Portal de Programas de Pós-Graduação (UFRN)

SIGAA - Sistema Integrado de Gestão de Atividades Acadêmicas

Qualisaúde PROGRAMA DE PÓS-GRADUAÇÃO EM GESTÃO DA QUALIDADE EM SERVIÇOS DE SAÚDE CENTRO DE CIÊNCIAS DA SAÚDE Phone: (84) 9992-96451 E-mail: qualisaude@ccs.ufrn.br https://posgraduacao.ufrn.br/qualisaude

Dissertations/Thesis

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2025

	Dissertations
1	FRANCISCA KELCE MATIAS MACHADO IMPROVEMENT CYCLE FOR NOISE REDUCTION IN INTENSIVE CARE UNIT IN EMERGENCY SERVICE Advisor : VIVIANE PEIXOTO DOS SANTOS PENNAFORT COMMITTEE MEMBERS : ANA CAROLINA PATRICIO DE ALBUQUERQUE SOUSA SUSANA CECAGNO VILANI MEDEIROS DE ARAUJO NUNES VIVIANE PEIXOTO DOS SANTOS PENNAFORT Data: Feb 7, 2025 Show Abstract Introduction: The intensive care unit of the emergency service presents noise from numerous sources, such as conversations between professionals, students and the operation of various devices, with alarms being routinely triggered, which influences the noise pollution of the environment and the reduction of concentration, contributing to irritability and stress among professionals. Thus, alarm fatigue appears as a desensitization in the perception of sound signals, due to exposure to excessive alarms, leading to an increase in the health professional's response time. Objective: Develop an improvement cycle with the multidisciplinary team to reduce noise in the Intensive Care Unit in the Adult Emergency Service. Methodology: This is a study with a quantitative approach, quasi-experimental, before and after, without a control group, through the application of quality improvement cycles with analysis of the problem, identification of opportunities for improvement, selection of interventions , assessment of improvement and monitoring. The study will take place in an Intensive Care Unit, in the Emergency Service of a tertiary hospital in the interior of Ceará, with interventions expected to be implemented from December 2023 to May 2024, after approval of the project by the Research Ethics Committee . Preliminary results: To define the Opportunity for improvement, the Brainstorming technique was applied, in which seven thematic groups were listed. The improvement team defined the thematic Group to be prioritized, the Organization and Silence Group. Then, the prioritization matrix was used, in which the need to work on reducing noise pollution in the sector was defined. According to what was stated by the group, the causes and sub-causes were arranged in the Ishikawa Diagram format.
2	NAYANA NAYLA VASCONCELOS ROCHA EFFECTS OF A MULTIFACETED INTERVENTION TO IMPROVE THE IMPLEMENTATION OF THE THERAPEUTIC PLAN IN A PUBLIC HOSPITAL IN CEARÁ Advisor : ZENEWTON ANDRÉ DA SILVA GAMA COMMITTEE MEMBERS : LAURA MARIA CÉSAR SCHIESARI PETALA TUANI CANDIDO DE OLIVEIRA SALVADOR ZENEWTON ANDRÉ DA SILVA GAMA Data: Feb 11, 2025 Show Abstract INTRODUCTION – The therapeutic plan organizes care delivery, enhances interprofessional communication, guides treatment decisions, and ensures individualized patient care. At the Hospital Regional do Sertão Central, its implementation faces challenges related to execution, professional engagement, and organizational structure, which compromise its effectiveness. Optimizing this process may enhance the quality of care provided. OBJECTIVE – To evaluate the effect of a multifaceted intervention on improving the implementation of the therapeutic plan in a public hospital in Ceará. METHODS – This study, conducted from January 2023 to April 2024, followed the SQUIRE 2.0 model with a quasi-experimental pre-post design. A group of professionals from the institution led the improvement cycle, analyzing the root causes of the problem and targeting modifiable factors. Data collection was based on a random sample of medical records, and interventions were planned using the Pareto Principle. Post-intervention evaluation was performed in two phases, analyzing point estimates, confidence intervals, absolute and relative improvements to assess the effectiveness of the implemented actions. RESULTS – The interventions included the development of flowcharts, the provision of standardized therapeutic plan forms, the restructuring of clinical rounds, the revision of care processes, team training sessions, and the reorganization of monitoring mechanisms. Implementation led to significant improvements in compliance with key criteria, particularly in the documentation of discharge planning (absolute improvement of 15%, p=0.042), inclusion of medical goals (47%, p<0.001) and multidisciplinary team goals (22%, p=0.001), timely goal evaluation (22%, p=0.007), and the execution of rounds for therapeutic plan assessment (70%, p<0.001). The analysis also demonstrated a reduction in nonconformities (from 250 to 136) and the sustainability of changes over time. CONCLUSION – The multifaceted intervention demonstrated the potential to enhance the implementation of the therapeutic plan, fostering more coordinated and patient-centered care. However, the sustainability of these improvements may depend on contextual factors, highlighting the need for further studies to confirm the intervention’s effectiveness in different settings.
3	ESTELAMARIS DA SILVA SANTOS EVALUATION AND IMPROVEMENT OF NATIONAL PATIENT SAFETY INDICATORS IN THE STATE OF PARANÁ Advisor : ZENEWTON ANDRÉ DA SILVA GAMA COMMITTEE MEMBERS : ZENEWTON ANDRÉ DA SILVA GAMA CECILIA OLIVIA PARAGUAI DE OLIVEIRA SARAIVA TATIANA VIEIRA SOUZA CHAVES HEIKO THEREZA SANTANA Data: Feb 26, 2025 Show Abstract Introduction: National patient safety indicators reveal opportunities for improvement in risk management within Brazilian healthcare services. This study evaluated the impact of a participatory and multifaceted intervention, based on responsive regulation strategies, on the performance of the state of Paraná in patient safety indicators. Method: The study was conducted between 2022 and 2024, involving 20 hospital units from the state-owned network of the Paraná State Health Department. The intervention followed five stages: 1) Identification and prioritization of the problem; 2) Prioritization of indicators; 3) Initial compliance analysis; 4) Design and implementation of the intervention; and 5) Reevaluation of effectiveness. Using a quasi-experimental before-and-after design, the prioritized indicators included regular notifications in NOTIVISA, compliance with patient safety plans, and participation in the national assessment of patient safety culture. Data analysis was performed descriptively and analytically, comparing results before and after the intervention to identify significant changes, which were demonstrated through a Pareto Chart. Results: Significant improvements were observed. The "Patient Safety Culture Assessment" indicator showed an absolute improvement of 75% and a relative improvement of 88.24%. The regularity of notifications in NOTIVISA improved by 55% (absolute) and 78.6% (relative). The Institutional Safety Plan increased from 60% in the first assessment to 75%, with an absolute improvement of 15% and a relative improvement of 37.5%. Non-compliance cases decreased from 47 in the first evaluation to 27 in the second and 16 in the third, demonstrating improvement after the multifaceted interventions. Conclusion: Strategies based on responsive regulation and multifaceted approaches can contribute to the improvement of patient safety indicators and the reduction of non-compliance in healthcare services. However, the limitations of the quasi-experimental design and the influence of contextual factors indicate the need for further studies to validate the effectiveness and replicability of the intervention in different settings.

