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Master's Dissertation
DOI
https://doi.org/10.11606/D.22.2021.tde-14122021-174922
Document
Author
Full name
Francielle Oliveira Piantino
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2021
Supervisor
Committee
Gabriel, Carmen Silvia (President)
Lima, Silvana Andrea Molina
Machado, Juliana Pereira
Sousa, Fernanda Raphael Escobar Gimenes de
Title in Portuguese
Ocorrência de potenciais eventos adversos em um hospital de grande porte
Keywords in Portuguese
Estudos retrospectivos
Potenciais evocados adversos associados a procedimentos cirúrgicos
Segurança do paciente
Abstract in Portuguese
A abordagem ao tema a segurança do paciente na assistência prestada pelos serviços de saúde é cada vez mais relevante. Investigar e conhecer os eventos adversos (EA) dentro de uma unidade que presta atendimento à saúde é essencial para entender as causas principais dos danos que podem ocasionar aos pacientes. Mediante a carência de informação epidemiológica sobre os EA no país, esta pesquisa buscou analisar os potenciais eventos adversos (pEA) registrados em prontuários de internação de pacientes adultos em hospital geral do Estado de Minas Gerais, no ano de 2015, sobretudo os incidentes relacionados aos casos cirúrgicos. Metodologicamente foram aplicados instrumentos de coleta de dados para identificar a ocorrência de pEA e verificar a associação entre pEA e os fatores de rastreamento que envolveram procedimento cirúrgico, baseados no Canadian Adverse Events Study: Tracking Form. Foram realizadas análises descritivas considerando os seguintes grupos de variáveis: características do paciente, dados da admissão, fatores intrínsecos e extrínsecos e critérios de rastreamento de pEA. As análises consistiram em avaliar as frequências absoluta e relativa dos fatores indicados pelo instrumento de coleta de dados. Para a análise das possíveis correlações e associações com pEA e procedimento cirúrgico foram realizados testes de correlação de Spearman, Qui-quadrado e Teste Exato de Fisher, respectivamente. Em todos os testes foram adotados nível de significância de α=0,05 e intervalo de confiança de 95%. Foi identificado uma correlação positiva entre idade e dias de internação nos 249 prontuários pesquisados. Na amostra estratificada de 72 prontuários que apresentaram pEA os resultados mostraram maior frequência do atendimento em pacientes do sexo masculino, cor branca, atendimento pelo Sistema Único de Saúde (SUS), internações eletivas e Classificação Internacional de Doenças (CID-10) referentes a doenças do aparelho circulatório, neoplasmas, lesões, envenenamento e outras causas externas. Foi evidenciado ainda que os fatores intrínsecos com maior porcentagem foram: hipertensão arterial, diabetes e neoplasia. Quanto aos fatores extrínsecos foram identificados: cateter venoso periférico, sonda urinária fechada e traqueostomia. Em relação a associação entre fatores intrínsecos e os procedimentos cirúrgicos, foi possível verificar a neoplasia e o fator hipoalbuminemia/desnutrição, quanto aos extrínsecos foram apontados o uso de cateter arterial e ventilação mecânica. Concluiu-se que os procedimentos cirúrgicos estão associados a pEA e que as características dos pacientes como idade, tipo de convênio, caráter de internação, fatores intrínsecos e extrínsecos podem potencializar a ocorrência de EA em ambiente hospitalar.
Title in English
Occurrence of potential adverse events in a large hospital
Keywords in English
Patient safety
Potential adverse events associated with surgical procedures
Retrospective studies
Abstract in English
The approach to the subject of patient safety in the assistance provided by health services is increasingly relevant. Investigating and knowing adverse events (AE) within a health care unit is essential to understand the main causes of the damage they can cause to patients. Due to the lack of epidemiological information on AE in the country, this research aimed to analyze the potential adverse events (pAE) described in medical records of adult patients in a general hospital in Minas Gerais State (Brazil) in 2015, especially the incidents related to the cases surgical. Methodologically, data collection instruments were applied to identify the occurrence of pAE and to verify the association between pAE and the tracking factors that involved surgical procedure, based on the Canadian Adverse Events Study: Tracking Form. Descriptive analyzes were carried out considering the following groups of variables: patient characteristics, admission data, intrinsic and extrinsic factors and pAE tracking criteria. The analyzes consisted of evaluating the absolute and relative frequencies of the factors indicated by the data collection instrument. For the analysis of possible correlations and associations with pAE and surgical procedure, Spearman's correlation tests, Chi-square test and Fisher's exact test were performed, respectively. In order to identify possible predictors of pAE, Logistic Regression Tests were performed. In all these tests, a significance level of α= 0.05 and a 95% confidence interval were adopted. A positive correlation between age and days of hospitalization was identified in the 249 medical records surveyed. In the stratified sample of 72 medical records that presented pAE, the results showed a higher frequency of care in male patients, white, care by Unified Health System (SUS), elective hospitalizations and International Classification of Diseases (ICD-10) referring to diseases of the circulatory system, neoplasms, injuries, poisoning and other causes external. It was also shown that the intrinsic factors with the highest percentage were: arterial hypertension, diabetes and neoplasia. In relation to the extrinsic factors were identified: peripheral venous catheter, closed urinary catheter and tracheostomy. Regarding the association between intrinsic factors and surgical procedures, it was possible to verify the neoplasia and the hypoalbuminemia/malnutrition factor, as for the extrinsic ones, the use of arterial catheter and mechanical ventilation were pointed out. It was concluded that the surgical procedures are associated with pAE and that the characteristics of the patients (age), type of health insurance, type of hospitalization, intrinsic and extrinsic factors can potentiate the occurrence of AE in a hospital environment.
 
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Publishing Date
2022-01-06
 
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