Segurança da assistência no perioperatório: integração de uma complexa rede intra-hospitalar

Abstract

The safety of perioperative care is promoted both by non-human factors (such as checklist, materials and equipment) and the practice of various human actors in-hospital network. This study aimed to analyze the safety of perioperative care in the view of professionals who work directly and indirectly in the anesthetic-surgical procedure, focusing on the connection of the different actors of intra-network hospital. This is a case of qualitative study involving 32 professionals working in the operating room and in medical clinics or supporting the anesthetic-surgical act. Data collection was conducted through interviews with semi-structured script and observation. Data were analyzed using the technique of Thematic Content Analysis. The results of the research were grouped into three categories: "intra-hospital network for the surgery in a public reference hospital for emergency care and education"; "Security Situations and insecurity in surgical procedures"; and "Surgical safety checklist: the apparent simplicity of the real complexity" In the first category there was a mystification of the Surgical Center by professionals working internally and externally to this sector. In-hospital network was considered vital, but is fragmented and most of the participants do not have a systemic view of all phases of the perioperative period. In the second category, presented to security and insecurity situations in everyday surgical care and how small actions result in major surgical incidents. Emerged four minimum dimensions, indispensable, inter and co-dependent for the safety of surgical care: structural condition, work processes, patient characteristics and professional attitudes. Urgent and emergency surgeries were considered the most unsafe procedures due to the fact that demand is unpredictable and require decision making and quick actions. It was observed a culture still unsolidified to handle errors and accidents. The completion of the checklist in the studied hospital showed as a mechanical process, which as such has not been able to be barrier to the incidents. Was established by a small group of professionals, not being widely reported and there was no awareness of the involvement and adherence to the checklist. Filling collectively and their valuation by professionals who work directly and indirectly in the operating room is a challenge. To this end, among other actions, should develop and implement engagement strategies for a greater number of professionals in-hospital network, consider the complex environment of an operating room and demystify the simplicity of use of the checklist once that interfere in the effectiveness of its use.