2024

	Dissertations
1	PERLA SONÁLY BISPO ARAÚJO IMPROVING QUALITY IN MONITORING INDICATORS SEPSIS IN A HOSPITAL IN PARAÍBA Advisor : VIVIANE EUZEBIA PEREIRA SANTOS COMMITTEE MEMBERS : VIVIANE EUZEBIA PEREIRA SANTOS CECILIA OLIVIA PARAGUAI DE OLIVEIRA SARAIVA DANIELE VIEIRA DANTAS MAYARA LIMA BARBOSA Data: Feb 27, 2024 Show Abstract Introduction: Sepsis is a complex and extremely serious disease, life-threatening, and a significant public health problem, with a high potential for mortality, being the leading cause of death from infection. Objective: Enhance the quality of monitoring indicators related to sepsis in an Emergency and Trauma Hospital in Campina Grande-Paraíba. Methodology: This research is a descriptive observational study with a time series analysis of sepsis indicators, implemented through an improvement cycle. The study included all patients admitted to the hospital with a diagnosis or suspicion of sepsis from February 2022 to January 2023. The dataset were collected on lactate measurement, blood culture collection, initiation of antibiotic therapy, and sepsis-related mortality. Activities for improving data collection were carried out, involving the Infection Control Service team and healthcare professionals directly assisting sepsis patients in the hospital. Data analysis was discussed and presented in form of tables and graphs. The study was approved by the Human Research Ethics Committee (HREC) (CAAE: 68120623.4.0000.5292). Results: The study involved 960 medical records. Adherence rates for lactate and blood culture collection criteria were low, while the antimicrobial therapy criterion showed better adherence to the protocol. The mortality rate varied, with an average of 47%. After interventions, more satisfactory results were observed, coinciding with changes in the intervention strategies within the improvement cycle. Conclusion: The study revealed issues with the quality levels associated with adherence to recommended care measures in the Sepsis Protocol. Although improvement interventions did not reach expected goals, the execution of the improvement cycle significantly influenced the alteration of intervention strategies related to quality management and the organization of sepsis indicator monitoring. The findings emphasize the ongoing importance of evaluating and improving health practices to ensure efficient care delivery.
2	JOSÉ FERREIRA LIMA QUALITY IMPROVEMENT IN THE SURGICAL CIRCUIT Advisor : WILTON RODRIGUES MEDEIROS COMMITTEE MEMBERS : VIVIANE PEIXOTO DOS SANTOS PENNAFORT WILTON RODRIGUES MEDEIROS SUSANA CECAGNO Data: Feb 28, 2024 Show Abstract 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.
3	PLÍNIO BRAGA LINHARES GARCIA EVALUATION THE LEVEL OF ADHERENCE AND COMPLIANCE WITH THE THERAPEUTIC PLAN IN THE CARE LINE OF PATIENTS WITH FEMUR FRACTURE Advisor : ANA CAROLINA PATRICIO DE ALBUQUERQUE SOUSA COMMITTEE MEMBERS : ANA CAROLINA PATRICIO DE ALBUQUERQUE SOUSA KATIA REGINA BARROS RIBEIRO VICTOR GRABOIS Data: Mar 15, 2024 Show Abstract Introduction/Justification: In recent years, quality management has assumed increasing importance in the hospital process, particularly in the surgical area. In 2007-2008, WHO member countries launched the second global challenge, entitled “Safe Surgery Saves Lives”, which aimed to reduce the number of deaths and complications associated with surgical procedures. In this context, implementing a therapeutic plan for patients with femoral fractures can play a crucial role in improving the quality of care and outcomes for these patients. A therapeutic plan can be defined as a structured approach to managing a patient's medical condition, outlining specific interventions and goals for treatment. Evidence suggests that a comprehensive therapeutic plan, with involvement of a multidisciplinary team, can improve outcomes for patients hospitalized with femur fractures. Objectives: to evaluate the level of adherence and compliance with the Therapeutic Plan (PT) in the line of care for patients with femoral fractures in a reference hospital, before and after an improvement cycle. Materials and Methods: This is a retrospective, quasi-experimental study to evaluate the level of adherence and compliance with the Therapeutic Plan in the line of care for patients with femoral fractures, before and after an improvement cycle. The study was carried out at the Hospital Regional do Sertão Central - HRSC, located in Quixeramobim-CE. The medical records of patients admitted and operated on at HRSC, in the line of care for patients with femoral fractures, from January to December 2023 were included. Reoperations, procedures without a surgical incision and patients who required the use of arthroplasty were excluded. Data were collected through consultation of safety management spreadsheets, the care line spreadsheet for patients with femoral fractures and medical records. The patients' sociodemographic information was collected through the medical records, in addition to the following parameters: length of hospital stay and compliance with the Therapeutic Plan. Results: It was observed that the majority of patients were female (67.88%), with a mean age of 72±15.61 years, with no statistical difference between the groups before and after the improvement cycle. It was observed that, after the improvement cycle, there were significant improvements in the level of adherence to the Therapeutic Plan, with improvements in the rate of timely opening of the plan and improvement in its compliance rate. There was no statistical difference between the groups before and after the improvement cycle in relation to the length of hospital stay. The main procedural flaws identified were related to the failure to reevaluate medical goals and the failure to reevaluate nursing goals, with a representation of around 61% (32% and 29%, respectively), in the Pareto analysis. The implemented improvement cycle was responsible for process adjustments, generating growth in compliance with the therapeutic plan from 11% to 82.35% of samples after the improvement cycle, this difference being statistically significant.
4	LIDIANE BEZERRA TEIXEIRA BULHÕES DEVELOPMENT AND VALIDATION OF A PATIENT ASSESSMENT TOOL AFTER PERCUTANEOUS PROCEDURES IN THE HAEMODYNAMICS UNIT Advisor : ANA ELZA OLIVEIRA DE MENDONCA COMMITTEE MEMBERS : ANA ELZA OLIVEIRA DE MENDONCA SANCHA HELENA DE LIMA VALE VICTOR GRABOIS Data: Mar 15, 2024 Show Abstract 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.
5	DIANA KARLA MUNIZ VASCONCELOS CHECKLIST FOR SAFETY OF HOSPITALIZED KIDNEY PATIENTS SUBMITTED TO MOBILE HEMODIALYSIS Advisor : VIVIANE PEIXOTO DOS SANTOS PENNAFORT COMMITTEE MEMBERS : VIVIANE PEIXOTO DOS SANTOS PENNAFORT ANA ELZA OLIVEIRA DE MENDONCA ELIANE SANTOS CAVALCANTE KEILA MARIA DE AZEVEDO PONTE MARQUES Data: Mar 26, 2024 Show Abstract Introduction: Hemodialysis (HD) is a form of Renal Replacement Therapy (RRT), indicated for chronic and acute kidney disease patients. It is known that HD patients are more susceptible to the development of bacterial infections, resulting in a worse prognosis, with higher mortality rates, compared to the general population. Objective: Build and validate a safety checklist for hospitalized kidney patients undergoing mobile hemodialysis. Methodology: methodological study using a qualitative approach, carried out from July 2023 to February 2024, through the construction and validation of a safety checklist carried out in two stages: construction of the instrument based on literature review and validation through of a focus group, composed of professionals from the hospital itself, approved by the Research Ethics Committee (CEP), under opinion number 6,626,783. Results and Discussion: The version of the checklist, presented to the focus group participants, consisted of 25 checking items before, 10 during and 13 after the mobile hemodialysis session, totaling 48 points to be observed, extracted based on scientific literature consulted and adjusted after a pre-test carried out with 5 professionals from the dialysis service, including a nurse and 4 nursing technicians. The instrument was validated by 14 professionals who participated in the focus group, from the medical and nursing categories, including: 4 doctors, 7 nurses and 3 nursing technicians. All with more than 5 years of experience in their areas of activity, representing the infection control service, the patient safety center, the dialysis service and the care team. With the collaboration of the participants, 4 checking items were added, one before, one during and 2 after dialysis and 2 were removed, resulting in an instrument with 51 safety items to be observed in the three moments of mobile hemodialysis. Final considerations: The checklist for safety in mobile hemodialysis, constructed from available literature and validated by professionals at the institution, is an important instrument to support the safety of hospitalized kidney patients who require renal replacement therapy through of mobile hemodialysis.
6	TELMA RÉGIA BEZERRA SALES DE QUEIROZ IMPROVEMENT OF QUALITY OF CARE FOR CERVICAL CANCER IN SECONDARY REFERENCE UNIT IN CEARÁ Advisor : PAULO JOSE DE MEDEIROS COMMITTEE MEMBERS : PAULO JOSE DE MEDEIROS ANA CAROLINA PATRICIO DE ALBUQUERQUE SOUSA JULIANA FLORINDA DE MENDONCA REGO Data: Apr 10, 2024 Show Abstract 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.
7	ALBERTINA PROENÇA RODRIGUES ALVES QUALITY IMPROVEMENT CYCLE IN PALLIATIVE CARE IN AN OUTPATIENT ONCOLOGY SERVICE Advisor : VILANI MEDEIROS DE ARAUJO NUNES COMMITTEE MEMBERS : VILANI MEDEIROS DE ARAUJO NUNES ANA CAROLINA PATRICIO DE ALBUQUERQUE SOUSA SUSANA CECAGNO VICTOR GRABOIS Data: Jul 22, 2024 Show Abstract Introduction: part of comprehensive care for cancer patients is prevention, early detection, diagnosis, treatment and the provision of palliative care for those who need it. Objective: to evaluate the impact of interventions carried out in the quality improvement cycle on care for patients identified with the Palliative Performance Scale (PPS) equal to or less than 50% in an outpatient oncology service. Methodology: this is a multi-method study that sought to develop a quality improvement cycle in the palliative care service provided in an outpatient oncology institution. The research was developed in two stages: first, a longitudinal study was carried out with a quantitative approach with the aim of identifying opportunities for improvement that require intervention. The second stage was a quasi-experimental before-and-after study, without a control group, with the aim of evaluating the effectiveness of the implemented actions. The results were evaluated through a comparative analysis of the initial assessment with two other assessments (in August 2023 and the first quarter of 2024). Results: analysis of the first and third assessment identified a reduction in non-conformities from 15 to 8 (46.7%). After implementing the planned improvement actions, criterion 1 had a 50% reduction in non-conformities. Criterion 4 showed statistical improvement (0.28%) but requires further analysis due to being associated with multifactors. Conclusions: Different approaches and expectations of patients, staff and families regarding Palliative Care are identified depending on the context and culture in which they are inserted. Therefore, successful practices in other countries may not adapt to the Brazilian northeastern reality and vice versa. However, it is noteworthy that the study suggests that analysis using the Improvement Cycle tool can be efficient in other health organizations regardless of their location or the type of patient they serve, by helping to identify and implement multifaceted actions in modifiable causes of any type of improvement opportunity presented.
8	ANDERSON ALARES DA SILVA MELO IMPROVEMENT CYCLE TO ADAPT THE USE OF ANTIMICROBIALS IN A REGIONAL HOSPITAL Advisor : MARISE REIS DE FREITAS COMMITTEE MEMBERS : MARISE REIS DE FREITAS CECILIA OLIVIA PARAGUAI DE OLIVEIRA SARAIVA CLAUDIA FERNANDA DE LACERDA VIDAL Data: Sep 3, 2024 Show Abstract 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.
9	ZAIRA SANTIAGO DE LIMA DAMAZIO DEVELOPMENT AND IMPLEMENTATION OF QUALITY IMPROVEMENT TOOLS FOR THE ELECTIVE CARDIAC CATHETERISATION SCHEDULING PROCESS Advisor : ANA ELZA OLIVEIRA DE MENDONCA COMMITTEE MEMBERS : ADRIANA MONTENEGRO DE ALBUQUERQUE ANA ELZA OLIVEIRA DE MENDONCA KATIA REGINA BARROS RIBEIRO Data: Sep 24, 2024 Show Abstract Introduction: Cardiac catheterization is an essential procedure in interventional cardiology, used for the diagnosis and treatment of complex heart diseases. In response to the needs of the Unified Health System, Emergency Care Units play a crucial role in the emergency and urgent care network, facing challenges such as the temporary hospitalization of patients due to the lack of hospital beds. The introduction of the Internal Regulation Center has been fundamental in managing patient flows, including scheduling complex procedures such as cardiac catheterization, through the National Regulation System. The research context is presented, highlighting the importance of implementing quality tools to optimize the management of health resources and improve the care provided to patients. Objective: To develop and implement quality improvement tools in the scheduling process for elective cardiac catheterizations. Methodology: The methodology employed in the study is based on Convergent Care Research, which integrates scientific investigation with professional practice. Quality improvement tools were developed, such as the Standard Operating Procedure, the Kanban board, and the informational folder, with the objective of standardizing processes, improving communication among teams, and providing an informed experience for patients. The validation of the tools was carried out through internal and external evaluations. Results: The validation of the Standard Operating Procedure achieved an acceptance rate of over 80% among the evaluating judges. The Kanban board was assessed by the Emergency Care Unit team using a specific method, with satisfactory results. Although the informational folder did not undergo formal evaluation, it was well received by the patients who used it. The implemented tools contributed to process standardization, improved communication among teams, and included patients in the scheduling process for cardiac catheterization, resulting in a smoother and more informed experience. Conclusion: The research concludes that the implementation of quality improvement tools in the elective cardiac catheterization scheduling process at the Emergency Care Unit promoted operational excellence, humanized care, and optimized hospital resources. The developed initiatives strengthened the quality management of health services, aligning with the guidelines of the Unified Health System and exemplifying replicable best practices. Process standardization, effective communication, and patient inclusion were fundamental to improving the care provided by the Emergency Care Unit.
10	PAULA BEATRIZ DE MORAIS ARCANJO LIMA IMPLEMENTATION OF THE WHO SAFE CHILDBIRTH CHECKLIST (SCC) IN A HIGH-RISK MATERNITY IN NORTHEAST BRAZIL Advisor : TATYANA MARIA SILVA DE SOUZA ROSENDO COMMITTEE MEMBERS : DANIELE VIEIRA DANTAS SUSANA CECAGNO TATYANA MARIA SILVA DE SOUZA ROSENDO Data: Oct 8, 2024 Show Abstract Introduction: The World Health Organization (WHO) Safe Childbirth Checklist (SCC) is an evidence-based and low-cost tool for improving practices in the care of mothers and infant during childbirth. Due to the recent increase in maternal mortality indicators, it was important to assess the effects of the WHO SBC on childbirth care in a high-risk maternity hospital in Brazil. Objectives: The aim was to evaluate the effects of the WHO Safe Childbirth Checklist (SCC)on childbirth care in a high-risk maternity hospital in northeastern Brazil by assessing the incidence of good practices and adverse events. Methodology: A quasi-experimental study was conducted where the SCC was implemented in a high-risk maternity hospital in the metropolitan region of Natal-RN. This involved adapting the SBC, training teams, evaluating safety culture, providing leadership support, and monitoring. Good practices (GP) indicators, adverse events (AE) in mothers and newborns, and adherence to the SBC were evaluated before and after the intervention using data collected through Qualiparto. Results: Data from 995 deliveries (March 2023 to May 2024) were collected. Overall adherence to the SBC was low at 7.6%. The median compliance with good practices was similar before and after the intervention at 57%. There was a slight variation in the median of maternal good practices (33.3%), while neonatal good practices remained stable (72.1%). The mean percentage of adverse events in general, maternal, and neonatal cases showed a decrease from baseline, with maternal adverse events showing a tendency to decrease. Discussions: The introduction of new practices faced resistance from the team, possibly due to the local context of work overload and the safety culture's maturity level. The designed strategy requires new improvement cycles with actions to raise awareness and prepare for using the instrument. Investing in the training of health service leaders is necessary to motivate changes and ensure sustainability. Conclusions: Some obstacles made it difficult to adhere to the list, such as a weakened safety culture, and thus no improvement in good practices and a decrease in adverse events were observed, despite maternal adverse events. It is also necessary to strengthen the patient safety center and develop leadership.
11	STEPHANIE CARNEIRO DE VASCONCELOS PROCESS OF DISPENSING AND ADMINISTRATION OF MEDICATION FOR THE PATIENT'S OWN USE IN THE HOSPITAL: EVALUATION AND IMPROVEMENT Advisor : VIVIANE EUZEBIA PEREIRA SANTOS COMMITTEE MEMBERS : ANDREA TAYSE DE LIMA GOMES BRUNA CRISTINA CARDOSO MARTINS CECILIA OLIVIA PARAGUAI DE OLIVEIRA SARAIVA VIVIANE EUZEBIA PEREIRA SANTOS Data: Oct 24, 2024 Show Abstract Introduction: Medication errors can lead to harm and global and national actions have been studied to prevent them and thus to promote the strengthening of patient safety barriers. From this perspective, there is a need to discuss patient’s own drug, which is taken from home to the hospital and which, for various reasons, may not be available at the institution. Thus, developing quality management activities is essential for better results in health care for patients who use their own medication in hospital services. Objective: To evaluate and improve the process of dispensing and administering patients' own medication in a secondary hospital in the state of Ceara. Methodology: This is a quasi-experimental before-and-after study with no control group and a quantitative approach, with data collection in November 2023, January and March 2024. Between each data collection, multifaceted interventions were implemented to improve the service. Seven criteria were considered to verify the quality of the process of using the patient's own medication in two storage locations: pharmacy and bedside. The data was imported into the IBM-SPSS software and Fisher's Exact Test was applied to verify the association between the variables. The project was approved by the research ethics committee of the Instituto de Saude e Gestao Hospitalar, under CAEE: 74775723.5.0000.5684. Results: In the initial assessment there was variation in the level of compliance of the criteria in both storage locations. In the re-evaluation, measured 90 days after the first interventions, there was an absolute improvement in all the criteria, regardless of where they were stored. The improvement was significant for three criteria in the bedside storage scenario (C3 - adequate scheduling, C4 - compliant administration and C6 - correct storage and identification). Interventions were implemented regarding the professionals' work process, recording systems and educational actions. Conclusion: The study showed that the multifaceted activities are effective in improving the quality of the use of patients' own medicines in the institution, achieving their objective, and highlighting the importance of their continuity and improvement in order to achieve increasingly significant results.
12	NATHALYA JULIANNY DE MACEDO OLIMPIO QUALITY IMPROVEMENT IN PRESSURE INJURY TREATMENT Advisor : SANCHA HELENA DE LIMA VALE COMMITTEE MEMBERS : CAMILA XAVIER ALVES DANIELE VIEIRA DANTAS MARCIA MARILIA GOMES DANTAS LOPES SANCHA HELENA DE LIMA VALE Data: Oct 29, 2024 Show Abstract Introduction: Pressure injuries (PI) are a worldwide problem and are described as localized damage to the skin and/or underlying tissue, usually over a prominent bone, and can be caused by prolonged and/or intense pressure combined with shear. Critical patients are generally in a serious, unstable situation and are often subjected to prolonged hospitalizations and highly complex procedures. Nursing records constitute an integral part of the patient's medical record and are essential to the care process. Enteral Nutritional Therapy (ENT) in patients with pressure injuries is indicated whenever the patient is unable to meet their nutritional needs through the conventional oral route. The healing process consumes energy, using mainly carbohydrates in the form of glucose. For the body to use proteins in the healing process, an adequate supply of calories is important. Objective: Develop actions to improve the quality of pressure injury treatment. Methodology: This is a longitudinal study that will use data produced by the multidisciplinary care service of a public hospital in the city of Natal-RN. The results of a quality improvement cycle in PI treatment will be evaluated and the effect of the interventions carried out will be measured. Partial Results: Demonstrates fragility mainly in the adequacy of energy and protein intake, which is of great relevance for the healing of PI.
