Construção e validação de protocolo para paciente politraumatizado em serviço de atendimento móvel de urgência

Abstract

Clinical Protocols and Therapeutic Guidelines are documents that contain recommendations aimed at optimizing patient care, which can be called clinical practice guides, manuals, guidelines, notebooks, protocols, among others that should be adopted to improve this process, considering the importance of monitoring risks and standardizing the care process for polytraumatized patients in practice settings. In this context, this study aimed to build and validate a protocol for polytraumatized patients in a Mobile Emergency Care Service in Rio Grande do Norte. This was a quantitative study to develop a technological product for the construction and validation of the content and appearance of the Standard Operating Procedure (SOP). The product was built through the following stages: 1) scoping review on the subject; 2) construction of the instrument based on the characterization of the checklist items with the mapping of the scoping review; and 3) process of validation of content and appearance using the Delphi technique composed of a panel of judges (nurses). The judges were invited by e-mail. The study complied with the ethical guidelines for research with human beings described in Resolution 466/2012 of the National Health Council, with approval from the Research Ethics Committee of the Federal University of Rio Grande do Norte, certified by Opinion No. 6.046.885. In the results, items with a Content Validity Index ≥ 0.90 and checklist reliability by Kappa agreement ≥ 0.83 were considered valid. After constructing and structuring the POP, the Delphi stage was carried out with the responses of 6 judges to validate the content and appearance, using a form organized using a Likert-type scale. The checklist was categorized into five items. Round 1 assessed the individual content of the items. Round 2 assessed the attributes of the instrument and Round 3 the appearance and general assessment (comparison between immobilization before and now). The level of agreement between the judges and the validation of content and appearance reached final values of 1.00. These professionals (100%) have worked at SAMU 192 for between five and ten years. This study revealed the need to standardize, by means of a protocol, nursing care for victims of accidents with forearm injuries, in order to help standardize the procedure for immobilizing the affected segment, optimize knowledge of the technical condition and keep professionals up to date on the treatment of orthopaedic trauma in different scenarios. The product of this study consisted of a standard operating protocol to guide the procedure for immobilizing the upper limbs (forearm), based on the improvement strategies raised collectively in the interviews, with a view to standardizing the process of immobilizing the upper limbs of polytraumatized people, which are fragile and unaligned.