Lesão por pressão: análise de prontuários e notificações do evento adverso

Abstract

Introduction: The movement for patient safety seems increasingly globalized. Thus, strategies to leverage patient safety are necessary for this asset to be consolidated in the healthcare dynamics of health organizations. Objective: Evaluate in parallel the records of reports on pressure injuries with reports of adverse events in a public university hospital. Method: Descriptive study, from a documentary source. It was developed with patient records and reports of pressure injury in the Intensive Care Unit for adults and neurology and orthopedics unit of a hospital in Parana. Variables of clinical and demographic characterization of the sample were extracted; intrinsic and extrinsic risk factors for pressure injury, in addition to comparative incidence in documentary records in medical records and reports. Descriptive statistical analysis was performed. Results: A total of 658 medical records were analyzed, predominantly of men (62.0%), hospitalized in the non-critical sector (69.7%). It was found 91 (13.8%) records of incidence of pressure-related injuries in the medical records. Several intrinsic and extrinsic risk factors were raised. There were three reports of the adverse event in the same period, revealing that 96.7% of the injuries identified in the medical records were not properly reported. Conclusions: There is a clear discrepancy between the incidence of pressure injury observed in medical records and reports of adverse events.