IMPLEMENTATION OF AN INSTRUMENT OF TRANSFER FOR PRIMARY HEALTH CARE: THE EXPERIENCE OF A MEDICAL SURGICAL UNIT 1. ABSTRACT

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1 IMPLEMENTATION OF AN INSTRUMENT OF TRANSFER FOR PRIMARY HEALTH CARE: THE EXPERIENCE OF A MEDICAL SURGICAL UNIT 1. FARÃO, Elaine Miguel Delvivo 2 ; SOARES, Rhéa Silvia de Ávila 3 ; SAUL, Alexandra Micheline Real 4 ; WEILLER, Terezinha Heck 5 ; ENGEL, Rosana Huppes 6 ; FERNANDES, Marcelo Nunes 7 ; ABSTRACT The health care network is composed of group in services and health facilities that are like nodes in a network. Each multidisciplinary team, each of these services that comprise the network of care under the Sistema Único de Saúde (SUS) becomes responsible for integrity. In this context, report the experience of a clinical unit that has deployed a surgical instrument of transfer users in hospital for primary health care. The instrument of transfer was prepared by members nursing team of the unit of the surgical clinic in conjunction with residents of the residency program in a multidisciplinary hospital university It was presented at the team meeting of the unit, discussed the relevance of their application in hospital. Between the months of March and April were performed fourteen telephone transfers, through the instrument to the reference healthcare units in the municipalities of Santa Maria, Passa Sete, Mata, Júlio de Castilhos and Restinga Seca. We noticed that most professionals contacted were receptive, and many stressed the importance of continuity of care at home, also observed greater involvement of professionals in discharge planning. We understand that many are the "critical nodes" found, especially regarding the care regulation, being constituted in a significant challenge in practice of health professionals in search of integrality. Keywords: Integrality, extended clinic & healthcare regulation 1 Relato de Experiência 2 Apresentador (a). Enfermeira do Programa de Residência Multiprofissional Integrada em Sistema Público de Saúde, Ênfase em Gestão e Atenção Hospitalar da Universidade Federal de Santa Maria 1

2 (UFSM). Membro do Grupo de Estudo, Pesquisa e Extensão em Saúde Coletiva (GEPESC) da UFSM. elainebiofis@yahoo.com.br 3 Enfermeira da Unidade de Internação Cirúrgica do Hospital Universitário de Santa Maria, Especialista em Saúde Pública. Membro do Grupo de Lesões de Pele (GELP) do HUSM. Preceptora da Residência Multiprofissional Integrada em Sistema Público de Saúde, Ênfase em Gestão e Atenção Hospitalar da Universidade Federal de Santa Maria (UFSM). Membro do Grupo de Pesquisa Gestão em Enfermagem e Saúde. rheasilviasoares@yahoo.com.br 4 Enfermeira da Unidade de Clínica cirúrgica do Hospital Universitário de Santa Maria(HUSM),Coordenadora do Grupo de Estudos de lesões de Pele(GELP) do HUSM.Mestranda pela UTNBAs (Universidad Tecnológica Nacional de Buenos Aires) Argentina. Membro do Grupo de Gestão em Enfermagem e Saúde. alexsandrarsaul@hotmail.com 5 Enfermeira. Doutora em Enfermagem em Saúde Pública. Profª Adjunto do Dep. de Enfermagem/UFSM. Coordenadora do Grupo de Estudo, Pesquisa e Extensão em Saúde Coletiva - GEPESC/UFSM. weiller2@hotmail.com 6 Enfermeira do Programa de Residência Multiprofissional Integrada em Sistema Público de Saúde, Ênfase em Gestão e Atenção Hospitalar da Universidade Federal de Santa Maria (UFSM). Membro do Grupo de Estudo, Pesquisa e Extensão em Saúde Coletiva (GEPESC) da UFSM. nanaengel@gmail.com 7 Enfermeiro da Estratégia de Saúde da Família, Especialista em Gestão Educacional,Especialista em Saúde Coletiva, Especialista em Educação Ambiental, Especialista em Tecnologias da Informação e da Comunicação Aplicadas à Educação.Graduando do Programa Especial de Formação de Professores para a Educação Profissional (UFSM). Especializando em Saúde da Família (UnA- SUS/UFPel). Mestrando do Programa de Pós-graduação em Enfermagem (PPGEnf/UFSM). Membro do Grupo de Estudo, Pesquisa e Extensão em Saúde Coletiva (GEPESC) da UFSM. marcelonsf@gmail.com IMPLEMENTATION OF AN INSTRUMENT OF TRANSFER FOR PRIMARY HEALTH CARE: THE EXPERIENCE OF A MEDICAL SURGICAL UNIT 1 1. INTRODUTION The health care network consists of the set of services and health facilities that are available in a particular geographic territory, be it a health district, a municipality or a regional health. These services are like nodes in a network: a basic health unit, a general hospital, a psychosocial care center, a municipal health council, among other 1. However, to build a network in health need to question the relationship between services that make up this network and what the flow driven by the user in search of improving their quality of life. Each multidisciplinary team, each of these services that comprise the network of care within the Health System becomes responsible for the comprehensive care of the sick, for all 2

