Evaluación de la seguridad en el cuidado con vacunas: construcción y validación de protocolo

Medeiros, Suzane Gomes de; Lima, Alcides Viana de; Saraiva, Cecília Olívia Paraguai de Oliveira; Barbosa, Mayara Lima; Santos, Viviane Euzébia Pereira

doi:10.1590/1982-0194201900008

Suzane Gomes de Medeiros Autor correspondente Suzane Gomes de Medeiros, E-mail: suzanegomesm@gmail.com

Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil

https://orcid.org/0000-0002-4196-4557

Alcides Viana de Lima Neto

Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil

Cecília Olívia Paraguai de Oliveira Saraiva

Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil

Mayara Lima Barbosa

Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil

Viviane Euzébia Pereira Santos

Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil

Autor correspondente Suzane Gomes de Medeiros, E-mail: suzanegomesm@gmail.com

Conflitos de interesse: nada a declarar.

Colaborações

Medeiros SG, Lima Neto AV, Saraiva COPO, Barbosa ML e Santos VEP declaram que contribuíram com a concepção do estudo, análise e interpretação dos dados, redação do artigo e aprovação da versão final a ser publicada.

Figuras (1)
Tablas (3)

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Fonte: Domansky RC. Elaboração de protocolos. In: Domansky RC, Borges EL. (orgs.). Manual de prevenção de lesões de pele: recomendações baseadas em evidências. 2. Ed. Rio de Janeiro: Rubio; 2014. p. 231-272.

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Quadro 1
Síntese das alterações sugeridas pelos juízes na Fase I da Delphi

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Tabela 1
Consenso entre os juízes nas etapas Delphi 1 e 2 para os itens avaliados no protocolo

