Acurácia de enfermeiros na classificação de risco em Unidade de Pronto Socorro de um Hospital Municipal de Belo Horizonte

• Ano de defesa: 2009
• Autor(a) principal: Alexandre Duarte Toledo
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Triagem; Serviços Médicos de Emergência; Registros de Enfermagem; Acolhimento; Cuidados de Enfermagem; Humanização da Assistência; Enfermagem/classificação; Enfermagem; Unidades de terapia Intensiva/classificação; Classificação; Questionários; Terminologia como assunto
• Link de acesso: http://hdl.handle.net/1843/GCPA-7SPFZW

The demand for care in the emergency services has increased considerably in recent years. As a strategy for organizing and humanization of the assistance has been implanted with the home-risk rating. Strategies with the host protocols for the classification of risk havebeen deployed in the emergency services and Brazil. These have included protocols to ensure that standardized criteria for evaluation of the users are implemented. This study aimed at investigating the accuracy of the nurses in the assessment and classification of risk inestablished institutional protocol of a municipal hospital in Belo Horizonte, Minas Gerais, for the evaluation of the records of Bulletins of Entry (BE), the differences in the evaluation made by nurses regarding the collection of information and establishment of priorities for care; in assessing the vital data and by determining the accuracy of the nurses in the establishment of classification levels of risk, by agreement between them and the institutional protocol. It is retrospective cohort study, with analysis of records of 382 sheets of service users in the sector attended the evaluation and classification of risk, since the implementation of the strategy to host on 22 September 2005 until September 22, 2007. There was a descriptive analysis with the establishment of simple frequency and percentage, as well as indexes of agreement to determine the accuracy of nurses binders with respect to the classification assigned. For this, we calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Kappa coefficient for each level of classification. Considering that the records are central to the award of the degree of risk to the user the results indicate a low quality of the records made at the user's assessment and allocation of risk. The lack of data recorded by nurses at the time of the initial consultation showed no influence on the classification of risk held by institutional protocol. The only data that showed a limited association with the discrepancy in the classification of risk undertaken by nurses and institutional protocol were the vital data. There was a correlation between poor to reasonablelevels of classification, represented by the general Kappa coefficient obtained (0.36). The results also indicate a trend of nurses in classifying the degrees of risk users with less serious than that provided in institutional protocol and, in return, in some cases there was a tendencyto overestimate the risk, which can determine an overload of the Emergency Department by the increase in demand for care of patients who are in clinical situations characterized by little or no urgency. The study points to the need for periodic training of professional nurses thatsector with regard to clinical evaluations based on institutional protocol established to improve the records and consequently the accuracy of them. These strategies may represent more security for the team and improvement of health care users with regard to the care ofemergency.