II) 8. Indicadores de calidad para enfermería (INDICAS)

Indicators of Quality and Safety in Nursing Care

Overview of the System

• The topic covers quality and safety indicators in nursing care, part of a strategy by the health department.

• The system allows monitoring and comparison of quality indicators across health services nationwide.

Types of Indicators

• There are indicators for primary care units, hospitals, medical personnel, and user treatment.

• Specific nursing indicators aim to ensure quality and safety in medical attention throughout the country.

Focus on Nursing Indicators

• Six specific nursing indicators are monitored at the second level of care.

• First three focus on medication administration, patient dignity by nurses, highlighting barriers to safety.

Safety Indicators in Patient Care

Key Safety Measures

• Three additional indicators address patient safety: fall prevention, pressure ulcer prevention, urinary tract infection prevention.

Sample Size Determination

• Sample size for applying these indicators is determined quarterly; not all patients are included.

Implementation Process

Data Collection Strategy

• Establishes how many patients will be surveyed each month/week based on previous quarter data.

High-Risk Patient Identification

• Focuses on high-risk patients for falls or pressure injuries to determine sample size effectively.

Dignified Treatment Indicator

Assessment Criteria

• The first indicator assesses dignified treatment through a specific form filled by nursing management during visits.

Patient Interaction Standards

Importance of Patient Interaction

• Nurses must address patients directly and explain essential actions to ensure understanding.

• Clear communication helps alleviate patient fears and ensures a pleasant hospital stay through kindness and respect.

• Nurses should maintain patient privacy during procedures by closing doors or curtains.

Ensuring Patient Comfort and Safety

• Nurses create a sense of security by explaining procedures, treating patients with respect, and using their names.

• Education for patients and families about care post-discharge is crucial to prevent confusion regarding medications.

• Continuity in nursing care is vital for effective treatment across shifts, ensuring comprehensive patient evaluations.

Evaluating Patient Satisfaction

• Direct questions to patients help assess their satisfaction with the care received from nursing staff.

• Friendly greetings upon introduction and departure are essential for establishing rapport with patients.

• Meeting 95% of established criteria indicates that nurses provide dignified treatment.

Infection Control Measures

• Proper management of infusion therapy reduces infection risks associated with healthcare settings.

• Seven key actions by nursing staff are necessary to prevent nosocomial infections related to intravenous therapy.

Documentation Standards in Nursing Care

• Accurate documentation includes patient details, service period, and specifics about the administered solution.

• Solutions must be changed every 24 hours; failure to do so can lead to complications or errors in treatment.

Guidelines for Venous Catheterization

• Use hypertonic solutions or parenteral nutrition; change equipment every 24 hours and label with installation date and time.

• Ensure the catheter is free of residues to prevent infections; check for compatibility of medications and solutions.

• Immediate changes are necessary if blood residues are found in the equipment, as this can lead to infection.

Monitoring Catheter Condition

• Assess peripheral catheter function through nursing records; report any pain or issues at the insertion site.

• Ensure catheters are securely installed and clean; avoid common mistakes in placement that could lead to complications.

• Maintain visibility of the insertion site using transparent dressings to monitor cleanliness.

Closed Circuit Solutions

• Use a closed circuit for parenteral solutions to minimize infection risk; ensure all connections are secure.

• Limit manipulation of the circuit during use, adhering strictly to safety protocols.

• Compliance with seven criteria reduces infection risks associated with peripheral catheters.

Medication Administration Protocol

• Verify patient data against medical orders before administering oral medications; ensure accuracy in medication delivery.

• Confirm medication name and presentation match medical indications to avoid errors during administration.

Medication Administration and Patient Safety

• Medication administration must adhere to official schedules and be recorded in the nursing clinical record.

• Inform patients about the medication being administered, ensuring they understand the procedure for their safety.

• Nurses should verify that patients actually ingest medications, especially during night shifts when patients may be asleep.

Ensuring Correct Medication Intake

• Presence of nursing staff is crucial when patients take medications to ensure proper administration.

• It’s important to document any alternate medications given according to established formats.