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Referências Ahmed M, Arona S, McKay J, Long S, Vincent C, Kelly M, et al. Patient safety skills in primary care: a national survey of GP educators. BMC Fam Pract. 2014;15(206):1-8. Alameddine M, Saleh S, Natafgi N. Assessing health-care providers' readiness for reporting quality and patient safety indicators at primary health-care centres in Lebanon: a national cross-sectional survey. Hum Resour Health. 2015;13(37):1-14. Aranda CMSS, Moraes JC. Rede de frio para a conservação de vacinas em unidades públicas do município de São Paulo: conhecimento e prática. Rev bras epidemiol. 2006;9(2):172-8. Astier-Peña MP, Torijano-Casalengua ML, Olivera-Cañadas G, Silvestre-Busto C, Agra-Varela Y, Maderuelo-Fernández JA. Are Spanish primary care professionals aware of patient safety? Eur J Public Health. 2015;25(5):781–7. Bodur S, Filiz E. A survey on patient safety culture in primary healthcare services in Turkey. Int J Qual Health Care. 2009;21(5):348-55. Bondevik GT, Hofoss D, Hansen EH, Deilkâs ECT. Patient safety culture in Norwegian primary care: A study in out-of-hours casualty clinics and GP practices. Scand J Prim Health Care. 2014a;32(3):132-8. Bondevik GT, Hofoss D, Hansen EH, Deilkâs ECT. The safety attitudes questionnaire – ambulatory version: psychometric properties of the Norwegian translated version for the primary care setting. BMC Health Serv Res. 2014b;14(139):1-10. Brasil. Manual de Rede de Frio. Brasília, DF: Ministério da Saúde, 2013. Brasil. Manual de Normas e Procedimentos para vacinação. Brasília, DF: Ministério da Saúde, 2014. Cabral IC. Avaliação da Rede de Frio local do Distrito Sanitário III de João Pessoa –PB [dissertação]. João Pessoa: Universidade Federal da Paraíba; 2013. Car LT, Papachristou N, Gallagher J, Samra R, Wazny K, El-Khatib M, et al. Identification of priorities for improvement of medication safety in primary care: a prioritize study. BMC Fam Pract. 2016;17(1):1-10. Carr C, Byles J, Durrheim D. Practice nurses best protect the vaccine cold chain in general practice. Aust J Adv Nurs. 2009;27(2):35-9. Crane S, Sloane PD, Elder N, Cohen L, Laughtenschlaeger N, Walsh K, et al. Reporting and Using Near-miss Events to Improve Patient Safety in Diverse Primary Care Practices: A Collaborative Approach to Learning from Our Mistakes. J Am Board Fam Med. 2015;28(4):452-60. Daker-White G, Hays R, McSharry J, Giles S, Cheraghi-Sohi S, Rhodes P, et al. Blame the Patient, Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care. PLoS One. 2015;10(8):1-42. Douglas H, Pace WD, Harris, DM, West DR, Main DS, Westfall JM. Event Reporting to a Primary Care Patient Safety Reporting System: A Report From the ASIPS Collaborative. Ann Fam Med. 2004;2(4):1-6. Dowell D, Manwell LB, Maguire A, An PG, Paluch L, Felix K, et al. Urban Outpatient Views on Quality and Safety in Primary Care. Healthc Q. 2005;3(1):2-8. Ely JW, Kaldjian LC, D'Alessandro DM. Diagnostic Errors in Primary Care: Lessons Learned. J Am Board Fam Med. 2012;25(1):87-97. Fiandt K, Doeschot C, Lanning J. Characteristics of risk in patients of nurse practitioner safety net practices. J Am Acad Nurse Pract. 2010;22(9):474-9. Gaal S, Hombergh PVD, Verstappen W, Wensing M. Patient safety features are more present in larger primary care practices. Health Policy. 2010;97(1):87-91. Gaal S, Verstappen W, Wensing M. Patient safety in primary care: a survey of general practitioners in the Netherlands. BMC Health Serv Res. 2010;10(21):1-7. Gaal S, Verstappen W, Wensing M. What do primary care physicians and researchers consider the most important patient safety improvement strategies? BMC Health Serv Res. 2011;11(102):1-6. Gabrani JC, Knibb W, Petrela E, Hoxha A, Gabrani A. Provider Perspectives on Safety in Primary Care in Albania. J Nurs Scholarsh. 2016;48(6):552-60. Gehring K, Schwappach DLB, Battaglia M, Buff R, Huber F, Sauter P, et al. Safety climate and its association with office type and team involvement in primary care. Int J Qual Health Care. 2013;25(4):394-402. Gehring K, Schwappach DLB, Battaglia M, Buff R, Huber F, Sauter P, et al. Frequency of and Harm Associated With Primary Care Safety Incidents. Am J Manag Care. 2012;18(9):323-37. Grant AM, Guthrie B, Dreischulte T. Developing a complex intervention to improve prescribing safety in primary care: mixed methods feasibility and optimisation pilot study. BMJ Open. 2014;4(1):1-8. Hernan AL, Giles SJ, Fuller J, Johnson JK, Walker C, Dunbar JA. Patient and carer identified factors which contribute to safety incidents in primary care: a qualitative study. BMJ Qual Saf. 2015;24(9):583-93. Kostopoulou O; Delaney B. Confidential reporting of patient safety events in primary care: results from a multilevel classification of cognitive and system factors. Qual Saf Health Care. 2007;16(2):95-100. Luna GLM, Vieira LJES, Souza PF, Lira SVG, Moreira DP, Pereira AS. Aspectos relacionados à administração e conservação de vacinas em centros de saúde no Nordeste do Brasil. Ciênc Saúde Colet. 2011;16(2):513-21. Mahfouz AA, Abdelmoneim I, Khan MY, Daffalla AA, Diab MM, Shaban H, et al. Injection safety at primary health care level in south-western Saudi Arabia. East Mediterr Health J. 2009;15(2):443-50. Marchon SG, Mendes Junior WV. Segurança do paciente na atenção primária à saúde: revisão sistemática. Cad Saude Publica. 