Segurança do paciente na atenção primária à saúde: análise do processo de implantação dos núcleos e guia de orientação para os municípios de uma região de saúde do estado de Goiás

Abstract

Patient safety is essential for reducing risks and harm associated with healthcare, focusing on improving basic quality strategies. Although most patient care occurs in Primary Health Care (PHC), patient safety evaluations are generally concentrated in hospitals due to the complexity of hospital procedures. Objective: To analyze the stage of implementation of the Patient Safety Policy in Primary Health Care to support the municipalities in the Rio Vermelho Health Region in the State of Goiás; identify the process of implementing Patient Safety Centers (PSCs) in Primary Health Care; identify nursing team practices for achieving patient safety goals; and propose a manual with guidelines for implementing PSCs in PHC. Method: Mixed methods were used, combining qualitative and quantitative techniques, with a preliminary analysis of the PSC implementation status in the 8 municipalities of the region. The initial two stages consisted of quantitative cross-sectional studies, with electronic questionnaires applied to UBS professionals and APS coordinators. The third stage involved a focus group with 9 members of nursing teams, selected by convenience, to gain a deeper understanding of the challenges and opportunities in implementing Patient Safety. Results: In the two quantitative stages, 7 municipal APS coordinators and 8 nursing professionals participated, mostly women (86.6%), representing 8 municipalities. Among the 7 municipalities whose coordinators responded, 5 have already implemented PSCs, but only 2 (28.57%) meet all the required criteria for their functioning, such as registration with NOTIVISA, internal regulations, team appointment, patient safety plan, and monthly meetings. Adherence to patient safety practices varied among municipalities. Four municipalities adopted correct patient identification practices; 7 mplemented hand hygiene protocols; and 7 also adhered to practices for checking medication administration and dispensing. However, no adequate practices were identified for the management of high-alert medications. Additionally, there was a noted fragility in practices for preventing patient falls and effective communication, especially during transfers between care units, with poorly systematized practices. Safe surgery practices were observed only in dental health and showed considerable variability among respondents, indicating fragility in implementation. The focus group confirmed these results and highlighted the need for greater state coordination to support PSC implementation in municipalities. Conclusion: The lementation of PSCs in PHC in the Rio Vermelho Health Region is uneven and faces challenges due to a lack of clear guidelines and centralized coordination. These deficiencies undermine the uniformity and effectiveness of patient safety practices. The analysis of nursing practices revealed an urgent need for a Patient Safety Plan with clear protocols and specific goals. Products: A Guide for the Implementation of PSCs was created, aimed at healthcare teams, with the goal of promoting an integrated strategy to ensure the effectiveness and continuous improvement of patient safety in the region.