13	RENATA ROCHA DA COSTA Quality Improvement on Patient Safety Practices in Dialysis Service Advisor : CECILIA OLIVIA PARAGUAI DE OLIVEIRA SARAIVA COMMITTEE MEMBERS : CECILIA OLIVIA PARAGUAI DE OLIVEIRA SARAIVA SUSANA CECAGNO VIVIANE EUZEBIA PEREIRA SANTOS DIANA PAULA DE SOUZA REGO PINTO CARVALHO Data: Oct 29, 2024 Show Abstract Introduction: Hemodialysis is a modality of renal replacement therapy indicated for patients with renal injury and at potential risk for adverse events. Therefore, patient safety practices must be implemented and encouraged to improve quality, using strategies such as quality improvement cycles. Objectives: To evaluate the effect of a quality improvement cycle on patient safety practices in a hemodialysis service. Methodology: This is a multimethod study conducted in two stages. The first stage is a cross-sectional study with a quantitative approach to evaluate the safety culture of resilience. The second stage is a quasi-experimental, pre- and post-intervention study, without a control group, with a quantitative approach, developed through the implementation of a quality improvement cycle for patient safety practices in the hemodialysis service. Both stages were conducted between April 2023 and April 2024. The study analyzed dialysis patient care, patient records from the unit, the hemodialysis safety checklist, and incident reports for the improvement cycle, considering eight criteria based on indicators adopted by ANVISA's Patient Safety Practices in Dialysis Services to assess the quality level of patient safety practices. During the reevaluation, the Resilience Safety Culture (RSC) questionnaire, translated and adapted to the Brazilian cultural context, was applied to assess the culture of resilience. The pre- and post-evaluation data were presented in Pareto diagrams to highlight the level of improvement and its significance. A descriptive statistical analysis of the RSC data was conducted, with the results presented in tables. The study received approval from the Research Ethics Committee of the Walter Cantidio University Hospital under CAAE No. 75601123.3.3001.5045. Results: The initial evaluation revealed low quality levels in all criteria, except one, which showed 100% compliance. In the reevaluation, there was an absolute improvement of 73.95% in the other six criteria compared to the initial evaluation. The Resilience Safety Culture (RSC) analysis showed a positive perception in most domains within the context of rapid changes in the complex challenges faced by the dialysis unit. Conclusion: The improvement cycle proved to be effective in quality improvement and patient safety in dialysis renal.
14	FERNANDA PEREIRA MARINHO AMARO IMPROVING ADHERANCE TO THE WHO SAFE CHILDBIRTH CHECKLIST (SCC) IN A BRAZILIAN MATERNITY Advisor : TATYANA MARIA SILVA DE SOUZA ROSENDO COMMITTEE MEMBERS : CECILIA OLIVIA PARAGUAI DE OLIVEIRA SARAIVA SUSANA CECAGNO TATYANA MARIA SILVA DE SOUZA ROSENDO Data: Nov 14, 2024 Show Abstract Introduction: In Brazil, the Maternal Mortality Ratio remains high, and even with the decrease in infant mortality, avoidable neonatal mortality continues to be responsible for most deaths. The World Health Organization (WHO) proposes a way to improve care and increase adherence to safe practices in childbirth, it is the use of the Checklist for Safe Childbirth. Even with the evidence that its use can increase the performance of good practices in childbirth, the continuous use of LVPS is still a challenge. Objective: Increase adherence to the WHO Safe Birth Checklist (LVPS) to 70% in a high-risk maternity hospital in northeastern Brazil, specifically intended: to identify possible barriers to the use of the List; implement interventions to improve adherence to the LVPS and monitor adherence before and after interventions. Method: This is a quasi-experimental study (without control group), of time series, with measurement of six months before and six months after the interventions, totaling 692 medical records (332 before and 360 post-intervention); the study site is a high-risk maternity hospital in Natal, Rio Grande do Norte. The project follows the steps of an improvement cycle: root cause analysis, definition of improvement measurement criteria, baseline analysis, participatory planning of interventions, implementation of interventions, and monitoring. The analysis of the causes used the Ishikawa Diagram and the Consolidated Framework for Implementation Research (CFIR). The criteria measured were: percentage of Lists fully completed; percentage of items completed and percentage of items completed by time of pause (admission, immediately before delivery, shortly after birth, and before discharge). The analysis of improvement was carried out through run charts, considering the significance of 5%. Results: The barriers to adherence identified were related to three domains of the CFIR: inner setting, innovation and implementation process. After the interventions, the median percentage of items filled out increased from 38.8% to 58.7%, a significant improvement. There was also a significant improvement at the time of admission and shortly after birth. The moment with the lowest completion was immediately before delivery (median of 27.6%). The moment of discharge showed an increase in adherence, but was not significant. Conclusions: The identification of barriers allowed us to direct the interventions of the improvement cycle. The context was favorable to the implementation of process changes, especially due to the involvement of the Quality Management sector. There was an improvement in adherence to the LVPS, and it is important to invest in strategies such as permanent education, raising awareness of leaders and strengthening the safety culture for its sustainability.
15	MARIA APARECIDA DE ALBUQUERQUE FERNANDES RAMALHO IMPROVEMENT CYCLE FOR MONITORING PATIENTS WITH DIABETES IN PRIMARY CARE Advisor : VILANI MEDEIROS DE ARAUJO NUNES COMMITTEE MEMBERS : ANA ELZA OLIVEIRA DE MENDONCA SUSANA CECAGNO VILANI MEDEIROS DE ARAUJO NUNES VIVIANE PEIXOTO DOS SANTOS PENNAFORT Data: Nov 27, 2024 Show Abstract Introduction: Diabetes Mellitus is one of the chronic non-communicable diseases and is considered an important global health problem as it affects an increasing number of people and, consequently, an increase in the number of complications related to the disease. Among the complications, diabetic foot stands out. To reduce this occurrence, the assessment of the feet of people with diabetes must be carried out periodically by trained professionals from the Primary Health Care team. The nurse, as a member of this team, must offer care aimed at preventing and controlling the disease, with the aim of improve quality of life and minimize complications. Objective: To carry out a quality improvement cycle in Nursing consultations for people with Diabetes in Primary Health Care. Methodology: Based on a quality improvement cycle, a quantitative before and after study will be developed, without a control group , following the SQUIRE guidelines, preserving the ethical precepts of resolutions Nº 466/12, 510/16 and 580/18. It is intended to implement the interventions in the second half of 2023, after approval by the Ethics Committee. Expected results: It is expected that the interventions will provide opportunities for improvement, increasing the chance of success in resolving the quality problems found and favoring better care for patients with diabetes.
16	IRLA MILENA DE ALBUQUERQUE BIEGING IMPROVEMENT CYCLE FOR THE PROGRESSION OF FUNCTIONALITY PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT Advisor : THAIZA TEIXEIRA XAVIER NOBRE COMMITTEE MEMBERS : HELGA CECILIA MUNIZ DE SOUZA THAIZA TEIXEIRA XAVIER NOBRE VILANI MEDEIROS DE ARAUJO NUNES Data: Dec 11, 2024 Show Abstract Introduction: The prolonged length of stay of patients admitted to an intensive care unit (ICU) predisposes the incidence of complications arising from immobility, bringing rapid functional decline that may negatively impact the quality of life of the hospitalized individual, increasing care costs. Objective: Develop an improvement cycle to optimize mobility in patients admitted to the Intensive Care Unit. Methodology: This is a quasi-experimental, before-after study, without a control group, with a quantitative approach, to be carried out in a public hospital in Pernambuco through an improvement cycle with the following steps: identification and prioritization the opportunity for improvement through the application of the Nominal Group and Prioritization Matrix Techniques; carrying out a Cause and Effect Diagram to understand the potential causes related to this improvement opportunity; survey of quality criteria, totaling nine criteria, and they were analyzed and validated, so that they could be assessed whether or not they met the defined quality level; planning and implementation of possible intervention proposals, to later be reevaluated and compared. Results: This study made it possible to optimize functional mobility in patients admitted to the ICU after implementing good practices in an improvement cycle.
17	CLÁUDIA LENIZE PEREIRA GALVÃO DA SILVA EFFECTS OF A QUALITY IMPROVEMENT CYCLE IN DRUGSTORE HEALTH INSPECTION Advisor : THAIZA TEIXEIRA XAVIER NOBRE COMMITTEE MEMBERS : ANA ELZA OLIVEIRA DE MENDONCA Sheila Cristina Rocha Brischiliari THAIZA TEIXEIRA XAVIER NOBRE Data: Dec 11, 2024 Show Abstract Introduction: Given the need to ensure the population's safe and quality access tohealth products and services of interest to health, as well as to prevent the emergence ofhealth problems, the Health Surveillance (VISA) was conceptualized by Law8.080/1990, together with the creation of the SUS. In the context of VISA's activities,medicines also require special care. With the milestone of Law 13.021/2014, whichelevated pharmacies and drugstores to the status of health establishments and due to theincrease in the number of these establishments throughout the national territory.Objective: To analyze the impact of a quality improvement cycle on health inspectionsof drugstores in a municipality in northeastern Brazil. Methods: This is a multi-methodstudy that aims to develop a Quality Improvement Cycle in health surveillance in themunicipality of Paulista. The study was carried out in two stages. The first stage, of across-sectional and quantitative nature, aimed to identify the critical points andopportunities for improvement in health inspections, guiding the definition ofintervention actions. The second stage, a quasi-experimental study, without a controlgroup of the before and after type, aimed to evaluate the effectiveness of theseimplemented actions, comparing the results obtained before and after the intervention.Results: The implemented improvement cycle resulted in: Significant reduction indeadlines; the average waiting time for the first inspection and for the issuance of thehealth license decreased considerably. Improvement in the quality of inspections: Therewas a 20% reduction in nonconformities found in inspections, indicating an increase inthe quality of the services provided by drugstores. Increase in the supply of certainservices: There was a 2.5% increase in the number of establishments selling controlleddrugs and a significant 45% increase in the supply of EAC 1 type laboratory tests.Stability in other services: The services of measuring clinical and biochemicalparameters, administering injectable drugs and earlobe piercing remained stable.Reduction in a specific service: There was an 18.27% reduction in the supply of rapidtests for Covid-19. Conclusion: The improvement cycle proved to be a fundamental tool for ensuring the quality and safety of health inspections in drugstores, standardizingprocesses and reducing variability.
18	DIJAYNA DE CÁSSIA VERÇOSA DE LIMA QUALITY IMPROVEMENT IN THE PROCESS OF MULTIDISCIPLINARY CARE FOR PEOPLE WITH SICKLE CELL ANEMIA Advisor : CECILIA OLIVIA PARAGUAI DE OLIVEIRA SARAIVA COMMITTEE MEMBERS : CECILIA OLIVIA PARAGUAI DE OLIVEIRA SARAIVA ISABELLE CAMPOS DE AZEVEDO MAYARA LIMA BARBOSA VIVIANE EUZEBIA PEREIRA SANTOS Data: Dec 12, 2024 Show Abstract Introduction: Sickle cell anemia is the most prevalent genetic disease in Brazil and worldwide, with relevance in public health due to its chronic condition. This disease causes clinical manifestations throughout the body, requiring multidisciplinary health care throughout the individual's life. Multidisciplinary care and access to quality health care are essential and can ensure a satisfactory quality of life for these people. Thus, carrying out quality management activities in multidisciplinary care, such as improvement cycles, is relevant to improve the health levels of this population. Objective: To develop a quality improvement cycle in multidisciplinary care for people with sickle cell anemia in a hematology outpatient clinic. Method: This is an intervention study, with a quasi-experimental design, of the before-after type, without a control group, with a quantitative approach, carried out through a quality improvement cycle in a hematology outpatient clinic at the Blood Center of Alagoas. The improvement cycle consists of six stages: identification and prioritization of improvement; analysis of the causes of the problem; development of quality criteria; initial assessment of the quality level; planning and implementation of multifaceted interventions and reassessment of the quality level. The opportunity for quality improvement identified was irregular multidisciplinary monitoring of people with sickle cell anemia and from the analysis of the causes of the quality problem, seventeen criteria were defined to assess the quality level regarding the records of consultations by the multidisciplinary team and the records of the results of laboratory and imaging tests. These criteria were developed in accordance with the recommendations of the Ministry of Health, observing the precepts of face, content and criterion validity. The study was carried out from January 2023 to May 2024. Data analysis was performed by point estimates of criterion compliance. And to analyze the effect of the intervention, absolute and relative improvement values were estimated. Statistical significance was tested using the Z-value test and presented in a Pareto diagram. The study followed the ethical procedures required by Resolutions No. 510/2016 and No. 466/2012 and was approved by the Research Ethics Committee of the Onofre Lopes University Hospital/UFRN under opinion No. 6,416,792. Results: The first evaluation revealed decreased levels of compliance in most of the criteria evaluated, especially regarding the records of laboratory and imaging exam results. The reevaluation, after the implementation of multifaceted interventions, showed significant levels of improvement in the criteria related to the records of nursing consultations (74%), social work (69%), physiotherapy (47%), and hematology (35%). The reevaluation of exam records showed a slight increase in compliance levels. Conclusion: With the implementation of the quality improvement cycle, an improvement was observed in the records of all components of the multidisciplinary team evaluated, with the exception of dentistry due to a deficit in the physical structure of the office. An overall absolute improvement of 38% was observed in these criteria. This study made it possible to insert the discussion on improvement projects and their tools for improving work processes into the context of the hematology outpatient clinic at HEMOAL and created the opportunity to improve interaction between team professionals, in addition to opening a space for dialogue and construction of knowledge.
19	ALINE SAMARA ACIOLE DA S DANTAS QUALITY IMPROVEMENT PATIENT SAFETY CORE IN HOSPITAL UNITS OF THE SESAP/RN OWN NETWORK Advisor : ANA TANIA LOPES SAMPAIO COMMITTEE MEMBERS : ANA TANIA LOPES SAMPAIO CIPRIANO MAIA DE VASCONCELOS ZENEWTON ANDRÉ DA SILVA GAMA Data: Dec 19, 2024 Show Abstract Introduction: Health occurs within a complex context, people and structures need to be well involved, trained, documented, and with minimum organizational apparatus for risk management at all points of health care to satisfaction, a point that must be well based on the local management of Patient Safety, the body legally responsible for this is the Patient Safety Center. In Brazil, the 2013 National Patient Safety Program aims to contribute to the quality of care provided, recently we had a strong ally in the global context. That said, it is necessary to strengthen the Patient Safety Centers and we seek in this project, through a cycle of quality improvement, to enable opportunities for improvement in the structuring of NSPs, and thus contribute to quality health care. Objective: Improvement of the documentary consolidation of the Patient Safety Centers of Hospitals within the SESAP network. Methodology: Quality improvement analysis study, of the Action Research type, in the Patient Safety Centers of Hospitals in the SESAP/RN network. Preliminary results: Contribute to the improvement of Patient Safety Centers and consequently to patient safety management.
20	MONALIZA VANESSA DE BRITO GONDIM MOURA MEDEIROS IMPROVING QUALITY IN THE IMPLEMENTATION OF PROTOCOLS FOR THE PREVENTION OF INFECTION RELATED TO HEALTHCARE IN INTENSIVE CARE UNITS Advisor : ANA TANIA LOPES SAMPAIO COMMITTEE MEMBERS : ANA TANIA LOPES SAMPAIO DIANA PAULA DE SOUZA REGO PINTO CARVALHO ZENEWTON ANDRÉ DA SILVA GAMA Data: Dec 19, 2024 Show Abstract Healthcare-Associated Infections are common adverse events in healthcare institutions, especially in Intensive Care Units, impacting patient safety and recovery. The National Health Surveillance Agency has highlighted the low adherence to protocols to prevent these infections, pointing to the urgent need to implement effective actions to improve compliance and guarantee better results for patient safety. Preventing damage and losses related to care resulting from failures in care processes and structures is a growing challenge at a global level. Implementing evidence-based infection prevention and control measures, such as bundles, current scientific research, is essential to reduce Healthcare-Associated Infections and improve the quality of care. Objective: Evaluate quality improvement in the implementation of an Improvement Cycle to increase the implementation of infection prevention protocols, in hospitals within the State Department of Public Health of Rio Grande do Norte's own network, with a focus on Intensive Care Units . Method: This action research, with a quasi-experimental before-and-after design, was approved by the Ethics Committee for Research with Human Beings (Opinion 6.413.818 and CAAE 73815823.4.0000.5292). The study aimed to evaluate protocols for preventing Primary Bloodstream Infection, associated with the use of Central Venous Catheters and preventing Pneumonia Associated with Mechanical Ventilation. Improvements to the protocols were planned based on an affinity diagram and Gantt diagram. Data collection took place before the planned improvement interventions and then after the execution of the actions between the years 2023 and 2024. Results: An absolute general improvement of 29.76% and a relative improvement of 44.64% was observed in the criteria evaluated for the implementation of infection prevention protocols in Intensive Care Units. It is evident that the findings show substantial improvements, especially in the implementation of the pneumonia protocol associated with mechanical ventilation with proven training for health professionals and in relation to care when removing the Central Venous Catheter, minimizing the risk of complications and contamination. t is noteworthy that the values reveal significant absolute increases. The proven training criterion on Pneumonia prevention associated with Mechanical Ventilation increased from 14.29% to 71.43%, an improvement of 57.14 percentage points, reflecting a significant advance in the construction of protocols and prioritization of professional training of health. Conclusion: The results of this study indicate a significant improvement in the implementation of infection prevention protocols, with emphasis on VAP prevention and proven training of health professionals. Regarding the analysis of non-conformities, based on the Pareto Diagram, a substantial reduction in compliance failures is revealed, highlighting the effectiveness of the corrective actions adopted. Furthermore, the data demonstrates consistent advances, with a positive impact on care and compliance with institutional protocols.