2014;30(9):1-21. Marchon SG, Mendes Junior WV, Pavão ALB. Características dos eventos adversos na atenção primária à saúde no Brasil. Cad Saude Publica. 2015;31(11):2313-30. McGuire MJ, Noronha G, Samal L, Yeh HC, Crocetti S, Kravet S. Patient Safety Perceptions of Primary Care Providers after Implementation of an Electronic Medical Record System. J Gen Intern Med. 2013;28(2):184-92. Mclaws ML, Ghahramani S, Palenik CJ, Keshtkar V, Askarian M. Assessment of injection practice in primary health care facilities of Shiraz, Iran. Am J Infect Control. 2014;42(3):1-5. Mira JJ, Nebot C, Lorenzo S, Pérez-Jover V. Patient report on information given, consultation time and safety in primary care. Qual Saf Health Care. 2010;19(5):1-4. Oliveira IP. Produção do cuidado da equipe de enfermagem nos serviços de imunização na atenção à saúde da família [dissertação]. Feira de Santana: Universidade Estadual de Feira de Santana; 2014. Oliveira VC, Gallardo MDPS, Arcêncio RA, Gontijo TL, Pinto IC. Avaliação da qualidade de conservação de vacinas na atenção primária à saúde. Cien e Saude Colet. 2014;19(9):3889-98. Oliveira VC, Guimarães EAA, Guimarães IA, Januário LH, Pinto IC. Prática da enfermagem na conservação de vacinas. Acta Paul Enferm. 2009;22(6):814-8. Oliveira VC. Avaliação da qualidade da conservação de vacina nas Unidades de Atenção Primária à Saúde da Região Centro-Oeste de Minas Gerais. Ribeirão Preto. Tese [Doutorado em Ciências da Saúde] - Universidade de São Paulo; 2012. Panagioti M, Stokes J, Esmail A, Coventry P, Cheraghi-Sohi S, Alam R, et al. Multimorbidity and Patient Safety Incidents in Primary Care: A Systematic Review and Meta-Analysis. PLoS One. 2015;10(8):1-30. Paranaguá TTB, Bezerra ALQ, Tobias GC, Ciosak SI. Suporte para aprendizagem na perspectiva da segurança do paciente na atenção primária em saúde. Rev Lat Am Enfermagem. 2016;24:1-9. Rees P, Edwards A, Panesar S, Powell C, Carter B, Williams H, et al. Safety Incidents in the Primary Care Office Setting. Pediatrics. 2015;135(6):1-9. Rhodes P, McDonald R, Campbell S, Daker-White G, Sanders C. Sensemaking and the co-production of safety: a qualitative study of primary medical care patients. Sociol Health e Illn. 2016;38(2):270-85. Rhodes P, Campbell S, Sanders C. Trust, temporality and systems: how do patients understand patient safety in primary care? A qualitative study. Health Expect. 2016;19(2):253-63. Samra R, Bottle A, Aylin P. Monitoring patient safety in primary care: an exploratory study using in-depth semistructured interviews. BMJ Open. 2015;5(9):1-7. Sánchez MR, Borrell-Carrió F, Parra CO, Fernàndez N, Gallego DAF. Auditorías en seguridad clínica para centros de atención primaria. Estudio piloto. Atención Primaria. 2013;45(7):341-8. Schwappach DLB, Gehring K, Battaglia M, Buff R, Huber F, Sauter P, et al. Threats to patient safety in the primary care office: concerns of physicians and nurses. Swiss Med Wkly. 2012;142:1-10. Shi L, Lebrun-Harris LA, Parasuraman SR, Zhu J, Ngo-Metzger Q. The Quality of Primary Care Experienced by Health Center Patients. J Am Board Fam Med. 2013;26(6):768-77. Smith-Strøm H, Thornes I. Patient safety regarding leg ulcer treatment in primary health care. Nord J Nurs Res. 2008;28(3):29-33. Smits M, Huibers L, Kerssemeijer B, Feijter E, Wensing M, Giesen P. Patient safety in out-of-hours primary care: a review of patient records. BMC Health Serv Res. 2010;10(335):1-9. Tabrizchi N, Sedaghat M. The First Study of Patient Safety Culture in Iranian Primary Health Centers. Acta Medica Iranica. 2012;50(7):505-10. Torijano-Casalengua ML, Olivera-Cañadas G, Astier-Peña MP, Maderuelo-Fernández JÁ, Silvestre-Busto C. Validación de un cuestionario para evaluar la cultura de seguridad del paciente de los profesionales de atención primaria en España. Aten Primaria. 2013;45(1):21-37. Tsang C, Bottle A, Majeed A, Aylin P. Adverse events recorded in English primary care: observational study using the General Practice Research Database. Br J Gen Pract. 2013;63(613):534-42. Verbakel NJ, Melle MV, Langelaan M, Verheij TJM, Wagner C, Zwart DLM. Exploring patient safety culture in primary care. Int J Qual Health Care. 2014;26(6):585-91. Verstappen W, Gaal S, Bowie P, Parker D, Lainer M, Valderas JM, et al. A research agenda on patient safety in primary care. Recommendations by the LINNEAUS collaboration on patient safety in primary care. Eur J Gen Pract. 2015;21(1):72-7. Verstappen W, Gaal S, Esmail A, Wensing M. Patient safety improvement programmes for primary care. Review of a Delphi procedure and pilot studies by the LINNEAUS collaboration on patient safety in primary care. Eur J Gen Pract. 2015;21(1):50-5. Wallis K, Dovey S. No-fault compensation for treatment injury in New Zealand: identifying threats to patient safety in primary care. BMJ Qual Saf. 2011;20(7):587-91. Wammes JJG, Verstappen W, Gaal S, Wensing M. Organisational targets of patient safety improvement programs in primary care; an international web-based survey. BMC Fam Pract. 2013;14(145):1-7. Webair HH, Al-assani SS, Al-haddad RH, Al-Shaeeb WH, Selm MAB, Alyamani AS. Assessment of patient safety culture in primary care setting, Al-Mukala, Yemen. BMC Fam Pract. 2015;16(136):1-9. Zwart DLM, Bont AA. Introducing incident reporting in primary care: a translation from safety science into medical practice. Health, Risk & Society. 2013;15(3):265-78.

