Banca de QUALIFICAÇÃO: CRYSLAINE CINTHIA CARVALHO NASCIMENTO

Uma banca de QUALIFICAÇÃO de MESTRADO foi cadastrada pelo programa.
DISCENTE : CRYSLAINE CINTHIA CARVALHO NASCIMENTO
DATA : 23/04/2019
HORA: 15:30
LOCAL: Laboratório do NUPEP (1° andar)
TÍTULO:

Analysis of risk classification activity in a High complexity school maternity: a contribution of ergonomics to patient safety.

PALAVRAS-CHAVES:

Risk assessment. Triage. Patient safety. Adverse events. Ergonomics. Health care Organization.

PÁGINAS: 68
GRANDE ÁREA: Engenharias
ÁREA: Engenharia de Produção
RESUMO:

This project is part of the field of patient safety, specifically as it relates to the activity of risk classification in a highly complex care organization that takes care of human health. While this type of organization is expected to be safe, it is not always the way it should be. The patient can be attended to and be affected by some adverse event, which could be avoidable. There are human health care systems where significant adverse events occur, of which many are preventable. "To err is human" is an expression that has become popular, and human error is assumed by many as an act that must be accepted in a comprehensive, non-punitive way, but this idea does not seem to be disengaged from the idea, also widely accepted, that at the head of the accident there is a causer, a culprit, and it is necessary to identify it, train it or remove it from the system or situation in question so that the occurrence does not recur. There is even the idea of punishing him in many organizations. The model for analyzing the problems associated with this safety vision seeks to identify unsafe acts and, to a more advanced degree, identify and analyze risks or adverse events. The problem solving model is expressed, in the first case, by the replacement of the individual in the work system and by the selection and "rigorous" recruitment of personnel. In the second case, the solution is established through the establishment of prescriptions (rules, procedures) and safety measures for each identified risk or adverse event, in accordance with the traditional safety approach, called Hollnagel de Safety I. This model is top-down ; the knowledge, experience and participation of workers in safety management are little taken into account. The solutions, according to this approach, are not enough to avoid or mitigate adverse events, especially when it comes to complex activities, such as the risk classification activity of patients in hospitals and maternities, which will be studied through this project . It is important to highlight that risk classification is a complex activity, since it is focused on the accumulated knowledge and experience of the risk classifier, but it is also conditioned by the availability and reliability of the information needed for decision making, the density of work , to the prescriptions, to the network of workers involved, to direct communications (worker-worker, worker-patient, worker-companion) and mediated by technologies, to the real context of work (variabilities, contractors, workload) etc. Contemporary Ergonomics and Resilience Engineering, when focusing on the study of patient safety and adverse events, accidents and disasters, take a systemic view on the causality of these types of occurrences. The most formalized interest in the subject of patient safety became widely known in 2000, when the Institute of Medicine in the United States published the book To err is human: building the safer health system, reporting the worrying situation regarding care in the country. This book brings a substantial amount of evidence on adverse events, which has led the ranking of causes of injury and death of patients in the United States. Adverse events may also occur during the risk classification process, formerly known as screening. The sector and risk classification process is the gateway to the health unit to which the patient is directed; is the place of first contact of the patient with the entire hospital care process. This process is characterized by the risk assessment of the patients, by the risk classification itself, by the decision of the hierarchy of prioritization of the visits and the initial referral of the patient to the examination, clinical or surgical care in a hospital or maternity. This process, which is dynamic and complex, becomes crucial when the demand for care exceeds the hospital's installed capacity to do so. It is, therefore, an important step in patient risk management linked to the management of patient care, which involves the entire flow of care. The unit of analysis of Ergonomics is the work situation, which has the work activity as its central element. The analysis of the work situations consists of the analysis of the activity performed by the people, considering the capacity, the restrictions and the state of health of these people, the conditions of execution and the contexts. This project will be developed in the Risk Classification Division of the Januário Cicco-MEJC Maternity School of the Federal University of Rio Grande do Norte, in the city of Natal-RN, Brazil. The object of study of the research is the analysis of the activity of risk classification, trying to identify the determinants of the activity that cause possible adverse events. Methodologically, action research and the ethnographic approach expressed by the Ergonomic Analysis of Work-AET will be adopted, which is a situated research method. In this sense, observational and interactive techniques will be adopted for field data collection, considering the behaviors, cognitive processes and interactions mobilized by the workers at the time of observations. The aim is to understand how the risk classification process takes place, the distance between what is planned for the risk classification (prescribed or imagined work) and what is actually done (actual work or how it is performed) , the contractors, the variabilities and the malfunctions of this process, the relation of these with the occurrence of possible adverse events and the strategies used by the workers to prevent or mitigate them. The Safety II approach, as presented by Hollnagel, brings "work as it is done" to the center of safety analysis and management. Through this approach, it will seek to understand the causes of possible adverse events and the strategies employed by the workers to ensure patient safety throughout the risk classification process. At the end of the study will be presented an ergonomic diagnosis of the activity of risk classification of the patient in the MEJC and proposed a set of measures to reduce adverse events and, consequently, improve patient safety.

MEMBROS DA BANCA:
Externo à Instituição - ALESSANDRO JATOBÁ - Fiocruz - RJ
Interno - 2329932 - JULIO FRANCISCO DANTAS DE REZENDE
Externa à Instituição - MARIA CHRISTINE WERBA SALDANHA - UFPB
Presidente - 1217772 - RICARDO JOSE MATOS DE CARVALHO