nursing: the importance for high quality surgery demographics and labor market vanessa de brito...
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NURSING: THE IMPORTANCE FOR HIGH QUALITY SURGERY
Demographics and Labor Market
VANESSA DE BRITO POVEDA
Regional Meeting - The LancetLatin America
SÃO PAULO2014
What is ‘quality surgery’?
The safest care and best outcomes to the patients
preventing complications improving surgical care
reducing costs
American College of Surgeons, 2010
First global patient safety challenge
2005 – 2006
WHO, 2003
Second global patient safety challenge
2007 – 2008
WHO, 2008
HOW FAR ARE WE FROM THE ACHIEVEMENT OF “HIGH QUALITY SURGERY”?
Surgical procedures - Brazil, 2009
Local
MODERATE COMPLEXITY
SURGERY
HIGH COMPLEXITY
SURGERY
SURGICAL PROCEDURES
N % N % N %
North 24.350 96,6 849 3,4 25.199 100
Northeast
84.333 93,1 6.240 6,9 90.573 100
Midwest
20.754 91,9 1.841 8,1 22.595 100
Southeast
115.335 89,0 14.319 11,0 129.654 100
South 46.661 85,3 8.042 14,7 54.703 100
Brazil 291.433 90,3 31.291 9,7 322.724 100Source: www.datasus.gov.br
Number of health professionals (medical doctor and nurse)/ 1000
inhabitant – Brazil
1991, 1996 e 1999
Local
1991 1996 1999
Physician
NursePhysici
anNurse
Physician
Nurse
Brazil 1,3 0,4 1,3 0,4 1,4 0,5
North 0,6 0,2 0,6 0,3 0,6 0,3
Northeast
0,8 0,3 0,8 0,3 0,8 0,4
Southeast
1,9 0,5 1,8 0,5 2,1 0,5
South 1,2 0,4 1,2 0,4 1,4 0,5
Midwest
1,3 0,3 1,3 0,4 1,3 0,4Source: Ministério da Saúde/CGRH e Conselhos ProfissionaisBases para cálculo da população: IBGE, Censos 1991 e 2000; Contagem da População, 1996
Nursing professionals - Brazil
Nursing professionals: 1.856.686 (nurses, nursing technician, nursing
auxiliary)
Nurses: 340.387
COFEN, 2012
Distribution of nurses - BrazilTotal 340.387
70.49919.860
180.781
20.439
48.808COFEN, 2012
1 nursing professional/ 1000 inhabitants
Brazil: 8,51 nursing professionals/1000 inhabitants
1,78 nurses/ 1000 inhabitants 3,72 nursing technician/ 1000 inhabitants 2,94 nursing auxiliary/ 1000 inhabitants
COFEN, 2011
PERIOPERATIVE NURSES - BRAZIL
Local
Number of Perioperative
Nurses
Number of nurses/100 surgical
proceduresNorth 45 0,2
Northeast 136 0,2Midwest 42 0,2
Southeast 408 0,3South 97 0,2Brazil 728 0,2
Source: www.datasus.gov.br-2011
Is 99,9% a standard of safety?
0,1% errors could mean: 20.000 wrong medicine prescriptions/year 15.000 accidental fall of babies at
hospitals/year 500 wrong surgery/week 2.000 lost documents/hour
to our patients= 100%
Rosenthal, Sutcliffe, 2002
WHERE DO WE HAVE TO INVEST?
WHERE DO WE HAVE TO INVEST? STERILIZATION
Good quality infrastructure First step: Cleaning process
Termodisinfection and ultrasonic cleaner
Perioperative
Preoperative and postoperative
A large number of qualified nurse professionals (perioperative nurses)
Surgical safety checklist Prevention of surgical site infection
Postdischarge surveillance
Zinn, 2013
Intraoperative
Maintain normothermia Use appropriative hair removal with electric
clippers Use appropriative selection and timing of
preoperative antibiotics Maintain glucose levels during surgery
Zinn, 2013
References American College of Surgeons. Lessons Learned in the Pursuit of Quality Surgical Health Care. [Internet]. American
College of Surgeons, 2010. [citado 2014 Ago 6]. Available in: https://www.facs.org/quality-programs/about/inspiring-quality/lessons-learned
World Health Organization. (WHO). Word Alliance for Patient Safety. Guidelines on hand hygiene in health care. 2003.
World Health Organization. (WHO). Word Alliance for Patient Safety. Guidelines Safe Surgery. First Edition. 2008.
Conselho Federal de Enfermagem. Recomendação encaminhada ao MEC repercute nas redes sociais. [Internet]. COFEN, 2012. [citado 2014 Ago 6]. Available in: http://www.cofen.gov.br/cofen-recomenda-que-cursos-de-enfermagem-a-distancia-nao-sejam-reconhecidos_16039.html?print=1
Zinn J. Surgical patients: a vulnerable population. AORN J 2013. 98(6): 647-52.
www.datasus.gov.br