Maria Angélica Sorgini Peterlini

BackgroundMagnet®-designated hospitals show superior nursing-sensitive indicators, yet evidence from outside high-income settings is scarce. We evaluated programme effects at a Brazilian tertiary hospital — the first in Latin America to receive Magnet® designation (June 2022) — over a period that intersected the COVID-19 pandemic.ObjectivesTo evaluate the effect of Magnet® designation on four nursing-sensitive indicators — inpatient falls with injury, hospital-acquired pressure injury, central line–associated bloodstream infection, and catheter-associated urinary tract infection — and on patient safety culture.DesignQuasi-experimental study.SettingTertiary-care, private, not-for-profit hospital in São Paulo, Brazil; Magnet®-designated June 2022.MethodsPre-designation (April 2017–December 2018) and post-designation (July 2022–December 2024) nursing-sensitive indicator data were compared using National Database of Nursing Quality Indicators methodology and international benchmarks; the implementation period (January 2019–June 2022) was analysed descriptively. Aggregate-event analyses produced incidence rate ratios or risk ratios with 95% confidence intervals. Patient safety culture was assessed via the Brazilian-validated Hospital Survey on Patient Safety Culture across four waves (2017–2023); benchmark attainment for thirteen items was compared using the chi-squared test.ResultsCentral line–associated bloodstream infection fell from 0.459 to 0.296 per 1,000 central line-days (incidence rate ratio 0.65; 95% confidence interval: 0.43 to 0.97; p = .034). Falls with injury showed a borderline reduction (incidence rate ratio 0.77; 95% confidence interval: 0.58 to 1.01; p = .057). Pressure injury prevalence was stable (risk ratio 0.98), with benchmark attainment rising from 42.9% to 70.0% of quarters. Urinary catheter infection remained low (incidence rate ratio 0.77). Patient safety culture improved on 10 of 11 dimensions, with largest gains in Nonpunitive Response to Error (+31.8 percentage points), Handoffs (+27.0 percentage points), and Communication Openness (+23.0 percentage points). Items meeting the benchmark rose from 15.4% to 46.2% (p = .202). The Overall Patient Safety Grade declined 16.7 percentage points from pre- to post-designation.ConclusionsMagnet® designation was associated with a significant reduction in central line–associated bloodstream infection, a borderline reduction in falls with injury, and stable benchmark-level performance for the remaining indicators, alongside broad gains in patient safety culture. These findings provide the first empirical evidence of Magnet® effects on clinical and cultural endpoints in Latin America.Tweetable abstractFirst Magnet® hospital in Latin America: CLABSI down 35%, fewer falls, safety culture up on 10/11 dimensions — beyond high-income settings.

O Manual de utilização da Caixa Lúdica para distração de crianças submetidas a procedimentos dolorosos é um material educativo destinado a orientar profissionais de enfermagem na utilização de recursos lúdicos durante procedimentos dolorosos realizados em crianças. A obra apresenta orientações para o planejamento e a realização de intervenções de distração, considerando as necessidades e preferências da criança, sua participação no cuidado e o envolvimento da família. Reúne sugestões de brincadeiras, estratégias de comunicação, medidas de conforto e orientações para o uso dos materiais que compõem a Caixa Lúdica, incluindo os cartões “Você escolhe! Nós apoiamos você!”. O manual busca contribuir para uma assistência de enfermagem humanizada e centrada na criança e na família, valorizando o brincar como recurso de apoio ao enfrentamento de experiências potencialmente dolorosas e estressantes.

