Introduction: Surgical procedures may be responsible for improving the quality of life of thousands of Brazilians who need this intervention to solve their health problems. However, until it can be performed, a series of obstacles can hinder this walk on the way through a virtual queue, which involves different stages, many comings and goings to the health unit that will be responsible for carrying out the procedure, waiting, anguish, hope, annoyances and disagreements. Many of the problems are caused by the difficulty in establishing an assertive communication process in the surgical circuit, both between professionals and patients, as well as between the different areas they will attend. In the university hospital that is the target of the field of study, the medical record is in a hybrid format (electronic part and documental part), which makes the communication process difficult, as there is nothing to guide the flow of communication or standardize the information. There are professionals who register in the computerized system of the medical record and others fill in the information in request forms or even in “pieces of paper” so that the patient can hand it over to another team that will organize the next stage of care. Objective: Improve the processes that make up the Surgical Circuit of a university hospital. Methodology: This is a quantitative study, with a quasi-experimental design, before-after type and without a control group, to improve the quality of communication processes within the surgical circuit. Results: To face this problem, it became necessary to develop intervention strategies focused on quality management in healthcare, with before and after assessments to quantify the degree of improvement achieved, in addition to building a protocol, process flowchart and a risk matrix. the path taken by the patient to improve effective communication, especially in the hospital's outpatient department, where the pre-surgical stages take place. Two evaluations of four criteria were carried out, one being the registration of the National Health Card in the AGHU computerized system and the other three being the recording of information in the electronic medical record. It was observed that, in absolute numbers, there were 44 non-compliances in the first assessment, compared to 19 in the second assessment, accounting for a reduction of 25 “quality defects”. This represented an absolute improvement of 56.81% through the improvement cycle. Conclusion: The application of the process improvement cycle in the Surgical Circuit proved to be a useful and effective quality tool, highly recommended for health services of any type. The significant improvement achieved in most quality criteria led to the inclusion of good practices in recording information in the electronic medical record, minimizing existing risks that could delay the steps in the Circuit, avoiding further delays in resolving the patients' health problems.

Introduction: Haemodynamics units (HDUs) are highly complex health services in which minimally invasive endovascular procedures are performed percutaneously.    Patients can suffer complications during or after percutaneous procedures, such as bleeding, haematoma, pseudoaneurysm, arterial thrombosis or distal embolisation. The development of a tool to guide the assessment of patients who have undergone percutaneous procedures in the haemodynamics unit will enable early reassessment of patients who require additional treatment, with a view to minimising damage and improving the quality of care, thus justifying this research. Objective: To develop and validate a patient assessment tool after percutaneous procedures in the haemodynamics unit.  Method: This is a methodological study to develop and validate an instrument for assessing patients undergoing percutaneous procedures in the haemodynamics unit. The research was carried out from February 2023 to February 2024, and consisted of two stages: 1- Construction of the instrument, 2- Validation of content and appearance by eight judges specialising in the subject, using the Delphi technique. The Content Validity Index (CVI) was calculated for the validation process. Results: The validated instrument is made up of 32 items that obtained a CVI > 0.80, divided into six dimensions: A: Identification data; B: General assessment and history; C: Procedure data; D: Analysis of risk factors for vascular complications; E: Vascular complications; F: Notification. Conclusions: The instrument was validated in terms of its appearance and content, proving to be a representative tool for assessing patients undergoing percutaneous procedures in the haemodynamics unit. Completing the instrument will be useful for planning and developing actions aimed at patient safety.

Introduction: Cervical cancer represents the second highest incidence of malignancy among women in the State of Ceará. Access to diagnosis and qualified treatment contribute to the prevention and effective control of this disease. In 2021, a quality improvement program was initiated in the cervical pathology service of the Cancer Prevention Institute, a state secondary reference unit for the prevention and early detection of cancer of the cervix, endometrium, breast and skin. Objective: To carry out a Quality Improvement Cycle in the health care service for women suspected of having cervical cancer. Methodology: Quasi-experimental study to evaluate the level of service quality, before and after the intervention. The Improvement Cycle followed the steps of Identification and Analysis of the improvement opportunity (OM), using the techniques of Brainstorm, Nominal Group, Prioritization Matrix and Ishikawa Diagram. Five quality criteria (C) were defined: C1 - Waiting time for excision of precursor lesions. C2 - Surgical margins free of neoplasia. C3 - First follow-up up to 6 months after excision of precursor lesions. C4 - Referral within 30 days after diagnosis of invasive lesions. C5 - Percentage of service promoters (client satisfaction). The initial assessment was retrospective, using data from the first half of 2021 from reports of the pathological anatomy laboratory and the Ars Vitae electronic medical record system. The intervention took place in the second half of 2021, using the techniques of Affinity Diagrams and Gantt, focusing on the dimensions of opportunity (access), technicalscientific quality and satisfaction. The post-intervention evaluation used data from the first half of 2022. Data analysis involved calculating the levels of compliance with the criteria in both assessments, and the 95% Confidence Intervals, in addition to estimating the absolute and relative improvements in compliance with each criterion and the statistical significance of the differences found. The analysis also used the Pareto Diagram before-after the intervention. Results: The levels of compliance with each criterion in the two assessments were respectively: C1: 75.0 (95% CI ± 7.0) and 93.0 (95% CI ± 6.0) (p= 0.005). C2: 40.0 (95% CI ± 8.0) and 62.0 (95% CI ±10.0) (p= 0.007). C3: 29.0 (95% CI ± 9.0) and 31.0 (95% CI ±10.0) (p=0.59). C4: 86.0 and 87.0 (p= 0.55). C5: 94.0 (95% CI ± 7,0) and 94.0 (95% CI ± 8,5) (p=0.5). For criterion C4 n=N. The Pareto Diagram analysis demonstrated that criteria C2 and C3 corresponded to 77% and 84.6% of the total non-conformities, in the first and second assessment, respectively. The initial assessment identified irregularities in the service's actions, with flaws in the internal and external regulation of patients, in the standardization of management, in the integration of teams and in monitoring actions. After the intervention, a significant improvement in criteria C1 and C2 was observed. In the case of C4 and C5 there was no difference between the two assessments, however the level of compliance remained high. No statistically significant improvement was observed in the level of compliance with C3. Conclusions: Training of health teams, using participatory methodologies, aimed at meaningful learning and interprofessional work, as well as the creation of the “regulation sector”, were essential elements for the success of the intervention. To increase C3 compliance levels, it is necessary to increase the number of medical professionals, develop and review protocols and continuously improve processes in the regulation and appointment scheduling sectors. To maintain the improvements achieved, continuing education and monitoring actions must be prioritized. 

The development of an Antimicrobial Stewardship Program (ASP) is a fundamental tool for preventing the spread of bacterial resistance, a global public health issue. Despite Brazil having updated guidelines on ASP implementation, few experiences have been described regarding its implementation using Quality Improvement Cycles. This study is an intervention with a quasi-experimental design, including before-and-after and time series analyses, conducted in a regional public hospital from January 2023 to June 2024. The improvement intervention was participatory, multifaceted, and based on data from a preliminary assessment with five quality criteria and context analysis using MUSIQ. Absolute and relative improvements in the criteria are estimated from reassessments and time series. The MUSIQ score of 106.42 indicated that the intervention could be successful but would face contextual barriers. Four out of five evaluated quality criteria showed significant improvement, positively impacting despite the challenging context. Implementing an antimicrobial stewardship program is a complex process involving multiple interventions and interfaces, for which the Quality Improvement Cycles method is appropriate.

The environment of health units can promote a feeling of cleanliness and well-being, as well as being a host and source of contamination for patients. Among the most common complications in hospital environments, Health Care-Related Infections stand out and control the spread of microorganisms becomes essential. Thus, Standard Operating Procedures for cleaning surfaces are important strategies for promoting safe and effective practices. In this sense, the study aimed to develop a quality improvement cycle in a Regional Hospital of Ceará to reduce Health Care-Related Infections through the development, validation and application of a Standard Operating Procedure to optimize the terminal cleaning of critical beds. To this end, an action research was developed from January 2022 to January 2023 with professionals from the cleaning team of the intensive care units and the management of the hygiene service, with steps from: integrative review to theoretical subsidy of the Operating Procedure Standard, focus groups with key informants (service workers) to add practical focus and build the document; participant sample training; implementation and monitoring through process and result indicators built with data from the checklist used in audits of the hygiene process; participatory analysis of results. In this way, safe critical bed hygiene management practices were systematized, based on the construction and validation of the SOP and checklist, constructed and validated by those involved in the work process and with satisfactory results achieved, which will potentially contribute to the reduction of infections, a key issue for risk management.

