CULTURA DE SEGURANÇA DO PACIENTE EM UNIDADES DE PRONTO ATENDIMENTO

Abstract

Patient safety, understood as reducing the risk of unnecessary harm related to health care to an acceptable minimum, has become one of the priority issues in recent years. Most studies have been carried out in hospital environments, however, it is of fundamental importance to carry out studies on the subject in Emergency Care Units, one of the main components of the Emergency Care Network of the Unified Health System. Objectives: Know the scientific production published in the literature on patient safety in urgent and emergency services; to identify evidence of validity, reliability and responsiveness of the Brazilian version of the Safety Attitudes Questionnaire for Emergency Care Units; to assess the safety climate in the Emergency Care Units in Vitória - ES, from the perspective of the health professionals who work there. Methods: The research was divided into three stages. Initially, an integrative review of the literature on patient safety in urgent and emergency services was carried out, with a bibliographic survey carried out in October 2020. In the second moment, a methodological study was developed in an Emergency Care Unit in the metropolitan region of the State of Espírito Santo, aiming to evaluate the evidence of validity, reliability and responsiveness of the Brazilian version of the Safety Attitudes Questionnaire instrument for Emergency Care Units. Reliability was verified through analysis of internal consistency, stability and reproducibility. The validity and responsiveness of the instrument were tested. Finally, a cross-sectional study was carried out in April and May 2022 with doctors, nurses, technicians and nursing assistants belonging to two Emergency Care Units in the capital of Espírito Santo, aiming to assess the safety climate. Two instruments were used: a questionnaire to characterize the participants' profile and the Safety Attitudes Questionnaire. Data were analyzed using IBM SPSS Statistics version 24.0. For comparison between domains, the Kruskal-Wallis test was used, and the association of domains with their respective factors of interest was performed through multiple linear regression with the forward variable selection method. Results: The review study resulted in 43 articles categorized into four thematic axes, according to the type of urgency and emergency service in which the research was developed. The evaluation study of the psychometric properties of the Safety Attitudes Questionnaire indicated a Cronbach's alpha=0.85, showing excellent internal consistency. All domains correlate with each other in a positive and significant way. In the stability assessment, the Job Satisfaction, Management Perception and Working Conditions domains showed strong correlations. In the third study, 172 professionals participated. All six SAQ domains had scores below the recommended in the literature. The domain with the highest average was Stress Perception (average = 72.48) and with the lowest average, Working Conditions (average = 38.81). For each domain, the variables that presented mean scores with statistical difference were identified. The variable “Are you satisfied working in UPA/PA?” showed significance with five of the six domains. Studies indicate that professionals who are satisfied with their work tend to build a better teamwork climate. Another important variable that showed statistical difference with the domains Climate of Safety and Perception of Stress was “Do you have another job or employment relationship?”. Professionals who had another employment relationship had lower scores in these domains, when compared to professionals who did not, showing that work overload, especially nursing, negatively influences the safety climate. Conclusion: The integrative literature review showed an incipient number of publications in Brazil, mainly focused on Emergency Care Units, which corroborated the importance of carrying out this thesis. The second study pointed out that the Safety Attitudes Questionnaire instrument presents satisfactory values in the evaluation of psychometric properties, showing evidence of validity, reliability and responsiveness, being validated to be reproduced in other Emergency Care Units. In the last study, the safety culture, through the measurement of the safety climate, proved to be extremely fragile, with results below the recommended by the literature in all domains of the Safety Attitudes Questionnaire. It is expected that the results found in this thesis will be used by managers, in order to direct specific actions on the subject in the Emergency Care Units. In addition, it is essential to improve working conditions, such as investments in infrastructure and equipment, expansion of care teams, better remuneration of professionals and periodic training. This study is a pioneer in assessing the safety climate in Emergency Care Units in Brazil. The results point to fundamental questions, however, they do not exhaust the discussion on the subject, which requires an assessment of the safety climate in Emergency Care Units belonging to other regions of the country, as well as qualitative studies to deepen the understanding of the findings of this research.