INTRODUCTION

Currently, there is a growing concern about patient safety in discuss= ions between government agencies, health service providers and class entities, as this theme is intrinsically associated with the quality of health services = and patient safety.= According to the International Classification of Patient Safety (ICPS), proposed by the World Health Organization (WHO), the definition of patient safety is the reductio= n of risks of damage or injuries, related to health care to an acceptable minimu= m ⁽¹⁾.=

Identifying the patient is a simple and basic strategy, but that can avoid complex problems= . It is one of the main pillars when it comes to safety, because when done prope= rly and systematized it is capable of preventing a true chain effect that can generate serious adverse events ⁽²⁾.

The correct identification of the patient is the first international goal of patient sa= fety and is a fundamental component in the provision of safe care, as it ensures that the procedure or treatment is provided to the person for whom it is intended, preventing errors that may cause injury. Failures in this process are associated with complications produced = by error in the administration of medications, blood products, in diagnostic tests, in surgical procedures and in the delivery of newborns to wrong fami= lies ⁽³⁾.

In this sense,= the process of correct identification of the patient aims to safely identify the individual who will be submitted to a certain type of service, treatment or procedure and ensure that this action is effectively the one that the patie= nt needs, preventing errors, mistakes and adverse events ⁽⁴⁾.<= /o:p>

Studies on the process of identifying patients with the use of wristb= ands have shown that there are high levels of professional awareness of the team= and have highlighted the importance of making decisions to apply the device at = the earliest possible time, especially in emergency patients. They emphasized the importance of patient participation to minimize the risk of erroneous data = and concern with the use of the device in some special clinical circumstances, = such as blood transfusion and medication administration. Consensus and expert re= ports indicate significant reductions in the occurrence of errors after the implementation of patient identification processes ⁽⁵⁾.=

Incidents related to the care provided to the patient in the hospital environment are capable of causing lethal damage, which can generate an emotional conflict, a barrier between = the health professional and the patient, hindering trust, affective and technic= al development at the time of care ⁽⁶⁾.

Approved patient identifiers are usually items of information that ca= n be used when administering care services and can basically include the patient= 's name (name, possibly middle and last name), date and place of birth, gender, address, medical record number, individual health identifier ⁽⁷⁾.

The practice of identifying the patient is important, guiding him/he= rself or his/her family members, companions and caregivers on the importance of wearing identification bracelets. The nurse should not fail to observe whet= her the patient is making use of and the integrity of this identification devic= e, as this guarantees a safe care ⁽²⁾.

Increasingly, there are indications of the importance of patient identification, as an additional resource to minimize possible devastating errors that incorrect identification can bring. Besides being an indispensable step and inherent = to any therapy or care provided to the patient, therefore, it cannot be neglec= ted ⁽⁸⁾. In view of the above, this study aims to evaluate the use of= the identification bracelet in patients hospitalized in hospitalization units o= f a university hospital.

METHODS

Type of study

This is a descriptive, observational, quantitative study. The present study aimed to evaluate the identification protocol of patients hospitalize= d in a University Hospital.

= Study site

This research was carried out at the internment posts of a public sc= hool hospital located in Teresina, Piauí. The teaching hospital has 190 inpatient beds, 15 Intensive Care Units (ICU) and ten operating rooms for surgical and clinical patients.

Study participants

Patients hospitalized in the aforementioned sectors of the hospital during data collection were adopted as inclusion criteria in the study. The patients excluded were: outpatient consultations, diagnostic areas and therapeutic sessions, outpatient surgical sessions, operating room, intensive care unit, with hospitalization below 48 hours, in addition to patients who were unabl= e to sign the Informed Consent Form (ICF) and did not agree to participate in the study.

Data collection

The research w= as based on the application of a form on the identification protocol to patien= ts hospitalized in the hospital posts under analysis. Overall, the data collec= tion period was from November 2018 to July 2019. The instrument applied was the checklist used by the Care Risk Management Unit (CRMU) with the addition of= a questionnaire with open and closed questions about the patient identificati= on protocol.