2023

	Dissertations
1	JULIANA ALVES AGUIAR DA SILVA COSTA IMPROVING THE QUALITY OF EMERGENCY ASSISTANCE IN AN ARMY BATTALION IN THE AMAZON JUNGLE Advisor : MARISE REIS DE FREITAS COMMITTEE MEMBERS : ANA ELZA OLIVEIRA DE MENDONCA MARISE REIS DE FREITAS VICTOR GRABOIS Data: Feb 8, 2023 Show Abstract The Brazilian Army soldiers who work in the Amazon are exposed to risks inherent to military activity and risks related to the characteristics of the Jungle. In case of medical emergencies, they will be assisted by health personnel, who must be able to handle the critically ill patient without immediate backup from a tertiary service. This study describes an improvement cycle in the 53rd Jungle Infantry Battalion in 2020 and 2021 during which an opportunity for improvement was identified: training in emergencies. To solve this quality problem, an educational strategy for emergency care was planned and implemented, consisting of a theoretical-practical course and a cardiopulmonary resuscitation protocol. The course, lasting 10 hours/class, was applied to 18 military personnel with theoretical dialogued classes, simulated practices of cardiopulmonary resuscitation on a dummy and pre and post tests. The themes, chosen with the participation of the course participants, were: cardiopulmonary resuscitation; pre-hospital care; drowning; hypothermia; burns; accidents with venomous animals; rhabdomyolysis; use and maintenance of equipment. The specific cardiopulmonary resuscitation protocol for the service was designed, reviewed and approved by the group. There was absolute improvement and relative improvement of correct answers between pre-test and post-test, which can contribute to improve the quality of care.
2	JAMILA MARIA AZEVEDO AGUIAR ACTION RESEARCH FOR OPTIMIZING THE QUALITY OF HYGIENE IN HOSPITAL CRITICAL BED Advisor : FLAVIA CHRISTIANE DE AZEVEDO MACHADO COMMITTEE MEMBERS : DIANA PAULA DE SOUZA REGO PINTO CARVALHO FLAVIA CHRISTIANE DE AZEVEDO MACHADO JANMILLE VALDIVINO DA SILVA VIVIANE PEIXOTO DOS SANTOS PENNAFORT Data: Apr 13, 2023 Show Abstract 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.
3	MICLECIA DE MELO BISPO QUALITY IMPROVEMENT IN THE MEDICATION PROCESS IN A MOBILE PRE-HOSPITAL EMERGENCY SERVICE Advisor : CECILIA OLIVIA PARAGUAI DE OLIVEIRA SARAIVA COMMITTEE MEMBERS : CECILIA OLIVIA PARAGUAI DE OLIVEIRA SARAIVA RODRIGO ASSIS NEVES DANTAS VIVIANE EUZEBIA PEREIRA SANTOS DIANA PAULA DE SOUZA REGO PINTO CARVALHO Data: Jun 2, 2023 Show Abstract Introduction: The medication process is potentially dangerous and likely to cause harm to the patient, especially in the mobile emergency pre-hospital service. Thus, due to its complexity, carrying out quality management activities, such as improvement cycles, is relevant to strengthening patient safety in health services. Objective: To develop a quality improvement cycle in the medication process in a mobile emergency pre-hospital service. Methodology: Quasi-experimental, before-and-after study, without a control group, with a quantitative approach, through a cycle of quality improvement with problem analysis, intervention and monitoring in a mobile emergency pre-hospital service in January from 2022 to April 2023. The care records of patients in the service's advanced support unit were analyzed and eight criteria were considered to verify the quality of the record related to medication prescription. The results obtained were presented in Pareto Diagrams, in order to highlight the level of improvement and its significance. The project received approval from the Research Ethics Committee of the Federal University of Rio Grande do Norte, according to Opinion nº 5.688.192 and CAAE: 62920322.8.0000.5292. Results: In the initial evaluation, criterion C1 was verified with 100% compliance and the other criteria with a low level of quality, with emphasis on C4 and C7 with 0% compliance. In the reassessment of quality, measured 90 days after the interventions, there was a decline in the quality level of C1 of 12% and absolute improvement of 87.5% in the other seven criteria when compared to the initial assessment. Conclusion: Based on the results, the improvement cycle achieved its objective significantly, and proved to be an effective tool in increasing the quality and safety of health services.
4	MONIKY KEULY MARCELO ROCHA LIMA IMPROVEMENT CYCLE FOR FALL PREVENTION IN AN EMERGENCY CARE UNIT Advisor : THAIZA TEIXEIRA XAVIER NOBRE COMMITTEE MEMBERS : ANA ELZA OLIVEIRA DE MENDONCA VILANI MEDEIROS DE ARAUJO NUNES VICTOR GRABOIS Data: Jun 19, 2023 Show Abstract 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.
5	SILVIA LETICIA LIMA DE ARAUJO MARTINS QUALITY IMPROVEMENT OF PRESSURE RUDE PREVENTION IN AN INTENSIVE CARE UNIT Advisor : DANIELE VIEIRA DANTAS COMMITTEE MEMBERS : DANIELE VIEIRA DANTAS KATIA REGINA BARROS RIBEIRO RENATA SILVA SANTOS TATYANA MARIA SILVA DE SOUZA ROSENDO Data: Sep 1, 2023 Show Abstract Introduction: Pressure injuries are one of the most frequent adverse events in healthcare environments worldwide, with a significant impact on patients and healthcare services. Despite the negative potential, most of these injuries are preventable through the provision of quality health services and a focus on prevention. Improvement projects are a strategy for implementing effective and lasting pressure injury prevention programs. Objective: To improve the quality of the pressure injury prevention process in an adult Intensive Care Unit (ICU). Method: This is a study with a quantitative approach, almost experimental design, of the before and after type, without a control group, developed through the implementation of a quality improvement project, in an ICU, in the municipality of Currais Novos, Rio Grande do Norte, carried out from January 2022 to July 2023. The project was developed following the steps of an improvement cycle. The level of quality of injury prevention was measured before and after the interventions using six quality criteria. Interventions were didactically divided into two strategic lines: changes in records related to pressure injury prevention care and awareness/training of the multidisciplinary team on pressure injury prevention. In the second evaluation, the absolute and relative improvements of each of the criteria were estimated, as well as their statistical significance. Results: The initial quality assessment showed that the level of compliance of pressure ulcer prevention was low, with practically all the criteria with rates below 50%. After the interventions, there was an increase in the compliance of almost all criteria, with the exception of the assessment of the skin on admission, which showed a slight decrease. Conclusions: It was possible to improve the quality of the injury prevention process, despite the contextual factors that interacted to make implementation difficult. But the results indicate that there is still room for further improvement, especially in bed repositioning and skin assessment on admission. Furthermore, this improvement process needs to be continuous and dynamic.
6	MARIA FERNANDA APARECIDA MOURA DE SOUZA CYCLE OF IMPROVEMENT IN THE CARE OF PATIENTS WITH ISCHEMIC STROKE Advisor : VILANI MEDEIROS DE ARAUJO NUNES COMMITTEE MEMBERS : ANA CAROLINA PATRICIO DE ALBUQUERQUE SOUSA VILANI MEDEIROS DE ARAUJO NUNES VIVIANE PEIXOTO DOS SANTOS PENNAFORT SUSANE DE FÁTIMA FERREIRA DE CASTRO Data: Sep 11, 2023 Show Abstract 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.
7	ROSEMEIRE ANDREATTA IMPROVEMENT OF PREVENTIVE MEASURES FOR SURGICAL SITE INFECTION IN CESAREANS IN A PUBLIC TEACHING HOSPITAL Advisor : ZENEWTON ANDRÉ DA SILVA GAMA COMMITTEE MEMBERS : ZENEWTON ANDRÉ DA SILVA GAMA MARISE REIS DE FREITAS HEIKO THEREZA SANTANA Data: Sep 28, 2023 Show Abstract Introduction: Brazil has high rates of delivery through cesarean section, however, one of the frequent negative consequences is surgical site infection (SSI). This complication leads to prolonged hospital stays, makes it difficult to establish a bond between mother and newborn and generates additional costs for the health system. Objective: To analyze the effect of an intervention on the rate of SSI after cesarean sections in a public teaching hospital. Method: The study was carried out at the Cassiano Antonio Moraes University Hospital, a reference in high-risk pregnancies. In 2021, about 70% of deliveries were cesarean sections, totaling 706 deliveries. The study was a mixed quasi-experimental, using before-after and time-series analyses, with no control group. To assess the quality of SSI prevention, eight quality criteria were used (seven processes to monitor adherence to good practices recommended in the literature and one result to monitor the SSI rate). The intervention to improve quality was multifaceted, participatory and based on the analysis of the main causes of the problem, including the results of the initial quality assessment. The implementation period of the interventions was from May 2022 to March 2023. To analyze the context and measure the project's chance of success, the MUSIQ tool, Model for Understanding Success in Quality, was used. After the interventions, the criteria were reassessed and analyzes were performed to calculate the punctual estimates of compliance with the criteria, in addition to evaluating the absolute and relative improvement. Statistical significance was tested using the one-tailed z-value test and the results were presented in pareto charts. Results: After the intervention, there was a significant improvement in five of the seven process criteria for monitoring adherence to good practices. The greatest gains were observed in the criteria: adequate dressing, which showed a relative improvement of 95%; surgical antisepsis of the skin with adequate degerming solution, achieved absolute improvement of 63% and relative improvement of 83%; and adequate trichotomy with an absolute improvement of 49% and a relative improvement of 51%. These improvements configure a change of pattern with a p<0.001 value for the three criteria. As for the outcome criterion, an improvement in the accuracy of the SSI rate was obtained by increasing the active search rate for post-discharge cesarean sections from 63% to 93%. Conclusions: The study proved the importance of the improvement cycle approach in conjunction with the science of improvement to drive significant transformations in the context, resulting in greater involvement of people, improved teamwork, greater adherence to best practices and the ability to leverage better outcomes for patient safety.
8	LUCIANA SILVEIRA DA SILVA IMPROVEMENT OF INTERSECTORAL COMMUNICATION IN THE PERIOPERATIVE PROCESS OF A PUBLIC TEACHING HOSPITAL Advisor : ZENEWTON ANDRÉ DA SILVA GAMA COMMITTEE MEMBERS : ANA PAULA HERMANN PAULO JOSE DE MEDEIROS SUSANA CECAGNO ZENEWTON ANDRÉ DA SILVA GAMA Data: Sep 29, 2023 Show Abstract 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.
9	MARIA ALINE GOMES DE OLIVEIRA Quality improvement To prevent cardiac surgical site infection Advisor : SANCHA HELENA DE LIMA VALE COMMITTEE MEMBERS : ANA ELZA OLIVEIRA DE MENDONCA KATIA REGINA BARROS RIBEIRO SANCHA HELENA DE LIMA VALE JOCELLY DE ARAUJO FERREIRA Data: Nov 14, 2023 Show Abstract Introduction: Surgical site infection (SSI) is the most common complication resulting from surgery, which occurs in the first 30 days after surgery. It is among the main healthcare-associated infections (HAI) corresponding to 14 to 15% in Brazil. The high incidence can reach 33 to 77% and in cardiac surgery to 25%. The emergence of SSI represents a challenge as it has a high rate of morbidity and mortality, it is considered a preventable adverse event that threatens patient safety, in addition to significantly adding to medical-hospital costs, with negative repercussions on care practice. Efforts to reduce the rate of SSI in cardiac surgery include treating risk factors before the surgical procedure and adopting preventive practices. Objective: To implement and evaluate an improvement cycle to preventing of cardiac surgical site infection in a private hospital located in Natal city/RN. Methodology: This is an intervention study, with the implementation of an improvement cycle based on the assessment of the level of compliance with the protocol to prevent surgical site infection in cardiac surgery before and after its implementation. The target audience is adult patients admitted to the inpatient and intensive care units to undergo cardiac surgery. Reoperations and cardiac surgical procedures in pediatrics were excluded. Expected results: It is expected that the actions planned and developed in this improvement cycle can systematize patient care that will undergo the surgical procedure, thus establishing patient safety barriers. Improved compliance with surgical safety levels can mitigate the risks of SSI and other events related to hospital readmissions, operations, and deaths. Additionally, the application of the improvement cycle will support a practice committed to the quality of care.
10	BRUNA BIANCHI BILO APPLICATION OF THE IMPROVEMENT CYCLE TO REDUCE CALL TIME IN EMERGENCY SERVICES Advisor : ELIANE SANTOS CAVALCANTE COMMITTEE MEMBERS : ELIANE SANTOS CAVALCANTE SANCHA HELENA DE LIMA VALE VIVIANE PEIXOTO DOS SANTOS PENNAFORT SUSANA CECAGNO Data: Nov 27, 2023 Show Abstract 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.
11	AMANDA UMBELINO TRIGUEIRO BEZERRA HOSPITAL WASTE MANAGEMENT: IMPROVEMENT CYCLE UNIVERSITY HOSPITAL, RIO GRANDE DO NORTE, BRAZIL Advisor : TATYANA MARIA SILVA DE SOUZA ROSENDO COMMITTEE MEMBERS : SUSANA CECAGNO TATYANA MARIA SILVA DE SOUZA ROSENDO VIVIANE PEIXOTO DOS SANTOS PENNAFORT Data: Dec 11, 2023 Show Abstract Introduction: healthcare waste management is a set of procedures with the aim of minimizing waste generation and providing a safe, efficient destination. Therefore, it is essential to implement improvements aimed at waste management, aiming to protect workers and preserve public health, resources and the environment. Objective: to develop a quality improvement cycle in a University Hospital in Rio Grande do Norte to improve waste management and, specifically, identify the causes of inadequate segregation and reduce costs resulting from the treatment of infectious and chemical waste. Methodology: A quantitative study was carried out, with an experimental design, without a control group, before and after, from February 2022 to September 2023, based on an improvement cycle. The steps of an improvement cycle were carried out and eight quality criteria were measured before and after the interventions. The interventions carried out were: reformulation of the identification of waste classification stickers; relocation of trash bins; theoretical training and through realistic simulation with care teams and during the integration of new employees; construction of educational videos; updating the Hospital's Solid Waste Management Plan; preparation of an electronic form to record waste weighing and adjust the calibration of scales. The absolute and relative frequency of the level of compliance with the criteria and the absolute and relative improvement were analyzed comparing the pre- and post-intervention period, considering a statistical significance of 5%. Results: the main causes of inadequate segregation are related to the inadequate identification and location of bins, the lack of continuous training, the lack of specific containers for chemical waste, and the lack of periodic monitoring. In the initial assessment, a good level of quality was found only in the criterion of “Identification of bins by type of waste”. In the reevaluation, after interventions, an increase in the quality level was noted in all criteria with a significant improvement in the adequate segregation of waste, the identification of the white bag and the completion of the waste weighing form. A significant reduction was observed in the rate of generation of infectious waste as well as in the average cost of waste generation per patient/day. Conclusion: The improvement cycle improved waste management and management, as well as reducing the costs arising from this process, proving to be an effective strategy in increasing the quality of health services.