Introduction: Patient safety is directly associated with the quality of health services. In the context of Emergency Care Units, there is a gap in the implementation of safety protocols recommended by the National Patient Safety Program, such as the fall prevention protocol. Falls in patients result in damage in 30% to 50% of cases, and 6% to 44% of these damages are of a serious nature, such as fractures, subdural hematomas and bleeding, these events increase the length of stay, health care costs in health units and the risk of death. Objective: Establish care to reduce the occurrence of falls in patients in the Emergency Care Unit. Methodology: An experimental, before-and-after study, with a concurrent time series and a quantitative and qualitative approach, which took place at the Messejana Emergency Care Unit, located in the city of Fortaleza, in the state of Ceará. For data collection, an instrument called safety walk was used, applied in axis two of the Unit. Axis two is a wing where patients who stay more than 24 hours in the unit remain, being accommodated on stretchers. The site has a number of 16 patient beds, which are with transfer request and awaiting regulation. Results: Comparing the results obtained in March 2022 and March 2023, we had a 61% and 83% rate of compliance with the fall prevention goal safety walk requirements, respectively, with 14 samples in 2022 and five samples collected in 2023. Regarding the requirement to carry out the assessment of the risk of falls upon admission stratified by grade, we had 0% compliance in 2022 and 80% in 2023; regarding the requirements related to carrying out the daily assessment of the risk of falls stratified by degree, we had 0% compliance in 2022 and 100% in 2023; in the compliance requirement in the nursing prescription checked for care (keep the upper bed rails raised and wheels locked) we had 86% compliance in 2022 and 60% in 2023; in the requirement regarding the nursing prescription checked regarding care (guidance of the patient on the use of non-slip footwear) we went from 86% of compliance to 80%; in the requirement regarding signage for stratified fall risk, we went from 0% to 100% compliance; and as for the environment close to the patient, free of obstacles, illuminated and dry, we maintained 100% compliance in both years. Conclusions: The improvements made went far beyond the fall prevention protocol and contributed to the strengthening of the safety culture in the institution, through practices included in the routine of the service, active surveillance and involvement of all employees. It is necessary for safety issues to be part of the permanent agenda of health services and, for this to happen, it is important that there is a systematic planning, considering actions, structure, methods, definition of responsibilities and execution deadlines. It is also known that the implementation and dissemination of a safety culture requires a lot of effort, considering that managers, leadership teams and assistance teams need to be committed to issues related to safety, since the culture reflects the behavior of team members. an institution.

Introduction: Cerebrovascular Accident (CVA) is a highly prevalent disease, considered the second most frequent etiology of mortality. The ischemic subtype is the most common and is not treated quickly and effectively to produce permanent sequelae and disabilities. One of the most effective treatment modalities is intravenous thrombolysis. Intervening in terms of improving the quality and safety of services implies a reduction in time and cost, with consequent repercussions in terms of efficiency and performance of services. Objective: To evaluate the impacts on the door-to-needle time of patients with ischemic stroke (CVA) undergoing thrombolytic treatment after intervention of an audible warning at the entrance of the patient to the hospital and changes in the flow of care. Methodology: Descriptive observational quantitative study in which it will be evaluated whether there was a decrease in the needle door time after application of cycles of improvements in the flow of initial care for patients with ischemic stroke. The study population consisted of all patients undergoing thrombolytic therapy within a 6-month period before and after implantation of the improvement cycle. From the application of the Quality tool (Ishikawa Diagram), opportunities for improvement in the flow of care for patients with stroke undergoing thrombolytic therapy were detected. After strategic meetings with multidisciplinary teams, improvement cycles were defined to be implemented by the care teams. The cycles of improvements implemented were: creation of sound activation of a stroke code at the hospital entrance of patients in neurological window, availability of three exclusive beds for performing thrombolysis and changing the place where thrombolytic therapy is performed to the red emergency room. After the improvement interventions, monthly monitoring of the door-to-needle time was inserted into the institution's routine, based on the creation of indicators and trend/control graphs. The historical series for the construction of the indicator was at least 6 months of evaluation before and after the improvement cycles. Data were obtained secondarily through audits of records in electronic medical records of patients undergoing thrombolytic therapy. Preliminary results: After analyzing the graphs, it was observed that there was a reduction in the average of the individual values of the needle port time and tomography port time after implementation of the improvement cycle in May/2022 evidenced by four consecutive months (May - August 2022) with average values below of the midline.

Introduction: Poor communication is found in different healthcare environments, especially during transfers of complex patients, when a managed and agile approach is required, such as perioperative transfers.

Objective: Carry out an improvement cycle to reduce problems in the intersectoral surgical communication process of a public teaching hospital.

Methodology: A quasi-experimental study, before and after, without a control group, based on an improvement cycle. After a qualitative analysis of the problem, an intervention was planned and carried out in a participatory way between the months of April and December 2022. In order to assess the level of quality, criteria for quality of communication were defined and measured for patients hospitalized in the unit of surgical clinic, who performed procedures in February and March 2022 (1st evaluation), before the intervention and after the interventions in January and April 2023 (2nd and 3rd evaluation, respectively). For statistical significance of the detected improvement, a significance level of p ≤ 5% was considered, which rejects null hypotheses when p is <0.05.

Results: After the intervention, the surgery map was widely disseminated to all professionals involved in the surgical process. With the development and implementation of a communication instrument for perioperative care transition, there was an absolute improvement in communication between the surgical units in the study. Adherence to completing the preoperative checklist did not reach the expected improvement, and the engagement of the surgical team remains a major institutional challenge.

Conclusion: The project provided greater integration of the surgical units involved in the study, in addition to providing them with greater knowledge and skills to develop a cycle of improvement, even with the standardization of the use of the communication tool in the transition of care to the other areas of the hospital, it will be possible to make communication more effective.

Introduction: The quality of products and services is related to the value perceived by the customer and not only to the execution of their function and performance, in this sense there is a need to understand the causes of problems that are the reasons for dissatisfaction and that reduce the added value of the service for the user. Therefore, the justification for this work is based on the need for a hospital institution with a 24-hour emergency service to improve the level of satisfaction of the patients they serve through the delivery of a resolute, safe and value-added service to the customer in emergency care. Objective: Implement improvement cycles to reduce service time in the emergency department of a private hospital. Methodology: This is a quantitative and quasi-experimental time series quality improvement cycle. The research was carried out between January 2022 and July 2023. The study compared loyalty levels before and after a series of improvement interventions implemented at the institution. Followed the Standards for Quality Improvement Reporting Excellence 2.0 guidelines. In order to evaluate the improvement proposal, three quality evaluation criteria were applied: two evaluated the efficiency dimension and the other the customer experience (loyalty) served in the emergency service. The ethical requirements of resolution nº466/2012 were respected. Furthermore, all interventions were organized, planned and executed by an improvement team defined for the study. Results: After the interventions, there was an average increase of 13% in customer loyalty, suggesting that the improvements had a positive impact on patient satisfaction. Furthermore, there was a correlation between compliance with medical care times of up to 240 minutes and patient loyalty. The period of high demand, especially due to arbovirus cases, temporarily affected the ability to maintain compliance. The study also highlighted the importance of timely recording of clinical discharge in the system and the involvement of the medical team to ensure efficient care. Implementation of interventions has shown consistent and positive results over time, although seasonal challenges may impact compliance with service times in certain periods.

Introduction: Antineoplastics are drugs used in the treatment of malignant neoplasms. In general, they have a narrow therapeutic index, with a high potential to cause adverse events and harm to the patient when there is an error in their use. The occurrence of adverse events due to unsafe health care is probably one of the main causes of death and disability in the world, with half of the damage being preventable. The most harmful errors are related to prescription and use of medications. Investments in patient harm reduction can lead to financial savings and better patient outcomes. Objective: To evaluate the effectiveness of an intervention in the quality of prescriptions for anticancer drugs in a Brazilian university hospital of reference in cancer treatment. Methodology: This is a study developed through a quasi-experimental design, of the before-after type, without a control group, with a quantitative approach, using a quality improvement cycle. The improvement cycle will be carried out in the following stages: 1) Identification and prioritization of the quality problem; 2) Analysis of the causes of the problem; 3) Elaboration of quality criteria; 4) Quality level assessment; 5) Quality improvement intervention; 6) Reassessment of the quality level. Prescription quality criteria were based on the specialized literature and on the institution's safety prescription protocol. To assess the level of quality of prescription of anticancer drugs, prescriptions of anticancer drugs will be randomly selected from medical records of cancer patients undergoing treatment and considering the rates of compliance with each criterion. After the initial assessment, a structured quality improvement intervention will be applied regarding the safe prescription of antineoplastics, followed by reassessments to be carried out immediately after the intervention and after six months, in order to assess whether there has been an improvement in quality and whether the improvement has been maintained over time, respectively.

Introduction: Trauma is the leading cause of death among people aged 15 to 29 years. Due to the complexity of the problem, it is necessary that the service be carried out through protocols that favor the timely, safe and effective reception, providing identification and prompt action to life-threatening situations. Objective: To carry out a cycle of improvement, to increase the adherence of professionals to the Protocol of Initial Assistance to the Patient Victim of Trauma in a reference hospital in the region of Cariri in the Brazilian Northeast. Methodology: This is a quantitative, quasi-experimental, before and after study, carried out from September 2020 to February 2022, based on a quality improvement cycle, following the SQUIRE guidelines, divided into nine steps: identification and prioritization of improvement; analysis of the causes of the problem; development of quality criteria; quality assessment; analysis and presentation of evaluation data; designing interventions to improve; implementation of the intervention; reassessment and registration; and monitoring. It has an approval opinion in the CEP under n.4,963,590. For the evaluation, seven quality criteria were defined related to the causes of non-adherence to the trauma care protocol. The interventions were planned and implemented in a participatory and multifaceted way, with the aim of increasing adherence to the record of actions in the trauma care protocol, and took place from September 2021 to February 2022. After the interventions, the criteria were reassessed and the analysis was performed from the calculation of point estimates of criteria compliance and absolute and relative improvement. Statistical significance was tested using the one-sided z-value test and presented in a Pareto chart. Results: In the first evaluation, non-conformities were found in 74% of the criteria and in the re-evaluation, a reduction of 60% of this rate was observed, resulting in 71% of conformity. The greatest gains after interventions were related to the registration of Revised Trauma Score data, with a relative improvement of 96%; patient and trauma identification data filled in, achieving an absolute improvement of 41% and a relative improvement of 91%; and initial care based on the ATLS described in the Trauma Protocol form, with an absolute improvement of 62% and a relative improvement of 86%. As additional gains, there was a 59% increase in the number of protocol activations, and a 29% reduction in associated mortality. Conclusions: It is believed that the interventions planned with the help of quality tools provided a more accurate identification of the causes of the problems found, favoring the improvement of the quality of patient care.