Data collection occurred through direct observation of the identification bracel= et, observing whether the patient used the wristband, and whether the data and conditions of the wristband were in accordance with the patient identificat= ion protocol and the SOP (Standard Operating Procedure) of the institution. It = was performed at the institution's hospitalization posts, in the afternoon shif= t, for at least 2 hours a day.

Data were collected through the consented approach and completion of the collection instrument for patients at the corresponding hospitalization posts at the p= lace of hospitalization at the time available. At the time of data collection, t= he objectives of the study were elucidated for the prior knowledge of the participant or guardian and subsequent signing of the Informed Consent Form= - ICF.

Study variables

As depend= ent variables for this investigation, the patient uses an identification bracel= et, how long he/she has been without an identification bracelet, the patient was instructed by the professional what the purpose of the wristband, patient h= as already been incorrectly identified. The independent variables are gender, = age group, hospitalization time and diagnosis.

Data analysis

The data = were organized and tabulated at Microsoft Excel 2016 and statistically analyzed = in the Statistical Package for the Social Sciences – SPSS version 22, using si= mple descriptive statistics for the data referring to the identification bracele= t. With the intention of observing the associations and differences between dependent and independent variables, bivariate analyses were performed. The usual confidence level of 5% (0.05) was adopted.

Ethical aspects

The resea= rch project is part of the macroproject entitled "Good Nursing Care Practi= ces for Patient Safety" forwarded to Plataforma Brasil and to the ethics committee of the hospital for consideration, w= ith CAAE:66309017.9.0000.5214 and opinion number: 2.283.109. The participants w= ere presented the ICF, ensuring confidentiality and privacy, image protection, non-stigmatization and non-use of information to the detriment = of professionals, in accordance with the guiding principles set out in Resolut= ion n. 466/2012 of the National Health Council.

RESULTS

There were 340= patients interviewed, mostly female 53.5% (n=3D182), with predominant age group over= 60 years (50.9%). The average number of days in which the patients remained hospitalized was 14 days. The main reason for hospitalization was neoplasms with 28.5% (n=3D97) and 50.40% (n=3D171) were patients from another hospita= l (Table 1).

The interviewees were 115 elderly, aged between 60 and 90 years, with a mean age of 69 years and standard deviation= of 7.1, the predominant age group was 60 to 69 years (61.7%). The majority were female (58.3%) and brown (67%), married or in stable union (63.4%). In term= s of schooling, a significant number of illiterate (48.7%) stood out and in term= s of income, most families had 1 to 2 minimum wages (92.2%) (Table1).=

DISCUSSION

In this study,= there were 90.6% identification bracelet, although the percentage evidenced seems= to be a great result, the number of individuals correctly identified should approach 100%, because it is an important step that precedes most care. Monitoring the proportion of patients using the standardized wristband is o= ne of the practices reviewed in the patient identification protocol and the in= stitution's Standard Operating Procedure (SOP).

Thus, corroborating a study conducted in the Pediatric ICU of the University Hosp= ital Maria Aparecida Pedrossian – HUMAP of the Federal University of Mato Grosso= do Sul that obtained 96.4% of patients with the identification bracelet. There= is a recommendation in other studies that the rate of patients without identification bracelets remains between 0.2% and 0.3% ⁽⁹⁾.=

The reasons mo= st cited by the 9.4% of the patients to be without a bracelet were: patient to= ok out or patient refused to use; unaware of why the patient is without or did= not put it; it was tight; taken for surgery; puncture or other procedure and did not put it back. In this context, it is essential to educate and aw= are those responsible and/or companions so that they participate effectively in= the therapy, sharing responsibilities with patient safety, being an ally of the health team, at the same time acting as a supervisory and vigilant agent of= the care provided ⁽⁴⁾.

The absence of identification bracelets, in part of the sample, should be seen seriously. = Its use in the administration of medications is seen as an important strategy in the reduction of errors related to the wrong patient ⁽¹⁰⁾. Anoth= er study showed that the most used patient identification resource in the pediatric ICU of the hospitals studied was the identification plate, fixed = at the head of the bed or at the box door (n=3D94.98%). Another aspect that drew attention was the fact that no patient had = used the identification bracelet ⁽¹¹⁾.

