Incidentes de segurança do paciente na atenção primária à saúde de Manaus-am

Abstract

Patient safety is the reduction of the risk of unnecessary harm associated with healthcare to an acceptable minimum. Although the development of patient safety occurred mostly in the hospital setting, concerns about the subject are moving towards Primary Health Care (PHC) assistance, which is considered, erroneously, a very safe healthcare environment. In fact, patient safety incidents in PHC range from 2 to 3% for every 100 appointments and usually imply in low risk of harm to patients, according to the international literature. Besides, patient safety incidents in PHC are quite different from patient safety incidents that occur in hospital scenarios due to some specific characteristics of PHC assistance, such as diagnosis uncertainty and patient autonomy. In Brazil, data related to patient safety in PHC are scarce and suggest a similar prevalence of incidents compared to international data. The present study observed the occurrence of patient safety incidents in the PHC of Manaus-AM, by using a self-reporting questionnaire to collect information from doctors working in PHC, during a three-month period in 2018. The participants reported 105 patient safety incidents involving 89 patients (82%) in 34,087 PHC appointments, resulting in 0.3% incidents within the period of the study or an incidence rate of 3% of patient safety incidents per 1,000 appointments per trimester. Harm was detected in 37% of the incidents, although 33% of the adverse events were classified as minimum harm incidents. Besides low severity, patient safety incidents reported had high frequency (62% occurring twice a month or more) and high recurrence rates (87% affecting other patients). Errors in office administration were found in 54.1% of the incidents, particularly related to patient records, followed by 23% of wrong treatment decision with right diagnosis. Active patient involvement in the origin of PHC safety incidents was observed in 22% of the reports. Health education, user embracement, electronic patient record (EPR), selfcare, social networking for health and medication reconciliation are feasible strategies for the mitigation of patient safety incidents and harm in PHC. Safety culture dissemination and the definition of PHC-specific never-events are also important goals for the promotion of patient safety in this setting.