2022

	Dissertations
1	CARLOS EDUARDO PIRES DE SOUSA Quality improvement cycle in the prescription of antineoplastic drugs in a university hospital. Advisor : PAULO JOSE DE MEDEIROS COMMITTEE MEMBERS : PAULO JOSE DE MEDEIROS ZENEWTON ANDRÉ DA SILVA GAMA CARLOS FREDERICO L. BENEVIDES Data: Jun 1, 2022 Show Abstract 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.
2	LUCIANA MOREIRA DANTAS BARRETO QUALITY IN THE MANIPULATION OF ANTINEOPLASTIC THERAPY IN A UNIVERSITY HOSPITAL: APPLICATION OF AN IMPROVEMENT CYCLE Advisor : RODRIGO ASSIS NEVES DANTAS COMMITTEE MEMBERS : FRANCISCA SUELI MONTE MOREIRA RODRIGO ASSIS NEVES DANTAS ZENEWTON ANDRÉ DA SILVA GAMA Data: Jun 1, 2022 Show Abstract Introduction: Improving the safety in the use of medicines, especially those with high risk, is the third Global Patient Safety Challenge, launched in 2017 by the World Health Organization (WHO). Antineoplastic drugs are part of the high-alert medications list and for this reason have a high potential to cause adverse events. The complexity of antineoplastic therapy (AT) contributes to the high error rate and accentuated gravity. The present study has as its object the application of an improvement cycle in the AT manipulation process. Objective: To evaluate the quality of the process of handling antineoplastic therapy in a university hospital in Rio Grande do Norte and to analyze the effect of a participatory intervention to improve this process. Methodology: It involves the implementation of an internal improvement cycle, using a quasi-experimental before-after design, with a quantitative approach, carried out in an intravenous mixing center. Five quality criteria were developed to assess the handling of anticancer therapy. The results of the intervention were submitted to statistical analysis and presented in a Pareto chart, to better demonstrate the level of quality achieved. Results: After implementing the interventions, there was a significant improvement in three quality criteria for AT manipulation, as the other two already had a high percentage of compliance. Conclusion: The implementation of the improvement cycle proved to be effective, as it managed to improve the quality criteria addressed in this study and also caused a cultural change in the team, with a view to quality management in work processes.
3	NÁRYA MARIA GONÇALVES DE BRITO IMPROVEMENT CYCLE TO INCREASE ADHERENCE TO THE INITIAL CARE PROTOCOL FOR PATIENTS WITH TRAUMA Advisor : ELIANE SANTOS CAVALCANTE COMMITTEE MEMBERS : Victoriano Soria Aledo ELIANE SANTOS CAVALCANTE RODRIGO ASSIS NEVES DANTAS ZENEWTON ANDRÉ DA SILVA GAMA Data: Jun 7, 2022 Show Abstract 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.
4	LENIELA AFRA MEDEIROS JARDIM BERGAMO ANALYSIS OF THE IMPROVEMENT OF THE QUALITY OF REPROCESSING OF MATERIALS AVAILABLE IN A UBS OF THE FEDERAL DISTRICT Advisor : ANA TANIA LOPES SAMPAIO COMMITTEE MEMBERS : ANA TANIA LOPES SAMPAIO ANA ELZA OLIVEIRA DE MENDONCA ZENEWTON ANDRÉ DA SILVA GAMA JOÃO BOSCO FILHO Data: Jun 8, 2022 Show Abstract The study aims to assess the quality level of reprocessed products in a Basic Health Unit. It is an action research through the application of an internal cycle of quality improvement in UBS 1 of Paranoá, belonging to the Eastern Health Region of Federal District Health Department, with quasi-experimental design, before-after type, without a control group, considering the implementation of the Manual of good practices for improving the quality of reprocessable health products. The research that starts from the identification of a quality problem, problem prioritization, planning and intervention, has three important stages: implementation of a manual with good practices in cleaning, disinfection, preparation, storage and dispensing of reprocessable products from the UBS; analysis of the evolution of compliance rates in quality requirements after the implementation of the improvement plan; evaluation of the reduction in the frequency of non-compliance with quality criteria related to the activities performed according to the Gantt diagram. For this, six quality criteria are used, evaluated through a checklist applied to the reprocessed products available for use in the Unit, with a sample (n=30) for each evaluation, in a simple random way. Data from the first assessment was collected before the start of the planned improvement interventions and is reassessed monthly. To verify whether or not there was an improvement in the level of quality, the calculation of the point estimate with a 95% confidence interval is being carried out, as well as the absolute and relative improvement of each criterion, with statistical significance being verified using the Z test. The Preliminary Results point to a significant evolution in the improvement of quality criteria when analyzing the reduction in non-compliance rates in relation to the first and second assessments carried out. The improvements are related to the execution of the improvement actions programmed with the Gantt tool. It can be concluded that, even with the partial execution of the improvement plan, the study shows the effectiveness of the improvement cycle to improve service quality.
5	FERNANDA DE MACEDO COELHO LEITE PATIENT SAFETY WITH COVID-19 IN THE HOSPITAL CONTEXT: SCOPING REVIEW Advisor : DANIELE VIEIRA DANTAS COMMITTEE MEMBERS : CLEYTON CÉZAR SOUTO SILVA DANIELE VIEIRA DANTAS KATIA REGINA BARROS RIBEIRO VILANI MEDEIROS DE ARAUJO NUNES WILTON RODRIGUES MEDEIROS Data: Jun 10, 2022 Show Abstract 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.
6	ROGER PEREIRA VALIM IMPROVEMENT PROJECT TO REDUCE WAITING TIME FOR ELECTIVE UROLOGICAL SURGERY IN A GENERAL HOSPITAL Advisor : ZENEWTON ANDRÉ DA SILVA GAMA COMMITTEE MEMBERS : LAURA MARIA CÉSAR SCHIESARI PAULO JOSE DE MEDEIROS ZENEWTON ANDRÉ DA SILVA GAMA Data: Jun 20, 2022 Show Abstract Introduction: The long waiting times issue in healthcare is a priority for developed and developing countries. The guarantee of timely access to health permeates clinical, psychological, social, ethical, economic and legal aspects. Despite the relevance of the topic, studies aimed at the development of methods to reduce waiting lists in Brazil are limited. Objective: Reduce the waiting time for elective urological surgeries, through an improvement project, based on quality management and with an emphasis on flows and processes' redesign. Methodology: The quality improvement project was carried out at Hospital Geral Dr. Waldemar Alcântara, with a quasi-experimental design, without a parallel control group. After a qualitative analysis of the problem, an intervention in the work processes was planned and carried out in order to improve the integration between medical appointmentsand diagnostic exams, optimize the activities of professionals, establish goals in the process and implement a system to monitor the journey of care of patients. patients. The effects of actions were measured for seven consecutive months through the average total waiting time. The time of surgery indication, the time of scheduling the procedure and the number of surgeries performed were also measured. Results: After the intervention, there was an absolute improvement of 70 days in the average total waiting time (100 days versus 30 days), corresponding to a 70% reduction in waiting. The mean time for surgery was reduced by 76% (70 days versus 17 days). Average scheduling time decreased from 30 to 13 days, 55% improvement. In the trend graph, it is possible to observe that, after the intervention, the results remained below the median of the previous period, throughout the evaluation period (seven consecutive months), configuring a pattern change with a value of p<0.05. Before the intervention, only 6.5% of the patients were operated on within 20 days. After the intervention, that number rose to 60%. The number of elective surgeries also increased by 77% from one period to the next. Conclusions: The interventions performed were able to promote more timely access for patients to elective surgical procedures, improving the quality of health care.
7	PEDRO BRAGA LINHARES GARCIA EVALUATION OF THE IMPLEMENTATION OF THE SAFE SURGERY PROTOCOL IN THE CARE LINE OF PATIENTS WITH FEMUR FRACTURES BEFORE AND AFTER THE QUALITY IMPROVEMENT CYCLE Advisor : ANA CAROLINA PATRICIO DE ALBUQUERQUE SOUSA COMMITTEE MEMBERS : ANA CAROLINA PATRICIO DE ALBUQUERQUE SOUSA JULIANA MARTINS PINTO VILANI MEDEIROS DE ARAUJO NUNES Data: Jun 21, 2022 Show Abstract 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). Mais sobre o texto original
8	ROCHELLE RUFINO COSTA GOOD PATIENT SAFETY PRACTICES IN PRIMARY HEALTH CARE: IDENTIFYING IMPROVEMENT OPPORTUNITIES IN VACCINE ROOMS Advisor : VILANI MEDEIROS DE ARAUJO NUNES COMMITTEE MEMBERS : ANA ELZA OLIVEIRA DE MENDONCA SUSANA CECAGNO SUSANE DE FÁTIMA FERREIRA DE CASTRO VILANI MEDEIROS DE ARAUJO NUNES VIVIANE PEIXOTO DOS SANTOS PENNAFORT Data: Jun 21, 2022 Show Abstract Introduction: Vaccination is one of the best public health strategies, very important for the prevention of infectious diseases. The increase in the number of mistaken procedures makes it necessary to understand the processes involved in vaccine rooms to ensure the effectiveness of immunization agents and promote safe care for society. Objective: Evaluate adherence to quality and patient safety criteria in fourteen vaccine rooms in a capital in northeastern Brazil, before and after a cycle of improvement. Methodology: Quantitative, quasi-experimental, before-and-after study, without a control group, where an improvement cycle will be carried out based on the identification of non-conformities with quality and safety criteria in the vaccine room, established by the National Immunization Program. In data collection, a protocol with seven items and its sub-items will be used, of the checklist type, completed by two evaluators, simultaneously and independently, before and after 30 days of intervention. During the intervention, a training workshop on patient safety will be held in the vaccine room for professionals working in the units evaluated. Results: The preliminary analysis identified that 76% of non-conformities are related to measures taken with vaccine under suspicion, nursing behavior in the vaccine room and disposal of vaccines inside the refrigerator. In the final assessment, 27% of the rooms were classified as unsafe care and 66% as partially safe. These data point to weaknesses that compromise patient safety and the quality of immunization, on which we intend to intervene. Future perspectives: Improving adherence to safety and quality criteria in vaccination will allow for a comprehensive approach to aspects related to safe vaccination and will contribute to ensuring the effectiveness of immunization and preventing adverse events. In addition, it is expected that the discussion on patient safety among workers in vaccine rooms encourages reflection on the topic in a broader context in Basic Health Units, an important step for the advancement of the movement for Primary Health Care safer and more effective.
9	FRANCISCA BRUNNA DE CARVALHO COSTA VASCONCELOS EDUCATIONAL TECHNOLOGY IN VIDEO FORMAT FOR PREVENTION OF PRIMARY NEONATAL BLOOD CURRENT INFECTION Advisor : VIVIANE PEIXOTO DOS SANTOS PENNAFORT COMMITTEE MEMBERS : DANIEL HARDY MELO ANA ELZA OLIVEIRA DE MENDONCA ELIANE SANTOS CAVALCANTE VIVIANE PEIXOTO DOS SANTOS PENNAFORT Data: Aug 10, 2022 Show Abstract 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.
10	CARLLA CILENE ALVES DANTAS PETRÔNIO DOCUMENT MANAGEMENT IN A UNIVERSITY HOSPITAL: A CYCLE OF IMPROVEMENT Advisor : VIVIANE EUZEBIA PEREIRA SANTOS COMMITTEE MEMBERS : CECILIA OLIVIA PARAGUAI DE OLIVEIRA SARAIVA PATRÍCIA PERES DE OLIVEIRA QUENIA CAMILLE SOARES MARTINS VIVIANE EUZEBIA PEREIRA SANTOS Data: Aug 29, 2022 Show Abstract Introduction: Document management is a set of actions that seeks to control all stages related to their life cycle. It is noteworthy that these must be available and organized in order to raise the efficiency of the processes described in them, thus making the implementation of document management in health institutions coherent, in order to assist in the standardization of care and, therefore, strengthen effective communication in care institutions, in order to promote safe and qualified care. Objective: Improve document management at the Ana Bezerra University Hospital Methodology: a before-and-after quantitative study based on an improvement cycle, which involved the evaluation of documents before the implementation of the Standard for the elaboration of documents, after the implementation of the aforementioned norm and after the intervention, which consisted of the following actions: construction of a flow for the elaboration and processing of documents in the hospital; development of software for processing documents; training of those involved in each step that involves the flow, as well as in the use of the software. The activities took place in the 1st quarter of 2022 and involved the multidisciplinary team of the institution under study. The project was approved by the Ethics Committee of the Federal University of Rio Grande do Norte under number 4.816244. To assess the quality, before and after the intervention proposal, the point estimate and the confidence interval (CI= 95%) of the level of compliance with the adopted quality criteria were calculated. The absolute and relative improvement of each criterion was estimated in order to assess the effect of the intervention. To prove the statistical significance of the improvement detected, a unilateral hypothesis test was performed through the calculation of the Z value, the absence of improvement was considered null hypothesis, which was rejected when the p-value < 0.05. In addition, a graphic representation of the main quality problems identified in the evaluations was prepared. Results: The improvement can be observed from the implementation of Norm Zero, the 2nd evaluation, which showed advances in most criteria, with excess of criterion 4. However, the great qualitative leap in the criteria was established after the intervention stages, in this one evidenced improvement in all criteria, reaching 100% compliance in Criteria 2 and 5, which in turn deals with the standardization of the body of the text. With this, the improvement cycle proved to be efficient to improve the document management of the institution studied.
11	TÁRCILLA PINTO PASSOS BEZERRA INSTRUMENTS FOR EVALUATING HOSPITALISED PATIENTS IN PALLIATIVE CARE: Integrative Review Advisor : ANA ELZA OLIVEIRA DE MENDONCA COMMITTEE MEMBERS : ANA ELZA OLIVEIRA DE MENDONCA ELIANE SANTOS CAVALCANTE JOSÉ RONALDO VASCONCELOS DA GRAÇA VIVIANE PEIXOTO DOS SANTOS PENNAFORT Data: Sep 13, 2022 Show Abstract 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.
12	ADRIANNE GUSMÃO CAMARA BRASILEIRO IMPROVEMENT CYCLE TO INCREASE ADHERENCE TO THE PATIENT FALL PREVENTION PROTOCOL IN THE SURGICAL UNIT OF A PUBLIC HOSPITAL Advisor : ELIANE SANTOS CAVALCANTE COMMITTEE MEMBERS : ELIANE SANTOS CAVALCANTE ANA ELZA OLIVEIRA DE MENDONCA VIVIANE PEIXOTO DOS SANTOS PENNAFORT VERBENA SANTOS ARAÚJO Data: Sep 23, 2022 Show Abstract Introduction: the incident of falling in hospitalized patients requires attention from professionals due to its ability to worsen the clinical condition, which can result in death. When prevention and monitoring measures are adopted, this risk is minimized, this study is based on safety practices in the hospital context. Objective: to carry out an improvement cycle to increase the fall prevention indicator in the surgical clinic unit in a public hospital in Pernambuco/Brazil. Methodology: Based on a quality improvement cycle, a quasi-experimental, before and after, quantitative study was developed, without a control group, carried out in the 2021/2022 biennium, following the Standards for Quality Improvement Reporting Excellence 2.0 (SQUIRE) guidelines. For the proposed evaluation, a quality criterion was defined related to the causes of non-adherence to the patient's fall prevention protocol in a surgical unit of a public hospital. Interventions were planned and implemented in a participatory and multifaceted way, based on data and with the objective of increasing the adherence of the health team to the fall prevention protocol related to the quality criteria. The ethical precepts of Resolutions No. 466/12, 510/16 were preserved. Results: The initial evaluation showed 76% of non-compliance regarding the filling out of the Morse scale and the assessment of the risk of falling by the nurses of the surgical clinic and that the median of the monthly measurements of the rate of falls was 0%. After the intervention, the reassessment showed that there was 36% of non-compliance regarding the completion of the Morse scale of patients admitted to this sector, representing a 40% reduction in non-compliance regarding the completion of the Morse scale. The median drop rate moved to 0.35% and then to 0.08%, where it has remained since. Conclusions: It is inferred that the improvement cycle carried out in this study represents a valuable tool to intensify quality management, as it contributed to a relative improvement of 40% in compliance regarding the completion of the Morse scale and the assessment of the risk of falling by the Surgical clinic nurses. Based on the results achieved, the institution can disseminate important contributions to other hospitals in the public health network, by demonstrating the planned interventions with the help of quality tools, which can more accurately identify opportunities for improvement, increasing the chance success in solving the quality problems found and favoring the improvement of patient care.
13	GENILSON PEREIRA GURGEL IMPROVEMENT OF THE QUALITY OF PHARMACEUTICAL ASSISTANCE IN A MUNICIPALITY IN THE WESTERN POTIGUAR, BRAZIL Advisor : ANA TANIA LOPES SAMPAIO COMMITTEE MEMBERS : ANA TANIA LOPES SAMPAIO THAIZA TEIXEIRA XAVIER NOBRE FRANCISCA SUELI MONTE MOREIRA Data: Sep 28, 2022 Show Abstract 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.
14	LEILANE DE MELO OLIVEIRA IMPROVEMENT OF ADHERENCE TO COMPLETING THE CHECKLIST FOR SAFE BIRTH IN A UNIVERSITY HOSPITAL Advisor : WILTON RODRIGUES MEDEIROS COMMITTEE MEMBERS : WILTON RODRIGUES MEDEIROS TATYANA MARIA SILVA DE SOUZA ROSENDO CLAUDIA MARIA MESSIAS Data: Sep 29, 2022 Show Abstract Introduction: Maternal and neonatal morbidity and mortality are still considered a public health problem at a global level. The qualification of childbirth care is essential to reduce these indicators. One of the means used to standardize and promote good practices is through the Safe Childbirth Checklist (LVPS), benefiting the binomial from hospitalization to hospital discharge. Objective: To evaluate the effectiveness of implementing a cycle to improve adherence to filling out the LVPS in a university hospital. Methodology: This is a quasi-experimental study of the before-after type, without a control group, with a quantitative approach, using an internal quality improvement cycle that seeks to assess the level of quality in adherence to filling out the LVPS, with application of an improvement cycle. The opportunity for improvement was identified through the application of the Nominal Group Technique and Prioritization Matrix, during activities for the preparation of Practical Works (TP) of the Professional Master's in Quality Management in Health Services (Phase 1). This being, the alignment of processes and standardization of the conduct of the multidisciplinary teams in childbirth care. Then, the LVPS was identified as the ideal tool to act on the identified improvement opportunity (Phase 2). Based on this choice, an initial assessment of the quality level of adherence to the filling was carried out (Phase 4) after the definition of the quality criteria (Phase 3), quantifying the global completion of the list per patient (quality criterion 1), filling global per item (quality criterion 2), completion by time of the LVPS (quality criterion 3). From then on, there was the phase of defining intervention proposals (Phase 5), quality improvement intervention (Phase 6) and reassessment of the quality level (Phase 7), with the calculation of the improvement achieved. Result: LVPS was present in 100% of the records at baseline and at reassessment. The quality criteria verified at both times were: C1: the overall filling rate, which was 30% and 65% (p<0.001); C2: fill rate per break point which was: 91.6 and 96.7 at break point 1 (p>0.05), which was 31.6% and 65% at break point 2 (p <0.001), ranged from 30% to 71.6% at break point 3 (p<0.001) and 100% in both assessments. The filling rate per item (C3) was similar to the point at which it is inserted, since in this study there was no incomplete filling of the break points in the sample studied. Conclusion: The hospital studied already had high rates of adherence in relation to break points 1 and 4. The performance of the improvement cycle was effective in increasing adherence to the instrument at times that presented greater quality problems (pause points 2 and 3), which significantly impacted the overall adherence rate. The improvement came from the establishment of new routines in its use, construction of a guidance instrument (SOP) and agreement with the team. Such assets can be used as a model for the implementation or reassessment of the use of LVPS in other services.
15	SAMARA PEREIRA DANTAS LEMOS IMPROVEMENT OF THE QUALITY OF OBSTETRIC AND NEONATAL CARE IN HABITUAL RISK MATERNITY IN RIO GRANDE DO NORTE STATE, BRAZIL Advisor : TATYANA MARIA SILVA DE SOUZA ROSENDO COMMITTEE MEMBERS : CIPRIANO MAIA DE VASCONCELOS TATYANA MARIA SILVA DE SOUZA ROSENDO WILTON RODRIGUES MEDEIROS Data: Oct 5, 2022 Show Abstract 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.
16	ROSÁLIA TERESA CARVALHO DE ALMEIDA MEDEIROS IMPROVING THE REPORTING PROCESS OF PATIENT SAFETY INCIDENTS IN A REGIONAL PUBLIC HOSPITAL Advisor : ZENEWTON ANDRÉ DA SILVA GAMA COMMITTEE MEMBERS : MARGARIDA MARIA DE MATOS RODRIGUES E SILVA EIRAS WILTON RODRIGUES MEDEIROS ZENEWTON ANDRÉ DA SILVA GAMA Data: Oct 19, 2022 Show Abstract Introduction: A notification of patient safety incidents needs to be encouraged in health organizations in order to support the identification and analysis of the systemic causes of failures in the care process, generating learning and continuous improvement. Some factors still make reporting difficult, especially the low patient safety culture (CSP). Objective: Increase the quality level of the notification and learning process, based on the number and diversity of patient safety incidents in a regional public hospital. Methodology: The quality improvement project was carried out from January 2021 to June 2022, at Hospital Regional de Palmares. The study design was quasi-experimental, mixed type, comparable before and after and time series. The causes of the low number of safety incident reports were classified as an unmapped safety cause with the Ishikawa Diagram, where the low patient safety cause was classified. 13 interventions were chosen in a participatory and multifaceted way, covering: Leadership Development; Regulation and Standards; Organizational Capacity and Information Systems, grouped in the Affinity Diagram. To improve the improvement made with the learning of the change and learning process, all notifications being monthly. The context for improvement was drawn from the MUSIQ and CSP before and after the interventions. Results: MUSIQ scored 118, indicating that the project could be successful, but would face contextual barriers. The unfavorable context was also preserved by us at CSP. Even so, the number of patient safety incident reports showed a significant increase (p<0.05) in 6 of the 9 analysis criteria. The dimension of the frequency of reported CSP events showed an absolute improvement of 24% and a relative improvement of 47% (p=0.026). Of the 3 important survivals and developments, 11 were important, being the ones corresponding to the Organizational capacity of, the 111 main ones were the main ones. Conclusions: The intervention model implemented was useful to promote the increase of incident reports by professional patients and improve the learning in hospital safety patients with depth, its potential for reproduction in similar hospital characteristics.
17	FRANCISCO LINDOMAR DE SOUZA CYCLE OF IMPROVEMENT OF THE QUALITY OF PREVENTION OF PHLEBITE IN A MATERNITY SCHOOL Advisor : THAIZA TEIXEIRA XAVIER NOBRE COMMITTEE MEMBERS : THAIZA TEIXEIRA XAVIER NOBRE VILANI MEDEIROS DE ARAUJO NUNES SILVANA LOANA DE OLIVEIRA FRANCO THALYTA CRISTINA MANSANO SCHLOSSER Data: Nov 8, 2022 Show Abstract 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.
18	BEATRIZ DE FREITAS JUNQUEIRA QUALITY IMPROVEMENT STRATEGIES FOR MATERNAL-FETAL SYPHILIS PREVENTION Advisor : MARISE REIS DE FREITAS COMMITTEE MEMBERS : MARISE REIS DE FREITAS TATYANA MARIA SILVA DE SOUZA ROSENDO ROSELI CALIL Data: Dec 19, 2022 Show Abstract Introduction: Syphilis has had a simple, effective and relatively inexpensive treatment for more than three quarters of a century. However, both acquired syphilis and congenital syphilis have increased dramatically over the past two decades. In 2019, the detection rate of syphilis in pregnant women was 20.8/1,000 live births and the incidence rate of congenital syphilis, 8.2/1,000 live births. The numbers of cases of infection are worrying, despite all the efforts of recent years. The goal of the World Health Organization is to reduce it to 0.5 per 1,000 live births, however, it is very difficult to reach this goal. Objective: To build, with quality improvement tools, a theory of change and a measurement strategy to increase the timely diagnosis and treatment of pregnant women with syphilis, with the consequent reduction of its vertical transmission. Methodology: This is an improvement project with the development of a theory of change and a measurement strategy, jointly constructed by a multidisciplinary team from the Federal University of Rio Grande do Norte (UFRN) and the Institute for Healthcare Improvement (IHI), under the aegis of the IHI's Breakthrough Series Collaborative methodology. A pilot study with an improvement project design is underway, in which improvement teams from 10 municipalities in Brazil are testing the proposed theory. Once confirmed that this theory of change results in improvement, it will be available to be implemented for the care of people with syphilis. The measurement strategy of the theory of change was built in line with the objective of the project and the main processes involved, with result, process and balance indicators having been determined. Results: The Guiding Diagram is organized into 5 primary drivers: 1) Pregnant women with access to prenatal care; 2) Care flow for pregnant women with syphilis; 3) Highly qualified teams; 4) Pregnant women, family members and sexual partners involved; 5) Engaged leaders; to which 8 secondary drivers relate: 1) Co-create efficient mechanisms for scheduling and prenatal care; 2) Make the VDRL and Rapid Test for syphilis available daily at the units; 3) Promote the effective management of syphilis and reinfection cases; 4) Ensure the availability and application of medicines; 5) Train health professionals in the application of prenatal and care protocols for pregnant women with syphilis; 6) Train health professionals; 7) Develop culturally appropriate actions on syphilis for pregnant women, families and sexual partners; 8) Create mechanisms for leadership involvement in monitoring the Collaborative's actions and results. The Measurement Strategy describes, through operational definitions, 12 indicators related to the objectives of the pilot project that will be measured by the participants of the Collaborative. Conclusions: The theory of change represents an opportunity to promote transformations in the work processes of primary care teams for the care of pregnant women during prenatal care, with a view to reducing vertical transmission of syphilis and providing learning about the fundamentals of the Science of Improvement and the IHI Improvement Model, which may be used in the future in other initiatives, inside and outside the selected units.