Of the patients with white bracelet, 4.6% reported that the bracelet was not comfortable and inadequate size, since 21.2% of the patients stated that the bracelet had s= ome damage or was illegible. One study reve= aled that 16.2% of the information was erased, due to the clinical picture and t= he therapies used, the process of fluid retention and edema formation also exp= oses the patient to risks, and it is necessary to perform routine inspections by= the care team to avoid the limb's tourniquet.¹²

This is consid= ered an important nursing care for the critical patient and this action is point= ed out in the instructions on patient safety of the Regional Nursing Council of São Paulo (COREN/SP), being recommended the daily evaluation of the integri= ty of the skin of the limb in which the bracelet is installed ⁽¹³⁾.=

In a study conducted in the medical clinic wards of a university hospital located in R= io de Janeiro, composed of 52 beds, the state of conservation of the identification bracelet was identified as a relevant factor in patient safe= ty. Moreover, it is emphasized that the wear of the material was reported by the participants and is based on the quality of the material used, the research also points out that conditions inherent to the patient may disadvantage the identification by bracelet, such as: edema of limbs, anasarca, excessive sweating, amputation of limbs, decreased level of consciousness and excess invasive devices ⁽⁶⁾.=

Regarding the orientation of the patient performed by the professional on the importance = of the wristband, 313 participants answered no. The nurse has the role of educ= ator of their respective teams, training on care at the time of identification of patients is a practice that can be taught by nurses contributing to health promotion capable of ensuring the reduction of errors resulting from the la= ck of the use of patient identification bracelet ⁽⁶⁾.

One study addresses the report of 137 patients, and 90% (n=3D124) of them reported th= at they had no guidance. In addition, 61% (n=3D84) reported that professionals= did not check their wristband before performing procedures. When asked about the use of the bracelet, 73% (n=3D100) of the patie= nts considered it important to use it for their safety, noticing, in relation to the records in the medical records (n=3D137), that, in 35% (n=3D48), there = was at least one daily record, performed by the nurse and/or by nursing resident, about the presence and location (69% -33) and the conditions of the wristba= nd (31% -15)⁽¹⁴⁾.

In the category "if professionals check the identification bracelet before performing = some care", only 30% answered yes. In this sense, authors affirm that the practice of checking the patient's wristbands before the provision of care = ends up being neglected by health professionals and their users. Even with the measures of standardization, dissemination of knowledge, education and sensitization of health professio= nals about the identification of the patient, the practice of unambiguous valorization is weakened, not being recognized as an essential element in t= he field of safe care, despite the high proportion of adverse events and errors found in health care ⁽⁴⁾.

The correct identification of the patient is important to guarantee the care process; crucial for the correct execution of procedures, in all situations of consciousness, orientation, confusion and unconsciousness ⁽¹⁵⁾.<= o:p>

Checking = the bracelet is a simple procedure, low cost and easy to perform. Due to this simplicity, it is sometimes trivialized, either by forgetting its realizati= on or by the excessive self-confidence of the professional or even the intenti= on not to disturb the patient by continuously checking his/her identity ⁽¹⁴⁾. In this way, nurses play a fundamental role in promoting patient safety during the care process. Being the professional responsible for coordinating the nursing care provided ⁽¹⁶⁾.

It is evi= dent the need to face the identified failures, stimulate the exercise of continu= ing education together with professionals regarding the relevance of the wristb= and as a prevention instrument, and the need for supervision and screening of possible failures regarding its use ⁽¹⁷⁾. In this direction, in addition to the continuing education of health professionals, it is also recommended the training of the entire multidisciplinary team, since patient safety and risk prevention involve the entire multidisciplinary health team= ⁽¹⁸⁾.

Moreover,= the importance of educational activities directed to patients, companions and family members is emphasized, involving them in the identification process,= in order to provide knowledge to them and allow them to co-participate in the steps that require the conference of patient identification in the hospital environment. These moments allow identifying non-conformities in the application of the care protocol, as well as the lack of motivation and collaboration of professionals for its effective application in the care routine ⁽¹⁹⁾.

