RESUMO

INTRODUCTION: Counting of accountable items used during surgery, frequently called 'the count', is a fundamental practice to ensure that items such as surgical instruments, sponges and sharps are not forgotten within patients. Although inadvertently leaving behind a sponge or instrument at the end of an operation is a rare event, it is an error that may have serious implications. OBJECTIVES: The aim of this evidence implementation project was to contribute to promoting evidence-based practice in surgical counts in open abdominal and pelvic surgeries and thereby improving the outcomes of the surgical patients at a surgical centre of a university hospital. METHODS: The current evidence implementation project used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice (GRiP) audit and feedback tool. The JBI Practical Application of Clinical Evidence System and GRiP framework for promoting evidence-based healthcare involves three phases of activity: first, establishing a project team and undertaking a baseline audit based on evidence-informed criteria; second, reflecting on the results of the baseline audit and designing and implementing strategies to address non-compliance found in the baseline audit informed by the JBI GRiP framework; third, conducting a follow-up audit to assess the outcomes of the interventions implemented to improve practice, and identify future practice issues to be addressed in subsequent audits. These three phases were performed over a period of 6 months, from August 2017 to March 2018. RESULTS: The baseline audit revealed deficits between old and best practice in all criteria. Barriers for implementation of a protocol for surgical counts were identified, and strategies were implemented. The postimplementation (follow-up) audit showed improvement in compliance with best practice in six of the audit criteria selected except two, a multidisciplinary team approach to decrease retained surgical items, and limited staff hand-offs during surgical procedures to ensure the same team is present in all counting episodes. CONCLUSION: The main achievements of the study included substantial increases in compliance with best practice. However, registration and report and commitment of all members of surgical team to apply the entire protocol, avoiding to skip any step, persist as challenges.

Assuntos

RESUMO

OBJECTIVES: : to identify surgeons' knowledge and compliance rate to the Safe Surgery Protocol, as well as to assess the incidence of surgery-related adverse events, including patients' knowledge about the protocol. METHODS: this is a cross-sectional and prospective study. An instrument was developed to collect the socio-graphic characteristics of sixty-eight surgeons and residents, their knowledge and adherence to the safe surgery protocol. Eighty-two patients were assessed regarding their awareness about the surgical procedure. The operating environment was also evaluated. Descriptive statistics and the odds ratio are presented. RESULTS: the surgeons, despite their previous contact with the protocol throughout the graduation period, were poorly compliant with it. Adverse events such as the use of uncalibrated equipments or the presence of foreign bodies in several equipments such as drills and cautery pens were identified. In addition, some of the adverse events were identified and fixed, after patients had already been anesthesized, but before the beginning of the surgical procedure. Patients demonstrated knowledge about the operation they would undergo, but they did not know about its duration, and they were not introduced to the surgical team. CONCLUSION: there were failures in the dynamics and compliance regarding some phases of the protocol, which may impact the laterality errors and patient safety.

Assuntos

RESUMO

ABSTRACT Objectives : to identify surgeons' knowledge and compliance rate to the Safe Surgery Protocol, as well as to assess the incidence of surgery-related adverse events, including patients' knowledge about the protocol. Methods: this is a cross-sectional and prospective study. An instrument was developed to collect the socio-graphic characteristics of sixty-eight surgeons and residents, their knowledge and adherence to the safe surgery protocol. Eighty-two patients were assessed regarding their awareness about the surgical procedure. The operating environment was also evaluated. Descriptive statistics and the odds ratio are presented. Results: the surgeons, despite their previous contact with the protocol throughout the graduation period, were poorly compliant with it. Adverse events such as the use of uncalibrated equipments or the presence of foreign bodies in several equipments such as drills and cautery pens were identified. In addition, some of the adverse events were identified and fixed, after patients had already been anesthesized, but before the beginning of the surgical procedure. Patients demonstrated knowledge about the operation they would undergo, but they did not know about its duration, and they were not introduced to the surgical team. Conclusion: there were failures in the dynamics and compliance regarding some phases of the protocol, which may impact the laterality errors and patient safety.

