Assessment of safety in the use of vaccines in primary health care
Nursing, Patient safety, Vaccines, Health Assessment
The importance of safety in Primary Health Care services raises the need for studies on adverse events arising from medication errors, especially vaccines, which are frequently used at these sites. Therefore, the objective was to evaluate the safety of nursing care in the use of vaccines in primary health care. Methodological research, with a quantitative approach, divided into the following stages: 1) literature review - through national and international materials, ministerial manuals, laws, decrees, updated scientific articles, among others; 2) elaboration of a graphic protocol for the evaluation of safe nursing care in the use of vaccines in primary health care; 3) validation of content and appearance of the graphical protocol - which counted on the participation of twelve judges in Delphi 1 and eight in Delphi 2, with the completion of an electronic form made available by Google Forms. The relevance analysis of these items was by the Content Validity Coefficient (CVC) ≥ 0.78; 4) evaluation of vaccination rooms - occurred by the graphic protocol previously validated in its content and appearance, in 13 Health Units of the Family of Natal / RN / Brazil. The protocol was used in person, through the technique of non-participant observation, by two evaluators. The data collection period was from November 2016 to August 2018. The analysis of the data regarding the evaluation of the vaccination rooms was carried out using the instructions of the protocol itself and the Kappa coefficient, in order to demonstrate inter-observer reliability. All the steps of the research followed the ethical precepts with approval under Certificate of Presentation and Ethical Appraisal (CAAE) nº 59962316.8.0000.5537. The valid protocol in its content and appearance reached General Content Validity Coefficient (0.83) in Delphi 2. This value demonstrates that the instrument has reliability and reliability, with a recommendation of 75% of the judges for the application of the instrument in the practice of health services. The results and discussion are organized into four topics: patient safety in primary care, which identified a variety of patient safety actions at this level of attention, with emphasis on the importance of improving safety culture in primary care , using appropriate instruments to assess the safety culture in this context; the role of the nursing team in vaccine care, which allowed the listing of important aspects for the actions in the vaccine room, with emphasis on the need for professional training and supervision by the nurse. In the third topic, construction and validation of content and appearance of the graphic protocol, the evaluation of the judges considered valid the items of the instrument, with recommendation of its use in the primary care services. The fourth, safety assessment of nursing care in the vaccine rooms, identified unsafe care in seven investigated settings and partially safe care in five vaccine rooms. These results point out that nursing care with vaccines in Primary Health Care in the city of Natal presents fragilities capable of compromising patient safety. Thus, the periodic evaluation of the vaccine environments is necessary to detect factors that can affect the proper conservation of vaccines and their potency and efficacy, with damages to the health of the population. Thus, it is emphasized the importance of training and sensitization of the vaccinators to act according to the recommended norms, and the implementation of improvement cycles to qualify the services. It is also worth noting that further research in this area will be deepened to consolidate safe nursing practices in all vaccine contexts and to implement the public policies that involve the national immunization program.