Programa de cirurgia segura: proposta para consolidar a implementação em dois hospitais públicos terciários em Manaus-AM

Abstract

BACKGROUND: In 2007, World Health Organization (WHO) implemented the 'Safe Surgery Saves Lives' Program in order to reduce incidents and accidents during the perioperative period. In Brazil, in many institutions, despite being announced, the Program does not strictly follow the rules stipulated by the WHO. In the two largest human resources training tertiary hospitals in Surgery in Manaus it is no different and this is a reality to be changed. OBJECTIVES: General: To propose a method to improve the effective use of the Safe Surgery Protocol (SSP) in two public tertiary hospitals in the city of Manaus. Specific: To get to know the process of execution of the SSP in both hospitals; to evaluate the adherence to the safe surgical control list by the surgical team; to introduce a structured technique for designing innovation strategies that will support the effective implementation of the SSP in the hospitals; to propose solutions to ensure the full implementation of the SSP. METHOD: Design Thinking was used as a problem solving strategy with a sample of professionals who worked in the surgical facilities of the hospitals. After a literature review, the following steps were followed: 1) Discovery of the problem: non-interventional observation (shadowing) in both hospitals; 2) Synthesis of the problem: describing what was observed and discussion with those interested in the change; 3) Collective development and co-creation of solutions by the professionals who elected prototyped activities to solve the problem; and 4) Implementation of the tested solutions with proposition of the best solution. RESULTS: Sixty-three professionals directly involved in surgical procedures in the two hospitals were included. Shadowing was done for a total of 120 hours in both hospitals. It resulted in a report that pointed out several instances of noncompliance with the SSP. According to the observations, that were socialized with the professionals, the reasons for noncompliance with the standard SSP rules (Synthesis) were discussed. After the problem was defined, during meetings with the participants, its solution was developed and co-created, and a prototyped activity was collectively consented to be performed in order to start the execution of the SSP with one of the surgical services in each hospital. Finally, in view of the results obtained, definitive solutions to the problem were suggested to be implemented in order that the SSP be effectively executed in both hospitals. CONCLUSIONS: The adoption of the SSP protocol in two tertiary hospitals of Manaus was studied and it was not effectively executed in both. There was no initial adherence to the checklist of the SSP and, after the intervention by the researchers, it was still noted resistance to comply with the Protocol. Design Thinking was used to study, define and conceive a solution to solve noncompliance to the SSP in both hospitals. It was proposed to activate a Perioperative Surgical Home scenario in both hospitals and implement early education regarding the SSP in the undergraduate courses of Medicine and Nursing as definitive short- and medium-term solutions for solid implementation of the SSP in both tertiary hospitals. Keywords: Patient safety; Attitude of health personnel; Surgery.