Registro e gerenciamento de indicadores de qualidade da assistência de enfermagem em Unidades de Terapia Intensiva Neonatal: estudo documental

Abstract

Studying assistance to the patient in Neonatal Intensive Care Units and relating them to the particularities of the newborns, realizing the risks to the safety of care may be greater. Thus, quality indicators of nursing care are selected by the health clinics in the search for performance, the management of processes and decrease in the occurrence of adverse events. The objective of this study was to analyze the monitoring of quality indicators of nursing care in a neonatal intensive care unit. A descriptive, documental and retrospective study was carried out at the neonatal intensive care unit (NICU) of a reference pediatric hospital in Ceará, from April to May 2019. For the data collection, we used the records for observation and institutional documents adopted in the service for monitoring the indicators (Occurrence Bulletin and Monthly Indicator Sheet), and analyzed the records for the year 2018. The variables analyzed were: type of indicator, formula, responsible for recording, type of record, adopted behaviors and general observations related to the management of the indicators. The results were presented in tables and tables. The study was approved by the Research Ethics Committee of the institution (no3.023.603 / 2018). As a result, the use of 9 quality indicators in the unit was identified, being the majority of the process (non-programmed extubation, loss of central peripheral insertion catheter, skin lesion, phlebitis, loss of orogastric / oroenteric probe, error of medication, rate of infection). The analysis of the bulletins allowed to identify 72 registers referring to the indicators throughout 2018; 29 of these were related to unplanned extubation, 24 to central venous catheter loss, 10 to medication errors, 6 to skin lesion, 1 to almost medication error and 2 to unplanned orogastric / oroenteric catheter removal. It was evidenced underreporting of incidents and found that most of the records did not contain all the information about the events / incidents with the patients, which made it impossible to decide on the actions to improve the care provided and to reduce the damages associated with the incidents. It is concluded that the management of nursing care quality indicators has been effectively carried out in the neonatal intensive care center studied, contemplating nationally recommended quality requirements. Evidence-based instruments are used, but few details of the pipeline are reported after the incidents related to the indicators. It is suggested to invest in continuing education, as well as the monitoring of these records, in order to obtain better results in the quality of care practice.