Itens do protocolo	Aspectos incluídos a partir das sugestões dos juízes na Delphi 1
Sala de Vacina	Possui climatização ambiente entre +18°C e +20°C? Possui formulário para controle da temperatura interna da sala? Há rotina para verificação de validade dos imunos e dos insumos (seringas e agulhas)? Colocar uma nota de rodapé no final dizendo o que faz parte do Grupo A1. Na sala de vacina só existe refrigerador ou também possui câmara refrigerada?
Cuidados com o refrigerador	É feito o teste da borracha de vedação do equipamento?
Controle e registro da temperatura do refrigerador	Não houve acréscimo de itens
Condutas de enfermagem na sala de vacina	Orienta o responsável e/ou o vacinado quanto aos imunos administrados, a possível ocorrência de eventos adversos, questiona a possibilidade de gravidez, doença imunossupressora, alergias, e realiza os próximos agendamentos vacinais? Solicita o registro de vacinação aos responsáveis e acompanhantes durante o atendimento? O vacinador utiliza a técnica de deixar uma agulha e seringa no frasco/ampola para aspirar? Realiza a conferência dos “nove certos” antes de administrar a vacina?
Disposição das vacinas no refrigerador	Os frascos abertos estão identificados com a data de abertura? As vacinas estão acondicionadas na segunda e terceira prateleiras (para os refrigeradores domésticos)? Não utiliza a primeira prateleira para acondicionar vacinas (para os refrigeradores domésticos)? Os diluentes estão junto aos liófilos?
Condutas com caixas térmicas	Não houve acréscimo de itens