Introduction: COrona VIrus Disease - COVID-19, with its high transmissibility, has brought new challenges to health institutions. It required the redefinition of care flows and the creation of new protocols to offer safe and quality care. It is known that Patient Safety proposes measures to prevent and reduce incidents in health services, which result in unnecessary harm to the patient. Therefore, a set of skills developed in the field of patient safety are essential to adapt to a constantly changing environment. Objective: to map in the scientific literature the actions taken to promote patient safety with COVID-19 in the hospital context. Methodology: based on the scope review method, the steps proposed by the Joana Briggs Institute were followed. The research question was constructed based on the PCC method (Population, Concept, and Context): P: patients with COVID-19; C: promotion of safe care; C: hospital units. Searches were carried out in March 2022 in nine data sources, namely Cumulative Index to Nursing and Allied Health Literature, Cochrane library, Latin American and Caribbean Literature in Health Sciences, National Library of Medicine, and National Institutes of Health, Scientific Electronic Library Online, Science Direct, Elsevier's Scopus, Web of Science, Wiley Online Library. Results: of the 12,264 scientific articles found, 15 studies were selected to compose the final sample. The most recurrent patient safety practices were the contingency and reorganization of beds, rooms, and operating rooms, in addition to the isolation and distancing practiced by patients and professionals. Regarding the areas where the studies were developed, there was a predominance of surgical centers (26%), followed by adult and pediatric Intensive Care Units (20%). Conclusion: contingency practices and reorganization of beds, rooms, and operating rooms, isolation and distancing practiced by patients and professionals, use of personal protective equipment, patient risk classification, postponement of medical procedures, reorganization of triage, health education and training of professionals, swab patients, disinfection of equipment and environments and use of telehealth were present and had a positive impact in the context of the COVID-19 pandemic, to reduce the chances of complications to the user's health.

ntroduction/Justification: In 2007-2008, the member countries of the World Health Organization established the global challenge entitled “Safe Surgery Saves Lives'' and, in 2018, the Ministry of Health approved the Brazilian Guidelines for the Treatment of Neck Fractures of the Femur in the Elderly. It is known that investment in training and qualification of the surgical team is capable of improving safety indicators and increasing the safety of procedures. Objectives: This study aimed to assess the quality level of the implementation of the protocol for safe surgery for femoral fractures, in a reference hospital, before and after an improvement cycle. Materials and Methods: The study was carried out at the Hospital Regional do Sertão Central - HRSC, located in Quixeramobim-CE. This is an observational study to assess the implementation of a safe femoral fracture surgery protocol, before and after an improvement cycle, identifying procedural failures and the effects of the intervention. The femur fracture patient care line was implemented in 2019 at the HRSC and the safe surgery protocol improvement cycle for these patients was carried out in 2020. All patients admitted and operated on the femur fracture patient care line in year 2020 of the HRSC were evaluated for compliance with the protocols. Reoperations and those procedures without surgical incision were excluded. Data were collected by consulting the safety management worksheets, the line of care worksheet for patients with femoral fractures, the surgical safety checklist (“checklist”) and the medical record. The patients' sociodemographic information was collected from the medical records, in addition to the following parameters: surgical site infection rate; hospital readmission rate, reoperation rate and mortality rate in the first 90 days after admission; surgical outcome, length of hospital stay, time between fracture and hospital admission to the HRSC; time between admission and surgery; and compliance with the safe surgery protocol and the perioperative optimization protocol. Results: It was observed that most patients are female (65.8%), with a mean age of 73.5±16.5 years, with no statistical difference between the groups before and after the improvement cycle. As for the clinical outcomes, it was observed that, after the cycle of improvement, there was a slight decrease in the number of occurrences of the following adverse events: surgical site infection (p = 0.49), hospital readmission (p = 0.29), reoperation (p=0.19) and postoperative death (p=0.52), but this decrease was not statistically significant between the groups. The main procedural flaw identified was related to antibiotic prophylaxis, with representation around 80% in the Pareto analysis. Compliance with the safe surgery protocol rose from 28.7% before the improvement cycle to 48.4% after the improvement cycle, with this difference being statistically significant (p<0.001).
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Introduction: Health care-related infections are directly related to care procedures or hospitalizations in health services. Among the different types of HAI, primary bloodstream infections (IPCS) stand out as one of the main causes of in-hospital morbidity and mortality. In addition, they are among the main infections in the Neonatal Intensive Care Unit (NICU), associated with the increase in the length of stay of these patients and high hospital costs, representing a worrying public health problem. Objective: To build and validate an Educational Technology (ET) in video format for health professionals about the prevention of primary neonatal bloodstream infection. Methods: Methodological study regarding the construction and validation of an educational technology in video format on the theme Prevention of Primary Neonatal Blood Stream Infection, from August 2021 to July 2022. The research was conceived from a cycle of improvement initiated with the care team in the Neonatal Intensive Care Unit (NICU) of a tertiary care hospital, in the interior of Ceará, in which the need for guidance of professionals regarding the prevention of primary infection of the neonatal bloodstream was recognized. The video was built from scientific evidence about good practices in the prevention of IPCS in neonatology. This was followed by the stage of content and appearance validation by the judges (professionals and specialist professors in the areas of neonatology, communication and designer) and the target audience (professionals working in the neonatology area). For validation, a Likert scale was used, and items with agreement rates greater than or equal to 70% were considered validated. Data were analyzed by descriptive statistics. 18 expert judges and 28 professionals working in the NICU participated. The necessary changes were made, with the help of the designer, to edit the final version of the video. Ethical precepts related to resolutions were metNo.466/2012; No.510/2016 e No.580/2018. Results: The content and appearance of the video images were validated by the judges with an average agreement rate of suitability of 98.14% and 98.78% among the target audience. Most of the judges (77.8%) considered the ET totally suitable for promoting learning in different hospital contexts in the area of neonatology. In addition, 100% of the judges stated that the material addresses the issues necessary for training the target audience. It was highlighted that 17.9% of the target audience stated that they had never had access to educational material on the prevention of IPCS in neonatology and emphasized that video will help in professional performance and can also be used by any professional working in the neonatology area. Conclusion: The video was validated in all evaluated domains and can be used as a permanent education tool by the team of the Neonatal Intensive Care Unit.

The objective of the present study was to identify instruments used for the assessment of patients hospitalized in palliative care. This is an integrative literature review study, carried out from October to November 2021, on online database platforms: U.S. National Library of Medicine, Latin American and Caribbean Literature on information on Health Sciences, Scientific Electronic Library Online and the Virtual Health Library. A total of 126 scientific articles were located, of which 10 were selected to compose the study sample. Fifteen instruments were identified, six generic, four specific for people in palliative care, four specific for cancer patients and one for patients diagnosed with COVID-19. The instruments that were most repeated among the studies were: Palliative Performance Scale and Edmonton Symptom Assessment. The most relevant aspects to be evaluated in palliative care patients were: functional capacity, physical and psychological symptoms and advanced age. The instruments proved useful to guide health professionals in patient assessment, care planning and decision making.

In Brazil, among the responsibilities that municipalities assume with the Unified Health System (SUS), is Pharmaceutical Assistance (AF). There are different models, stages of organization and structuring of these health services in the municipalities. Several advances have been made since the publication of the National Medicines Policy (PNM), the National Pharmaceutical Assistance Policy, the Health Pact and Decree 7,508 of 2011. However, studies point to weaknesses in the current model of PA, making it difficult to compliance with the principles proposed by the SUS, through the Health Care Networks (RAS) with the challenge of overcoming the fragmentation of pharmaceutical services. In this sense, the present study aims to evaluate the improvement in the quality of Pharmaceutical Care in the city of Apodi-RN, Brazil, after the implementation of a cycle of quality improvement. It is an Action Research with a before and after evaluation study. The analysis of the criteria and indicators constructed was carried out in the Standards for Quality Improvement Reporting Excellence 2.0 (SQUIRE). Fourteen drug dispensing units were evaluated, being 12 Basic Health Units (UBS), 01 Psychosocial Care Center (CAPS) and 01 Supply Center. For each evaluation, a confidence interval (CI) of 95% was assigned. The research was approved by the Research Ethics Committee under the opinion number 5,077,998 (CAAE: 50990921.9.0000.5292). As a result, we had the elaboration and implementation of the Manual of Good Practices for Dispensing Medicines and Standard Operating Procedure (SOP); implementation of the HORUS system; hiring another pharmacist for the implementation of Pharmaceutical Assistance actions. In general, the study demonstrates the effectiveness of a plan to improve the quality of pharmaceutical care in the municipality.

INTRODUCTION: the maternal and neonatal morbidity and mortality can be prevented with quality and safety care. These are preventive measures that guarantee the improvement of the quality of care during labor and birth.

OBJECTIVE: to increase adherence to practices in the State of Rio Grande do Norte.

METHOD: This is a quasi-experimental study with a cycle of improvement with data analysis before and after the intervention. A retrospective review of medical records of 108 deliveries (baseline) and 102 deliveries (post-intervention) was performed, selecting 420 deliveries (mothers and newborns), selected by systematic total randomization. The intervention, carried out in conjunction with a service team and other changes, consists of training on good practices, reactivation of training on good practices, reactivation of collective actions. As variables of interest to the study, indicators include simple and composite events of good practices and adverse events. A descriptive analysis was performed with absolute and relative frequencies and a 95% confidence interval (95%CI) and for the analysis of the improvement of post-intervention good practices, the Student's T test was applied, considering a value of p<0.05.