2021

	Dissertations
1	FERNANDA DE LIRA NUNES PAULINO QUALITY MANAGEMENT IN A HEALTH SERVICE IN RIO GRANDE DO NORTE Advisor : MARISE REIS DE FREITAS COMMITTEE MEMBERS : MARISE REIS DE FREITAS WILTON RODRIGUES MEDEIROS PAULO SOUSA Data: Jan 20, 2021 Show Abstract 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.
2	KAREN SABOIA ARAGÃO E SILVA SCORES AS A TOOL FOR EVALUATING THE EFFECTIVENESS OF A QUALITY MANAGEMENT SYSTEM FOR A HEMOTHERAPY SERVICE Advisor : ELIANE SANTOS CAVALCANTE COMMITTEE MEMBERS : ELIANE SANTOS CAVALCANTE THAIZA TEIXEIRA XAVIER NOBRE VIVIANE PEIXOTO DOS SANTOS PENNAFORT VERBENA SANTOS ARAÚJO FERNANDA MARIA CHIANCA DA SILVA Data: Feb 10, 2021 Show Abstract Introduction: The National Policy on Blood, Components and Blood Products has once been created to ensure that Brazil is self-sufficient in the sector of hemotherapy, being executed and implemented by the National System of Blood, Components and Derivatives. An hemorrede was designed in Ceará to assist population in all regions, making blood and blood components available within the technical specifications of ANVISA, in accordance with the National Blood Policy recommended by the Ministry of Health. Continuous improvement of processes is a fundamental objective in any quality system. For the evaluation of the Quality Management System, the analysis of scores is part of the processes in a safe use of blood. This study is justified given the importance of using scores as tools for evaluating a Quality Management System (QMS). This research becomes relevant due to the fact that its resulting products will culminate in quality improvement, impacting on the monitoring, planning and continuous management of processes, contributing to decision making and professional improvement. Objectives: To analyze the perception of employees in a hematology and hemotherapy center in a municipality in northeastern Brazil about the applicability of a scores system (INDICAH) as a tool for the management of Quality Management System. Methodology: Exploratory-descriptive study with qualitative approach. 23 workers assigned to the study institution from February to April 2020. For data collection, focus group technique was used. Four categories were extracted from the narratives: Professional understanding of quality scores; Difficulties related to scores; Strategies for improving the system of quality scores and Usefulness of scores in practice. Interpretation of the categories occurred through thematic analysis of Bardin. Speeches recorded in the focus groups were transcribed into a Word document, then they were inserted in the Atlas-ti software, version 8.4.24.0, which favored coding of data and its organization into categories and subcategories. Results: This study made it possible to understand the perception of the team of workers in relation to the applicability of INDICAH System as a quality management tool at HEMOCE. Conclusion: These findings contribute to the planning of strategies for improving quality management through the use of scores, such as better communication, sectorial relations, greater dissemination of scores and ways to acquire blood donors according to local needs.
3	FABRÍCIA CAVALCANTE ROCHA IMPROVING QUALITY IN PLANNING SURGICAL-ORTHOPEDIC ASSISTANCE Advisor : VIVIANE PEIXOTO DOS SANTOS PENNAFORT COMMITTEE MEMBERS : VIVIANE PEIXOTO DOS SANTOS PENNAFORT WILTON RODRIGUES MEDEIROS VICTORIANO SORIA ALEDO ADRIANA CATARINA DE SOUZA OLIVEIRA Data: Mar 5, 2021 Show Abstract 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.
4	SABRINA BECKER Improving the quality of the medication process in a Clinic Medical at a Reference Hospital Advisor : WILTON RODRIGUES MEDEIROS COMMITTEE MEMBERS : BRUNA CRISTINA CARDOSO MARTINS ANA ELZA OLIVEIRA DE MENDONCA WILTON RODRIGUES MEDEIROS Data: Mar 8, 2021 Show Abstract Introduction: The quality of health services results from the integration and connection between different dimensions, a definition that according to Serapioni (2009) prevents restrictive interpretations. The Institute of Medicine (IOM) in 2001 and the World Health Organization (WHO) in 2006 pointed to safety as one of those dimensions of quality. Among the worldwide efforts to achieve higher levels of safety in patient care, those related to the medication process stand out. The objective of this study was to evaluate the effect of an improvement cycle on the medication process in a Internal Medicine clinic of a reference hospital. Methodology: This improvement cycle was carried out between the years 2019 to 2021, in a General Hospital in the city of Sobral, located in the State of Ceará. The improvement opportunity was identified and prioritized, through the application of the Nominal Group Technique and Prioritization Matrix. It was analyzed using a cause and effect diagram. Subsequently, there was a survey of the quality criteria, evaluation of the quality level, definition and realization of intervention proposals and reassessment of the quality level. The compliance with the quality of the randomly selected samples (n = 60) was estimated in a punctual manner and with a 95% confidence interval, as well as the statistical significance of the improvement achieved was treated with the Z test. One of the criteria used the entire universe of prescriptions existing at the time of collection, as it was related to a subgroup of drugs, antimicrobials. Results: Four of the five quality criteria included in this improvement cycle, showed an increase in the level of quality. Of these, the one related to the use of antimicrobials achieved an absolute improvement of 30%, among the other three, in two the improvement was statistically significant. It was not possible to carry out the planned intervention actions in the criterion that did not improve, due to the pandemic scenario of COVID-19. In short, the absolute improvement achieved through this improvement cycle in the medication process was 26%. Conclusion: The application of the cycle of improvement in the medication process in Medical Clinic of a reference hospital, despite the limitations related to the pandemic period, proved to be a useful and effective tool. The method can be replicated and assist in the treatment of other opportunities for improving the institution, or even other health services, whether they are similar or not.
5	MANUELA VEIGA DIAS ROCHA EVALUATION AND IMPROVEMENT OF ANTIMICROBIAN MANAGEMENT IN A PUBLIC HOSPITAL Advisor : THAIZA TEIXEIRA XAVIER NOBRE COMMITTEE MEMBERS : THAIZA TEIXEIRA XAVIER NOBRE MARISE REIS DE FREITAS HEIKO THEREZA SANTANA Data: Mar 9, 2021 Show Abstract 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.
6	FRANCISCA RAQUEL MONTEIRO DE MELO IMPROVEMENT OF MULTIDISCIPLINARY TEAM COMMUNICATION OF A PEDIATRIC CARE UNIT Advisor : DANIELE VIEIRA DANTAS COMMITTEE MEMBERS : DANIELE VIEIRA DANTAS ELIANE SANTOS CAVALCANTE GABRIELA DE SOUSA MARTINS MELO DE ARAUJO RENATA SILVA SANTOS Data: Mar 9, 2021 Show Abstract Communication is a fundamental process in health services to provide safe care. However, the communication of the multidisciplinary team has been limited by many causes, which may minimize the potential of patient care and may also lead to demotivation of the team by fragmented work. This study aims to evaluate the effect of an improvement cycle on the communication process of the multidisciplinary team of the Extended Care Unit of a pediatric hospital. This is a quantitative survey that will evaluate the quality of communication before and after the implementation of interventions. The evaluation of the communication will be through analysis of medical records regarding the fulfillment of previously defined criteria. Results will be presented showing the before and after evaluation of the communication.
7	MARIA SOLANGE MOREIRA DE LIMA PATIENT IDENTIFICATION IN AN INTENSIVE CARE CENTER: application of an improvement cycle Advisor : RODRIGO ASSIS NEVES DANTAS COMMITTEE MEMBERS : ANA ELZA OLIVEIRA DE MENDONCA ISABEL KAROLYNE FERNANDES COSTA RODRIGO ASSIS NEVES DANTAS Data: Mar 9, 2021 Show Abstract 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.
8	LADY ROSANY SILVA ALMEIDA VENANCIO IMPROVEMENT CYCLE AS A QUALITY MANAGEMENT TOOL FOR REDUCTION IN SURGERY CANCELATION Advisor : PAULO JOSE DE MEDEIROS COMMITTEE MEMBERS : PAULO JOSE DE MEDEIROS ZENEWTON ANDRÉ DA SILVA GAMA JOSE SEBASTIAO DOS SANTOS Data: Mar 9, 2021 Show Abstract Surgery is considered a medical specialty that uses manual and instrumental techniques to perform interventions in the treatment of illness, disability and trauma. About $ 1.3 billion is spent annually on surgical procedures, representing 17% of the hospital budget. The scheduling of surgery brings many changes in the patient's routine, putting him face to face with different feelings, such as the hope of healing, the fear and anxiety of what is to come. When surgery is canceled, the patient and family members are exposed to an unexpected situation that often causes disorders. Studies show that elective surgery cancellation rates vary between institutions, ranging from 17.6 to 33%. At the study site, it is about 13% per month. This project is justified by the adoption of quality management processes in scheduling and optimization of the operating room in order to reduce these rates. The objective is to evaluate the improvement of quality management in reducing cancellation of elective surgeries, contributing to the optimization of surgical supply. This is a research with quasi-experimental quantitative approach, before and after, without control group, to be conducted in 2019-2020, in the operating room of Dr. Waldemar Alcântara General Hospital, Fortaleza, Ceará. The required documentation was sent to the institution for research approval and, after the contract was signed, the project was submitted to Plataforma Brasil and approved. The ethical aspects are in accordance with Resolution 510, of April 7, 2016, as it is a research project for the completion of the professional master's degree. Its resulting products are expected to culminate in improving the quality of surgical processes.
9	JANETE FERREIRA PINHEIRO IMPROVING THE QUALITY OF HEALTH RISK REGULATION IN OBSTETRIC AND NEONATAL CARE SERVICES Advisor : ZENEWTON ANDRÉ DA SILVA GAMA COMMITTEE MEMBERS : AUREO DOS SANTOS VILANI MEDEIROS DE ARAUJO NUNES ZENEWTON ANDRÉ DA SILVA GAMA Data: Mar 19, 2021 Show Abstract 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.
10	RAFHAEL BRITO DE ALMEIDA SANTOS Improving the Quality of Assistance to Women in a Public Maternity by the Maternal Early Warning Score (MEWS) Advisor : NILMA DIAS LEAO COSTA COMMITTEE MEMBERS : KELIENNY DE MENESES SOUSA FREITAS NILMA DIAS LEAO COSTA VILANI MEDEIROS DE ARAUJO NUNES Data: Mar 24, 2021 Show Abstract INTRODUCTION: Quality of maternal health service can be measured by your technical-scientific dimension, defined by professional competence and use of good shreds of evidence to improve the health assistance. It was used the Maternal Early Warning Score (MEWS), like tool based in the vital signs changes that allow to detect, clinical worsening of the hospitalized patient, making it possible to intervene early, decreasing maternal morbidity. OBJECTIVE: Was to analyze the results of improvement of MEWS' implantation, in woman health assistance service. METHOD: It is an almost experimental study, non-controlled and before-after type, ruled in improve quality principles. Happened in Maternidade Escola Januário Cicco (MEJC), linked to Universidade Federal do Rio Grande do Norte (UFRN) and managed by statal Empresa Brasileira de Serviços Hospitalares (EBSERH). The target population composed by obstetrician medical professionals, nurses, auxiliaries and technicians, totalizing 455 professionals. Developed in five stages the approach the study presentation to managers, fluxogram creation, app development with information technology (TI), training for professionals and monitoring of vital signs. The collection of data was done monthly, retrospectively, in electronic medical records of 6969 patients, between the time of september of 2019 and august of 2020. The data analysis, descriptive initially and after inferential to verify the reliability considering the p-value <0,05. RESULTS: The "MEWS panel" developed by TI bringed benefits to data compilation and may possible an improvement cycle for vital sign gauging, provided significant improvement with the training of 30.7% of professionals and showing a relative improvement of 35% in the measurement of respiratory rate, 45% in heart rate, 20% in temperature and 34% in the measurement of all vital signs. CONCLUSION: The participation of TI was fundamental in the creation of the panel for the compilation of data, enabling the application of the improvement cycle throughout MEJC in the gauging of vital signs. The COVID - 19 pandemic caused many withdrawals and suspension of educational activities, jeopardizing the continuity of these effective interventions. The implementation process showed itself very challenger to need participation of many actors, of equipments for view of panel by professionals and effective implementation of MEWS to enable decreased severe morbidity in the MEJC.
11	LEANDRO DE SOUZA MARTINS QUALITY IMPROVEMENT IN HEMACY CONCENTRATE INVENTORY CONTROL OF A COLLECTION AND TRANSFUSION UNIT Advisor : TATYANA MARIA SILVA DE SOUZA ROSENDO COMMITTEE MEMBERS : KELIENNY DE MENESES SOUSA FREITAS NILMA DIAS LEAO COSTA TATYANA MARIA SILVA DE SOUZA ROSENDO Data: Mar 30, 2021 Show Abstract 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.
12	GLEICE MOREIRA SILVA EVALUATION OF THE PERFORMANCE OF OPERATORS OF HEALTH PLANS WITH CERTIFICATE OF ACCREDITATION Advisor : NILMA DIAS LEAO COSTA COMMITTEE MEMBERS : NILMA DIAS LEAO COSTA PATRÍCIA PERES DE OLIVEIRA VIVIANE EUZEBIA PEREIRA SANTOS Data: Mar 31, 2021 Show Abstract Abstract Introduction: Accreditation is a recent initiative in supplementary health and aims to evaluate the processes of health plan operators. Studies that prove its impacts regarding quality in health are scarce, as well as the analysis of performance in other government programs. Objective: To analyze the relationship between the accreditation of health operators and their performance in relation to the quality assessed by the National Supplementary Health Agency in the Operator Qualification Program. Method: Observational study carried out with a sample of 636 operators evaluated in the Operator Qualification Program (base year 2018) and among them, 53 operators accredited in the same period. Data collection was carried out through public reports available on the website of the National Supplementary Health Agency. For the analysis of the data, the profile of the accredited operators was drawn up; Student T test to assess whether accredited operators perform better in the Operator Qualification Program and the Mann-Whitney test to assess whether performance is increasing among accredited operators according to the classification level (Level I, III and III). Results: The accredited operators (n = 53) comprise 8.3% of active operators, 77.36% are in the most developed cities in the country; 89% are classified in Level I and 9% in Level II and only one Level III (2%); 51% are large and 38% are medium-sized. Performance in the Qualification Program averaged 0.7959 for accredited operators and 0.6118 for non-accredited operators (p value 0.00). The operators' performance did not present an increasing performance according to the level of accreditation classification. Conclusions: The tests carried out proved that accredited operators have better performance than those not accredited in the Operator Qualification Program. The indicator related to the management of access to services presented the worst performance of the operators. The results of this work can be used as an incentive to the accreditation and implementation of improvement processes.
13	ROBERTA DE FÁTIMA DA NÓBREGA SOUZA QUALITY IMPROVEMENT IN THE WORK PROCESS IN A HUMAN MILK BANK IN A MATERNITY HOSPITAL IN NORTHEASTERN BRAZIL Advisor : VILANI MEDEIROS DE ARAUJO NUNES COMMITTEE MEMBERS : ANA CAROLINA PATRICIO DE ALBUQUERQUE SOUSA SUSANA CECAGNO TATYANA MARIA SILVA DE SOUZA ROSENDO VILANI MEDEIROS DE ARAUJO NUNES Data: Apr 9, 2021 Show Abstract 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. .
14	FERNANDA MARTINS SOBRINHO Improvement in the use of an outpatient secondary health care service Advisor : ANTONIO MEDEIROS JUNIOR COMMITTEE MEMBERS : ANTONIO MEDEIROS JUNIOR ZENEWTON ANDRÉ DA SILVA GAMA MERY NATALI SILVA ABREU Data: Apr 29, 2021 Show Abstract Introduction: Access to specialized secondary care services is considered a “bottleneck” for the effectiveness of comprehensive care, precisely because of the restriction of access that, consequently, generates repressed demand for these services. A government policy in the state of Bahia aims to fill the care void linked to diagnostic support and specialized clinical care, through the implementation of Regional Polyclinics. However, in an implanted Polyclinic, 26.3% of the vacancies offered were not used in the second half of 2018. Thus, it is justified to carry out an improvement cycle, in order to optimize the use of the services offered. Objective: To improve the use of the services offered by the Regional Health Polyclinic, through the application of an improvement cycle. Methodology: This is an improvement cycle, a quasi-experimental study, without a control group, with before and after evaluations, combined with time series analysis, carried out in the 2019/2020 biennium, in a regional Health Polyclinic in the state from Bahia, Brazil. For the proposed cycle, three quality indicators were established to assess the use of services offered in two moments, pre-intervention and post-intervention. The analysis was performed based on absolute and relative frequency and absolute and relative improvement. Statistical significance was tested using the z-value test, using the OpenEpi statistical program. For graphical analysis, trend graphs were used. This study was approved by the Research Ethics Committee, according to opinion 4,378,642. Results: Before the interventions, an average service utilization of 75.4% in the quarter was identified in the assessment. From the implementation of the interventions, the first three quarters became more used than in the evaluation, with 80.4%, 79.5% and 79.3% of use, respectively. Only in the last quarter, the percentage of use was lower than in the evaluation, being 74.7%, influenced by the low use of exams / procedures. However, these differences were statistically significant, with a p-value <0.001. Conclusion: Through the application of improvement cycles, the objective of this study was achieved, since there was an improvement in the use of the services offered by the Polyclinic by the consortium municipalities. This study is expected to continue and to optimize the use of services to carry out new improvement cycles.
15	JOYCE WADNA RODRIGUES DE SOUZA IMPROVEMENT CYCLE APPLIED TO PATIENT EXPERIENCE IN AN INTEGRATIVE AND COMPLEMENTARY HEALTH PRACTICES SERVICE Advisor : ANA TANIA LOPES SAMPAIO COMMITTEE MEMBERS : ANA ELZA OLIVEIRA DE MENDONCA ANA TANIA LOPES SAMPAIO ISABEL CRISTINA AMARAL DE SOUSA ROSSO NELSON MARCELO COSTA FERNANDES Data: Jul 16, 2021 Show Abstract 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

2020

	Dissertations
1	RAQUEL RAIZA FERREIRA DE FRANÇA CULTURE OF PACIENT SAFETY IN A SMALL CITY Advisor : GRASIELA PIUVEZAM COMMITTEE MEMBERS : ADALA NAYANA DE SOUSA MATA CECILIA OLIVIA PARAGUAI DE OLIVEIRA SARAIVA GRASIELA PIUVEZAM VIVIANE EUZEBIA PEREIRA SANTOS Data: Nov 23, 2020 Show Abstract Introduction: In the current context, it is important to establish safe health services focused on strengthening the culture of patient safety, replacing guilt and punishment with the opportunity to learn from failures and improve health care. The research arose from the need to discuss actions aimed at strengthening the culture of patient safety in the context of a small city in the state of Rio Grande do Norte. Objective: To carry out an internal cycle of quality improvement aimed at the culture of patient safety from the perspective of primary health care and hospital professionals. Methodology: The Improvement cycle was carried out in the 2019-2020 biennium of the before and after type. With target audience professionals from NASF, ESF teams, Municipal Hospital and Health Managers, totaling 58 participants with an average response rate of 82% in both phases of collection. The questionnaire "Research on Patient Safety Culture for Primary Care" was used, which evaluated twelve dimensions of patient safety culture: Open communication, Communication about error, Exchange of information with other institutions, Standardization of processes, Organizational learning, General perception of patient safety and quality, Leadership support for patient safety, Monitoring of patient care, SP and quality problems, Team training, Team work, Pressure and work pace. For each assessment, the 95% confidence intervals were calculated for the conformity estimates and the absolute and relative improvement values were estimated. The differences in conformities before and after were tested for statistical significance and the Z value was calculated for the alternative hypothesis of improvement that is accepted when the null hypothesis is p <0.05. The analysis also identified the “strengths” of the safety culture with a percentage of positive responses equal to or greater than 75% and the “weaknesses” with a percentage of positive responses below 50%. Results: There was a significant increase in the percentage of compliance observed at the end of the cycle from seven to nine of the twelve dimensions of the patient safety culture assessed, with a total absolute improvement of 6.2%. Conclusion: The completion of this improvement cycle is associated with an increase in the rate of compliance with the dimensions / criteria analyzed, reduction of non-conformities and a predominance of the positive character in the perception of the safety culture.
2	LORAINE MACHADO DE ARAÚJO Evaluation and improvement of the quality of phlebitis prevention in a teaching hospital Advisor : ANA ELZA OLIVEIRA DE MENDONCA COMMITTEE MEMBERS : ADRIANA MONTENEGRO DE ALBUQUERQUE ANA ELZA OLIVEIRA DE MENDONCA GABRIELA DE SOUSA MARTINS MELO DE ARAUJO LIDIANY GALDINO FELIX VIVIANE PEIXOTO DOS SANTOS PENNAFORT Data: Dec 15, 2020 Show Abstract 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.

2019

	Dissertations
1	ALINE PATRICIA DOS SANTOS BEZERRA QUALITY MONITORING OF HEALTH SURVEILLANCE ACTIONS IN A BRAZILIAN CITY Advisor : ZENEWTON ANDRÉ DA SILVA GAMA COMMITTEE MEMBERS : ZENEWTON ANDRÉ DA SILVA GAMA TATYANA MARIA SILVA DE SOUZA ROSENDO JOÃO HENRIQUE CAMPOS DE SOUZA MAGDA MACHADO DE MIRANDA COSTA Data: Feb 8, 2019 Show Abstract Introduction: Health surveillance actions in Brazil have been the target of a national quality management program that includes setting targets, indicators, annual evaluation and performance-based financial incentive. However, there are many challenges regarding the timely monitoring of indicators during the year, making it difficult to make a decision to reach the goals proposed and consequent loss of the associated financial incentive. Objectives: To evaluate the quality of health surveillance actions in a Brazilian municipality under the perspective of the Program for Qualification of Health Surveillance Actions (PQA-VS), as well as to describe the monitoring of indicators, analyze improvement trends and estimate cost related to the loss of financial incentives related to quality. Methodology: Ecological study of a time series, retrospective, descriptive and analytical. The results of the 14 indicators of the PQA-VS predicted for the city of Natal, Rio Grande do Norte, based on the official information systems, were analyzed. The absolute improvement achieved during the four-year period 2014-2017 was calculated and trend charts were also constructed by monthly monitoring of the indicators. In addition, we analyzed the fixed financial resources and annual variables for health surveillance actions, estimating the cost of poor quality related to the loss of possible financial incentives focused on the quality of health surveillance actions. Results: After four years, the quality is still unsatisfactory, since only six out of 15 indicators reached the annual target. The indicators that showed improvements were timely feeding of information systems on deaths, births and vaccination, timely closure of immediate notification diseases, in addition to the number of HIV tests carried out per year and filling of the occupational field in the reports of diseases and (DART). Significant patterns of variation (p <0.05) were identified in nine indicators, which define the processes related to it as unstable and targets for diagnosis and intervention. In 2014, 40% of the incentive was received and in 2017 60% of this resource was incorporated. The municipality stopped earning in the four-year period R $ 1,566,255.63 in variable incentives aimed at the qualification of Health Surveillance Conclusions: The evolution in the quality of VS actions in Natal has been slow, despite the national program and financial incentives for performance. The methodologies available for monitoring and evaluation of VS practices have proved to be insufficient, which is why the implementation of monitoring with monthly run charts can allow decision making in a more timely manner during the year to guide the projects and actions of improvements developed by VS.