	Etapa Delphi 1			Etapa Delphi 2
Itens avaliados	Inadequado n(%)	Parcialmente Adequado/Adequado n(%)	CVC	Inadequado n(%)	Parcialmente Adequado/Adequado n(%)	CVC
Comportamento	1(8,3)	11(91,7)	0,86	1(12,5)	7(87,5)	0,83
Objetividade/desejabilidade	−(−)	12(100,0)	0,92	1(12,5)	7(87,5)	0,83
Simplicidade	1(8,3)	11(91,7)	0,86	−(−)	8(100,0)	0,88
Clareza	−(−)	12(100,0)	0,86	−(−)	8(100,0)	0,92
Relevância/pertinência	−(−)	12(100,0)	0,89	2(25,0)	6(75,0)	0,79
Precisão	1(8,3)	11(91,7)	0,86	1(12,5)	7(87,5)	0,79
Tipicidade	1(8,3)	11(91,7)	0,86	−(−)	8(100,0)	0,83
Amplitude	1(8,3)	11(91,7)	0,83	1(12,5)	7(87,5)	0,79

Referências
Ahmed M, Arona S, McKay J, Long S, Vincent C, Kelly M, et al. Patient safety skills in primary care: a national survey of GP educators. BMC Fam Pract. 2014;15(206):1-8.
Alameddine M, Saleh S, Natafgi N. Assessing health-care providers' readiness for reporting quality and patient safety indicators at primary health-care centres in Lebanon: a national cross-sectional survey. Hum Resour Health. 2015;13(37):1-14.
Aranda CMSS, Moraes JC. Rede de frio para a conservação de vacinas em unidades públicas do município de São Paulo: conhecimento e prática. Rev bras epidemiol. 2006;9(2):172-8.
Astier-Peña MP, Torijano-Casalengua ML, Olivera-Cañadas G, Silvestre-Busto C, Agra-Varela Y, Maderuelo-Fernández JA. Are Spanish primary care professionals aware of patient safety? Eur J Public Health. 2015;25(5):781–7.
Bodur S, Filiz E. A survey on patient safety culture in primary healthcare services in Turkey. Int J Qual Health Care. 2009;21(5):348-55.
Bondevik GT, Hofoss D, Hansen EH, Deilkâs ECT. Patient safety culture in Norwegian primary care: A study in out-of-hours casualty clinics and GP practices. Scand J Prim Health Care. 2014a;32(3):132-8.
Bondevik GT, Hofoss D, Hansen EH, Deilkâs ECT. The safety attitudes questionnaire – ambulatory version: psychometric properties of the Norwegian translated version for the primary care setting. BMC Health Serv Res. 2014b;14(139):1-10.
Brasil. Manual de Rede de Frio. Brasília, DF: Ministério da Saúde, 2013.
Brasil. Manual de Normas e Procedimentos para vacinação. Brasília, DF: Ministério da Saúde, 2014.
Cabral IC. Avaliação da Rede de Frio local do Distrito Sanitário III de João Pessoa –PB [dissertação]. João Pessoa: Universidade Federal da Paraíba; 2013.
Car LT, Papachristou N, Gallagher J, Samra R, Wazny K, El-Khatib M, et al. Identification of priorities for improvement of medication safety in primary care: a prioritize study. BMC Fam Pract. 2016;17(1):1-10.
Carr C, Byles J, Durrheim D. Practice nurses best protect the vaccine cold chain in general practice. Aust J Adv Nurs. 2009;27(2):35-9.
Crane S, Sloane PD, Elder N, Cohen L, Laughtenschlaeger N, Walsh K, et al. Reporting and Using Near-miss Events to Improve Patient Safety in Diverse Primary Care Practices: A Collaborative Approach to Learning from Our Mistakes. J Am Board Fam Med. 2015;28(4):452-60.
Daker-White G, Hays R, McSharry J, Giles S, Cheraghi-Sohi S, Rhodes P, et al. Blame the Patient, Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care. PLoS One. 2015;10(8):1-42.
Douglas H, Pace WD, Harris, DM, West DR, Main DS, Westfall JM. Event Reporting to a Primary Care Patient Safety Reporting System: A Report From the ASIPS Collaborative. Ann Fam Med. 2004;2(4):1-6.
Dowell D, Manwell LB, Maguire A, An PG, Paluch L, Felix K, et al. Urban Outpatient Views on Quality and Safety in Primary Care. Healthc Q. 2005;3(1):2-8.
Ely JW, Kaldjian LC, D'Alessandro DM. Diagnostic Errors in Primary Care: Lessons Learned. J Am Board Fam Med. 2012;25(1):87-97.
Fiandt K, Doeschot C, Lanning J. Characteristics of risk in patients of nurse practitioner safety net practices. J Am Acad Nurse Pract. 2010;22(9):474-9.
