Evidence-based practice to promote patient safety

Pedreira, Mavilde Luz Gonçalves

doi:10.1590/S0103-21002009000700007

PALESTRA

Mavilde Luz Gonçalves Pedreira

Adjunct professor of the "Universidade Federal de São Paulo" School of Nursing Department of Nursing, São Paulo (SP), Brazil. Researcher of the "Conselho Nacional de Desenvolvimento Científico e Tecnológico" - CNPq (National Council for Scientific and Technological Development)

Corresponding Author

INTRODUCTION

To provide adequate care at the right moment, in the right way and to the right individual, aiming to achieve the best possible results, is a principle on which quality of care is founded and which guides the practice of nurses who seek to offer ethical and respectful care, based on patient and family needs, clinical excellence and the best scientific information available.

Hippocratic principles, allied to contemporary models of continuous application of scientific knowledge and technologies to practice, aimed at achieving increasingly better results of quality of life and longevity, guide the daily behavior of health professionals.

Thus, health care is characterized as one of the most complex and dynamic activities performed by human beings. However, such development has not been followed by investments that make the health system safe⁽¹⁾.

Whereas efforts and investments have been made in the manufacturing, aviation, financial and military fields to develop human error prevention systems, a culture of punishment of individuals committing mistakes has remained in the health field, with feelings of guilt, fear and shame being aroused by these actions. The first question that dominates health institutions is "Who has done this?", as if errors were rare and related to certain health professionals' questionable conduct⁽¹⁾.

However, major epidemiological studies conducted in developing countries show that the system's complexity, relationships, culture and environment lead to the occurrence of innumerable avoidable adverse events and errors, which compromise patient safety, causing deaths or sequelae.

The World Health Organization⁽²⁾ warns that millions of people worldwide suffer from debilitating injuries or die as a result of health practices that are unsafe. It is estimated that one in every ten patients will be a victim of an error. Such estimate comes from studies performed in developed countries, with more structured health systems than those of developing countries, where epidemiological data are still scarce. In the United States, it is estimated that 100 people die daily due to errors made while receiving health care. This is considered the eighth cause of mortality⁽¹⁾.

Thus, errors in the health system are not rare and must be viewed as results of systems that disregard the fallibility intrinsic to the human cognitive process. In addition, efforts must be made to change the culture from one of punishment to another of safety, where each error is conceived under the perspective of system failures, which should be analyzed in a broad context so they can be corrected and prevented, including actions to be performed when their occurrence cannot be avoided.

James Reason, prominent researcher in the area of human error, argues that it is impossible to extinguish the possibility of errors, once they are an immutable human characteristic. However, human beings can change the environment they live in, designing systems that make it easier to do what is right, while making it more difficult to do what is wrong⁽¹⁾.

GOOD NURSING PRACTICES

In terms of nursing, studies have shown that the health system is not designed to promote good nursing practices^(3-5). All nursing professionals worldwide, more than 13 million in all, must have patient safety as the foundation of their practice, although few work under proper conditions that enable them to provide the nursing care they learned or idealized for patients and family members.

Scientific evidence produced in different countries indicate that institutions including an adequate number of nurses with higher professional qualification, this last aspect being more significant to the results, show better results in health and promotion of safety, with a reduction in hospital infection rates, falls, pressure ulcers and medication errors, and thus contributing to significant decreases in length of stay in health institutions and patient mortality^{(3-4, 6-7)}.

The search for and use of scientific evidence in nursing to promote patient safety are based on the assumption of using and encouraging the performance of studies that can create innovative nursing practices, aimed at sustaining actions and relationships of professionals in the health system, in addition to showing the impact of such actions on the results of this system.

Nursing professionals who work in the fields of teaching, health care and research need to join efforts to demonstrate that nurses and remaining professionals in the field of nursing in Brazil do not have sufficient numbers, professional qualification and resources to enable them to develop efficient and safe nursing practices. In this country's health care context, few nurses work in environments where actions are focused on scientific evidence. Many spend their work day correcting failures in the system; searching for materials; exchanging broken pieces of equipment; looking for misplaced prescriptions and documents; and correcting laundry, drugstore, maintenance, nutrition and cleaning errors. Consequently, by the end of the day, they realize they could not provide direct nursing care to the patient, nor could they effectively supervise the care provided by nursing technicians or assistants.

In this context, the nursing profession must include strategies that promote the actual connection between theory and practice in a revolutionary and dynamic way, aiming to achieve protection of essential nursing values and to center actions around the patient and the family in a complete and personal way, thus distinguishing nursing actions from those performed by other health professionals.

The ability to demonstrate that the number of nursing professionals changes the results of healthcare provided to the patient is a contribution from research on nursing that has caused changes in public policies of developed countries, where such evidence has led to the creation of laws regulating the minimum number of nursing professionals per patient and health service characteristics⁽⁶⁾.

Another priority in Brazil, in the search for evidence in nursing that promotes patient safety, refers to the association between professional qualification and health results^(4,7). It is necessary to show that more qualified nursing professionals produce better results in patient care, increasing user satisfaction with and trust in the health care system, yet reducing morbidity and mortality above all, as evidenced in major studies performed abroad^(3-4,7).

Only by being able to work in an environment that has the adequate number and qualification level of nursing professionals, can nursing practices based on evidence be performed in a broad and solid context and new evidence, capable of changing patient safety results now identified, be sought. This is because nursing is the one profession that, among all professions in the field of health, is able to promote practices centered around protection, due to its constancy and proximity to patients and families.

REFERENCES

1. Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Washington. D.C.: National Academy Press; 2000.
²
World Health Organization [Internet]. World Alliance for Patient Safety. Forward Program 2006-2007.[cited 2009 Jul 12]. Available from: http://www.who.int/patientsafety/information_centre/WHO_EIP_HDS_PSP_2006.1.pdf
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