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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Ergonomia Segurança do paciente Eventos adversos Maqueiros Transporte de pacientes |
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Ergonomia Segurança do paciente Eventos adversos Maqueiros Transporte de pacientes Silva, Aianna Rios Magalhães Véras e 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 |
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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. |
| author2 |
Carvalho, Ricardo José Matos de |
| author_facet |
Carvalho, Ricardo José Matos de Silva, Aianna Rios Magalhães Véras e |
| format |
masterThesis |
| author |
Silva, Aianna Rios Magalhães Véras e |
| author_sort |
Silva, Aianna Rios Magalhães Véras e |
| title |
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 |
| title_short |
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 |
| title_full |
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 |
| title_fullStr |
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 |
| title_full_unstemmed |
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 |
| title_sort |
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 |
| publisher |
Universidade Federal do Rio Grande do Norte |
| publishDate |
2021 |
| url |
https://repositorio.ufrn.br/handle/123456789/31671 |
| work_keys_str_mv |
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| _version_ |
1773961408512262144 |
| spelling |
ri-123456789-316712021-03-07T08:50:06Z 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 Silva, Aianna Rios Magalhães Véras e Carvalho, Ricardo José Matos de http://lattes.cnpq.br/2890510167355626 http://lattes.cnpq.br/8748974599377029 Rezende, Júlio Francisco Dantas de http://lattes.cnpq.br/7433758989886841 Saldanha, Maria Christine Werba http://lattes.cnpq.br/9125249342119563 Ergonomia Segurança do paciente Eventos adversos Maqueiros Transporte de pacientes 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. Nos últimos tempos, a segurança do paciente vem se tornando uma preocupação de âmbito mundial, compreendendo, para assegurá-la, uma gama de aspectos a considerar, tais como a cirurgia segura, a identificação do paciente, a higienização das mãos, a prevenção de quedas, o uso seguro de medicamentos, o ambiente seguro de cuidado, entre outros, tornando mais complexo o conhecimento e o controle de todas essas variáveis, quando se trata do gerenciamento dos sistemas de atendimento de pacientes, como hospitais e maternidades, entre outros. A segurança do paciente, assim como as causas dos eventos adversos (EAs) e suas consequências, em maior ou menor grau, têm relação com a qualidade das instalações, dos equipamentos e dos serviços prestados, com o dimensionamento de pessoal para realização dos serviços, com a jornada diária e semanal de trabalho, com a densidade ou intensificação do trabalho, com a complexidade do quadro clínico dos pacientes, com a remuneração dos profissionais, com a gestão da segurança e saúde do trabalhador, com a gestão da infecção hospitalar, entre outros. Nesse contexto, o transporte e a transferência de pacientes realizados por maqueiros no ambiente intra-hospitalar expressa preocupação como atividade suscetível à ocorrência de eventos adversos com os pacientes envolvidos, devido à frequência com que são realizados, bem como a sua complexidade, porque envolve todos os aspectos citados anteriormente. Apesar disto, do tempo de internação prolongado, das consequências aos pacientes e dos custos envolvidos com os eventos adversos, as pesquisas sobre este tema ainda não são abundantes. A ideia de segurança, conforme preconizada por Hollnagel, na abordagem Safety II, ressalta a importância de se analisar o trabalho como é realmente feito ou realizado (“work as done-WAD”), diferentemente de analisar o trabalho como foi imaginado ou prescrito (“work as imagined-WAI”), como é a abordagem Safety I. A abordagem Safety II valoriza o conhecimento e a experiência dos trabalhadores sobre o trabalho que realizam e se interessa sobre como e por que as coisas dão certo (“go right”). A abordagem Safety I, por sua vez, largamente adotada nos sistemas de gestão de segurança das organizações em geral, inclusive hospitalares, centra-se nos aspectos normativos e prescritivos, no conhecimento de especialistas e gestores, e interessa-se por conhecer o porquê de as coisas não darem certo (“go wrong”), a exemplo dos modelos de análise de riscos do trabalho e de erros utilizados. O trabalho real do maqueiro é muito mais do que transportar e transferir o paciente de um local a outro. Consiste em transportar e fazer transferência do paciente com