RESULTS: It was observed that 89.52% of the mothers were between 14 and 34 years of age, 96.19% of the total deliveries were carried out in the term or post-term period (with 37 or more gestations), 89% of the pregnant women had up to 03 days of hospitalization and 60.9% of the deliveries were normal. The main causes of the low performance of good practices are related to the work process and continuing education. After the intervention, there was an increase in practices: filling in the partogram (p=031), time for the companion (p=0.002), replacement of the 1st skin between mother and baby (p<0.001), administration of vitamin k (p <0.001) and newborn identification with a bracelet (p<0.001). The proportion of deliveries with at least one adverse event in relation to the total deliveries considering the two periods was 9.5%.

CONCLUSIONS: it is possible to induce an increase in the implementation of good practices in childbirth care in health services through a multifaceted intervention. It is necessary to invest in strategies for the sustainability of this improvement.

Introduction: Intravenous Therapy (IVT) is a routine procedure performed by Nursing professionals. It is a set of interventions performed with patients for the treatment of diseases and performed through central or peripheral access through the practice of venipuncture. Intravenous Therapy can cause several complications, including phlebitis. Objective: To apply an improvement cycle for the prevention of phlebitis and to assess the level of quality of care in intravenous therapy. Objective: To apply an improvement cycle for the prevention of phlebitis and to assess the level of quality of care in intravenous therapy. Methodology: This is a quasi-experimental, before-and-after, time series study with a quantitative-qualitative approach. A cycle of improvements was carried out in the high-risk ward of the Januário Cicco Maternity School, based on the quality criteria established to measure the current level of quality. The intervention took place between May and September 2022, being carried out through five phases: Phase 1: Identification and prioritization of the opportunity for improvement; Phase 2: Analysis of the improvement opportunity; Phase 3: Quality assessment; Phase 4: Intervention to improve; Phase 5: Reassessment and recording of the improvement achieved. Results: Ten quality criteria related to the care process in intravenous therapy were selected, considered useful to assess the improvement in the quality of phlebitis prevention. For that, the indicators of puncture and maintenance of peripheral intravenous catheters before and after the interventions were monitored and the level of compliance with the evaluated criteria was calculated. Absolute compliance was identified in two criteria, namely: C1: Performing hand hygiene before and after insertion of the peripheral catheter, with 100% compliance and C5: Use of peripheral catheters over needle. As for the criteria with levels of non-compliance, they were C3: Use of semipermeable and sterile transparent cover for stabilization of peripheral vascular accesses. C8: Protect the peripheral vascular access cover with plastic and/or aluminum foil during the patient's bath; C9: Use syringes filled with 0.9% saline solution for flushing administration in peripheral vascular access; and C10: Daily assessment of the peripheral vascular access insertion site by the nurse, monitoring the catheter maintenance time, which should not exceed 96 hours. The intervention consisted of a training course given by the master's student to nursing professionals working in the hospital's high-risk ward. After the interventions, the quality criteria were again evaluated between the months of September and October 2022 in the high-risk ward of the HMJC. In the reassessment after the intervention, it was found that there were changes in the levels of compliance with the criteria evaluated in a positive way, with significant improvements in most of the criteria. Conclusions: The implementation of a cycle to improve the quality of phlebitis prevention in the gynecology unit proved to be relevant for patient safety and stimulated the adoption of practices based on scientific evidence by Nursing professionals before and after the intravenous catheterization process.

Planning, reviewing and monitoring the performance of organizations are vital actions to effective management. A new outpatient and laboratory unit at UFRN had process management based on quality. In order to develop and describe the unit's planning with a focus on quality, an action research was carried out in four phases: planning (bibliographic research and agreement), action (definitions and mapping), description (elaboration of protocols and training) and evaluation (patient satisfaction survey). The first three phases were carried out before the Unit was opened to the community. During its realization, mission, vision, strategic lines, organization chart were defined; and construction of protocols. About 15 operational protocols were previously developed and another ten when the public service was started, anticipated due to the new coronavirus pandemic. Ten protocols were implemented and professionals trained in practice. The patient satisfaction survey was answered by 97 users. The service provided was characterized as very satisfactory by 64.3% of these, satisfactory by 21.4%, indifferent by 1%, unsatisfactory by 1% and very unsatisfactory by 12.2%. The debate with the leaders on the concepts of quality in the planning phase for opening to the public was significant in the organization of ideas, as it allowed the design of the processes to be fluid and consistent. The COVID-19 pandemic imposed a new demand for UFRN's social commitment, which prompted the opening of the unit. Thus, action research was an adequate method to structure process management in the unit.

Introduction: The surgical-orthopedic care planning process starts with the indication of the procedure according to the patient’s need, goes through preoperative care for the surgery performance in the operating room, and ends with postoperative care and guidelines for discharge. Surgical assistance in the three moments (pre-, intra-, and postoperative) is a peculiar dynamic, as it involves several actors and technologies of varying complexity that must be synchronized to achieve a final objective: a surgery performed in a timely manner and without any harm to the patient at any stage of the surgical care process. Objective: This study aimed to evaluate the improvement in the care planning for patients undergoing elective orthopedic surgery in a public trauma reference hospital. Method: It was a quasi-experimental study of before-and-after design, without a control group, and quantitative approach, using a quality improvement cycle with problem analysis, intervention, and monitoring. Twenty criteria were developed to evaluate the quality of surgical care planning, based on causes classified as modifiable, observing the precepts of face validity, such as logical or apparent relevance, of content related to the dimension of quality, professionals’ needs and expectations, and of criteria, using scientific evidence. The study was conducted from January 2019 to December 2020. Data resulting from the intervention were submitted to descriptive and inferential statistical analysis and presented in a Pareto chart to highlight the level of improvement and its significance. The study followed the ethical procedures required by Resolutions no. 510/2016 and no. 580/2018 and was approved by the Research Ethics Committee of the Onofre Lopes University Hospital. Results: Results of this study refer to the compliance or non-compliance to the quality criteria listed and analyzed after the intervention actions within the proposed improvement cycle. There was a global improvement in the criteria, in which 70% (14 of 20) of the analyzed criteria presented increasing levels of compliance. Criteria C1, C2, C7, C18, C19, and C20 stood out for a higher level of compliance in the second evaluation. Regarding statistical significance, there were significant improvements in ten of the twenty criteria, which showed improved level of quality. Criteria C1, C2, C3, C6, C7, C11, C15, C19, and C20 were statistically highly significant (<0.001), which indicated that the improvement was real and that the statistical analysis of improvement between the two evaluations have less than one in a thousand chance of being wrong. Criteria C4 and C5 did not have the level of compliance found in the first evaluation due to lack of registration in the data sources. Criterion C12 demonstrated decreasing quality according to the evaluation of the absolute improvement. Conclusion: It was observed that the intervention activities improved most of the evaluated criteria related to the surgical-orthopedic care planning process. The stages of the intervention cycle enabled the development of activities by the multiprofessional team capable of contributing to the improvement of assistance to orthopedic patients during the perioperative period.

Introduction: Antimicrobial resistance is a major public health concern as it is becoming ineffective. Although microbial resistance is a natural phenomenon, its spread is directly related to factors such as antimicrobial misuse and infection control programs and management of inadequate or non-existent antimicrobial therapy. Objective: Analyze the management of antimicrobials in a public hospital in São Luís - MA, to propose and implement an intervention for their proper management. Method: This is a quasi-experimental study without a control and error group, combining time series analysis and before and after analysis to improve the quality of antimicrobial management. Developed in a public hospital in São Luís - MA from November 2018 to October 2019. Based on the improvement cycles the study sought through the analysis of problems, and the identification of causes in the same way to develop with focus on the scope of the given quality rating. The multi-faceted intervention was participatory data-driven, covering improved standards and norms, improved information systems, communication, and education of staff and patients. The context was analyzed using MUSIQ. For the quality criteria conformity estimates 95% confidence intervals were calculated. To analyze the effect of changes, absolute and relative improvement values and differences in measures before and after interventions should be estimated, tested for meaningful statistics and calculated or Z-value. Results: In the initial quality assessment used in two requirements, safe prescription of antimicrobials and prescription according to the empirical antibiotic guide, which applies only 4%  (4%) in the first criterion and 12% (4%) in the second. When analyzing the context MUSIQ shows the score 111, suggesting that the intervention may be successful, but faces contextual barriers. Post-intervention data have not yet been measured. Conclusions: An assessment of the initial quality of antimicrobial management at the hospital demonstrated significant opportunity for improvement in the antimicrobial management process.

Introduction: Defined by the World Health Organization (WHO), patient identification is an action that aims to regulate the safety process in the care provided by health institutions, as well as to minimize the possibility of damage, and also to ensure that certain care, procedure or treatment is aimed at him. Objective: Assess the quality of identification before and after carrying out an improvement cycle and analyze the effectiveness of the intervention in improving quality in the patient identification process. Methodology: It is the implementation of an internal improvement cycle, observational and intervention, using an almost experimental design, before and after, with a quantitative approach in an Intensive Care Center. Seven criteria were developed to assess the quality of the identification process. The results of the intervention were submitted to statistical analysis and presented in a Pareto graph, to demonstrate the level of improvement. Results: It can be inferred that the quality of the identification process showed a significant improvement in the values related to compliance with the conformities in the evaluated criteria. Statistical significance (p<0.001) was observed in the assessments of criteria C1, C2, C3, C4 and C6 with an increase in compliance values after the improvement cycle intervention. The criterion C5 showed good results since the initial evaluation and C7 showed improvement, but did not reach the level of significance. Conclusions: The present study showed that the improvement cycle carried out with the aim of improving the quality of the patient identification process proved to be effective. It was possible to involve the interested parties, stimulate the participation of the assistance team and improve the organizational processes related to the theme.

