Ergonomia e segurança do paciente na prevenção e mitigação de eventos adversos no transporte e transferência de pacientes por maqueiros em uma maternidade de alta complexidade
Throughout the years, patient safety has become a worldwide concern, covering a range of aspects to be taken into consideration, looking to ensure it, such as safe surgery, patient identification, hands sanitization, prevention of falls, safe use of medicines, safe care environment, among others,...
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| Formato: | Dissertação |
| Idioma: | pt_BR |
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Universidade Federal do Rio Grande do Norte
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| Endereço do item: | https://repositorio.ufrn.br/handle/123456789/31671 |
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| Resumo: | Throughout the years, patient safety has become a worldwide concern, covering a range of aspects to
be taken into consideration, looking to ensure it, such as safe surgery, patient identification, hands
sanitization, prevention of falls, safe use of medicines, safe care environment, among others, making
the knowledge more intricate and the control of all these variables, when it comes to managing the
system of patient care, such as hospitals, maternity, amongst others. Patient safety, as well as the
causes of adverse events (AEs) and their consequences, to a greater or lesser extent, are related to the
facilities and equipment quality, the services provided, the distribution of the staff to do the services,
the daily and weekly work, the density or intensification of work, the complexity of the patients'
clinical conditions, the payment of the professionals, the management of the worker’s safety and
health, the management of infections in the hospital, among others. In this context, the transportation
and relocation of patients in the intra-hospital environment expresses concern due to the frequency it
occurs, its complexity, given the occurring aspects, above mentioned, and the possible manifestations
of adverse events related to these activities, in which are performed by the stretcher-bearers. However,
there is a scarcity of research that considers them as an important barrier to the occurrence of AEs.
Despite the hospital stay length, the side effects on the patients, and the costs caused by unexpected
events, the research on this theme is still not sufficient. The understanding of safety, as proposed by
Hollnagel, in the Safety II procedure, emphasizes the importance of analyzing the work as it is done
(WAD), unlike analyzing the work as it was imagined (WAI), as is the Safety I procedure. The SafetyII procedure values the workers' knowledge and experience on the job they execute, besides taking
interest in how and why things “go right”. The Safety I procedure, in turn, generally adopted in the
security management systems of organizations, including hospitals, focuses on normative and
prescriptive aspects, on the knowledge of specialists and managers, and is interested in knowing why
things “go wrong”, as the used work risk and error samples. The actual work of the stretcher-bearer is
much more than transporting the patient from one place to another. It consists of transporting and
relocating efficiently and safely, and this action involves the stretcher-bearer’s consideration of the
technological and organizational aspects, the layout of the facilities, the patient's health conditions as
well as the stretcher-bearer’s own cognitive strategies and health conditions, to avoid adverse events.
Ergonomics presents itself, in this context, as a fundamental scientific and methodological field,
through the Ergonomic Analysis of Work, to comprehend the work of the stretcher-bearer, to
formulate a diagnosis of their work and, to establish indications to improve the stretcher-bearer’s
activity and the health units that take care of the patients, aiming their safety during the activity of
transportation and relocation of the patient. Thus, the present work has as its main objective the
analysis of the stretcher-bearers’ activity in the Maternity School Januário Cicco (MEJC), situated in
the city of Natal-RN, proposing to identify the causes of this work activity that impact patients’ safety.
The objective is to indicate measures to improve stretcher-bearers’ work activity, to level down the
occurrence of possible adverse events, or vulnerabilities associated with the activity, and increase
patient safety. Therefore, it will adopt a method based on the Ergonomic Analysis of Work (TSA),
which is characterized for applying observational and interactional techniques and also for adopting an
inclusive and negotiable approach with interesting subjects to solve the aforementioned problems. The
preliminary results of the research show that the stretcher-bearers, when performing their work
activities, face physical problems, due to the characteristics of the physical facilities (deterioration of
equipment, inadequate layout, lack of elevator of access to unit B2, among others) of the MEJC and
the equipment used. They also endure usual incidents (the urgency of transportation, high demand x
low number of staff, high demand x availability equipment, etc.). To promote the efficiency and
security of the service provided, stretcher-bearers often deal with adjustments, such as the
development of strategies and actions, as in relying on the assistance of third parties to carry out
certain transportations and relocations of patients and make anticipations with forecasts of on-call
demands that encounter intense flows in certain periods and days of the week, remove all beds,
escort’s chairs and cradles from inside the bed when transferring the patient from the stretcher to the
bed, in addition to doing it in the hallway, suspending wheelchairs and stretchers when getting in and
out of elevators, running with wheelchairs when climbing very steep ramps, etc., part of these
strategies can increase the risk of an AE. These regulations aim to attenuate or eliminate contractors and accidental variabilities, facilitating the accomplishment of actions (patient’s transportation and
relocation). Considering the made discoveries it was suggested a series of measures to improve patient
safety, such as the acquisition of accessories for wheelchairs, the execution of an in-depth study to
analyze and estimate the demand of the sector, along with the implementation of collaborative
training, nurses and stretcher-bearers, as instructions for the follow-up protocol to callings. In addition,
the inclusion in this protocol of degrees to inform the patient’s illness condition, as to facilitate the
choices for the stretcher-bearers in moments of high demand, besides giving a greater awareness of the
patient’s health situation, preventing the rise of adverse events. Furthermore, the admission of
stretcher-bearers into training courses and lectures on patient safety, showing the importance of their
job and how to best perform it for the sake of patients’ professionals’ assurance, as to avoid that the
stretcher-bearers use risky maneuvers in the transportation of patients and the importance of handwashing pre and post care, especially in face of the current COVID-19’ pandemic state. |
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