eficiência e segurança, e isto envolve a consideração, por parte dos maqueiros, dos aspectos tecnológicos e organizacionais, do layout das instalações, das condições de saúde do paciente e das condições de saúde e estratégias cognitivas do próprio maqueiro, para se evitar eventos adversos com os pacientes. A Ergonomia apresenta-se, neste contexto, como um campo científico e metodológico fundamental que, através da Análise Ergonômica do Trabalho, permite que se compreenda o trabalho real do maqueiro, que se formule um diagnóstico da sua atividade e se estabeleça indicações de melhoria da sua atividade e das unidades de saúde que cuidam de pacientes, visando à segurança desses durante a atividade de transporte e transferência. Assim, o presente trabalho tem como objetivo central analisar a atividade dos maqueiros da Maternidade Escola Januário Cicco (MEJC), localizada na cidade de Natal-RN, visando identificar os determinantes dessa atividade laboral que impactam na segurança dos pacientes. Pretende-se, com isso, indicar medidas de melhoria da atividade dos maqueiros, que minimizem as possibilidades de ocorrência dos eventos adversos e aumentem a segurança do paciente. Para tanto, foi adotado o método situado da Análise Ergonômica do Trabalho (AET), que se caracteriza por aplicar técnicas observacionais e interacionais e por adotar uma abordagem participativa e negocial com os sujeitos interessados na solução dos problemas em foco. Os resultados da pesquisa demonstraram que os maqueiros, ao realizarem suas atividades, defrontam-se com contrantes físicos, devido às características das instalações físicas (degradação de equipamentos, ao layout inadequado, ausência de elevador de acesso à unidade B2, entre outros) da MEJC e dos equipamentos utilizados (cadeiras de rodas sem suportes, macas de diferentes modelos, entre outros). Defrontam-se, também, com contrantes temporais (urgência do transporte, alta demanda x baixo número de efetivos, alta demanda x equipamentos indisponíveis etc.). Para garantir a eficiência do serviço prestado, os maqueiros realizam regulações frequentemente, que consistem no desenvolvimento de estratégias e ações, tais como contar com auxílio de terceiros para realizar certas transferências e transportes de pacientes, e fazer antecipações com previsões de demanda de chamados, ao depararem-se com fluxos intensos em determinados períodos e dias da semana, retirar todas camas de leitos, cadeiras de acompanhantes e berços de dentro do leito, ao realizarem uma transferência da maca para cama do leito, além de fazê-la no corredor, suspender cadeiras de rodas e macas, ao entrarem e saírem dos elevadores, correr com cadeiras de rodas, ao subirem rampas muito íngremes etc., sendo que parte dessas estratégias constatadas podem aumentar o risco de ocorrência de uma EA. Essas regulações têm como objetivo atenuar ou eliminar os contrantes e as variabilidades incidentais, facilitando a execução das ações (transporte e transferência do paciente). Diante dos achados, sugeriu-se, uma série de medidas para melhoria da segurança do paciente, como, por exemplo, a aquisição de suportes para as cadeiras de rodas, a realização de um estudo aprofundado de análise e previsão de demanda do setor, a realização de um treinamento conjunto do setor de enfermagem e o setor dos maqueiros, quanto à instrução para o seguimento do protocolo de chamados, além disso, incluir nesse protocolo níveis que digam o grau de enfermidade do paciente, pois, assim, facilitaria para os maqueiros, em momentos de alta demanda, a escolha da estratégia utilizada, além de dar um maior noção do estado de saúde do paciente, o que ajudaria na prevenção de eventos adversos. Sugeriu-se, ainda, a inclusão dos maqueiros nos treinamentos, palestras, cursos etc. sobre a segurança do paciente, que incluam a importância da sua atividade e como fazê-la de forma segura para os pacientes e profissionais, evitando que os maqueiros utilizem manobras arriscadas no transporte de pacientes. Além disso, recomendou-se, também, que esses profissionais sejam alertados sobre a importância da lavagem das mãos pré e pósatendimento, principalmente, diante do momento atual de pandemia de COVID-19. 2021-03-03T23:10:32Z 2021-03-03T23:10:32Z 2020-10-19 masterThesis SILVA, Aianna Rios Magalhães Véras e. 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. 2020. 183f. Dissertação (Mestrado em Engenharia de Produção) - Centro de Tecnologia, Universidade Federal do Rio Grande do Norte, Natal, 2020. https://repositorio.ufrn.br/handle/123456789/31671 pt_BR Acesso Aberto application/pdf Universidade Federal do Rio Grande do Norte Brasil UFRN PROGRAMA DE PÓS-GRADUAÇÃO EM ENGENHARIA DE PRODUÇÃO |