2018

	Dissertations
1	ANA VIRGÍNIA COSTA DE MEDEIROS Quality Management in Hemotherapy Services of the State of Rio Grande do Norte Advisor : GRASIELA PIUVEZAM COMMITTEE MEMBERS : GRASIELA PIUVEZAM PATRÍCIA PERES DE OLIVEIRA VIVIANE EUZEBIA PEREIRA SANTOS Data: Jul 17, 2018 Show Abstract 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.
2	ANA EGLINY SABINO CAVALCANTE PROTOCOL IN A TERTIARY HOSPITAL OF CEARÁ Advisor : ANTONIO MEDEIROS JUNIOR COMMITTEE MEMBERS : ANTONIO MEDEIROS JUNIOR JOÃO BOSCO FILHO MARISE REIS DE FREITAS Data: Jul 18, 2018 Show Abstract Introduccion: Sepsis is a set of severe manifestations on the whole organism produced by an infection. It is currently, in Brazil, the leading cause of death in Intensive Care Units (ICUs) and one of the leading causes of late hospital mortality, surpassing myocardium infarction and cancer. This health problem also reflects the reality of the hospital in study, corresponding to the primary cause of mortality of admitted patients, especially in the pediatric services. Objective: Improving the quality of sepsis protocol care in the pediatric axis in a tertiary hospital in Ceará. Methodology: Based on a quality improvement cycle, a study quasi-experimental design developed, before and after, without a control group, following the SQUIRE guidelines. The research was carried out in the pediatric axis of a tertiary hospital in the interior of the state of Ceará between 2017 and 2018. Quality criteria was defined according to evidence for the adequate management of sepsis. The interventions were planned and implemented in a participatory manner with the objective of improving adherence to the quality criteria evaluated. After the interventions, the criteria were reassessed in order to measure their effects and identify the remaining improvement opportunities that could guide the continuity of local actions. We calculated the point estimate of the criteria in each evaluation, the absolute and relative improvement after the intervention and the statistical significance of the improvement with unilateral Z hypothesis test. The ethical precepts of resolution 466/12. Results: Eight quality criteria related to the pediatric sepsis protocol were evaluated and compliance levels in the first evaluation ranged from 56.9% to 97.1%. After the interventions, the criteria ranged from 62.8% to 93.8%. There was improvement in 6 evaluated criteria and a reduction in compliance of 2 criteria that were more than 90% compliant in the initial evaluation. Conclusions: The quality criteria based on scientific evidence and the results obtained by assessing their level of compliance before and after the intervention demonstrated that the internal quality improvement cycle was useful to ensure a better quality of the pediatric sepsis protocol through systematic procedures, uniform procedures and safe care.
3	ACÁSSIO ALVES DE SÁ Improvement of the Quality of Outpatient Dispensing Process of Oral Antineoplastic Medications Advisor : WILTON RODRIGUES MEDEIROS COMMITTEE MEMBERS : ANA ELZA OLIVEIRA DE MENDONCA HELAINE CARNEIRO CAPUCHO WILTON RODRIGUES MEDEIROS Data: Jul 19, 2018 Show Abstract 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
4	MARCELO MUNIZ MACHADO Establish safe methods for prescribing, dispensing, and administering potentially hazardous medications. Advisor : PAULO JOSE DE MEDEIROS COMMITTEE MEMBERS : AMALIA CINTHIA MENESES DO REGO PAULO JOSE DE MEDEIROS VIVIANE EUZEBIA PEREIRA SANTOS Data: Jul 19, 2018 Show Abstract Introduction: Medication-Related Problems (PRM) are among the leading causes of adverse events in the world. Unsafe drug use and medication errors are one of the main causes of health care damage. Damage can occur at different stages of the drug use process. The development of precise processes that aim to mitigate errors of prescription, dispensation and administration of medicines are inseparable aspects of a safe care. Aiming at improving the services provided in the drug chain, the elaboration of a cycle of improvement in the MPP prescription, dispensing and administration processes is amply justified. General Objective: To evaluate the results of a cycle of improvement in the quality of prescription, dispensing and administration of potentially dangerous drugs in a public hospital in Uberlândia. Specific Objectives: 1- Evaluate the quality of the MPP prescription, dispensing and administration practices practiced in the study institution. 2- Identify fragile aspects related to patient safety in the evaluated processes. 3- Propose actions to improve patient's quality and safety for the processes under study. Methodology: Initially will be evaluated the procedures of prescription, dispensing and administration of medicines practiced in the participating hospital institution. The data will be analyzed for the accomplishment of the situational diagnosis. Using a multiprofessional collegiate using the nominal group technique, the causes will be attributed to the problems encountered and established the necessary action plans to improve the quality of the target processes of the study. After the implementation of the action plan, new assessments will be applied to measure the improvement achieved in order to establish a time series in the proposed improvement cycle.
5	RODRIGO DELLA TORRES IMPROVEMENT OF PATIENT SAFETY CULTURE IN AN ONCOLOGY SERVICE Advisor : MARISE REIS DE FREITAS COMMITTEE MEMBERS : MARISE REIS DE FREITAS PATRÍCIA PERES DE OLIVEIRA ZENEWTON ANDRÉ DA SILVA GAMA Data: Jul 19, 2018 Show Abstract 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.
6	LUCIANA ANDRADE DE LIMA Root cause analysis and modal analysis of failures and effects in pediatric units: systematic review Advisor : RODRIGO ASSIS NEVES DANTAS COMMITTEE MEMBERS : RENATA SILVA SANTOS RODRIGO ASSIS NEVES DANTAS THAIZA TEIXEIRA XAVIER NOBRE Data: Jul 20, 2018 Show Abstract In the context of child hospitalization, specifics influence the safety of the patient, with the pediatric public having three times greater damage than adults in the same situation. According to the development of quality management, there were increments of tools, programs and quality methods for reducing errors related to health care. Among the tools used worldwide to reduce the occurrence of errors in health care, we highlight the Root Cause Analysis (ACR) and Modal Analysis of Failures and Effects (AMFE). The objective of the study was to analyze the usefulness of the Root Cause Analysis (ACR) and Modal Failure and Effects Analysis (AMFE) tools for the improvement of qualified assistance in pediatric units. This is a structured systematic review of the PRISMA strategy. The following databases were searched: 1. Scopus, 2. Ebsco, 3. Scientific Electronic Library Online (SciELO), 4. Latin American and Caribbean Literature in Health Sciences (LILACS), 5. Web of Science, 6 (CINAHL), 8. Cochrane Library, 9. Science Direct, 10. National Library of Medicine and Natural Institutes of Health (PubMed) , 11. Pan American Health Organization (PAHO), 14. Medical Literature Analysis and Retrieval System Online (WHOLIS), and 15 Wiley Online Library. The qualitative analysis of the articles was done through the application of an adapted and summarized version of the SQUIRE 2.0 guide. 8.254 studies were retrieved in database searches, after analysis using the relevant inclusion and exclusion criteria, 15 articles were included in the review. Of these, 09 were published between 2013 and 2018, 05 were developed in the United States, 12 used AMFE in several themes. Note the importance of using indicators to mediate quality improvement. The review reinforces the use of these tools to improve the quality of care in the pediatric units, permeating health services attitudes and behaviors that guarantee more safety, contributing to the development of a safety culture.
7	PATRÍCIA LOPES OLIVEIRA Evaluation of the quality of records in medical records of a Brazilian Northeastern Hospital Advisor : DANIELE VIEIRA DANTAS COMMITTEE MEMBERS : DANIELE VIEIRA DANTAS RENATA SILVA SANTOS THAIZA TEIXEIRA XAVIER NOBRE Data: Jul 20, 2018 Show Abstract 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.
8	SOLANE MARIA COSTA INSTITUTIONAL SUPPORT OF COSEMS: A COURSE WITH VIEWS TO IMPROVEMENT IN MONITORING HEALTH MANAGEMENT IN THE MUNICIPALITIES OF RIO GRANDE DO NORTE Advisor : ANA TANIA LOPES SAMPAIO COMMITTEE MEMBERS : ANA TANIA LOPES SAMPAIO ISABEL CRISTINA AMARAL DE SOUSA ROSSO NELSON RODRIGO ASSIS NEVES DANTAS Data: Jul 20, 2018 Show Abstract Since the 1988 Federal Constitution, the Multi-Year Plan (PPA), the Budget Guidelines Law (LDO) and the Annual Budget Law (LOA) are mandatory instruments for public management planning. In health, the legislation of the Unified Health System (SUS) defines the conditions for the municipalities, states and the Union to make feasible their management, the elaboration of health planning instruments: the Health Plan, the Annual Health Program and the Annual Management Report (RAG). In the administrative scenario of planning, RAG stands out as a pillar for evaluation and monitoring of health actions, an instrument for verifying the application of resources, with the purpose of guiding the elaboration of annual programming, as well as possible redirections necessary in the Health Plan , in the three spheres of direction of SUS. Law 141/12 defines as an obligation of the health manager, to feed annually in the Management Report Support System (SARGSUS). This study aims to analyze the reflexes of the institutional support of COSEMS-RN to the municipalities, regarding the feeding of SARGSUS, as one of the important strategies for monitoring the quality of health management in the municipalities of Rio Grande do Norte. This is a documentary analysis based on information provided by COSEMS / RN and primary SARGSUS data. The evolution of the SARGSUS of the 167 municipalities of the NR in the period 2016 to 2018 was analyzed. It was possible to document the institutional support of COSEMS-RN through specific sensitization workshops with managers and management teams called "Collaborative Network for Strengthening of the Municipal Management of SUS - Application Workshop for Construction of Management Instruments ". The Offices took place in the beginning of 2017 in the eight Health Regions. The Initial situation was a high rate of default, where only 27.54% of the municipalities fed SARGSUS in the year 2016. After the awareness and training of the management teams regarding the need to system, there was a significant evolution, reaching in 2018 the compliance with 98.20% of the municipalities that elaborated the RAG and fed the system with the instruments required by SARGSUS. It was possible to prove that this visible improvement was due to the mobilization of COSEMS-RN and the monitoring of institutional support regarding the need to comply with the normative acts of the system, the managers assumed their responsibilities, elaborated and fed the SARGSUS, specifically the RAG. It was thus perceived the importance and the primary role of the institutional supporter as fundamental for the qualification of municipal management in the SUS
9	MARIA DO SOCORRO TELMA BATISTA ARAÚJO TIMÓTEO Evaluation for improving the quality of health records of an emergency prehospital emergency service Advisor : DANIELE VIEIRA DANTAS COMMITTEE MEMBERS : DANIELE VIEIRA DANTAS RENATA SILVA SANTOS RODRIGO ASSIS NEVES DANTAS THAIZA TEIXEIRA XAVIER NOBRE Data: Sep 13, 2018 Show Abstract 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.
10	EDUARDO QUEIROZ DA CUNHA IMPROVEMENT CYCLES FOR IMPLEMENTATION OF AN EARLY WARNING SYSTEM IN AN UNIVERSITY HOSPITAL Advisor : MARISE REIS DE FREITAS COMMITTEE MEMBERS : ALDAIR DE SOUSA PAIVA GRASIELA PIUVEZAM HELAINE CARNEIRO CAPUCHO MARISE REIS DE FREITAS Data: Sep 26, 2018 Show Abstract In the hospital environment, the complexity of care and the heterogeneity of care make it difficult to properly identify a potentially ill patient. The institution of the early warning scores allows the redirection of the deteriorating patient to an appropriate care and monitoring environment. Objectives: To implement the National Early Warning Score (NEWS) in a university hospital setting through the use of improvement cycles. Methodology: A quasi-experimental study, in which NEWS was implemented in the cardiovascular disease ward of a university hospital, from December 2017 to June 2018. Three improvement cycles were performed, based on the qualification of the medical staff and nursing. Eight indicators were used to evaluate the adequacy of the process. Unilateral Z-test was used to analyze the effect of the interventions and absolute and relative improvement values were calculated. Non-compliance data from subsequent evaluations were analyzed using a Pareto before-and-after graph. Results: A total of 86 professionals were trained. Four of the eight criteria achieved adherence above 95% and two criteria with significant improvement before and after the intervention (P <0.05). There was a 42.2% reduction in the number of nonconformities in the third and last evaluation after the intervention (P = 0.017). The total number of compliments of the indicators at the end was 75.2%. Conclusions: Quality improvement tools, particularly improvement cycles, can be used to implement an early warning system, thus ensuring greater safety in the inpatient care and with the possibility of clinical deterioration.
11	JOSÉ MARIANO PESSOA Evaluating the difficulties to carry out the consultation of growth and development in a small municipality of northeast brazil Advisor : NILMA DIAS LEAO COSTA COMMITTEE MEMBERS : NILMA DIAS LEAO COSTA WILTON RODRIGUES MEDEIROS ARDIGLEUSA ALVES COELHO Data: Sep 26, 2018 Show Abstract . 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.
12	BRENA GABRIELLA TOSTES DE CERQUEIRA Evaluation and improvement of the quality of care to gestational syphilis in primary health care Advisor : ZENEWTON ANDRÉ DA SILVA GAMA COMMITTEE MEMBERS : ANA TANIA LOPES SAMPAIO ARDIGLEUSA ALVES COELHO VICTOR GRABOIS ZENEWTON ANDRÉ DA SILVA GAMA Data: Sep 26, 2018 Show Abstract Introduction: Improving the quality of syphilis care, especially syphilis in pregnancy, is an urgent need in countries such as Brazil, where there is an increase in the detection of syphilis in pregnant women and in the incidence of congenital syphilis. Objectives: To evaluate the quality of care provided to pregnant women with syphilis and to test the effect of an improvement strategy. Method: The project was carried out in 26 Basic Health Units of the city of Rio de Janeiro between January and December 2017. The design was quasi-experimental mixed with before and after analyzes and time series. The care was evaluated in all pregnant women with syphilis and prenatal care already completed (n = 178) using 10 quality criteria and a contractual indicator. The intervention was planned based on data, in a participatory and multifaceted way, covering permanent education, improvement of registration and information systems, auditing and feedback, patient education and organizational changes and work processes. Estimates of compliance with the criteria, absolute and relative improvements, and statistical significance were calculated using unilateral z-test and statistical control rules (α = 5%). The context was analyzed according to the categories of the MUSIQ model. Results: The quality of care in the first evaluation ranged from 42.8% to 91.4%. In a positive way, the pregnant women were receiving the appropriate treatment regimen as recommended (criterion 5 = 91.4%). On the other hand, the main opportunities for improvement were related to the testing and treatment of sexual partnerships and to adequate recording of treatment in the medical record (criteria 6, 7 and 10 = 42.8%). The intervention was effective, since eight of the 10 criteria had absolute improvement, being significant (p <0.05) in four of them. The monthly indicator has also improved significantly and sustainably, although there is still ample room for progress. Contextual factors such as the pressure to improve the results of the indicator, since it composes the matrix of the Organization's performance evaluation, and the political-economic crisis experienced by the municipality in 2017, interacted with the intervention both as facilitators and as improvement. Conclusions: The project was useful for identifying priorities and guiding interventions to improve the quality of syphilis care. The improvement cycle must be continued to increase its results and new strategies for change must consider the contextual factors of this study.
13	DAMITO ROBSON XAVIER DE SOUZA EVALUATION AND IMPROVEMENT OF THE CARE PROCESS FOR THE PATIENT WITH SEPSE IN AN EMERGENCY HOSPITAL Advisor : VILANI MEDEIROS DE ARAUJO NUNES COMMITTEE MEMBERS : PATRÍCIA PERES DE OLIVEIRA VICTOR GRABOIS VILANI MEDEIROS DE ARAUJO NUNES ZENEWTON ANDRÉ DA SILVA GAMA Data: Sep 27, 2018 Show Abstract 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.
14	JULIA CARVALHO ALVES SOUSA PERDIGÃO Access to Speech and Hearing Care: Interventions for the improvement of Quality. Advisor : NILMA DIAS LEAO COSTA COMMITTEE MEMBERS : NILMA DIAS LEAO COSTA STELA MARIS AGUIAR LEMOS WILTON RODRIGUES MEDEIROS Data: Oct 4, 2018 Show Abstract Introduction: Quality improvement can be achieved through different groups of activities, including improvement cycles that allow quality problems to be detected, analyzed and intervened with a view to promoting better care. Access is one of the dimensions of Quality in Health Services and can be verified through two dimensions: socio-organizational and geographical. Objective: Improving the accessibility in its socio-organizational dimension for an Ambulatory Service of Speech-Language Pathology in the city of Natal, state of Rio Grande do Norte. Methodology: Quantitative study of the quasi-experimental type of time series resulting from a cycle of quality improvement. The quality level was assessed by means of criteria related to the absence rate at the consultations, appointment for screening and for initiation of speech therapy. The evaluations took place from January 2017 to August 2018 and the data collection was performed through reports issued by the scheduling program and waiting lists. The data were compiled and subsidized the delineation of run charts graphs by means of which the presence of patterns indicative of situations significantly different from the expected ones (p <0.01) and the compliance with the quality criteria were verified. Results: The quality level established was achieved in some periods. No changes were observed with statistical significance in the behavior of the indicator when related to the interventions. Conclusion: The changes in the organization of the Service and the monitoring Indicators show improvement in access, but there is still instability in the process highlighting the need for new interventions.
15	ALESSANDRO DA SILVA DANTAS Protocol of analgesia, sedation and delirium in intensive care unit as an instrument of quality improvement Advisor : PAULO JOSE DE MEDEIROS COMMITTEE MEMBERS : PAULO JOSE DE MEDEIROS DANIELE VIEIRA DANTAS ANA CRISTINA ARAUJO DE ANDRADE GALVAO PAULA ADRIANA BORBA Data: Oct 23, 2018 Show Abstract 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.
16	ERICKA CECILIA RESENDE DE SOUZA ALVES ASSESSMENT OF SAFE PRACTICES IN THE ADMINISTRATION OF MEDICINES IN PEDIATRICS Advisor : ANA ELZA OLIVEIRA DE MENDONCA COMMITTEE MEMBERS : ANA ELZA OLIVEIRA DE MENDONCA DEBORAH DINORAH DE SA MORORO MARIA CONCEBIDA DA CUNHA GARCIA WILTON RODRIGUES MEDEIROS Data: Oct 23, 2018 Show Abstract Objective: to analyze the implementation of safe practices in process the administration of medication in the pediatric intensive care unit. Method: this is an study observational analytical, cross-sectional, and a approach quali-quantitative, carried out in a university hospital of Rio Grande do Norte. The data were colected in the period from March to July 2018. The measurement of level of quality was given through of the technique of non-participant observation of 18 previously constructed criteria, in 66 processes of preparation and drugs administration in children. Results: the investigation of the possible causes of the error of drugs administration in children, revealed that innumerable factors are related to the “methods”, that is, to the activities carried out to execute the activity. Accordingly, it was evaluated the nível of quality of drugs administration process through the adherence of the nursing professionals to the nine correct, as a practice that aims to guarantee the safety of that process. Was evaluated 18 quality criteria, of which 8 were met above 90%, and a criterion reached 100%, related to the preparation of the medication immediately before administration. It was observed that three criteria were not met, the allergy check, the patient identification conference and the record of the not administered medications. Six criteria are considered problematic, representing together 82% of nonconformities. The professionals which participated of study submit suggestions of intervention for the better quality of service, distributed in five geral categories: organizated of work, change in infrastructure and supplies, formation of nursing equip and communication. Conclusion: the implementation of recommendation for the security in the drugs administration process in the unit studied was positive. It was observed which the participation of nursing professionals in the indentification of barrier and risks existent in the process, represent an important strategy to promove the improvement of the quality of care and the development of the safety culture.
17	TAINARA BARBOSA NUNES EVALUATION AND IMPROVEMENT OF WELCOMING OF THE SPONTANEOUS DEMAND IN A BASIC HEALTH UNIT Advisor : ANA ELZA OLIVEIRA DE MENDONCA COMMITTEE MEMBERS : ANA ELZA OLIVEIRA DE MENDONCA ANA TANIA LOPES SAMPAIO SANDRA MARIA DA SOLIDADE GOMES SIMÕES DE OLIVEIRA TORRES WILTON RODRIGUES MEDEIROS Data: Oct 23, 2018 Show Abstract 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.
18	GREICE KELLY GURGEL DE SOUZA Evaluation of the implemantation of humanescent self-training ateliers in the improvement of quality of the Works of the health staff from the Âtonio Simão’s UBS Advisor : ANA TANIA LOPES SAMPAIO COMMITTEE MEMBERS : ANA TANIA LOPES SAMPAIO JANETE LIMA DE CASTRO ISABEL CRISTINA AMARAL DE SOUSA ROSSO NELSON Data: Nov 1, 2018 Show Abstract Unified Health System (SUS) that was instituted since 1988 has as basilar principles the integral attention desenvolved by the Family Health Strategy (ESF). One of the structurants policies for this integral care is the humanazing nacional policy lauched since 2003, which incorporate as a device to the enlarged clinic in the Basic Attention scope. The county of Rodolfo Fernandes, which is located in the Potiguar’s West, has subscrived it self to the Access and Quality Improvment program(PMAQ) in the basic attention and its staffs have been avaluated and monitorized through patterns predifined by th continuous cycle of improvement, that was implanted by the Health System. One of the main troubles indentified in the UBS, after the aplications of the cause and effect diagram it’s been the team relationship, which hampers the implementation of changings in the work. This work is a qualitative research with a action research type (Barbier, 2002) and a sociopoetic approach (Gauthier, 2005) and it has as goal to describe and analyze how the humanescent self-tranings ateliers could contribute to improve the quality in the health staffs work processo of the UBS named Antônio Simão, what it is consequente in the implantation of protocols to a viabilization of a extended clinic.
19	MÁRCIA AMARAL DAL SASSO Monitoring and evaluation in the management of quality in health: implementation of a panel of online patient safety indicators Advisor : GRASIELA PIUVEZAM COMMITTEE MEMBERS : ANA ELZA OLIVEIRA DE MENDONCA GRASIELA PIUVEZAM MARIA EULALIA LESSA DO VALLE DALLORA Data: Dec 17, 2018 Show Abstract 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.