Gaal S, Hombergh PVD, Verstappen W, Wensing M. Patient safety features are more present in larger primary care practices. Health Policy. 2010;97(1):87-91.
Gaal S, Verstappen W, Wensing M. Patient safety in primary care: a survey of general practitioners in the Netherlands. BMC Health Serv Res. 2010;10(21):1-7.
Gaal S, Verstappen W, Wensing M. What do primary care physicians and researchers consider the most important patient safety improvement strategies? BMC Health Serv Res. 2011;11(102):1-6.
Gabrani JC, Knibb W, Petrela E, Hoxha A, Gabrani A. Provider Perspectives on Safety in Primary Care in Albania. J Nurs Scholarsh. 2016;48(6):552-60.
Gehring K, Schwappach DLB, Battaglia M, Buff R, Huber F, Sauter P, et al. Safety climate and its association with office type and team involvement in primary care. Int J Qual Health Care. 2013;25(4):394-402.
Gehring K, Schwappach DLB, Battaglia M, Buff R, Huber F, Sauter P, et al. Frequency of and Harm Associated With Primary Care Safety Incidents. Am J Manag Care. 2012;18(9):323-37.
Grant AM, Guthrie B, Dreischulte T. Developing a complex intervention to improve prescribing safety in primary care: mixed methods feasibility and optimisation pilot study. BMJ Open. 2014;4(1):1-8.
Hernan AL, Giles SJ, Fuller J, Johnson JK, Walker C, Dunbar JA. Patient and carer identified factors which contribute to safety incidents in primary care: a qualitative study. BMJ Qual Saf. 2015;24(9):583-93.
Kostopoulou O; Delaney B. Confidential reporting of patient safety events in primary care: results from a multilevel classification of cognitive and system factors. Qual Saf Health Care. 2007;16(2):95-100.
Luna GLM, Vieira LJES, Souza PF, Lira SVG, Moreira DP, Pereira AS. Aspectos relacionados à administração e conservação de vacinas em centros de saúde no Nordeste do Brasil. Ciênc Saúde Colet. 2011;16(2):513-21.
Mahfouz AA, Abdelmoneim I, Khan MY, Daffalla AA, Diab MM, Shaban H, et al. Injection safety at primary health care level in south-western Saudi Arabia. East Mediterr Health J. 2009;15(2):443-50.
Marchon SG, Mendes Junior WV. Segurança do paciente na atenção primária à saúde: revisão sistemática. Cad Saude Publica. 2014;30(9):1-21.
Marchon SG, Mendes Junior WV, Pavão ALB. Características dos eventos adversos na atenção primária à saúde no Brasil. Cad Saude Publica. 2015;31(11):2313-30.
McGuire MJ, Noronha G, Samal L, Yeh HC, Crocetti S, Kravet S. Patient Safety Perceptions of Primary Care Providers after Implementation of an Electronic Medical Record System. J Gen Intern Med. 2013;28(2):184-92.
Mclaws ML, Ghahramani S, Palenik CJ, Keshtkar V, Askarian M. Assessment of injection practice in primary health care facilities of Shiraz, Iran. Am J Infect Control. 2014;42(3):1-5.
Mira JJ, Nebot C, Lorenzo S, Pérez-Jover V. Patient report on information given, consultation time and safety in primary care. Qual Saf Health Care. 2010;19(5):1-4.
Oliveira IP. Produção do cuidado da equipe de enfermagem nos serviços de imunização na atenção à saúde da família [dissertação]. Feira de Santana: Universidade Estadual de Feira de Santana; 2014.
Oliveira VC, Gallardo MDPS, Arcêncio RA, Gontijo TL, Pinto IC. Avaliação da qualidade de conservação de vacinas na atenção primária à saúde. Cien e Saude Colet. 2014;19(9):3889-98.
Oliveira VC, Guimarães EAA, Guimarães IA, Januário LH, Pinto IC. Prática da enfermagem na conservação de vacinas. Acta Paul Enferm. 2009;22(6):814-8.
Oliveira VC. Avaliação da qualidade da conservação de vacina nas Unidades de Atenção Primária à Saúde da Região Centro-Oeste de Minas Gerais. Ribeirão Preto. Tese [Doutorado em Ciências da Saúde] - Universidade de São Paulo; 2012.
