Segurança do paciente na odontologia: um instrumento de prevenção e controle a eventos adversos no ambiente acadêmico

Abstract

The provision of dental care in the scope of Primary Care represents a large portion of dental care, however, few studies related to prevention on adverse events (AE) in this level of care have been conducted to date. For many researchers, the key to changing this scenario would be associated with investments in patient safety practices still in academic training, given that areas of interest and clinical conduct applied in professional practice are closely related to experiences conducted during the academic training. In this context, the study aimed to understand the adverse events that affect primary care at the undergraduate level, as well as to propose a Dental Safety Checklist as an instrument for the prevention and control of adverse events at this level of care. This is a cross-sectional study, conducted using the method of retrospective review of medical records, adapted in this study in three distinct phases: Explicit Phase; Implicit Phase and Action Plan Phase. In the explicit phase, all active medical records for dental care at the Primary Oral Health Care clinic of the School of Dentistry of the Federal University of Minas Gerais, between 2020 and 2023, were selected for analysis. A validated instrument, consisting of 14 Adverse Event Trackers, was used to analyze the medical records. In the implicit phase, adverse events that were identified by the screening instrument were evaluated by two reviewers who confirmed and/or did not confirm the occurrence of the Avoidable Adverse Event. In the Action Plan Phase, understanding of the possible root causes of AE as well as the elaboration of a Dental Safety Checklist - LVSO. Descriptive and bivariate analyses were performed using Pearson's and Fisher's chi-square tests; (p<0.05). A total of 392 medical records were evaluated. Most of the patients were women (63.5%). The mean (SD) age was 52.4 (8.5) years. 49.2% (n=189) of the patients reported at least one chronic disease; 6.3% (n=24) consumed alcohol regularly and 62 (16.2%) were smokers. The frequency of detection of the event/incident was 26.3%, with procedures related to dentistry presenting a higher prevalence (17.3%). The frequency of events considered avoidable was 21.9%. The root cause of AE was mainly associated with failure in clinical procedures (19.1%). Individuals without chronic disease had a higher occurrence of detection of the event (p=0.002). There was a higher frequency of avoidable events when there was no presence of chronic diseases (p=0.024). There was no association with other variables. There was evidence that AEs occurred in the care provided by undergraduate students were mostly avoidable, and patients considered "less susceptible to risks" were paradoxically the most exposed to the occurrence of AEs. The LVSO presents itself as a strategic instrument to improve the quality of care in Primary Care in Dentistry, since it would provide both, the control and prevention of avoidable adverse events already in the process of professional training, as well as future studies on the Theme of Patient Safety in Dentistry.