Resumo Objetivo Avaliar o comportamento de soluções de vancomicina em diferentes concentrações (5 mg/mL e 10 mg/mL) e sob diversas condições de temperatura (22ºC e 37ºC) nos tempos de infusão de zero (T0), duas (T2) e quatro (T4) horas. Métodos O experimento simulou a prática clínica de infusão de vancomicina. Os antimicrobianos foram diluídos em 5 e 10mg/mL, estudados conforme variações de temperatura (22°C e 37°C) e submetidos a análises imediatamente após o preparo (T0), T2 e T4 horas de exposição ambiental. O método de cromatografia líquida de alta eficiência determinou a concentração e a estabilidade. Um total de 108 concentrações e 36 medições de pH foram analisadas para a média, desvio padrão, ANOVA e p≤0,05. Resultados Os valores de pH não apresentaram variações estatisticamente significativas durante as quatro horas, mantendo a característica ácida. Não houve variações significativas da vancomicina 5mg/mL a 22°C em T0 e T2, mas houve redução estatisticamente significativa da concentração em T4 (<0,001). Para a vancomicina a 10mg/mL e 22°C, o composto ativo teve aumento da concentração entre T0 e T2, com nova diminuição em T4 (p=0,006); a 37°C houve redução significativa da concentração em T2 e T4 (p<0,001)). Conclusão Houve redução significativa da concentração da vancomicina a 5mg/mL na quarta hora de infusão. A concentração da vancomicina a 10mg/mL aumentou nas duas primeiras horas de análise. Houve variações estatisticamente significativas nas concentrações de vancomicina ao longo do tempo e nas situações experimentais estudadas. Apesar dessas variações, todas as alterações permaneceram dentro do limite de 7% aceito pela Farmacopeia Europeia, indicando que a estabilidade da vancomicina é adequada para uso clínico nas condições testadas.

Objective To evaluate the behavior of vancomycin solutions in different concentrations (5 mg/mL and 10 mg/mL) and under various temperature conditions (22ºC and 37ºC) at infusion times of zero (T0), two(T2) and four(T4) hours. Methods The experiment simulated clinical practice of vancomycin infusion. Antimicrobials were diluted at 5 and 10mg/mL, studied according to temperature variations (22°C and 37°C), and submitted to analyses immediately after preparation (T0), T2 and T4 hours of environmental exposure. The high-performance liquid chromatography method determined concentration and stability. A total of 108 concentrations and 36 pH measurements were analyzed for mean, standard deviation, ANOVA, and p≤0.05. Results The pH values did not show statistically significant variations during the four hours maintaining the acidic characteristic. There were no significant variations of vancomycin 5mg/mL at 22°C at T0 and T2, but there was a statistically significant concentration reduction at T4(<0.001). For vancomycin at 10mg/mL and 22°C, the active compound had an increase in concentration from T0 to T2, with a further decrease at T4(p=0.006); in 37°C there was a significant in concentration in T2 and T4(p<0.001). Conclusion Vancomycin at 5mg/mL showed significant concentration reduction in the fourth infusion hour. For vancomycin at 10mg/ml, there was an increase in concentration in the first two hours of analysis. There were statistically significant variations in vancomycin concentrations over time and in the experimental situations studied. Despite these variations, all changes remained within the 7% threshold accepted by the European Pharmacopeia, indicating that vancomycin stability is adequate for clinical use under the tested conditions.

Severely ill children and newborns typically require a wide range of intravenous medications as part of specific therapies tailored to their developmental and growth characteristics. Intravenous medications for pediatric patients are dosed based on their weight and body surface area, and their response to drug therapy varies with age. Many drugs are originally developed for adults but are prescribed to children based on clinical experience and scientific publications, considering the severity of the condition. In this context, one such medication widely used in pediatric treatment since the 1970s is dobutamine hydrochloride, an inotropic drug with some vasodilatory effect. We aimed to validate High-Performance Liquid Chromatography to determine the concentration and stability of dobutamine hydrochloride. The dobutamine hydrochloride (250mg/ 2mL of water) was used as the sample. The parameters of analytical performance determined were selectivity, linearity, range, precision, accuracy, robustness and stability. The developed method has proved to be selective; linear in the range from 80% to 120% of the theoretical test concentration; precise in repeatability and intermediate precision; exact at the concentrations of 0.40, 0.50 and 0.60 mg/mL; robust with drug variations proportional to the deliberate changes caused in the composition and flow rate of MF, and column temperature; and stable for 24 hours after sample preparation. The High-Performance Liquid Chromatography analytical methodology for dobutamine hydrochloride was considered validated according to Resolution 899/2003 of the Brazilian Health Regulatory Agency (Anvisa).

