quarta-feira, dezembro 18, 2013

Estratégias de Segurança para implementar agora

Top Patient Safety Strategies to implement now. Medscape Crit Care, 26/nov/2013.

1. Checklist pré-operatório e de anestesia
Treadwell JR, Lucas S. Preoperative checklists and anesthesia checklists. Rockville, MD: Agency for Healthcare Research and Quality, http://www.ahrq.gov/research/findings/evidence-based-reports/patientsftyupdate/ptsafetyIIchap13.pdf Accessed October 13, 2013.
de Vries EN, Hollmann MW, Smorenburg SM, Gouma DJ, Boermeester MA. Development and validation of the SURgical Patient Safety System (SURPASS) checklist. Qual Saf Health Care. 2009;18:121-126.

2. Prevenir infecções relacionadas a cateteres venosos centrais: cada infecção aumenta em cerca de 2 semanas a internação e acrescenta em torno de 90 mil reais ao custo de cada paciente internado
Chopra V, Krein SL, Olmsted RN, Saint S. Prevention of central line-associated bloodstream infections: brief update review. Rockville, MD: Agency for Healthcare Research and Quality. http://www.ahrq.gov/research/findings/evidence-based-reports/patientsftyupdate/ptsafetyIIchap10.pdf
Stone PW, Braccia D, Larson E. Systematic review of economic analyses of health care-associated infections. Am J Infect Control. 2005;33:501-509.

3. Reduzir uso de cateteres urinários
Meddings J, Krein SL, Fakih MG, Olmsted RN, Saint S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infections: brief update review. Rockville, MD: Agency for Healthcare Research and Quality. http://www.ahrq.gov/research/findings/evidence-based-reports/patientsftyupdate/ptsafetyIIchap9.pdf

4. Pacote de medidas para prevenção de pneumonia associada a ventilação mecânica: cabeceira elevada > 30 graus, higiene oral com clorexidine, tubos com aspiração subglótica e interrupção de sedação
Winters BD, Berenholtz SM. Ventilator-associated pneumonia: brief update review. Rockville, MD: Agency for Healthcare Research and Quality. http://www.ahrq.gov/research/findings/evidence-based-reports/patientsftyupdate/ptsafetyIIchap11.pdf

5. Lavagem das mãos antes e após contato com pacientes e seus utensílios
World Health Organization. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge. 2009. www.who.int/gpsc/country_work/en/
Pfoh E, Dy S, Engineer C. Interventions to improve hand hygiene compliance: brief update review. Rockville, MD: Agency for Healthcare Research and Quality. http://www.ahrq.gov/research/findings/evidence-based-reports/patientsftyupdate/ptsafetyIIchap8.pdf

6. Evitar abreviações relacionadas ao cuidado com os pacientes: VO, IV, RCR, UI, etc.
Glassman P. The Joint Commission's "Do Not Use" list: brief review (new). Rockville, MD: Agency for Healthcare Research and Quality. http://www.ahrq.gov/research/findings/evidence-based-reports/patientsftyupdate/ptsafetyIIchap5.pdf

7. Prevenção de úlceras de pressão
Lyder CH, Ayello EA. Annual checkup: the CMS pressure ulcer present-on-admission indicator. Adv Skin Wound Care. 2009;22:476-484.
Sullivan N. Preventing in-facility pressure ulcers. Rockville, MD: Agency for Healthcare Research and Quality. http://www.ahrq.gov/research/findings/evidence-based-reports/patientsftyupdate/ptsafetyIIchap21.pdf

8. Punção venosa profunda orientada com ultrassom
Shekelle PG, Dallas P. Use of real-time ultrasound guidance during central line insertion: brief update review. Rockville, MD: Agency for Healthcare Research and Quality. http://www.ahrq.gov/research/findings/evidence-based-reports/patientsftyupdate/ptsafetyIIchap18.pdf

9. Profilaxia de trombose venosa profunda: apenas 60% dos pacientes cirúrgicos e 40% dos clínicos recebem a profilaxia corretamente
Haut ER, Lau BD. Prevention of venous thromboembolism: brief update review. Rockville, MD: Agency for Healthcare Research and Quality. http://www.ahrq.gov/research/findings/evidence-based-reports/patientsftyupdate/ptsafetyIIchap28.pdf

10. Estratégias com menos evidências, porém potencialmente importantes:
Reduzir quedas
Participação de farmacêuticos clínicos nas UTIs (reduzir eventos adversos relacionados a medicações)
Pesquisa ativa de preferências de cuidados de fim de vida pelo paciente
Aplicar termo de consentimento informado antes de procedimentos
Treinamento para formação de times

André Japiassú