Banca de DEFESA: ELIELTON PEDROZA DOS SANTOS

The activity of the nursing technician during the surgical process in a public trauma hospital in Natal/RN: a contribution of Ergonomics to improving patient safety

Ergonomics. Patient safety. Adverse events. Nursing. Surgery.

Adverse events (AEs) are increasingly at the center of public health policy concerns around the world, as this type of occurrence is not rare and has affected many patients. In Brazil, from 2006 to 2022, 1,783 AEs related to surgical interventions were reported, with over 92% of these events classified as higher risk to the patient (classes III and IV), according to ANVISA. In Rio Grande do Norte, from 2013 to 2022, AEs due to surgical interventions accounted for 1.92% of the total notifications. Faced with the rise of the surgeries AEs, the World Health Organization (WHO) launched the second Global Challenge at the Patient Safety (PS) in 2008, with the theme “Safe Surgeries Save Lives”, aimed at the safety of surgical care. The overall objective of this study is to analyze the relationship between constraints and incidental variabilities and the occurrence of adverse events in patients during surgical processes at a public trauma hospital, the strategies adopted and the regulations carried out by nursing technicians to prevent adverse events or mitigate their impacts. Methodologically, bibliographic research, document analysis and field research were conducted. For field research, the situated and participatory method of Ergonomic Work Analysis (EWA) was used, through which interactional and observational techniques were applied, assisted by photographic and filming records, focusing on the nursing technician's activity during the surgical assistance process. This approach allowed to identify the following evidence related to the nursing technician's activity (surgical scrub nurse and operating room circulating nurse) in providing surgical assistance, among others: a ) activity determinants: lack of training in PS, lack of maintenance and replacement of equipment/ instruments, shortage of professionals, ineffective or absent communication; b) physical constraints: difficulty in transporting stretchers and hospital beds due to the existence of some floors with cracks, in addition to the risk of accidents involving the patient and the professional; stretchers and hospital beds with damaged castors and protective bars, requiring greater use of force by professionals and posing a risk of patients falls, as well as torn mattresses with damaged foam, causing discomfort to the patient; c) temporal constraint: difficulty for professionals to take breaks from work due to the high demand of patients in the surgical center (SC); d) incidental variabilities: breakage of the anesthesia cart, surgical table and other equipment during surgeries, causing surgical delays or the need for rescue ventilation with an Ambu; old, worn and damaged surgical instruments, hindering surgical instrumentation, which causes surgical delays and potentially prolonging anesthesia time. To ensure the efficiency of the activity and prevent AEs and mitigate their harm, technicians constantly make adjustments to the activity, employing strategies and actions, among others: fixing the protective bars of hospital stretchers with bandages to avoid patient fall; placing cardboard support below the stretcher mattress to make it more comfortable and avoid pressure injuries; opening other surgical boxes to find better surgical instruments to the surgeries. Based on the findings, the following measures were recommended to prevent and/or mitigate the risks of AEs in surgical patients, among others: use of the checklist or safe surgery verification list; establish effective intersectoral and interprofessional communication; acquire new or better-maintained stretchers and hospital beds to facilitate patient transportation and transfer; expand the nursing staff, reducing the physical and mental burden on professionals with turnover in surgeries. Therefore, it is concluded that there is a need to implement improvements regarding PS in the perioperative period of the evaluated hospital, considering the obstacles and challenges encountered during the nursing technician's activity that, in some way, threaten the quality of the service provided and PS in the surgical environment. As contributions, this research adds to existing knowledge about the nursing technician's activity in the surgical process, its importance and its relation to PS; demonstrates the applicability of the AET method for this type of research; establishes a theoretical, methodological and practical relationship between Ergonomics and PS; and proposes measures to reduce the occurrence of AEs in patients during surgical processes. For future work on this topic, it is suggested to replicate the methodology of this research in similar activities in other SC of public and/or private hospitals at national and international levels, and that comparative analyzes be carried out, aiming to reduce AEs during care surgery.