Gest?o da qualidade em unidade de terapia intensiva materna

• Main Author: Vale, ?rico de Lima
• Other Authors: 02371412481
• Language: Portuguese
• Published: MESTRADO PROFISSIONAL GEST?O DA QUALIDADE EM SERVI?OS DE SA?DE 2017
• Subjects: CNPQ::CIENCIAS DA SAUDE: GEST?O DA QUALIDADE EM SERVI?OS DE SA?DE; Unidades de terapia intensiva; Hipertens?o gestacional; Ecl?mpsia; Gest?o da qualidade; Pr?-eclampsia
• Online Access: https://repositorio.ufrn.br/jspui/handle/123456789/21770

Submitted by Automa??o e Estat?stica ([e-mail]) on 2017-01-26T15:26:50Z No. of bitstreams: 1 EricoDeLimaVale_DISSERT.pdf: 1912656 bytes, checksum: d9fad5e12618fef8d0405ac649e8f9df (MD5) === Approved for entry into archive by Arlan Eloi Leite Silva ([e-mail]) on 2017-01-26T15:45:09Z (GMT) No. of bitstreams: 1 EricoDeLimaVale_DISSERT.pdf: 1912656 bytes, checksum: d9fad5e12618fef8d0405ac649e8f9df (MD5) === Made available in DSpace on 2017-01-26T15:45:09Z (GMT). No. of bitstreams: 1 EricoDeLimaVale_DISSERT.pdf: 1912656 bytes, checksum: d9fad5e12618fef8d0405ac649e8f9df (MD5) Previous issue date: 2016-08-01 === Objetivos: Realizar um ciclo de melhoria da qualidade em uma unidade de terapia intensiva materna (UTIM) e avaliar seu impacto na assist?ncia multiprofissional ?s pacientes com doen?as hipertensivas gestacionais (DHG). M?todos: Foi realizado um ciclo de melhoria de maio a julho de 2015; os per?odos pr? e p?s interven??o foram de janeiro a abril e de agosto a outubro do mesmo ano, respectivamente. Os crit?rios definidos para avalia??o foram: (1) solicita??o de exames laboratoriais quando da admiss?o na UTIM; (2) solicita??o de ultrassom obst?trico quando da admiss?o na UTIM; (3) controle de picos press?rico com uso de Hidralazina intravenosa;(4) uso de anti-hipertensivos orais para controle press?rico; (5) uso de Inibidores da Enzima Conversora da Angiotensina (IECA) ou Bloqueadores do Receptor da Angiotensina (BRA); (6) restri??o h?drica intravenosa; (7) indica??o do corticoide Betametasona em pacientes com idade gestacional menor que 35 semanas; (8) uso do sulfato de magn?sio (MgSO4) e (9) manuten??o do MgSO4 no p?s parto. Todas as mulheres admitidas na UTIM com diagn?stico de DHG nos per?odos pr? e p?s interven??o foram eleg?veis para o estudo. Foram analisadas as admiss?es antes (50) e ap?s (50) a realiza??o do ciclo de melhoria da qualidade. O desfecho avaliado foi a taxa de adequa??o total e individual das recomenda??es baseadas em evid?ncias nas pacientes com DHG. Em cada avalia??o foram calculados os intervalos de confian?a de 95% para as estimativas de conformidade, suas diferen?as absoluta e relativa e o valor Z (uma cauda), sendo considerado significativo valor de p <0,05. Resultados: Houve aumento da taxa total de adequa??o dos crit?rios (p1=88+3%, p2=92+1%; p=0,018) e solicita??o de ultrassom fetal (p1=72+10%, p2=88+4%; p=0,023), e redu??o no uso de anti-hipertensivos orais (p1=100%, p2=94+3%; p=0,039), n?o houve altera??es significativas nos demais crit?rios. Conclus?o: A realiza??o de um ciclo de melhoria est? associado a um aumento na taxa de ades?o as recomenda??es baseadas em evid?ncia para o tratamento de pacientes com DHG. === 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.