Objective: to investigate markers of red cell hemolysis in stored blood infused by pneumatic pressure bags under a pressure of 300 mmHg. Methods: ex vivo experimental study simulating the clinical practice of massive packed red blood cell transfusion by pressure bags. The experiments were carried out under controlled conditions in a laboratory and the levels of hemolysis markers [total hemoglobin (g/dL), hematocrit (%), free hemoglobin (g/dL), potassium (mmol/L), lactate dehydrogenase (U/L) and degree of hemolysis (%)] were assessed before device inflation (control), and immediately, one and two hours after inflation under a pressure of 300 mmHg. Data were analyzed with parametric and non-parametric tests and the significance level was set at 5%. Results: the analysis showed increased free hemoglobin level (p=0.004) and hemolysis ratio (p=0.004) immediately after compression, increased lactate dehydrogenase one hour after compression (p=0.020), and decreased total hemoglobin (p=0.002) two hours after compression, without significant variations in potassium or hematocrit levels. Conclusion: the use of pressure bags for infusion of red blood cells caused alterations in hemolysis markers mainly after two hours of compression.

Objective: To perform the translation and adaptation of the Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics (miniMAGIC) into Brazilian Portuguese. Methods: Methodological study performed in five recommended stages: initial translations; synthesis of the translations; back translations; assessment of the back translations; expert committee assessment. The expert committee was composed of three registered nurses and two doctors who had a Master’s and/or PhD degree, and an expertise in intravenous therapy and pediatric and neonatal care. To assess the semantic, idiomatic, experiential and conceptual adequacy, a Likert scale was applied, in which 1, “not equivalent”; 2, “inequivalent”; 3, “cannot assess”; 4, “quite equivalent”; 5, “totally equivalent”. The terms mostly analyzed as negative in equivalence and with a lower than 20 score were reviewed and submitted to a new assessment, with the Delphi Technique until consensus was obtained. The results were stored in electronic spreadsheets and treated with concordance index, with a minimum acceptable result of 0.80. Results: The content of all recommendations, named as miniMAGIC-Brasil, was validated by the expert committee after two stages of evaluation. All recommendations had an overall agreement index of 0.91. Conclusions: The miniMAGIC-Brazil guide was validated in respect to the adequacy of the translation after two steps.

Objetivo: avaliar o índice de sucesso na primeira tentativa de cateterização intravenosa periférica em crianças após capacitação de profissionais de enfermagem para o uso de transiluminação. Método: estudo observacional, prospectivo, comparativo do tipo antes e depois, realizado com enfermeiros e técnicos de enfermagem que foram capacitados para a cateterização guiada pela transiluminação e observados executando 35 procedimentos antes e 35 após a capacitação, no período de novembro de 2018 a maio de 2019, após aprovação do mérito ético do protocolo de pesquisa. Os dados foram analisados de forma descritiva e analítica. Resultados: o índice de sucesso na primeira tentativa foi de 62,9% antes e 65,7% depois (p=0,803). Os técnicos de enfermagem executaram mais a punção antes da capacitação e os enfermeiros depois (pConclusão: a capacitação de profissionais para realizar a punção guiada pela transiluminação não aumentou o índice de sucesso na primeira tentativa de punção intravenosa periférica.

Vancomycin hydrochloride is a tricyclic glycopeptide that contains amino acids and sugars. This substance is indicated to treat serious infections caused by Gram-positive bacteria by intravenous infusion. The objective of this study was to develop and validate an analytical methodology by high performance liquid chromatography with ultraviolet detection (HPLC-UV) to determine vancomycin hydrochloride content by assessing the parameters of selectivity, linearity, working range, matrix effect, robustness, precision, and accuracy. The sample used was vancomycin hydrochloride in a vial and analyzes were carried out on HPLC-UV system, with C18 reverse-phase column at 30 °C, pH=4 and diode-array detection (220 nm). The mobile phase was composed of acetonitrile and monobasic ammonium phosphate buffer (8:92 v/v), 1 mL min-1 flow, injection volume of 20 μL and 15 minute of run time. The method has been shown to be selective, free from mobile phase interference, diluent and other substances on vancomycin hydrochloride retention time; the method is linear in the range between 25 and 175 µg mL-1; matrix effect showed parallelism between the lines, thus indicating the absence of interference of the matrix constituents in analysis of the compound of interest; the method was robust with drug variations proportional to the deliberate changes caused by the change in the flow rate of the mobile phase and in the column temperature; the method showed accuracy at 25, 50, and 75 µg mL-1 concentrations, showing satisfactory recovery rate after addition of the standard. The analytical methodology described proved to be simple, fast, safe and was considered valid.