Cirurgia segura: validação de checklist pré e pós-operatório
Publication year: 2014
A seguranca do paciente cirurgico e considerada componente critico da qualidade do cuidado em saude e constitui o Segundo Desafio Global para a Seguranca da Organizacao Mundial da Saude. Para atender a este desafio, o Programa Cirurgias Seguras Salvam Vidas (PCSSV), lancado no bienio 2007 e 2008, tem como objetivo diminuir a morbimortalidade e elevar os padroes de qualidade em servicos de assistencia a saude. Considerando que as acoes de seguranca incluem a assistencia de enfermagem perioperatoria, esta pesquisa teve por objetivo elaborar, avaliar e validar checklist de seguranca cirurgica para os periodos pre e pos-operatorio. A pesquisa do tipo metodologica com abordagem quantitativa foi realizada entre marco de 2013 a outubro de 2014, em um hospital universitario do estado do Parana e aprovada em Comite de Etica. A trajetoria ocorreu por meio do Ciclo PDCA e seguiu diretrizes e principios do PCSSV. Inicialmente foi elaborada uma versao preliminar de checklist, submetida a apreciacao de 14 enfermeiros de unidades cirurgicas, para ajustes e complementacoes. A seguir, o instrumento foi submetido a teste piloto em oito unidades cirurgicas, cuja versao sofreu adaptacoes, a partir de reunioes e oficinas com as enfermeiras daquelas unidades. Depois desta fase houve a validacao do checkist, por meio da Tecnica Delphi com Escala Likert por oito especialistas. Foram enviados aos especialistas um formulario de avaliacao com tres blocos de respostas, acompanhado do checklist organizado em seis categorias de avaliacao, o qual foi submetido a teste de confiabilidade pelo coeficiente Alfa de Cronbach. As respostas dos especialistas foram submetidas a mensuracao quantitativa, pelo calculo do escore do Ranking Medio e apresentaram escores de Likert .1 e grau de concordancia . 75%, atingindo-se o consenso nos atributos objetividade, clareza de redacao, pertinencia, credibilidade, validade de aplicacao, validade de instrumento, informacoes claras e concisas, organizacao logica do conteudo e interface entre o profissional e o paciente cirurgico. O checklist construido, avaliado e validado contempla 97 indicadores de seguranca em seis categorias: Identificacao (9 indicadores), Pre-operatorio (13 indicadores), Pos-operatorio Imediato (13 indicadores), Pos Operatorio Mediato (28 indicadores), Outras Complicacoes Cirurgicas (20 indicadores) e Alta Hospitalar (14 indicadores). Concluiu-se que o conteudo do Checklist de Seguranca Cirurgica Pre e Pos-operatorio e efetivo e eficaz para direcionar as acoes de enfermagem ao paciente nos periodos pre e pos operatorio; contribui para a seguranca do paciente, por meio da monitorizacao de sinais e sintomas de alerta, producao de indicadores e pode ser utilizado e adaptado para outros servicos de saude.
The safety of surgical patients is considered a critical health care component of quality and for the World Health Organization it is the Second Global Safety Challenge. To meet this challenge, the Safe Surgery Saves Lives Program (PCSSV), launched during the years 2007 and 2008 aims to reduce morbidity and mortality and to raise the standards of quality in healthcare services. Whereas safety initiatives include the assistance of perioperative nursing, this study aimed to develop, evaluate and validate surgical safety checklist of the pre and postoperative. The research methodology using the quantitative approach was conducted from March 2013 to October 2014 in a university hospital of Parana state and it was approved by the Ethics Committee. The trajectory was through the PDCA cycle and followed the guidelines and PCSSV principles. Initially it was developed a draft checklist, submitted for consideration of 14 nurses in surgical units with ends of adjustments and additions. Next, the instrument was piloted in eight surgical units whose version was adapted from meetings and workshops with nurses from those units. After this phase there was the checklist validation by eight experts using the Delphi Likert Scale Technique. The experts were sent an evaluation form with three blocks of responses, accompanied by the checklist organized into six categories of evaluation, which was subjected to reliability test by Cronbach's alpha coefficient. The responses of the experts were subjected to quantitative measurement by calculating the Average Ranking score and presented scores of Likert .1 and degree of agreement . 75%, reaching the consensus on the attributes of objectivity, clarity of writing, relevance, credibility, validity of application, validity of the instrument, clear and concise information, logical organization of content and interface between the professional and the surgical patient. The built, evaluated and validated checklist includes 97 safety indicators in six categories: Identification (9 indicators), Preoperative (13 indicators), Immediate Postoperative (13 indicators), Mediate Postoperative (28 indicators), Other Surgical Complications (20 indicators) and Hospital Discharge (14 indicators). It was concluded that the content of the Surgical Safety Checklist Pre and Post-operative proved to be effective and efficient to direct the actions of nurses to patients pre- and postoperative. It contributes with patient's safety through the monitoring of signs and warning symptoms, through the development of indicators and it can be used and adapted for other health services.
