Imunização contra Covid-19 e segurança do paciente: estudo de métodos mistos

Abstract

Patient safety is a necessary and relevant topic in the context of immunization against Covid-19, as errors and incidents have been common in this activity, in addition to their underreporting in the context of prevention and treatment. The objective was to analyze how the process of immunization against Covid-19 influenced patient safety in the state of Ceará, from the perspective of nursing professionals. This is a mixed methods research, of the sequential explanatory type, carried out in 2022. In the first phase (quantitative), a cross-sectional study was carried out with 148 nursing workers who acted as vaccinators in the immunization campaign against Covid-19. Data collection was carried out via an electronic form, covering sociodemographic, professional and work process-related variables, experiences and aspects of patient safety in immunization. The results were processed in the Excel 2016 program and subjected to descriptive statistical analysis. In the second stage (qualitative), an exploratory and descriptive study was carried out, with the objective of elucidating the findings of stage 1. Seven professionals participated in a focus group recorded in the Google Meet® application. The testimonies were submitted to thematic categorical content analysis and processed in the MAXQDA® software. In the last step, analysis and interpretation of the merged quantitative and qualitative data was carried out. Data were presented in charts, figures and tables. The research was approved by the Research Ethics Committee (Opinion No. 5,373,628). As a result, a profile of workers formed by young adult women with considerable experience in the area of immunization was obtained, who positively evaluated the quality of care provided and professional satisfaction in the area. The average number of vaccinations/day was 54.2. The non-conformities found included: storage of different immunizers in the same thermal box (66.9%), wasted doses (27.7%) and use of immunizers from different vials to compose a dose (26.4%). Half of the sample observed an error in immunization against Covid-19, with most of these in the scheduling stage of subsequent or current doses; in both manual and computerized registration and reporting. Of the 17 professionals who registered incidents, most classified it as no damage. The incidents witnessed involved the administration of the wrong immunizer (56.2%), scheduling the immunizer outside the recommended time (8.7%) and extravasation of the immunizer (12.5%). Most of the contributing factors were professional (47%) and external (23.5%). A total of 74 improvement actions implemented after the incidents were reported, including reports/notification of the error or incident, actions directed at the patient, the professional and the health service. The difficulties mentioned in the quantitative phase converged with the findings of the qualitative phase, highlighting the lack of dialogue, ineffective management communication with professionals and users, in addition to unhealthy working conditions, marked by the absence of basic resources/inputs such as water, working hours for meals, lack of transportation assistance, lack of employment and poor pay. It is concluded that the process of immunization against Covid-19, in Ceará, was permeated with structural, organizational and communication difficulties, which had repercussions on patient safety in cases of errors and incidents. It is known that one of the biggest challenges is to ensure good practices for a safe immunization process. Thus, it is suggested to review processes and practices from the producer to the administration of the immunizer by the nursing professional, with the implementation of protocols and training for all involved, as well as investments in safe working conditions and quality inputs.