Introduction: Maternal and neonatal mortality is a serious public health problem that must be tackled by a combination of internal (from the health services involved) and external (from health system regulators) actions. However, there are weaknesses in the regulation of health risks in Obstetric and Neonatal Care Services (SAON) and uncertainties about how to improve this process. Objective: To evaluate the quality of the regulation carried out by the Health Surveillance in the SAON and test the effect of an improvement strategy. Method: This involves implementing a cycle to improve the quality of the SAON regulation process, in the context of the Sanitary Surveillance of the State of Santa Catarina, carried out in the 2019-2020 biennium. After qualitative analysis with a cause-effect diagram on the current regulation process, six quality criteria that represent good regulation of these services were built and evaluated. Based on the evaluation of the regulation of the 43 SAONs with ICU beds in the state, a participatory and multifaceted intervention was designed to improve quality aimed at the most problematic criteria. The effect of the intervention was analyzed with a quasi-experimental design, before and after, without a control group (n = 43). Descriptive statistical analysis of the absolute and relative improvement of the criteria and analysis of the statistical significance of the changes was performed (p <0.05). Results: In the initial assessment of the 43 SAON, all quality criteria were flawed. After the intervention, the minimum relative improvement was 81% in one of the six evaluated criteria. An overall relative improvement of 93% was achieved in the 06 criteria with significant improvement (p <0.05). Conclusion: The implementation of an improvement cycle prioritized the weaknesses in the management of health risk in the SAON and enabled the implementation of an intervention project based on an evaluation process. As well as demonstrated that it is possible to externally induce improvement actions in health services through multifaceted actions involving responsive regulation, monitoring, inspection, and training. Consequently, it is hoped that it may favor the reduction of the occurrence of incidents and adverse care events, in particular maternal mortality and care infections. Its publication may inspire its replication within the scope of the National Health Surveillance System.

Introduction: The Currais Novos-RN Collection and Transfusion Unit (UCT) routinely conducts blood donation campaigns in various media, which reflects a constant concern with the expansion and loyalty of donors. The service constantly presents imbalances in the red cell concentrate stock, because although it eventually goes through moments of shortage in the stock of this red blood component, it records high rates of disposals per maturity. This is due to the lack of inventory management processes. Objective: To perform an improvement cycle in the control of red cell concentrate pouch inventory. Methodology: This is a quantitative, quasi-experimental, time series study with 12 measurements before (retrospective) and 12 measurements after the beginning of the intervention (prospective) to identify the evolution of quality indicators. The development of the improvement cycle was divided into 5 phases. Phase 1: Identification and prioritization of improvement opportunity; Phase 2: Analysis of the opportunity for improvement; Phase 3: Quality assessment; Phase 4: Develop and implement an intervention strategy to improve inventory control of red blood cells; Phase 5: Reassess the quality monitoring indicators after the intervention has been implemented. Results: In the analysis of the data collected before the intervention, we noticed that at various times there is a decrease in the utilization of packed red blood cells units, as well as a decrease in the sending to other hemotherapy services, as well as the distribution to other hospitals. Conclusions: It is hoped that the implementation of a stock management system that can calculate a demand forecast, support the decision to send surplus stock to other hemotherapy services, as well as signaling risk of shortage can contribute to the improvement quality of stock control of other Hemocenters and UCT's of the state Hemorrede.

Introduction: This study integrates the implementation of a quality improvement cycle to evaluate the work processes in a Human Milk Bank (BLH). The BLH is a specialized service responsible for the promotion, protection and support of breastfeeding and the collection of lactic production of the nursing mother, its processing, quality control and distribution, governed by the Collegiate Board Resolution ( DRC) n.171 / 2006 of the National Health Surveillance Agency (ANVISA). It is BLH's responsibility to record the steps of the work process. The poorly designed work process is considered to be one of the problems with the greatest impact on patient quality and safety, and it is effective and important to define them through well-connected actions, using prior planning, to make them safe. Rationale: Given the importance of the actions performed by the BLH, it is emphasized the need to manage the quality of work processes, through studies that strive for quality improvement. Such studies, increasingly present in health services, are characterized by local context analysis to identify the occurrence of quality problems. Objectives: To evaluate the work processes in a Human Milk Bank (BLH) before and after the completion of a quality improvement cycle; Characterize the BLH in the physical aspects, human resources and operational; Identify in BLH, possible opportunities for improvement; Perform quality improvement cycle; Test the effects of interventions; Monitor the results achieved. Method: This is a qualitative study, with quasi-experimental design of the type before and after the completion of a cycle of improvement in the BLH Maternity School Januário Cicco, a public institution that integrates the Federal University of Rio Grande do Norte, located in the municipality. from Natal-RN. Expected Outcomes: It is expected to contribute to improving the quality and improvement of management of BLH activities, from handling LHO to distribution and consumption, as well as speeding up work processes and adapting to good patient safety practices. .

Introduction: Comprehensive care is one of the main guidelines of the Unified Health System, Integrative and Complementary Health Practices (PICS) were officially introduced in SUS in 2006, through the National Policy of Integrative and Complementary Health Practices (PNPIC) .A The patient's experience is essential for the advancement of person-centered attention, encompassing aspects that permeate the sensations and perceptions, so that it is possible to estimate the extent to which they are receiving care that is respectful and consistent with their individual preferences, needs and values. Given this, it is important to add the assessment of patient experience to the scenario of integrative and complementary practices, paying attention to fundamental elements for the quality of health care, such as the effectiveness and safety of care. Objective: Apply the improvement cycle to the patient experience in a service of integrative and complementary health practices. Method: This is a research with quasi-experimental design, before and without control group, of qualitative type, which will be developed through the application of an internal quality improvement cycle in the Laboratory of Integrative and Complementary Practices in Health ( LAPICS), an Administrative Unit of the Department of Collective Health (DSC) linked to the Health Sciences Center (CCS) of the Federal University of Rio Grande do Norte (UFRN). For this, quality criteria will be used, evaluated before and after improvement intervention through a questionnaire applied to service users, with a sample (n = 30) for each evaluation, in a simple random way. Data from the first assessment will be collected after review and approval by the Research Ethics Committee in November 2019 and will be re-evaluated following an improvement intervention in March 2019. To check whether or not to hear improvement of the quality level will be performed. the calculation of the point estimate with a 95% confidence interval, as well as the absolute and relative improvement of each criterion, with the statistical significance being verified through the Z test. Expected Results: It is expected to know the perception of service users about aspects. regarding effectiveness, efficiency, ambience and patient-centered attention, so that they can intervene in non-compliant aspects, generating improvement for the service

Introduction: Intravenous therapy aims at the administration of solutions or drugs in the circulatory system. The peripheral intravenous catheter is used in approximately one third of hospitalized patients and may present local and systemic complications. Phlebitis is one of the most frequent local complications according to the Intravenous Nurse Society (2011) and its prevention is part of the work process of the nursing staff. Objective: To evaluate the quality of phlebitis prevention in patients undergoing peripheral insertion catheter implantation. Methodology: This is a quasi-experimental, before and after study, with no control group with quantitative approach, using a quality improvement cycle with analysis of the opportunity for improvement; undertaking the quality level study; planning and execution of timely interventions; and reassessment of the quality level. The place of study was the wards of the central internment building of the Onofre Lopes University Hospital. The selected population consisted of 120 peripheral venous catheter insertion procedures, 60 before and 60 after intervention with the nursing staff. Data collection to identify the quality level was performed from May to June 2019, using non-participant observation of the procedure of puncture and maintenance of the peripheral venous catheter with the completion of a checklist instrument, consisting of 19 criteria. Of Quality. The intervention took place from August to October 2019 and covered an educational action directed to nursing team professionals and another to patients / caregivers, in addition to updating the Standard Operating Protocol available at the hospital. The study followed the ethical procedures required by Resolution No. 466/2012, and was approved by the Research Ethics Committee of the Onofre Lopes University Hospital. Results: The study of possible causes related to phlebitis prevention revealed numerous factors related to the professionals. Thus, the quality level was evaluated and among the 19 criteria evaluated, 4 had compliance equal to or above 90%. It did not observe criteria that had no compliance (0%) or that had 100% compliance. 8 criteria were considered problematic, together representing 69.1% of nonconformities. Conclusions: This study is expected to contribute to the development of improved quality of phlebitis prevention based on interventions aimed at appropriate care and the improvement of procedures related to puncture and maintenance of the peripheral venous catheter.

Introduction: The Blood Sanitary Surveillance exercises the control of transfusion risks related to hemotherapy services and aims to minimize the health risks arising from the provision of these services, the production and use of blood components (hemotherapy), seeking the protection of collective health . Existing health legislation requires that such services have policies and actions that ensure the quality of products and services, ensuring that procedures and processes take place under controlled conditions and defines the quality system as an organizational structure with responsibilities, policies, processes , procedures and resources established by the executive director of the institution to achieve the quality policy.

Objective: The objective of this study was to conduct an external quality improvement cycle aimed at the development of quality management activities in the Hemotherapy Services of the interior of the State of Rio Grande do Norte, based on the evaluation and performance of the Sub-coordinator of Sanitary Surveillance (SUVISA), in accordance with what determines the current legislation.