RESUMO Objetivo: identificar o conhecimento e a taxa de adesão ao Protocolo de Cirurgia Segura pelos cirurgiões, assim como a incidência de eventos adversos relacionados à operação, além do conhecimento dos pacientes sobre o protocolo. Métodos: estudo transversal, prospectivo com caráter quantitativo. Para a coleta de dados, foi elaborado, pelos autores, um instrumento que coletou o perfil sócio gráfico de sessenta e oito cirurgiões e residentes, o conhecimento e a adesão destes ao protocolo de cirurgia segura. Oitenta e dois pacientes foram entrevistados, e o ambiente de cirurgia avaliado. Os dados foram analisados de maneira descritiva e teste Razão das Chances com Índice de Confiança (IC) de 95%. Resultados: parte dos cirurgiões demonstraram que apesar do contato com o protocolo durante o período de formação, houve deficiência à adesão, ocasionando eventos adversos como o uso de equipamentos não calibrados ou presença de corpos estranhos nos equipamentos, como brocas e canetas. Além disso, foi constatado que em pacientes já anestesiados, as falhas foram percebidas e reparadas antes do começo do procedimento. No caso dos pacientes, estes demonstraram conhecimento quanto à cirurgia que iriam realizar, porém não sabiam a duração da mesma ou tinham sido introduzidos à equipe cirúrgica. Conclusão: houve falhas na dinâmica e na adesão de algumas etapas do protocolo, prejudicando a lateralidade no processo e a segurança do paciente.

Assuntos

Assuntos

Assuntos

RESUMO

Este é um estudo documental, retrospectivo e de natureza quantitativa, que trata dos determinantes para as suspensões cirúrgicas eletivas em um centro cirúrgico de um hospital universitário do município do Rio de Janeiro. O objetivo foi identificar o quantitativo de cirurgias eletivas suspensas em um recorte temporal de nove meses, considerando e analisando determinantes sobre as implicações emocionais, físicas e sociais para clientes, familiares e instituição. O resultado da investigação apontou que 27,4% das cirurgias suspensas tiveram como fator determinante as relações entre os clientes e a instituição. Além disso, a falta de condições clínicas (24,5%), o não comparecimento para internação (8,3%), a falta de material (10,3%) e o adiantado da hora (12%) foram citados como fatores que interferem no processo que culmina numa cirurgia. Parece evidente que alguns determinantes para os cancelamentos cirúrgicos podem e devem ser controlados e restringidos, o que leva à recomendação de um sistemático procedimento de conscientização de todos os envolvidos no processo, a fim de que se alcance a diminuição dos índices de suspensão cirúrgica na instituição em questão.

This is a documentary, retrospective and quantitative study that aims to determine the reasons for cancelling elective surgery at a University Hospital of Rio de Janeiro. It aims to identify the number of elective surgeries cancelled in a periodof nine months, considering emotional, physical and social implications for the clients, family and institution. The most frequent reason for cancelling a surgery was the relationship between customer and institution (27.4%). Lack of clinical conditions (24.5%), no show at the hospital (8.3%), lack of material (10.3%) and late hours (12%) were also mentioned as factors that interfere with the surgery. Apparently, some reasons could and should be controlled and restricted, leading to the recommendation of a systematic process of awareness in order to diminish surgical cancellation rates in this hospital.

El presente estudio es documental, retrospectivo y cuantitativo y enfoca los factores determinantes para la suspensión de cirugías electivas en el quirófano de un hospital universitario de Río de Janeiro. Su objetivo era determinar el número de cirugías electivas suspendidas durante un recorte de tiempo de nueve meses, teniendo en cuenta y analizando determinantes de las repercusiones emocionales, físicas y sociales en los clientes, la familia y la institución. El resultadode la investigación mostró que en 27,4% de las cirugías el factor determinante para su suspensión fue la relación entre el cliente y la institución. Además, la falta de condiciones clínicas (24,5%), el no presentarse para la internación (8,3%), la falta de material (10,3%) y la hora avanzada (12%) fueron citados como factores que interfieren en el proceso que culmina con la cirugía. Es evidente que algunos de los factores determinantes de la cancelación de cirugías pueden y deben ser...

