). Variables were selected to control for variables related to children, professionals and intravenous therapy characteristics. The 150 PIC that composed the sample were inserted in 68 children, predominantly of preschool age, male, with brown skin color, eutrophic and with gastrointestinal system diseases. The majority of the PIC was installed by nursing auxiliaries in veins of the dorsal arch of the hand. The type of dressing exerted a significant influence (p = 0.022) on the average dwell time of the studied PIC: EG 1 (46.12 hours), EG 2 (29.53 hours) and CG (38.18 hours), concluding that the dressing with sterile gauze maintained the catheter inserted for a longer time.

Órfãos de terapia medicamentosa: a administração de medicamentos por via intravenosa em crianças hospitalizadas

Estudo descritivo, realizado em um hospital universitario, que verificou quantidade e tipo de medicamentos administrados por via intravenosa em criancas, alem da adequacao da apresentacao farmacologica para uso em pediatria e custo estimado de administracao de algumas drogas. Em trinta dias, foram administradas 8.245 doses de medicamentos, com media diaria de 274,83 doses, e projecao anual de 98.940. Os principais medicamentos utilizados foram metilpredinosolona, vancomicina, furosemida, ranitidina, penicilina, amicacina, midazolan, fentanil, ceftriaxone e cefalotina. Nenhum dos 41 medicamentos identificados possuia apresentacao pediatrica, acarretando, em alguns casos, maior manipulacao durante o preparo, risco de contaminacao e perda da estabilidade. Observou-se que a falta de apresentacao pediatrica gerou aumento dos custos de atendimento; na prescricao de uma crianca em pos-operatorio, com tempo de internacao estimado de cinco dias, a terapia administrada diaria foi de US

Oral care with 0.12% chlorhexidine for the prevention of ventilator-associated pneumonia in critically ill children: Randomised, controlled and double blind trial §

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Redesenho das atividades de enfermagem para redução de erros de medicação em pediatria

39.52 de medicamentos tiveram que ser desprezados, por excederem as necessidades terapeuticas da crianca.Descriptive study, developed at a general university hospital that aimed at verifying the number and types of i.v. drugs administered to children, the adequacy of their pharmacological presentation for pediatric use and the estimated costs of some drugs administration. In a period of 30 days, 8,245 drug doses were administered, with an average of 274.83 doses a day, and a yearly estimation of 98.940. The most used drugs were methylprednisolone, vancomycin, furosemide, ranitidine, penicillin, amikacin, midazolam, fentanyl, ceftriaxone, cephalothin, oxacillin, ampicillin and metronidazole. None of the 41 different drugs had a pediatric presentation, what caused, in some cases, more manipulation during the preparation, increasing the contamination risks and the loss of stability. Authors observed that the lack of pediatric presentation generated an increase in care costs; as an example, considering the prescription of a child in the period after surgery, with an estimated time of hospitalization of 5 days, the daily therapy costs were of U