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Che cosa gli infermieri vedono? Frequenza e tipologia degli sprechi in area medica e chirurgica: studio cross-sectional

Angelo Dante, Michela Marega, Adriana Peteani, Adriana Cecchi, Loreto Lancia

Abstract

Scopo. Documentare la frequenza e la tipologia degli sprechi nella pratica clinica infermieristica nonché le differenze tra l’area medica e chirurgica.

Metodo. È stato condotto uno studio cross-sectional in un’Azienda Sanitaria del nord Italia. La raccolta dati, condotta su 100 infermieri nel settembre 2015, è stata effettuata con un questionario semi-strutturato costituito da 56 item suddivisi in 8 dimensioni di spreco (Sovrapproduzione/Sottoutilizzo, Attese, Scorte, Processo, Disservizi ed errori, Trasporto materiali e flussi informativi, Movimenti, Dispersione delle conoscenze).

Risultati. Nella settimana lavorativa sono stati segnalati 2028 sprechi, con una media di 20.2 ±9.2 infermiere. Settecentocinquantanove (37.4%) di essi si sono verificati in area medica, mentre 1269 (63.6%) in area chirurgica. Nella dimensione “processo” si è verificato il maggior numero di sprechi (398; 19.6%). Nelle diverse dimensioni le principali tipologie di spreco sono state: l’uso improprio di energia (30.0%), l’attesa del medico (17.1%), la carenza di materiali (33.1%), l’eccesso di risorse umane distribuite in modo non ottimale (31.8%), la disponibilità di risorse umane inferiore alle esigenze organizzative (22.4%), le prescrizioni terapeutiche incomprensibili e/o incomplete da parte del medico (22.6%), la ricerca di presidi in magazzini lontani o esterni al reparto (23.9%), il trasferimento di utenti da un reparto ad un altro (30.0%) e la ridotta applicazione delle evidenze scientifiche nella pratica clinica (51.7%). Non sono emerse differenze significative tra le due aree cliniche indagate (p-value = 0.480).

Conclusioni. Lo studio rappresenta un contribuito al dibattito nazionale sul fenomeno degli sprechi in ambito sanitario e fornisce utili spunti di riflessione sulle possibili strategie di contenimento.

Parole chiave: spreco, infermieri, pratica clinica, studio cross-sectional


What nurses see? Occurrence and typology of wastes in medical and surgical wards: a cross-sectional study.

Aim. To describe the occurrence and the typology of waste in the nurses clinical practice as well as the differences between the medical and surgical area.

Method. A cross-sectional study was conducted in a north eastern Italian hospital. Data collection, conducted on 100 nurses in September 2015, was carried out using a semi-structured questionnaire consisting of 56 items and eight dimensions (Overproduction / Underutilisation, Wait, Stocks, Process, Inefficiency and Errors, Material Transport and Information Flows, Movements, Dispersion of Knowledge).

Results. In a nurses’ working week 2,028 ± 9.2 waste occurrences were reported, with an average of 20.2 ±9.2 per nurse. Seven hundred fifty-nine (37.4%) of them occurred in the medical area, while 1,269 (63.6%) occurred in the surgical area. The most frequent number of waste (398; 19.6%) occurred in the “Process” dimension. Across the investigated dimensions, the main types of waste were: the inappropriate use of energy (30.0%), waiting for the physician (17.1%), shortage of materials (33.1%), the excess of human resources distributed in a sub-optimal manner (31.8%), human resources shortage (22.4%), incomprehensible and/or incomplete therapeutic prescriptions (22.6%), the search of materials in distant warehouses or in outside locale (23.9%), the transfer of team members from one department to another (30.0%), and limited application of scientific evidence in clinical practice (51.7%). No statistical differences emerged between the two investigated clinical areas (p-value = 0.480).

Conclusions. The study is a contribution to the national debate on the phenomenon of waste in health care organizations, and provides useful insights on the possible strategies of its containment.

Key Words: waste, nurses, clinical practice, cross-sectional study

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