Panagioti M, Stokes J, Esmail A, Coventry P, Cheraghi-Sohi S, Alam R, et al. Multimorbidity and Patient Safety Incidents in Primary Care: A Systematic Review and Meta-Analysis. PLoS One. 2015;10(8):1-30.
Paranaguá TTB, Bezerra ALQ, Tobias GC, Ciosak SI. Suporte para aprendizagem na perspectiva da segurança do paciente na atenção primária em saúde. Rev Lat Am Enfermagem. 2016;24:1-9.
Rees P, Edwards A, Panesar S, Powell C, Carter B, Williams H, et al. Safety Incidents in the Primary Care Office Setting. Pediatrics. 2015;135(6):1-9.
Rhodes P, McDonald R, Campbell S, Daker-White G, Sanders C. Sensemaking and the co-production of safety: a qualitative study of primary medical care patients. Sociol Health e Illn. 2016;38(2):270-85.
Rhodes P, Campbell S, Sanders C. Trust, temporality and systems: how do patients understand patient safety in primary care? A qualitative study. Health Expect. 2016;19(2):253-63.
Samra R, Bottle A, Aylin P. Monitoring patient safety in primary care: an exploratory study using in-depth semistructured interviews. BMJ Open. 2015;5(9):1-7.
Sánchez MR, Borrell-Carrió F, Parra CO, Fernàndez N, Gallego DAF. Auditorías en seguridad clínica para centros de atención primaria. Estudio piloto. Atención Primaria. 2013;45(7):341-8.
Schwappach DLB, Gehring K, Battaglia M, Buff R, Huber F, Sauter P, et al. Threats to patient safety in the primary care office: concerns of physicians and nurses. Swiss Med Wkly. 2012;142:1-10.
Shi L, Lebrun-Harris LA, Parasuraman SR, Zhu J, Ngo-Metzger Q. The Quality of Primary Care Experienced by Health Center Patients. J Am Board Fam Med. 2013;26(6):768-77.
Smith-Strøm H, Thornes I. Patient safety regarding leg ulcer treatment in primary health care. Nord J Nurs Res. 2008;28(3):29-33.
Smits M, Huibers L, Kerssemeijer B, Feijter E, Wensing M, Giesen P. Patient safety in out-of-hours primary care: a review of patient records. BMC Health Serv Res. 2010;10(335):1-9.
Tabrizchi N, Sedaghat M. The First Study of Patient Safety Culture in Iranian Primary Health Centers. Acta Medica Iranica. 2012;50(7):505-10.
Torijano-Casalengua ML, Olivera-Cañadas G, Astier-Peña MP, Maderuelo-Fernández JÁ, Silvestre-Busto C. Validación de un cuestionario para evaluar la cultura de seguridad del paciente de los profesionales de atención primaria en España. Aten Primaria. 2013;45(1):21-37.
Tsang C, Bottle A, Majeed A, Aylin P. Adverse events recorded in English primary care: observational study using the General Practice Research Database. Br J Gen Pract. 2013;63(613):534-42.
Verbakel NJ, Melle MV, Langelaan M, Verheij TJM, Wagner C, Zwart DLM. Exploring patient safety culture in primary care. Int J Qual Health Care. 2014;26(6):585-91.
Verstappen W, Gaal S, Bowie P, Parker D, Lainer M, Valderas JM, et al. A research agenda on patient safety in primary care. Recommendations by the LINNEAUS collaboration on patient safety in primary care. Eur J Gen Pract. 2015;21(1):72-7.
Verstappen W, Gaal S, Esmail A, Wensing M. Patient safety improvement programmes for primary care. Review of a Delphi procedure and pilot studies by the LINNEAUS collaboration on patient safety in primary care. Eur J Gen Pract. 2015;21(1):50-5.
Wallis K, Dovey S. No-fault compensation for treatment injury in New Zealand: identifying threats to patient safety in primary care. BMJ Qual Saf. 2011;20(7):587-91.
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[1] Autor correspondente Suzane Gomes de Medeiros, E-mail: suzanegomesm@gmail.com

Brasil

Brasil

Evaluación de la seguridad en el cuidado con vacunas: construcción y validación de protocolo

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