Avaliação e melhoria da qualidade da prevenção de flebite em um hospital de ensino

Abstract

Objective: to evaluate the effect of implementing a cycle to improve the quality of phlebitis prevention in patients undergoing peripheral intravenous catheter implantation before and after educational interventions. Methodology: this is a quasi-experimental study, of the type before and after, without a control group with a quantitative approach, using a cycle of quality improvement, carried out in four stages (1) analysis of the opportunity for improvement; (2) carrying out the quality level study; (3) planning and executing timely interventions and (4) reassessing the quality level. The study was carried out in a teaching hospital from May 2019 to March 2020. 120 peripheral intravenous catheter insertion procedures were evaluated, 60 before and 60 after educational interventions with the nursing team. The identification of the quality level was performed through non-participant observation of the puncture and maintenance procedure of the peripheral intravenous catheter and completion of the checklist, composed of 17 quality criteria. For data analysis and improvement between pre- and post-intervention assessment, the point estimate was calculated with a confidence interval of 95% of the level of compliance with the criteria. The values of absolute and relative improvement and statistical significance were estimated through the unilateral hypothesis test by calculating the value of z for p≤0.05. Results: There was an increase in the level of compliance with the quality criteria with percentages greater than 90% in the 2nd evaluation, in addition to the number of criteria that reached these percentages, that is, from five in the 1st to seven in the 2nd evaluation, from a total of 17 evaluated criteria. Regarding statistical significance, the improvements were significant in seven of the thirteen criteria in which there was an improvement in the level of quality. The total non-compliance with quality criteria during the insertion and maintenance procedures of the catheter in the pre-intervention evaluation was 435 and decreased to 293 in the post-intervention evaluation, which corresponded to an absolute improvement of 32.6%. Conclusions: The results obtained in the development of the improvement cycle proved to be effective and of low cost in expanding the quality of phlebitis prevention in the service based on the definition and focused interventions of the main quality defects. It is noteworthy that the continuous monitoring of the quality level and the implementation of new strategies that encourage the participation of professionals and the involvement of patients in their care process can contribute to an increase in the valuation and promotion of good practices.