Methodology: The quantitative study conducted in the biennium 2017-2018 was almost experimental, before and after, without a control group, with the elaboration and evaluation of thirteen quality criteria, from causes classified as modifiable, observing the precepts of face, content and criterion validities. The intervention in the eight hemotherapy services in the interior of the newborn, among which there were two regional blood banks, two collection and transfusion units and four transfusion agencies occurred in the period from 06/07 to 01/09/2017. After this stage, the quality criteria were reevaluated, from 11 to 10/24/2017, in order to visualize the effect of the improvement cycle and prioritize the remaining opportunities.

Results: The results referred to the compliance and non-compliance levels of the thirteen criteria, based on their relative and accumulated absolute frequencies, and showed that the compliances increased from 44 (42.3%) to 66 (63.5%), resulting in a decrease of non-compliances or quality defects from 60 to 38, after intervention in the hemotherapy services evaluated. Criteria 1, 2, 3, 4 and 11 maintained the same level of care after interventions in the improvement cycle, and presented compliance of more than 60%. However, a higher percentage of compliance was observed in criterion 6, referring to "established procedures and registered for the treatment of nonconformities and corrective measures", from 12.5% to 75%, showing an improvement of 62.5 %. Similarly, there was an increase in compliance with criteria 5, 7, 10, 13 (37.5%), criteria 6, 8 and 9 (25%) and criterion 12 (12.5%), among which corresponding to the main quality defects identified in the 1st evaluation and which were prioritized in intervention actions and quality improvement in the hemotherapy services of the study. At the same time, the individual performance of each service was evaluated against the improvement cycle and the comparison of the spatial distribution of compliance and non-compliance levels, according to the location of the services in the health regions of the state.

Conclusions: When comparing the results of the two evaluations, the effectiveness of the improvement cycle in the eight hemotherapy services in the interior of the NB was demonstrated and demonstrated that the use of quality management strategies and tools was useful to identify priorities for improvement and improvement specific problems, with a view to the quality of hemotherapy products and processes, as well as transfusion safety. The Health Surveillance initiative as a regulatory and supervisory body in the hemotherapy services was fundamental to boost and monitor improvement processes, understanding that quality management and evaluation are mandatory requirements that must be met by such services, as determined by legislation sanitary legislation.

Introduction: Nowadays, because of the changes in the demographic profile and in population’s morbidity and mortality, an increase has been observed in chronic degenerative diseases, what includes cancer. In its treatment, the use of orally administered medications is increasing, they tend to be more convenient, but also increase the risk of adverse events. This fact reinforces the importance of consolidating its qualified and safe use, specifically at the dispensation stage, which should have a preventive and corrective nature in this process. Purpose: To evaluate and promote the process suitability of outpatient dispensing, administered with oral antineoplastic medications, through an improvement cycle. Methodology: This is a quantitative, near-experimental design, before-after and without control group study, carried out at a referral hospital in the treatment of cancer, located in the north of Minas Gerais. In which, from seven, previously defined and validated quality criteria, the quality level of the outpatient dispensing process of oral antineoplastics was evaluated, and based on the most problematic criteria, improvement interventions were implemented followed by a quality reassessment. The quality compliance of randomly selected samples (n=60) was estimated in a timely manner and in a 95% confidence interval, as well as the statistical significance of the achieved improvement was treated with Z test. Outcomes: It was noticed that all seven quality criteria evaluated, showed across-evaluation improvements. Most of them (four out of seven) had a statistically significant increase in quality levels (p<0.05), with a relative improvement of at least 75%. In absolute data, it was noticed that the non-compliance decreased from 148 in the first evaluation to 67 in the re-evaluation, what represents a 54.7% improvement. Conclusion: The study provided an evaluation of the process of outpatient dispensing, administered with oral antineoplastics in the institution, identifying the quality criteria, what favored the prioritization and effectiveness of the interventions. The improvement cycle contributed to the inclusion of good dispensing practices and to a better involvement of the staff with regards to quality requirements

Introduction: It is undeniable that the constant concern for patient safety should be one of the main focuses of attention of the health services and the safety culture in these institutions has a great influence on this issue because it is the product of individual and group values, attitudes, perceptual abilities, and behavioral patterns that determine commitment to patient health and safety management, style and proficiency. In recent decades, there has been a significant mobilization around patient quality and safety programs in health organizations, but the implementation of a Patient Safety Program (PSP) in a systematic way, taking into account the high attributes level of safety culture, especially in outpatient oncology services, is still a poorly debated topic. Objectives: To improve the patient's safety culture in an oncology service and to evaluate the effect of implementing a safety program on the institution's culture. Methodology: Almost experimental study of the before and after type, without control group, performed from July 2017 to April 2018 in an ambulatory oncology service in the city of Ponta Grossa-Paraná. The questionnaire from the Agency for Healthcare Research and Quality (AHRQ), translated and validated for use in Brazil, was applied to health professionals before and after the implementation of the PSP in that specialized service. The questionnaire has 14 dimensions with 44 items and was applied to all professionals working in the institution, in both phases. In the process of implementing the PSP, data from the safety culture served as the basis for the design of the improvement cycle consisting of multidisciplinary meetings; definition of responsibilities; training and training program; implementation and adoption of policies and protocols; definition and measurement of structure, process and results indicators; among others. For the interpretation of the data, the definitions contained in the AHRQ manual (2016) were assumed - as negative the responses marked as: totally disagree, disagree, rarely, never, very bad and bad; as neutral: neither agree nor disagree, sometimes acceptable; as positive: I agree totally, agree, always, almost always, very good and excellent. Use of Microsoft Excel 2016 for data analysis. Results: Of the total of 60 professionals who were invited to participate in the survey, 43 (72%) answered the questionnaire, of which 37% were doctors, 12% comprised the nursing team, 10% the reception staff, 10% the hygiene team, 8% of radiology, 7% of the pharmacy, 7% of the administrative sector and the other 9%, nutritionist, psychologist and physiotherapist. In the pre-implantation stage of the PSP, there was a predominance of a negative result for six (43%) of the 14 dimensions, being: Organizational learning/continuous improvement, Feedback and communication regarding errors, Openness for communications, Frequency of reports of incidents are reported in the various modalities, Non-punitive responses to errors and Number of reported incidents. Four (28.5%) dimensions showed a predominance of neutrality: Expectations/actions to promote manager safety, Management support for patient safety, Generalized safety perceptions, Patient safety level; and four (28.5%) dimensions with a predominance of positive results: Teamwork in the area/sector, Teamwork among areas/ sectors, Personnel, Internal transfers and shift tickets. When the post-implantation phase of the PSP was evaluated, a significant improvement was observed in all dimensions of the patient's safety culture, which assumed a positive predominance. Conclusions: The improvement of the safety culture of an institution is directly related to quality management, and the measurement of the safety culture was an important quality improvement tool, insofar as it identified the fragilities of the organization, providing planning and assertive actions taken in the patient safety program. This provided a shift in the setting in the patient's safety culture in the oncology service, making their commitment to quality of health care more robust.

The medical record is the communication element among professionals, users and health services that can measure and evaluate the type and quality of the care provided by carrying a set of information about the interventions performed and serving to follow the health history of the user. Proper recording of information becomes an important tool in patient care and safety, as well as legal backing for institutions and professionals. The present study has as general objective to evaluate and improve the records in medical records of Hospital Geral de Farias Brito. The research is a quantitative study, with a quasi-experimental design, before-and-after evaluation of quality criteria. The data were obtained through the analysis of the records made in the records of patients admitted to the unit. An improvement cycle was implemented with problem analysis, intervention and monitoring. Regarding the type of evaluation, it can be stated that it is internal, retrospective and cross-referenced. It was evaluated the eight criteria to verify the quality of the records related to the identification of the patient and the assistant professional, legibility and aspects of the multiprofessional evolution, obtaining satisfactory results, confirming the improvement strategy evaluated.

Improvement cycles can be used to strengthen managerial functions, contributing to the detection of problems or opportunities, with a view to solving and / or improving them. The objective of this study is to evaluate the effect of the implementation of a quality improvement program on filling in the records of occurrences of the Mobile Emergency Care Service (SAMU), in Patos, Paraíba (PB). It is a quasi-experimental study of a time series without control group, divided in six stages: identification and prioritization of improvement, analysis of the opportunity for improvement, construction and validation of quality criterion, evaluation of quality level, intervention, revaluation . Three evaluations were performed between 2016 and 2018 with random sampling of 100 cases in each evaluation, based on seven criteria: identification, clinical evaluation, pathological antecedents, documented registry standardization, legible-correct-accurate registry, professional accountability and Systematization of Care Nursing (SAE). The complete analysis showed failure in all the criteria with emphasis on SAE. Interventions were made in a multifaceted way, grouped by related areas, directed to the quality criteria of worse conformity in the evaluations until new characterization was achieved, with completeness favorable to quality. However, the need for new interventions and monitoring was maintained for the continuity of the be reassessed in 2018 under the same criteria. For the established criteria, the statistically established difference is accepted with Z values of significance <0.001 in 86% of the criteria using SQUIRE 2.0 adapted (2018). The representation of the joint results among the three evaluations was able to highlight progressive improvement in the compliments of each criterion, highlighting the reduction of the defects (not compliments) found, considering the limitations of the study.