• Confirm that oral medications are fully ingested before recording them as administered.

Preventing Patient Falls

• Implement actions to prevent falls among hospitalized patients, focusing on risk factors.

• Utilize a checklist with seven criteria aimed at reducing fall risks in medical units.

• Assess patient fall risk using a scale and create personalized care plans based on identified risks.

Assessing Fall Risk Factors

• Evaluate previous falls, medication effects, sensory deficits, and mental state of the patient.

• Use scoring from the assessment scale to determine if a patient is at high, medium, or low risk for falls.

• Tailor interventions based on specific criteria from the fall risk assessment scale.

Utilizing Resources for Patient Safety

• Leverage available resources and equipment to enhance patient safety regarding fall prevention.

• Educate patients and families about fall risks and necessary precautions during hospital stays.

Utilization of Medical Equipment

• Importance of explaining the use of medical equipment like bed rails and crutches to patients and families.

• Nursing interventions must be re-evaluated based on patient condition at the start of each shift or when health status changes.

• Documenting any falls during care is crucial as it represents an adverse event.

Prevention of Pressure Ulcers

• Definition: Actions by nursing staff to prevent pressure ulcers in hospitalized patients.

• Increased incidence of pressure ulcers noted during COVID due to immobility among hospitalized patients.

• High rates observed in bedridden patients, emphasizing the need for proper care protocols.

Risk Assessment Criteria

• Six criteria established for assessing risk factors for pressure ulcers in patients.

• First criterion involves evaluating risk factors using a standardized scale (Braden Scale).

• Establishing a care plan based on identified risks is essential for effective patient management.

Patient and Family Education

• Educating patients and families about preventing pressure ulcers is vital, especially for those who will remain bedridden.

• Continuous re-evaluation of nursing interventions according to patient status helps mitigate risks effectively.

Braden Scale Overview

• The Braden Scale assesses sensory perception, moisture exposure, mobility, nutrition, friction, and shear risk factors.

• Scoring from 1 to 4 provides a risk level indicating potential for developing pressure ulcers.

Identifying Risks in Clinical Settings

• Lower scores indicate higher risk; thus, monitoring is critical in hospital settings.

Risk Management in Patient Care

• Discusses the use of a rotation clock to manage high-risk patients and prevent pressure injuries.

• Emphasizes adherence to guidelines for patient positioning regardless of diagnosis.

• Introduces urinary tract infection prevention measures for patients with indwelling catheters.

Key Indicators for Catheter Care

• Importance of keeping the collection bag below bladder level to prevent backflow and infections.

• Ensures catheter is secured according to patient's sex to avoid injury.

• Highlights the need for proper identification on catheters, including installation date and personnel details.

Maintaining Catheter Connection

• Stresses that drainage systems must remain connected to prevent infection risks.

• Encourages regular monitoring and documentation of catheter function and drainage system integrity.

• Advises on checking for kinks or obstructions in the catheter circuit.

Monitoring Catheter Duration

• Notes the importance of documenting days a catheter is in place as per medical prescriptions.

• Calls attention to recognizing signs of urinary tract infections, which are often overlooked by nursing staff.

• Lists symptoms such as changes in urine color, fever, or suprapubic pain that indicate potential infections.

Hygiene Practices for Patients with Catheters

• Recommends daily genital hygiene using soap and water to reduce infection risk.

• Emphasizes thorough cleaning techniques from pubis to catheter insertion site.

Importance of Avoiding Risks in Patient Care

• Focus on preventing attraction from the catheter to avoid patient harm and minimize risks associated with urinary catheters.

Evaluating Quality Indicators in Nursing

• Assessing indicators helps understand compliance with safety quality in nursing care.

• Nurses must be aware of actions required for each patient based on six key indicators.

Understanding Evaluation Criteria for Nursing Staff

• It's crucial for nursing staff to know the criteria used by management during evaluations.

• Awareness of these criteria allows nurses to meet compliance percentages effectively.

Standards and Documentation in Nursing Care

• The goal is to achieve 100% compliance with established quality indicators.