It was noticed the need for sensitization aimed at the nursing team regarding the quality of patient safety. Continuing education, updates, and improvement a= im to increase the knowledge acquired in basic curricular training and help re= duce failures in the work process ⁽²⁰⁾.

This study has some limitations, such as biases due to data collection, since the form= has subjective and open questions. In addition, some patients may interfere with verbal reporting due to the fear of changing treatment when addressing questions about health professionals.

CONCLUSIONS

The resul= ts of this research allowed evaluating that the hospital adhered to the identi= fication bracelet, but there are still flaws during the identification process. It w= as possible to analyze and recognize the vulnerable aspects that need improvem= ent for the quality and safety of patients in the service studied.

REFERENCES

<= /o:p>

1. Ribeiro GT. A percepção dos profissionais de enfermagem referente à importância do uso da pulseira de identificação dos recém-nascidos internados em Unidade de Terapia Intensiva Neonatal de um Hospital Público Municipal. Disser= tação [TCC Especialização]. Universidade de Santo Amaro – UNISA. São Paulo, 2018; [Acesso em 26 fev. 2021] 11p. Disponível em:https://pesquisa.bvsalud.or= g/portal/resource/pt/biblio-995895.

2. Fujii= Neta A, Girardi C, Santos DTR, Oliveira JLC, Oliveira RP, Maraschin MS. Adesão à identificação do paciente em hospital universitário público. Rev Adm Saúde, 2018:18, 70. Disponível em: = http://dx.doi.org/10.23973/ras.70.70.

3. Panno= SF, Costenaro RGS, Diaz C, Zamberlan C. Uso de pulseiras na identificação do paciente: Implicações para o cuidado seguro. Disciplinarum Sci Ciênc Saúde [Internet]. 2017 [Acesso em: 01 mar. 2021]; 18 (1): 145-55. Disponível em: = https://periodicos.ufn.edu.= br/index.php/disciplinarumS/article/view/2258/2022.

4. Souza Pascoal R, Fernandes VD Rocha RG, de Almeida LF, Tavares JMA, Moreira APA, Assad LG. Identificação do paciente em terapia intensiva e a adesão da equi= pe de enfermagem. Saúde Coleti= va (Barueri) [Acesso em: 03 mar. 2021]. 2019;9(50), 1810-1813. Disponível em: http://www.revistas.mpmcomunic acao.com.br/index.php/saudecoletiva/a= rticle/view/162.

5. Machado GS. Protocolo de identificação do paciente. Protocolo do Ministério= da Saúde adaptado à realidade institucional do HU/FURG. 2017. [Acesso em: 26 f= ev. 2021]. Disponível em: <= span class=3DLinkdaInternet>http://www2.ebserh.gov.br/documents/1688403/16884 63/PROTOCOLO+IDENTIFICA%C3%87%C3%83O+DO+PACIENTE+FURG+II.pdf/0f6520c8-8968-= 4996-8d36-b279dd46f88e.

6. Silva= MMRP, Assad LG, Júnior EFP, de Paula VG, do Nascimento Bessa JH, Teti TT. Análise= da adesão da identificação do paciente no setor de clínica médica. Revista Enfermagem Atual In Derme, 2019: 87(25). Dispon= ível em: https://doi.org/10.31011/reaid-2019-v.87-n.25-art.188<= /span>.

7. Lippi G, Chiozza L, Mattiuzzi C, Plebani M. Patient and Sample Identification. Out of the Maze? Journal of medical biochemistry, 2017;36(2), 107–112. Disponível em: = https://d= oi.org/10.1515/jomb-2017-0003.

8. Zampo= llo N, Contrin LM, Beccaria LM, Frutuoso IS, Rodrigues AMDS, Wernek AL. Adesão ao protocolo de identificação do paciente e medicação segura. Rev. enferm. UFPE on line, 2018= ;2667-2674. Disponível em: https://doi.org/10.5205/198= 1-8963-v12i10a234885p1129-1139-2018.