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Introduction: The Growth and Development Consultation – (CD) - is a programmatic action offered in the context of the work of Primary Health Care teams, which aims to offer prevention and promotion actions to children's health, as well as anticipate problems of children in the first years of life. Nowadays, although great advances have been achieved with SUS, there are still factors that make it difficult to implement policies, programs and strategies, which is no different in the PHC reality of the municipality under study. Objective: to recognize the difficulties for conducting the CD consultation in a small municipality of Northeast Brazil. Methodology: cross-sectional evaluative research with a quantitative approach, the database came from the external evaluation of the II Program Cycle of Improvement of Access and Quality (PMAQ). The research was carried out in the framework of six FHS teams that were evaluated by the PMAQ in the year 2015. The evaluation instrument was composed of a set of quality standards, aligned with the standards contained in the AMAQ-AB instrument, and which were organized in five major dimensions (institutional support of management for the basic care, reception and accessibility teams, care process , care coverage and active search) with the observation of the specific variables that are relate to each of them. These represent or translate the quality or the difficulties to perform the CD consultation in the reality of basic care worked. The ethical precepts of the resolution 510/16 were preserved. Results: the variables related to the five dimensions were evaluated and it was verified that a great part of these are limited and fragilized, negatively affecting the assistance offered in CD in the APS of this municipality. Conclusions: the quality assessment research carried out allowed us to represent the scenery of the CD consultation offered in the reality under study, at the same time as it gave answers to the objectives outlined. It was verified that many are the challenges still present for the correct operationalization of this programmatic action in this municipality and that stands out among them the need to rescue the critical reflection of the work process of the PHC teams based on the collective planning of the service, as well as , the need for several interventions in this service, given the inherent fragility verified in the assistance offered.

Abstract: This is an intervention research that aims to identify and describe the situation, the context and, at the same time, propose actions to qualify the existing activities in the emergency sector of a hospital unit. The present study integrates the implementation of an improvement cycle within the context of a serious public health problem called sepsis. Sepsis has been affecting millions of people around the world, tied to a high mortality rate. The increase in the life expectancy of the population and consequently, the increase in the number of immunosuppressed patients, the improvement in the emergency care, the accomplishment of more invasive procedures, the accomplishment of more complex surgeries, the increasing use of immunosuppressants and steroids and the growth of bacterial resistance has contributed to the high incidence of sepsis, despite the great advance of medicine in the last decades. It is believed that around 17 million cases are diagnosed worldwide each year. In Brazil, there are few studies on sepsis lethality and with very varied results, where it indicates that the lethality is around 67,4%, among the largest in the world. Recognizing this situation, since 2004, some world societies have launched the Sepsis Surviving Campaign (SSC), an initiative where guidelines have been developed and published for their treatment with a view to the early detection of these patients and the establishment of programs to improve the quality of care based in well-defined indicators, leading to a reduction in sepsis mortality. In this context, the active and continuous search to detect and treat patients early becomes a target of any hospital institution, with a search to improve the quality of care and patient safety. Rationale: The high mortality due to sepsis in Brazil, especially in the public network, may be attributed in part to the lack of awareness among health professionals about the signs of seriousness associated with infectious conditions, leading to late recognition of these patients, of clear treatment guidelines for this pathology by many organizations. In the Hospital Regional do Cariri, as well as in other brazilian institutions, despite adherence to SSC measures, mortality rates remain high and, according to internal statistics, sepsis is the main cause of death for this institution. In this sense, it is necessary to propagate policies and programs related to sepsis, in order to make this disease better known and diagnosed early, so that interventions with a high impact on the morbidity and mortality of sepsis can be instituted at the appropriate time. Objectives: To evaluate the effect of an improvement cycle for the process of care of patients with sepsis in an emergency hospital. Characterize the profile of the patients involved in the study; Implement measures for early diagnosis, monitoring and reevaluation of patients with sepsis.Design: The study will be of the type before-after (phase I / phase II), in the period between January 2017 (with the participation of patients with sepsis) and the identification of the opportunity for improvement) to July 2018 (including the intervention stage) in the Emergency Department of Hospital Regional do Cariri, a state tertiary public institution located in the interior of the state of Ceará, with 70 Emergency beds. The study will be reviewed by the local ethics committee, where we affirm that we are aware of following all ethical precepts in accordance with Resolution 466 / CONEP. All patients diagnosed with sepsis / septic shock in the emergency during the period considered will be included in this study, and serious patients, considered in medical records, will be excluded as terminals. Phase I will differentiate itself from phase II by the improvement cycle to be implemented. Expected Results: It is expected that from the intervention to be implemented in the sector, that health professionals, with knowledge on the subject, become more sensitive to early diagnosis of patients with risk of sepsis, preventing this disease from evolving for more severe stages and after death.

Introduction: The analgesia, sedation and delirium protocols in the Intensive Care Units (ICUs) promote comfort, reduce stress and accelerate patient recovery, reduce errors of clinical evaluation and quality of treatment, adjusting the use of drugs, favoring patient safety.

Objective: to implant protocol of analgesia, sedation and delirium in an ICU of a regional hospital of the Brazilian northeast using a cycle of quality improvement. Methodology: quantitative study of the quasi - experimental type, before and after, without control group, and intervention, for quality improvement, developed with the multidisciplinary team of the adult ICU of the Deoclécio Marques de Lucena Regional Hospital, Parnamirim - RN, in the period from March to August of 2018. Fifteen criteria and six indicators were added to measure the quality and daily measurements of these were made in the pre- and post-intervention period. The intervention included the implementation of the assistance protocol in a participatory manner, with permanent education and changes in work processes. The data for non-compliance with the criteria were analyzed in the Pareto before-and-after graph, the values of absolute and relative improvement were estimated and the statistical significance was assessed using the unilateral Z-value test for p <0.05.

Results: The medical records of 40 patients in each phase of the study were analyzed. There were no statistically significant differences in demographic data and severity criteria (apache II) in the two groups, and 43 professionals in the care team who were trained in the intervention phase, 74% stated that they did not have previous knowledge of the scales used, but all reported safety in their use after the intervention. There was a significant improvement (p <0.001) in 12 of the 15 criteria, but no difference in quality indicators.

Conclusions: The protocol of analgesia, sedation and delirium in an intensive care unit implanted with the use of quality improvement tools (improvement cycles) are easy to handle, low cost and effective in patient safety.

Objective: To evaluate the level of quality of the welcoming of spontaneous demand in a basic health unit and to verify the effectiveness of an intervention aimed at improving quality. Method: This is a quantitative research, with a near-experimental design, type before and after and without control group, developed through the application of an internal cycle of quality improvement in a basic health unit, located in the northeast region of Brazil. For this purpose, five quality criteria were used, evaluated before and after improvement intervention. The samples for each criterion (n = 60) were randomly selected. The point estimate was calculated with a 95% safety interval, as well as the absolute and relative improvement of each criterion. Statistical significance was verified through the Z test. Data from the first evaluation were collected in January and reassessed in July 2018, using an instrument with semi-structured questions, through an interview with users classified as spontaneous demand.  Results: It was verified that of the five quality criteria, one had statistical significance between evaluations, another had absolute improvement of 5%, two remained stable and one worsened. Conclusion: the level of fulfillment of the criteria of quality of the welcoming the spontaneous demand was positive in the second evaluation, except for criterion three. The application of the quality improvement cycle proved effective as a method of quality management.

Monitoring and evaluation are ancillary works planning and management in health. In the area of quality, especially on patient safety, monitor and evaluate indicators aim to ensure minimising the chances of occurrence of preventable adverse events, since they address the creation of operational systems and processes that reduce the likelihood of errors and maximize the possibility of interception of the incidents before that these occur. Come to think of it, a brazilian State company, present in 23 of the 27 States, has developed a tool called Panel of patient safety Indicators, in computerized format, available in digital platform, in which each one of the 40 institutions, comprising a network of federal, University hospitals is responsible for filling out your data. The aim of this study is to analyze the data, fill between the period of October to March 2016, 2018 and accomplish improvement cycles based on the opportunities identified. For this we conducted a study of improvement of the quality of the almost experimental type before and after, to assess the impact of the improvement in the rate of compliance with the dichotomous criteria elaborated. It was found that, after the implementation of improvement cycles, the twelve criteria to evaluate the quality, drawn from documents that guide the National Policy of patient safety, showed improvement. In addition to the technical approaches targeted to each indicator that composes the tool, was developed evaluation culture in the network of hospitals, which culminated in the institutionalization of the Indicators Panel, through the Programa Gestão à Vista.

Introduction:  Urinary tract infection in pregnancy is an important condition that can harm the  health  of  both,  the  mother  and  child  and  increase  maternal  and  neonatal  mortality. Adverse  pregnancy  outcomes  are  related  to  failures  in  prevention  and  response  capacity before  prenatal  complications,  childbirth  and  postpartum.  Currently,  the  lack  of  studies  on strategies that promote improved quality of prenatal care and strengthen public management strategies  to  optimize  work  processes,  improve  access  of  women  to  services  that  perform prenatal and especially  qualify the assistance  during  pregnancy.  Objective:  To evaluate the effects  of  a  quality  improvement  cycle  in  the  prevention  and  management  of  UTI  during prenatal.  Methodology:  This  is  a  quantitative  study  with  partly  completed  experimental design  type  before  and  after,  no  control  group.  An  external  cycle  of  quality  improvement, with  evaluation  of  five  criteria  of  quality  and  two  sentinel  indicators  were  applied.  Two evaluations  were  carried  out,  considering  the  time  of  three  months  between  them,  and  two monitoring type Lot Quality Acceptance Sampling -  LQAS. Between the first and the second evaluation,  a  participatory  intervention,  planned  and  guided  by  the  first  evaluation  was applied.  Samples were random, consisting of 120 cards pregnant women between 36 and 42 for  the  assessment  of  the  criteria  1,  2,  3  and  4,  besides  the  perinatal  mortality  data  were collected from the Municipal Management Report.  In order to identify the level of  quality, it was  used  the  point  estimate  and  confidence  interval  (95%)  of  compliance  with  the  criteria.Aiming  to  prove  the  effectiveness  of  the  intervention,  the  Absolute  and  Relative improvements  were  calculated  between  the  first  and  second  evaluation,  as  well  as  its statistical  significance  with  one-sided  z  test.  Results:  Multivariate  analysis  of  quality improvement, it was observed that most of the criteria of statistical significance (p> 0.001), except criterion 1 which showed a p lower than expected.  The criteria 1, 2 and 4 achieved a percentage above 65% compliance in both the samples. With respect to criterion 5, it can be inferred that 10.8% of the analyzed sample contained record examination results EQU and / or altered urine culture, and of these 53% had adequate treatment record. Perinatal mortality rate had a significant decline of 4.7% between 2014 and 2015, and early neonatal mortality rate decreased by 3.23% between 2013 and 2015. Conclusion:  The methodology used to improve the  quality  of  the  external  cycle  collaborated  in  the  remodeling  of  the  care  processes  of prenatal and especially in the integration between care teams and managers of different levels of  complexity  worked,  strengthening  co-management  and  co-participation  of  workers involved directly in care for users in the municipal health management processes. It has also enabled reflections on the existing flowcharts, providing the redesign of the same as reflected in improving access of pregnant women to health services and quality care.