2016

	Dissertations
1	MAGDA MACHADO DE MIRANDA COSTA Effects Of A National Quality Improvement Cycle Applied To Prevention Of Infections Related To Health Care In Brazilian Hospitals Advisor : ZENEWTON ANDRÉ DA SILVA GAMA COMMITTEE MEMBERS : EDUARDO ALEXANDRINO SERVOLO DE MEDEIROS MARISE REIS DE FREITAS PEDRO JESÚS SATURNO HERNÁNDEZ ZENEWTON ANDRÉ DA SILVA GAMA Data: Jul 27, 2016 Show Abstract Introduction: Healthcare-Associated Infections (HAIs) are a serious care quality related problem throughout the world, but little is known whether the adoption of quality management strategies (QA) can collaborate to reduce these undesired outcomes when implemented externally and nationally. Objective: The objective of this study was to evaluate the effect of a national quality improvement cycle strategy instituted by the Hospital Infection Control Committees (CCIH) of Brazilian hospitals and directed to the HAIs prevention. Methodology: The National Health Surveillance Agency (ANVISA), responsible for risk control in the Brazilian health services, held an improved nationwide quality cycle using a quasi-experimental design before-after. After setting 11 quality criteria based on evidence for the prevention of HAIs, a national evaluation was conducted (March 2015) addressed to all Brazilian hospitals with adult, pediatric or neonatal (N = 1,869) Intensive Care Units (ICU). Using the information from this assessment an external national intervention was planned and implemented (April 2015 to February 2016), in order to improve adherence to the assessed quality criteria. After the intervention, a national revaluation was performed (01/03 to 15/04/2016), to measure the effects of the intervention and identifying the remaining opportunities for improvement that could guide the continuity of national actions. The point estimate is calculated and confidence interval (95%) of the criteria in each evaluation, absolute and relative improvement after the intervention and the statistical significance of improvement with one-sided Z test. Results: 563 Brazilian hospitals with ICU beds participated in the 1st assessment (30.1% response, total of 86,837 beds), 681 hospitals participated in the 2nd assessment (36.4% response, the sum of 101 231 beds) and 388 hospitals participated in both assessments. When comparing the results of the two evaluations, evidence of the effectiveness of the improvement cycle, as there was significant improvement (p <0.05) in 10 of the 11 criteria assessed quality. In assessing the composite indicator: Quality of prevention of HAIs, constructed from the pooled analysis of all 11 criteria, there was significant improvement: 82.4% to 88.3%, p = 0.001 (relative improvement average 33.5%). The positives of hospitals, revealed the criteria with greater compliance after the intervention, were that "the ICUs had structural conditions and quality of supplies for hand hygiene (HM) of health professionals" (97.9% vs 100%; p = 0.001) as well as "owned protocol implemented HM" (92.9% vs. 96.9%; p = 0.001); and that "health services performed notification of IRAS regularly, based on national diagnostic criteria" (91.8% vs 92.4%; p = 0.407). On the other hand, the main weaknesses highlighted by fewer compliances are "monitoring of adherence to hand hygiene by professionals" (60.7% vs 70%, p = 0.001); "existence of institutional protocol deployed to the targeted use of antimicrobial agents" (73.2% vs 80.7%; p = 0.001) and "professionals of CCIHs promote strategies to increase the participation of patients / caregivers / family members of ICU in prevention and control of HAI "(76.6 %% vs. 82.8%; p = 0.004). Conclusions: The quality improvement cycle was helpful to identify priorities for action at the national level and in the states and the Federal District and to guide the establishment of an intervention project for quality and patient safety based on an evaluation process. In addition, this project demonstrated that it is possible to achieve real improvement nationwide HAI prevention actions through the use of QA strategies.
2	SUSANA CECAGNO QUALITY MANAGEMENT IN PRE- CHRISTMAS ASSISTANCE : INFECTIONS TO ATTENTION URINARY GESTATIONAL Advisor : JANETE LIMA DE CASTRO COMMITTEE MEMBERS : JANETE LIMA DE CASTRO JOÃO BOSCO FILHO ZENEWTON ANDRÉ DA SILVA GAMA Data: Jul 28, 2016 Show Abstract 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.
3	ERICO DE LIMA VALE Quality Management in Maternal Intensive Care Unit Advisor : GRASIELA PIUVEZAM COMMITTEE MEMBERS : GRASIELA PIUVEZAM PAULA ADRIANA BORBA VIVIANE EUZEBIA PEREIRA SANTOS Data: Aug 1, 2016 Show Abstract Objectives: To conduct a quality improvement cycle in a maternal intensive care unit (MICU) and assess their impact on multidisciplinary care for patients with gestational hypertensive disease (GHD). Methods: An improvement cycle was conducted from May to July 2015; pre and post intervention were from January to April and from August to October of that year, respectively. The criteria for evaluation were: (1) request for laboratory tests at admission in MICU; (2) obstetrical ultrasound request when admission to the MICU; (3) control of pressure peaks with the use of intravenous hydralazine; (4) use of oral antihypertensive drugs for blood pressure control; (5) use of inhibitors of Angiotensin Converting Enzyme (ACE) inhibitors or Angiotensin Receptor Blockers (ARBs); (6) intravenous fluid restriction; (7) indication of betamethasone steroids in patients with gestational age less than 35 weeks; (8) use of magnesium sulphate (MgSO4) and (9) MgSO4 maintenance postpartum. All women admitted in MICU diagnosed with GHD pre and post intervention were eligible for the study. The implementation of the recommendations was investigated before (n = 50) and after (n = 50) the implementation of the quality improvement cycle. The primary outcome was the rate of overall and individual adherence to evidence-based recommendations in patients with GHD. In each evaluation were calculated 95% confidence intervals for the estimates of compliance, their absolute and relative differences and the Z value (one tail), being considered significant an p <0.05. Results: There was increase in total adherence ratio (p1 = 88 + 3%, p2 = 92 + 1%; p = 0.018) and individual fetal ultrasound request (p1 = 72 + 10%, p2 = 88 + 4%; p = 0.023), and a reduced use of oral anti-hypertensives (p1 = 100%, p2 = 94 + 3%; p = 0.039), there were no significant changes in other criteria. Conclusion: The completion of a quality improvement cycle was associated with an increase in the adhesion rate of the evidence-based recommendations for the treatment of patients with GHD.
4	JOSE GOMES NETO JUNIOR Improvement cycle for correct patient identification in two cancer hospitals Advisor : PAULO JOSE DE MEDEIROS COMMITTEE MEMBERS : PAULO JOSE DE MEDEIROS REJANE MILLIONS VIANA MENESES VIVIANE EUZEBIA PEREIRA SANTOS ZENEWTON ANDRÉ DA SILVA GAMA Data: Aug 4, 2016 Show Abstract 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.
5	CARLOS ALEXANDRE DE SOUZA MEDEIROS Effects of a cycle of improvement in the quality of prescribing and administration of medicines at a public brazilian hospital. Advisor : RICARDO OLIVEIRA GUERRA COMMITTEE MEMBERS : HELAINE CARNEIRO CAPUCHO RICARDO OLIVEIRA GUERRA ZENEWTON ANDRÉ DA SILVA GAMA Data: Aug 5, 2016 Show Abstract Patient safety is considered one of the main items in the evaluation of quality of services and at the same time is a challenge for health professionals. Prevent the occurrence of adverse events during drug therapy becomes extremely important in providing safer care. As one of the most important means of communication between the team and therefore present a high incidence of errors, prescription processes and drugs administration have great relevance, and essential for maintenance and improving the quality of service in hospitals. The aim of this study was to determine the effectiveness of a cycle of improvement in the quality of prescriptions and medication administration at a public hospital. The study was developed through a quasi-experimental design, before-after in a referral hospital for infectious diseases in the state of Rio Grande do Norte, RN, Brazil. To evaluate the level of quality of prescription and administration of medications were randomly selected hospitalized patients medical records and found 12 developed quality criteria previously developed by a group of experts. The initial assessment revealed deficiency in the level of quality on 11 criteria and after planning and implementation of a structured intervention yielded significant improvement in the criteria for the presence of erasures, training of nursing staff and practice of the nine certain medication administration (p <0.05) and the two criteria on the completeness of the prescription (p <0.001). Based on these results, we can conclude that despite the difficulties faced during the planned intervention, the improvement cycle reached its goal significantly in almost half of the evaluated criteria.
6	LUZIA CLARA CUNHA DE MENEZES Root Cause Analysis and Failure Mode and Effects Analysis in Intensive Care Units: a systematic review. Advisor : GRASIELA PIUVEZAM COMMITTEE MEMBERS : DANIEL ÁNGEL GARCÍA GRASIELA PIUVEZAM HELAINE CARNEIRO CAPUCHO ZENEWTON ANDRÉ DA SILVA GAMA Data: Aug 19, 2016 Show Abstract 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.
7	LUCIANO LUIZ DA SILVA JUNIOR Medical Record Quality Improvement In Patients With Prostate Cancer in referral hospitals in Oncology Advisor : DYEGO LEANDRO BEZERRA DE SOUZA COMMITTEE MEMBERS : DYEGO LEANDRO BEZERRA DE SOUZA GRASIELA PIUVEZAM KLEBER CAVALCANTI NÓBREGA Data: Aug 23, 2016 Show Abstract In spite of the fact that attention to cancer is a global public health priority, simple failures capable of resonating in the increase of morbidity and mortality of patients still persist nowadays. The Inadequate recording of clinical information leads to the repetition of tests, diagnostic and treatment errors, waste of time and unnecessary costs. This study aims at verifying the effectiveness of a cycle of improvement of medical records in a referral hospital in oncology, by evaluating the level of quality in filling in the patient’s medical records, identifying the quality criteria that presents the greater amount of errors and analyzing the effectiveness of the continuous evaluation cycles that contributed to the improvement of the quality of filling in the patient’s medical records. To this end, ten quality criteria in medical records of patients diagnosed with prostate cancer were examined. From simple random sampling, these criteria were assessed before and after the proposed interventions. Such actions involved administrators and doctors, being directed especially at medical awareness and restructuring of the patient’s medical records via a checklist. In order to identify the level of quality, the point-in-time estimate and confidence interval (95%) of the criteria compliance were selected. In order to prove the effectiveness of interventions, the absolute and relative improvements between the first and the final evaluation, as well as its statistical significance (p < 0.05) were calculated. Compliance rates of 66.4%, on average, and a total of 411 non-conformities, meaning 34.2% of non-compliance were verified in the initial measurement. The associated pathologies criteria, 81.9%, and staging - TNM, 9.5%, stood out as the highest and lowest percentage of non-compliance. In the second measurement, a reduction in the total number of defects of 49.4% was observed. In short, the criteria-based evaluation made possible the identification of quality defects in filling in the surveyed patient’s medical records, which, in turn, directed the proposed interventions. Considering the improvements achieved, it is reasonable to assume that the cycle of improvement was effective in decreasing the defects observed, besides contributing significantly to the progress of quality of the medical record.
8	POLYANA DE OLIVEIRA CACHO Difficulties in Registration the Medical Records Information on a Basic Unit in Perception of Health Workers Advisor : NILMA DIAS LEAO COSTA COMMITTEE MEMBERS : GRASIELA PIUVEZAM JOÃO BOSCO FILHO NILMA DIAS LEAO COSTA Data: Aug 31, 2016 Show Abstract 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
9	SABRINNA FERNANDA DE ANDRADE ARRUDA Quality Of Attention Improvement In Diabetes Mellitus Type 2 Carrier In A Care Facility Health Primary Advisor : ANTONIO MEDEIROS JUNIOR COMMITTEE MEMBERS : ANTONIO MEDEIROS JUNIOR CLÁUDIA HELENA SOARES DE MORAIS FREITAS PAULO DE MEDEIROS ROCHA ZENEWTON ANDRÉ DA SILVA GAMA Data: Aug 31, 2016 Show Abstract Introduction: Mellitus diabetesis constituted as an important public health problem nowadays, featuring high morbidity and mortality and significant loss on quality of life. Its chronic condition, the severity of complications and the resources needed to hold back them, make the DM a very costly disease not only for the affected individuals and their families, but also for health systems in different countries. The care related to diabetes is complex and it involves a variety of aspects that go beyond blood glucose control and the use of hypoglycemic drugs. A compilation of evidence support a range of interventions in order to improve the macro and microvascular outcomes on DM. Goals: Evaluating and improving the care provided to diabetics by using the quality improvement cycle in a Basic Health Unit, intervene in the main shortcomings identified, and verify if there has been some effect due to the intervention performed. Methodology: This is a quantitative and retrospective research, developed through application of an internal quality improvement cycle, carried out in a basic health unit. The quality level was evaluated by 9 quality criteria developed and validated locally. Two evaluations were made at two different times. To quantify the effectiveness of the intervention, it was calculated the absolute and relative improvement, besides the statistical significance of the absolute improvement through unilateral test of value z. Results: After intervention, the relative improvement varies between 50% and 76%, considering highly significant (p <0.001) in most of these criteria. The absolute frequency of non-compliance decreased from 593 (first evaluation) to 214 (second evaluation), corresponding to an improvement of 379 in total of non-compliance of the criteria evaluated. Conclusions: The internal evaluation cycle proved to be useful and effective as a quality management instrument of care process evaluated, despite not having reached the level of great quality, in other words, the absence of non-compliances of all the analyzed criteria.
10	PRISCILA CUMBA DE ABREU COSTA Failure Mode and Effects Analysis for safety in preparation and dispensing chemotherapeutic drugs Advisor : VILANI MEDEIROS DE ARAUJO NUNES COMMITTEE MEMBERS : GRASIELA PIUVEZAM SUSANE DE FÁTIMA FERREIRA DE CASTRO VILANI MEDEIROS DE ARAUJO NUNES ZENEWTON ANDRÉ DA SILVA GAMA Data: Sep 16, 2016 Show Abstract 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.
11	AURELIA CRISTINA DE MEDEIROS Quality Improvement in Adherence to Hand Hygiene in a NICU Guided by Multimodal Strategy Advisor : PAULO DE MEDEIROS ROCHA COMMITTEE MEMBERS : PAULO DE MEDEIROS ROCHA WILTON RODRIGUES MEDEIROS JOÃO BOSCO FILHO Data: Sep 29, 2016 Show Abstract Introduction: hygiene of the hands is a simple action, but that brings immeasurable beneficial to patients and health professionals in hospital infection control and patient safety. Objective : The present study aims to improve the adhesion of the practice of professional hygiene of the hands, in five moments of the Multimodal Strategy assistance from the World Health Organization.. Methodology: the methodology of the study design is almost like before and after trial, held in the NICU of the maternity School in Rio Grande do Norte. To calculate the improvement between the evaluations there was the calculation of the point estimate with a confidence interval (95%) of the compliance level with the criteria of the selected samples, calculated the values of the absolute and relative improvements to each of the criteria, and the statistical significance of improving detected held a one-sided hypothesis test by means of calculating the value of Z considering how null hypothesis the lack of improvement, when p-value was the < 0.05. Results: The first evaluation (n = 44), 55% of professionals have met criteria for hand hygiene, on entering the ICU Neo. Held four more observations, three with (n = 179), opportunities for 96 actions developed, distributed in October with 53 opportunities (18% of developed actions) in November 88 chances (58% of actions) and in December 38 opportunities (24% of actions). The fifth observation (n = 44) 86% fulfilled criterion of Hand Hygiene to enter in ICU Neo and 14% did not meet. The study shows that the adherence to hand hygiene, still is too low, when linked to the five times of assistance, while in relation to the criterion of HH when entering in the ICU, there has been a significant improvement. Makes necessary continuing education and planned actions. It should Works with the culture of hygiene of hands in five moments of assistance in the pursuit of quality and safety in health care, reducing not only the hospital infection, but also the index of morbidity and mortality.
12	HELIDA MARIA BEZERRA Ventilator-associated pneumonia - an opportunity for improvement Advisor : MARISE REIS DE FREITAS COMMITTEE MEMBERS : GILSELENA KERBAUY LOPES GRASIELA PIUVEZAM MARISE REIS DE FREITAS Data: Oct 7, 2016 Show Abstract 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.
13	MABEL MENDES CAVALCANTI Perspective Risk Management Applied To Medicine Dispensing Errors In A Brazilian Hospital. Advisor : ZENEWTON ANDRÉ DA SILVA GAMA COMMITTEE MEMBERS : ZENEWTON ANDRÉ DA SILVA GAMA GRASIELA PIUVEZAM HELAINE CARNEIRO CAPUCHO Data: Oct 14, 2016 Show Abstract Introduction: health services have increasing use of complex technologies and processes that provide high risks for patient care. Prospective methods of identification and risk reduction can be helpful, but there is little description of your application in the Brazilian context. Objective: this study aims to describe the application of HFMEA tool in drug dispensing process, in order to prospectively know the possible failures and their effects. Method: it is a descriptive study, developed in a university hospital, using the HFMEA according to Veterans Affairs, implemented by multidisciplinary team for 3 months. They were identified and analyzed failure modes in the drug dispensing process, according to their severity and frequency, from the priority analysis of causes, management and monitoring of risks. Results: the highlights 21 ways to fail in dispensing drugs. Subprocesses with major failures were, in descending order, separation of the product (06), prepare the dose (06), evaluation of the prescription (03), unitarization of drugs and delivery of the dose (02), the drug release (01) and conference dose (01). Three of these failures were selected for analysis and intervention: "misidentification of medicine" (unitarization), "different separate drug's prescribed" (separation of the product) and "delay in dose delivery" (the drug release). After the analysis of the causes, we established some necessary interventions, namely: audit to assess adherence to the sub-process protocol "unitarization" and dissemination of results, construction of a standard operating protocol for storing medicines with sound and the like spelling and implementation of the security protocol in prescription, use and administration of medications. Conclusion: the study allowed us to analyze the process of dispensing drugs, where we identified the possible failures that could increase the risk of adverse events in this stage of the medication process. HFMEA was useful to assist multidisciplinary group better understand the weaknesses in the work process, which can help to faults, and assists in prioritizing corrective interventions and possible improvements to safety in dispensing drugs.
14	MARÍLIA SANTOS FAGUNDES Quality in health services: perception of the users, professionals, managers and service providers Advisor : ANA TANIA LOPES SAMPAIO COMMITTEE MEMBERS : ANA TANIA LOPES SAMPAIO JOÃO BOSCO FILHO MAURICIO ROBERTO CAMPELO DE MACEDO Data: Dec 29, 2016 Show Abstract 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).