Costa KF, da Silva ACCR, Reis T, Goulart L, de Sousa Freire AB, Messias ALB, Andrade UV. Segurança do paciente: a identificação da pulseira. Brazilian Journal of Health Review, 2020;3(6), 19472-19480. Disponível e= m: https://doi.org/10.34119/bjhrv3n6-326.

10. Lemos CS, Cunha KCDS. O uso da identifi= cação de pacientes em uma unidade hospitalar. Rev. enferm. UFPE on line, 2017;130-139. Disponível em: DOI: 10.5205/reuol.9978-88449-6-1101201716.

11. Bernal SCZ, Raim= ondi DC, de Oliveira JLC, Inoe KC, Matsuda LM. "Práticas de identificação do paciente em unidade de terapia intensiva pediátrica." Cogitare Enfermagem, 2018; 23(3). Disponível em: https://dx.doi.org/10.5380/ce.v23i3.55390<= /span>.

12. Siqueira DRD Silva JSCD, Silva LCD, Sil= va SLD, Caminha MDFC, Santos RLDN. 2017. [Acesso em: 03 mar. 2021]. Identifica= ção do paciente pediátrico para uma assistência segura. Disponível em: <= span style=3D'font-size:12.0pt;font-family:"Times New Roman",serif'>http://tcc.fps.edu.br:80/js= pui/handle/fpsrepo/20.

13. Conselho Reg= ional de Enfermagem do Estado de São Paulo, Rede Brasileira de Enfermagem e Segur= ança do Paciente, Polo São Paulo. (2010) [Acesso em: 26 fev. 2021]. 10 passos pa= ra a segurança do paciente. São Paulo, Brasil: Autor. Disponível em: https://portal.coren-sp.gov.br/10-passos-para-a-segura= nca-do-paciente/.

14. Assis TG, de Alm= eida LF, Assad LG, Rocha RG, Fassarella CS, Aguiar BGC. Adesão a identificação correta do paciente pelo uso de pulseira. Revi= sta de Enfermagem UFPE, 2018.12: 2621-2627. Disponível em: https://doi.org/10.5205/1981-8963= -v12i10a234632p1129-1139-2018.

15. Brito MDFP, Gabriel CS, Machado JP, Cândido MP, de Oliveira VB. Processo de identificação do paciente em serviços de saúde. Brazilian Journal of Health Review, 2021;4(2), 4343-56. Disponível em: <= /span>10.34119/bjh= rv4n2-030.

16. Cestari VRF, Ferreira MA, Garces TS, Moreira TMM, de Paula Pessoa VLM, Barbosa IV= . Aplicabili= dade de inovações e tecnologias assistenciais para a segurança do paciente: revi= são integrativa. Cogitare Enferm. 2017; 22 (3): e45480. Disponível em: http://= dx.doi.org/10.5380/ce.v22i3.45480.

17. Silva RR, da Cos= ta Santos R, Oliveira L, Costa T, Menezes HF, Fernandes S, Lima FR, et al. Avaliação da conformidade de utilização de um protocolo para identificação = de pacientes. Rev Cubana Enferm [Internet]. 2020 [Acesso em: 9 Mar 2021]; 36(2= ). Disponível em: http://revenfermeria.sld.cu= /index.php/enf/article/view/2792.

18. Souza Pascoal R, Fernandes VD, Rocha RG, de Almeida LF, Tavares JMAB, Moreira APA, Assad LG. Identificação do paciente em terapia intensiva e a adesão da equipe de enfermagem. [Acesso em 02 mar. 2021] Saúde Coletiva (Barueri), 2019;9(50), 1810-1813. Disponível em: http://www.revistas.= mpmcomunicacao .com.br/index.php/saudecoletiva/article/view/162.