Assuntos

RESUMO

Introducción: El funcionamiento y manejo del Instrumental de cirugía videoendoscópica, diariamente se ve involucrado con su limpieza y desinfección, ya que de ello depende una buena esterilización para proteger la salud e integridad del paciente; por ende, la función del enfermero instrumentista se asocia íntimamente con la limpieza y desinfección del instrumental de cirugía videoendoscópica. Objetivo: Determinar los conocimientos y prácticas que tienen los enfermeros instrumentistas sobre la técnica de limpieza y desinfección del instrumental de cirugía videoendoscópica. Metodología: La presente investigación es de tipo Cuantitativo porque mide y cuantifica las variables de estudio, es de nivel Aplicativo ya que permite tomar los resultados del estudio a fin de establecer estrategias para mejorar la técnica de limpieza y desinfección del instrumental de cirugía videoendoscópica, y el método es Descriptivo Transversal. Resultados y Conclusiones: El 68 por ciento de los enfermeros instrumentistas del Hospital Nacional Hipólito Unanue, conocen la técnica de limpieza y desinfección del instrumental de cirugía videoendoscópica, según los datos obtenidos a través de un cuestionario, sin embargo, el 32 por ciento desconocen la realización del lavado meticuloso del instrumental, debido a que no se ponen de acuerdo el tiempo que debe estar sumergido el instrumental en el enzimático y en el desinfectante de alto nivel, ya que cada fabricante varia el tiempo que este debe estar sumergido; según los criterios de fabricación

Introduction: The operation and management of Instrumental videoendoscopic surgery, daily is involved with its cleaning and disinfection, because of this depends a good sterilization to protect the health and integrity of the patient; hence, the role of nurse instrumentalist associated closely with the cleaning and disinfection of instrumental videoendoscopic surgery. Objective: To determine the knowledge and practices that have the nurses instrumentalists on the technique of cleaning and disinfection of the instruments of videoendoscopic surgery. Methodology: This research is Quantitative because it measures and quantifies the variables of study, is level Software in that it allows the results of the study to establish strategies to improve the technique of cleaning and disinfection of the instrumentation of videoendoscopic surgery, and the method is descriptive. Findings and Conclusions: 68 per cent of the nurses instrumentalists of the National Hospital Hipolito Unanue, aware of the technique of cleaning and disinfection of the instruments of videoendoscopic surgery, according to data obtained through a questionnaire, however, 32 per cent unaware of the realization of washing meticulous instrumental, because it did not agree the time that must be submerged the instrumental in the enzyme in the disinfectant high level, since each manufacturer varies the time that this should be submerged; according to the criteria of manufacture

Assuntos

RESUMO

Operative Nursing (EO) allows for a new perspective in military nursing education. This case study from a qualitative approach aimed to describe the construction process of EO at the School of Health (ES) of a Brazilian Navy (MB) Hospital and to characterize "military nurses'" care performance in "crash" situations. Data collection started in 2002 through a literature review, combined with meetings between military to discuss the rules and bases of this modality, which gave rise to the reorganization of the curriculum, infrastructure and normative instruments and the review of ethical-legal aspects. This study discloses a valuing sense of human life and allows for the search to legitimize the activities of a differentiated nursing before competent organs.

Assuntos

RESUMO

This historic-sociological study aims to analyze the daily challenges faced by army nurses in the Theater of Operations during the Second World War in Italy. The primary sources of investigation consist of three photographs taken during that period as well as testimonies by nine nurses, while literature on the subject is used as a secondary source. The discussion is supported by Pierre Bourdieu's concepts. The results show that these nurses faced the challenges of daily life at war and managed to adapt themselves to the adversities of the camping sites and wards. We infer that their daily life in this scenario not only made them overcome barriers, but also provided them with an opportunity to get to know new cultures and technologies.

Assuntos

RESUMO

Estudo histórico-social, tem como objetivo analisar os desafios cotidianos enfrentados pelas enfermeiras do Exército no Teatro de Operações da 2ª Guerra Mundial, na Itália. Utilizou-se como fontes primárias três fotografias da época e depoimentos de nove enfermeiras que estiveram no conflito. As fontes secundárias constituíram-se do acervo literário referente ao assunto. Utilizou-se conceitos do sociólogo Pierre Bourdieu para apoiar a discussão. Os resultados evidenciaram que as enfermeiras enfrentaram os desafios do cotidiano na guerra e adaptaram-se às adversidades dos acampamentos/enfermarias. Conclui-se que o cotidiano das enfermeiras, nesse cenário, ao tempo que as levou ao enfrentamento de barreiras, propiciou a apreensão de novas culturas e tecnologias.

Assuntos