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Authors
Advisor(s)
Abstract(s)
Introdução: A segurança do doente assumiu um papel central nas organizações de saúde, desde a publicação “Err is Human”, sobre os erros associados aos cuidados médicos em 1999. Considerando que 80% das decisões médicas (diagnósticos, prognósticos e terapêuticas) dependem de análises/resultados laboratoriais, a Anatomia Patológica, apesar de não constituir uma especialidade clínica, não é alheia a esta temática. Pensar que 70% das atividades da rotina histopatológica são realizadas de forma manual, nas quais as amostras percorrem inúmeras etapas, com intervenção de vários profissionais, e como tal, com maior falibilidade, é utópico pensar-se na existência de um laboratório sem erros. Na perspetiva de definir um conjunto de métricas/indicadores da qualidade laboratoriais, surge em 2017 a “Initiative for Anatomic Pathology Laboratory Patient Safety” (IAPLPS), com o objetivo de desenvolver as melhores práticas para a mitigação do erro laboratorial em Anatomia Patológica, contribuindo para a segurança do doente. Objetivos: Assim, foi considerado pertinente, como dissertação de mestrado, investigar a monitorização dos indicadores da qualidade IAPLPS, ao longo da fase analítica laboratorial e sua relação com características laboratoriais e institucionais. Metodologia: Este estudo teve por base a resposta a um inquérito construído pelo autor e validado por um grupo de peritos, o qual foi respondido pelo técnico coordenador e/ou gestor da qualidade de cada um dos 21 laboratórios inquiridos, e posteriormente recolhidos para análise. Resultados: A maioria dos laboratórios de Anatomia Patológica são sensíveis ao cumprimento, verificação/monitorização dos indicadores IAPLPS definidos, com taxa de verificação média de 72,5%; taxa de incidência de erro estimado entre 0,18% e 0,42% em cerca de 30000 casos em média. Conclusão: Assim, podemos concluir que a monitorização de Indicadores IAPLPS, processos de certificação/acreditação revestem-se de enorme relevância na gestão, mitigação e prevenção dos erros ao longo do ciclo laboratorial em Anatomia Patológica, sendo também cruciais no desenvolvimento/implementação de uma cultura de segurança e notificação, privilegiando uma perspetiva sistémica, pois “não conseguimos mudar a condição humana, mas sim as condições onde trabalha”.
ABSTRACT - Introduction: Patient safety has played a central role in health organizations since the Err Is Human publication on errors associated with medical care in 1999. Considering that 80% of medical decisions (diagnoses, prognostics, and therapeutics) depend on laboratory analysis/results, pathological anatomy, although not a clinical specialty, is not unrelated to this theme. To think that 70% of histopathological routine activities are performed manually, in which the samples go through numerous stages, with the intervention of several professionals, and as such, with greater fallibility, it is utopian to think of the existence of a laboratory without errors. From the perspective of defining a set of laboratory quality metrics, the "Initiative for Anatomic Pathology Laboratory Patient Safety" (IAPLPS) was created in 2017 with the objective of developing best practices for the mitigation of laboratory error in pathological anatomy and contributing to the patient's safety. Objectives: Thus, it was considered pertinent, as a master's thesis, to investigate the monitoring of IAPLPS quality indicators, throughout the laboratory analytical phase and its relation with laboratory and institutional characteristics. Methodology: This study was based on a response to a questionnaire constructed by the author and validated by a group of experts, which was answered by the coordinating technician and/or quality manager of each of the 21 laboratories surveyed, and collected for analysis. Results: Most Pathological Anatomy laboratories are sensitive to compliance, verification/monitoring of defined IAPLPS indicators, with an average verification rate of 72.5%; estimated error incidence rate between 0.18% and 0.42% in about 30,000 cases on average. Conclusion: Thus, we can conclude that the monitoring of IAPLPS Indicators, certification/accreditation processes are of great relevance in the management, mitigation, and prevention of errors throughout the pathological laboratory cycle, being also crucial in the development/implementation of a culture of security and notification, favoring a systemic perspective, because “we cannot change the human condition, but the conditions where it works”.
ABSTRACT - Introduction: Patient safety has played a central role in health organizations since the Err Is Human publication on errors associated with medical care in 1999. Considering that 80% of medical decisions (diagnoses, prognostics, and therapeutics) depend on laboratory analysis/results, pathological anatomy, although not a clinical specialty, is not unrelated to this theme. To think that 70% of histopathological routine activities are performed manually, in which the samples go through numerous stages, with the intervention of several professionals, and as such, with greater fallibility, it is utopian to think of the existence of a laboratory without errors. From the perspective of defining a set of laboratory quality metrics, the "Initiative for Anatomic Pathology Laboratory Patient Safety" (IAPLPS) was created in 2017 with the objective of developing best practices for the mitigation of laboratory error in pathological anatomy and contributing to the patient's safety. Objectives: Thus, it was considered pertinent, as a master's thesis, to investigate the monitoring of IAPLPS quality indicators, throughout the laboratory analytical phase and its relation with laboratory and institutional characteristics. Methodology: This study was based on a response to a questionnaire constructed by the author and validated by a group of experts, which was answered by the coordinating technician and/or quality manager of each of the 21 laboratories surveyed, and collected for analysis. Results: Most Pathological Anatomy laboratories are sensitive to compliance, verification/monitoring of defined IAPLPS indicators, with an average verification rate of 72.5%; estimated error incidence rate between 0.18% and 0.42% in about 30,000 cases on average. Conclusion: Thus, we can conclude that the monitoring of IAPLPS Indicators, certification/accreditation processes are of great relevance in the management, mitigation, and prevention of errors throughout the pathological laboratory cycle, being also crucial in the development/implementation of a culture of security and notification, favoring a systemic perspective, because “we cannot change the human condition, but the conditions where it works”.
Description
Mestrado em Gestão e Avaliação de Tecnologias em Saúde
Keywords
Anatomia patológica Qualidade em saúde Segurança do doente Fase analítica Indicador de qualidade Anatomic pathology Quality in health care Patient safety Analytical phase Quality indicator Portugal
Citation
Borrecho GL. Verificação de indicadores da qualidade na fase analítica laboratorial em anatomia patológica: análise a 21 laboratórios Portugueses [dissertation]. Lisboa: Escola Superior de Tecnologia da Saúde de Lisboa; Escola Superior de Saúde da Universidade do Algarve; 2018.
Publisher
Instituto Politécnico de Lisboa, Escola Superior de Tecnologia da Saúde de Lisboa