19. Campelo RC, Silva WC, Sousa CKL, Araújo GL, Bizerra L, de Moura Leite AG, Araújo R. Atividade educativa para identificação correta do paciente: um rel= ato de experiência. J nurs health. 2018; 8(3):e188305. Disponível em: HTTPS://DOI.ORG/10.15210/JONAH.V8I3.14278<= /span>. =

20. Rebello LKZ, da Silva Quemel F, Peterlini OLG. Estratégias para a implantação do protocolo = de identificação do paciente em um hospital de médio porte no Noroeste do Paraná. Revista de Saúde Pú= blica do Paraná, 2019;2, 31-37. Disponível em: https://doi.org/10.32811/25= 954482-2019v2supl1p31.

Corresponding author:

Esteffany Vaz Pierot. Rua Rui Barbosa, nº1663, Bairro Matinha, CEP: 64002-180. Teresina, Piauí, Brasil. Telefone: (86) 99944-8172. E-mail: esteffany_pi@hotmail.com

Submission: = 2021-07-15

Approval: 2021-09-14

	N	%	Mean	Min=	Max=	Sd<= /p>
Sex
Female	182=	53.50%
Male	158=	46.50%
Age Group		57<= /p>	17<= /p>	95<= /p>	18<= /p>
≤24 years	18<= /p>	5.30%
25\|-\|59 years	149=	43.80%
≥ 60 years	173=	50.90%
Hospitalization Length (days)	14<= /p>	2	150=	15<= /p>
Medical diagnosis
Neoplasm	97<= /p>	28.50%
Cardiovascular	58<= /p>	17.10%
Orthopedic	39<= /p>	11.50%
Digestory	57<= /p>	16.80%
Neurological	12<= /p>	3.50%
Others	77<= /p>	22.60%
Sector
House	168=	49.60%
Other Hospital	171=	50.40%

	N	%
Does the patient use the wristband?
Yes	307=	90.6%
No	32<= /p>	9.4%
If the previous answer is NO. What reason? And how long has it been without identification bracelet?
Patient took out or patient refuses to use	17<= /p>	56.7%
Do not know why you are without or did not	4	13.3%
Was tight, took out for surgery, to puncture or another procedure = and did not put back	9	30.0%
White, comfortable bracelet and suitable size?
Yes	291=	94.8%
No	16<= /p>	5.2%
Bracelet damaged or unreadable?
Yes	65<= /p>	21.2%
No	242=	78.8%
Was there an exchange of the bracelet from the entrance to the hospital?
Yes	30<= /p>	9.8%
No	277=	90.2%
Does the patient use other identification bracelets?
Yes	68<= /p>	22.1%
No	239=	77.9%
Is the other bracelet in accordance with the SOP?
Yes	68<= /p>	100.0%
No	0	0.0%
Does the bracelet have at least two identification indicators?
Yes	307=	100.0%
No	0	0.0%
Full name
Yes	307=	100.0%
No	0	0.0%
Birthdate
Yes	307=	100.0%
No	0	0.0%
Number of the medical chart
Yes	297=	96.7%
No	10<= /p>	3.3%
Is white identification bracelet in accordance with the SOP of the institution?
Yes	303=	98.7%
No	4	1.3%

	N	%
Responsible for the answers:
Patient	272=	80.0%
Companion/Guardian	68<= /p>	20.0%
Was the patient oriented by the professional about the purpose of = the bracelet? Of the data on the bracelet?
Yes	27<= /p>	7.9%
No	313=	92.1%
Which guidance?
Identification	15<= /p>	55.6%
Safety	7	25.9%
Others	5	18.5%
Was the patient guided to seek the team in case of loss or damaged bracelet?
Yes	16<= /p>	4.7%
No	324=	95.3%
Does the patient know if the professional confers the data on the bracelet before making some care?
Yes	105=	30.9%
No	191=	56.2%
Sometimes	44<= /p>	12.9%
Has patient have already been identified incorrectly?
Yes	8	2.4%
No	332=	97.6%
If so, when?
Procedure exchange	1	12.5%
Called the wrong name	5	62.5%
Others	2	25.0%
Was the patient's bracelet placed at the time of admission to the hospital?
Yes	329=	96.8%
No	11<= /p>	3.2%