INTRODUCTION

The identification of the patient is a recommendation for national and international patient safety and despite being a simple measure, low cost and highly efficient, is partially deployed health services with few experiences reported about its effective implementation.

GOAL

Improve the process of identification of the patient in two referral hospitals in Oncology;

METHOD

It is a quantitative study, almost-type trial before and after, with no control group. The improvement cycle went on two institutions for cancer care, with evaluation of seven quality criteria inherent in the identification of the patient. These were analyzed as its validity and reliability by the Kappa index. The sampling was systematic, with retrospective review and direct observation. After initial assessment was drawn the diagram of affinities, orderly and systematic intervention for quality improvement. The fulfillment of the actions has been calculated by estimating and the 95% confidence interval. For comparison and analysis of the effectiveness of the improvement was estimated absolute improvement on statistical significance and by unilateral Z-value test (p ≤ 0.05).

RESULTS

The statistical significance was proven in four of the seven criteria of quality. The absolute improvement was achieved in the criteria for identifying the bed, blood products, request request for laboratory tests and parts identification of pathology. The identification criterion of imaging scans obtained 2% absolute improvement, identification of the chart presented negative development ( -9.0%) and bracelet identification showed no positive result. How much improvement on the most significant results criteria focused on identification of bed, blood products, request request for laboratory tests and identification of Imaging tests.

CONCLUSION

The cycle of improvement proved to be effective and contributed to redefining patient identification activities, with the involvement of health professionals, patients, the escorts and the senior management. In addition, strengthened institutional culture focused on safety and provided new study front existing shortages.

Health services have increasingly incorporated new technologies and techniques accompanied by additional risk to patient safety. Patients in Intensive Care Unit (ICU) are more susceptible to errors. Among the tools used in the world to prevent the occurrence or recurrence of these errors in health care, we highlight the Root Cause Analysis (RCA) and Failure Modes and Effects Analysis (FMEA). The objective of this study was to identify and analyze the application of RCA and FMEA tools for improving the quality of care in ICU. Systematic review of literature based on the PRISMA. We used the following data bases: Scopus, PubMed, SciELO, LILACS, Web of Science, Science Direct, Cochrane, WHOLIS, PAHO and EMBASE. The qualitative analysis of the articles was conducted by applying an adapted and abridged version of SQUIRE 2.0 guide. 1674 documents were recovered in searches and, after the relevant tests, 18 were included in the review articles. Of these, 16 were published between 2010 and 2016, 10 were developed in the United States, 11 were conducted in the Pediatric ICU or Neonatal, 16 used FMEA on different topics. These data suggest concern with quality planning, it is important to highlight the use of indicators to measure the improvement of quality in most of the selected studies. This review underscores the importance of using these tools to improve the quality of care in the ICU, permeating the health institutions of behaviors that ensure more safety, contributing to the development of an organizational safety culture.

The medical record is the most popular means of communication at all levels of care in the health area. Its proper fulfillment is critical to the Good Practices of the Services. Despite its importance, the incomplete filling is still part of the routine of many care units. This study aimed to identify the main difficulties in the registration information in the records of a Basic Health Unit in Natal, in the perception of health workers. The research was a case study, cross-sectional, qualitative. Data were collected through focus group meetings audios records held seventeen professionals responsible for completing records in that unit. Data analysis was performed using the Alceste textual analysis software, with the help of the cause and effect diagram. The results showed that the professionals know the importance of medical records in the health care process and value the reliable information for clinical. The difficulties encountered are related to the lack of presentation of documents identifying users through the opening of new records, shortcomings in the records of vital signs and anthropometric data, and the large number of queries. The resolution of the difficulties reported depends on various levels of management, and also run through the improvement of local labor, implementation of continuing education and empowerment of users through a more humanized care

INTRODUCTION: Chemotherapeutic drugs are medicines that require high-risk initiatives to prevent failures in care that cause unnecessary damage to patients. OBJECTIVE: Perform a Failure Mode and Effects Analysis (FMEA) to prospectively identify the risks related to the phase of the preparation and dispensing of chemotherapeutic drugs in a hospital. METHOD: This is a descriptive study performed in an outpatient unit of a reference center in Oncology, philanthropist, from the city of Natal-RN. For the application of the tool is composed of a multidisciplinary team consisting of a mediator, pharmacists, nurse specialist and nursing technician involved in the process. The steps for preparing and dispensing chemotherapeutic drugs were described graphically by means of a simple flowchart. Then were listed the possible failures of each subprocess using Rain of ideas. Each failure was assessed using the array of risk score. According to the score obtained was used a decision tree to detect which flaws needed interventions. From the results obtained were proposed interventions and monitoring indicators. RESULTS: 17 failure modes were identified in steps of preparation and dispensation of chemotherapeutic drugs. Among the 17 failure modes, three obtained value > 8 and were therefore analyzed with decision tree for HFMEA. The failure mode "to change the output window of the Medicine" potential causes: lack of attention, lack of signs in the window and lack of knowledge of the process. The failure mode "wrong Calculation of the dose of intrathecal drug" had as potential causes: defective calculator, change in presentation of the medicinal product and work overload. The following interventions have been proposed: stipulate limits of meds to be handled at a time, the Windows flag internally and externally, containing work instructions and perform the check calculation of double medicine intrathecal and record in own printed. CONCLUSION: The FMEA tool proved to be a valid method to improve patient safety, as it allows a prospective analysis in the process of chemotherapy medication preparation and dispensing phase, with the objective of identifying potential failures and their associated causes, and formulate strategies for fixing such vulnerabilities.

Objective: To increase adherence of the preventive practices concerning Ventilator-associated pneumonia (VAP) in intensive care units (ICU), through an internal improvement cycle.

Methodology: A quality improvement cycle, quasi-experimental design before-after was applied in two ICUs of a public hospital in the northeast of Brazil, with a total of 19 beds. Nine quality criteria related to the prevention of VAP were established and a composite indicator with which to assess the baseline level of quality and later two more subsequent assessments at intervals of four months seeking measure possible improvements acquired during these periods. The Pareto chart was used to represent the frequency of non-compliance of each criterion assessed in three moments. It was used the point estimation and the confidence interval (95%) for the measurement of the criteria. To quantify the effectiveness of the intervention, it calculated the absolute and relative improvement, beyond the statistical significance of the absolute improvement through unilateral test value of z.

Results: There was a slight improvement on all criteria when comparing the first two assessments, but this initial comparison, only one criteria showed a statistically significant improvement (p <0.05). In the second comparison between the 1st and 3rd evaluations, the results showed improvement in the performance of all the criteria almost, where the nine established criteria, eight showed improvement, and six with a statistically significant improvement (p <0.05), with two improvement without significance and one criteria has worsened in the percentage of compliance. The composite indicator, which summarizes all the criteria evaluated, obtained a significant improvement of almost 40% (p<0.05) in the second comparison.

Conclusions: The implementation of an internal improvement cycle was an important tool in quality management for the adoption of best practices for the prevention of VAP in ICU.

The brazilian Constitution of 1988, to create the Sistema Único de Saúde – SUS defined as guidelines, universality, integrality and social participation. The great legal and management operating differential in the current system is social control carried out by users, health professionals, managers and service providers, such as deliberative and propositional actors health councils and in Conferences. More than 25 yearsbroadened considerably the effectiveness of the system, however, many are still challenges for the efficiency and effectiveness of the SUS. The current crisis in the health system puts on the agenda issues related to access and quality. The Ministry of Health launched programs and projects, in particular areas, in order to evaluate and induce the improvement of quality, it has 15 national conferences, thus, knowledge on the subject and the institutionalization of a culture of evaluation of quality, is still far away. In 2015 took place in Brazil the 15th National Conference of health that had as its central theme "Public Health to take good care of people: right of the Brazilian people" and as a first axis of the thematic discussion: "right to health, ensuring access and Attention to Quality." The 27 Brazilian States held their conferences in the framework of the Rio Grande do Norte had the 8th State Health Conference-CES/RN. This research is a qualitative study, documentary analysis, which aims at the perception of the users, professionals, managers, health care providers regarding the concept of quality in health services. The data used in this research were the primary type, obtained from questionnaires filled out by delegates at the time of accreditation in the eighth CES-RN. To check, tab and categorisation of the utillizou Software data Analyse Lexicale par context and d'un Ensemble of Segments of Texte-ALCESTE. To and analysis of the material and interpretation of results use the technique of content analysis (Bardin, 2003).