3 aspects of your health and should develop projects that address the uniqueness of each individual, seeking to understand and meet their needs. The comprehensive care refers to meeting the needs of individuals in a larger way, being a major route in the construction of SUS and becoming a challenge in the journey of building the system. With respect to these formulations, as regards the criticism of the doctor-centered model and the fragmentation of medical practice, the valuation of promotion and prevention, the importance of interdisciplinary work and a stronger link between professionals and users to qualify the actions of health, the proposal to seek references teams where each user proposes a new format of the health team, valuing the core knowledge of different professionals and constituting therapeutic projects that aim to comprehensive care in Health2. In this perspective, the authors point out that 2.3 comprehensive health care can only be obtained in the network, since the "care line" fully thought through the many services health3. By the way, actions are needed in innovative health services that seek to give effect to the principles of the NHS, building an active network strategy is essential because it allows to create multiple responses for coping with the health-disease producing GOALS Report the experience at clinic unit surgery was worked a transferring instrument for users in discharged from the hospital for primary health care aiming to guarantee based in Integrality in attention in the health public system. 3. METHODOLOGY The transfer instrument was prepared by member in the nursing at Unit surgical clinic in set with residents of the residency program in a multidiciplinary teaching hospital, based on the literature, and it happened from the need service to formalize the action takenm by the time. This constain following inssues with: patient name, date of birth, hospital record number, home adress, profesional reference in the envent in case of hospital discharge, phone reference service (Basic Health Unit, Family Healht Strategy, among others.) name of 3

4 the person whom phone contact was made, date of admission, date of hospital discharge, clinical diagnosis of nursing,, surgery and / or procedure performed, home care needed; professionals involved in the transfer of the patient, nurse responsible for the transfer. It was also added at the end of the document the phone from the hospital and request that the referral service to confirm receipt of the duplicate. The first way is in the patient at hospital, and user-oriented and / or accompanying the duplicate is delivered in primary care unit of reference. The document was presented at the staff meeting of unit, discussed the relevance of its application in the hospital. It was agreed that the nurse is responsible for transferring the user and when this can be accomplished with a multidisciplinary team. Firstly, it is made telephone contact with the service user reference, in talk, if possible, with the professional reference in the event (agent community health nurse, nurse, social worker, among others). After this contact, the professional meets the documentation in two identical copies, and carries out user guidance on the care relevant to their case and the importance of the document is delivered to the primary care professional. 4. RESULTS The implantation of the transfer instrument began in February, two thousand twelve, being prioritized by the team at this early stage, the realization of transferring patients with health disorders as co morbidities, the return home into using nasogastric tube feedings or gastronomy, dressings that need more care and use of covers, among others. Between the months of March and April were performed fourteen telephone transfers, through the instrument to the reference health units in the municipalities in Santa Maria, Passa Sete, Mata, Júlio de Castilhos and Restinga Seca. We performed a transfer through conversation held personally with professional reference in the case. We noticed that most professionals contacted were receptive, and many stressed the importance of continuity in care at home. When possible home visit was scheduled team strategy family healthcare. Users were asked at hospital discharge to continue follow up the basic health unit and / or family health strategy. Admission unit received two units of reference calls, in order to confirm receipt of the duplicate instrument by user, as well as to request further information due to care guided by multidisciplinary team of hospital in the process of implantation of instrument we observed a 4

5 higher involvement of professionals in discharge planning, and investigated the possible needs for user at home, which has contributed to improving the quality life of individuals. 5. CONCLUSION The problems and challenges in the SUS, are produced in complex networks, and for this reason, complain understandings enlarged and intersectional interventions articulating different areas of knowledge and practices 5. The expectation is that, at the time of the transfer system for health services that make up the network of care is fully implemented, can be achieved more effectively care regulation, aimed at creating reference flows and standardized protocols 5. We understand that they are the "critical nodes" found, especially regarding the care regulation 5, being necessary to break with the traditional force, acting for effective communication between the professional services within the network of care, seeking the enforcement of intersectional constituting a a major challenge in the practice of health professionals in search of integrality. 6. REFERENCES 1 Carvalho SR, Campos GWS. Modelos de atenção à saúde: a organização de Equipes de Referência na rede básica da Secretaria Municipal de Saúde de Betim, Minas Gerais. Cad. Saúde Pública, Rio de Janeiro, 16 (2): , abr-jun, Pinheiro R, Matos RB, Organizadores. Os Sentidos da Integralidade na Atenção e no Cuidado à saúde. Instituto de Medicina Social, Associação Brasileira de Pós-Graduação em Saúde Coletiva, UERJ, IMS: ABRASCO, 2001, 180p. 3 Machado MFAS, Monteiro EMLM, Queiroz DT, Vieira NFC, Barroso, MGT. Integralidade, formação de saúde, educação em saúde e as propostas do SUS - uma revisão conceitual. Ciência & Saúde Coletiva, 12 (2): , Ministério da Saúde (Brasil). Secretaria de Atenção à Saúde, Política Nacional de Humanização da Atenção e Gestão do SUS. Redes de produção de saúde Brasília: Ministério da Saúde,

6 5 Ministério da Saúde (Brasil). Diretrizes para a implantação de Complexos Reguladores / Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Regulação, Avaliação e Controle de Sistemas. Brasília: Ministério da Saúde,