Safety evaluation in vaccine care: elaborating and validating a protocol

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 Corresponding author Suzane Gomes de Medeiros, E-mail: suzanegomesm@gmail.com

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

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

Alcides Viana de Lima Neto

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

Cecília Olívia Paraguai de Oliveira Saraiva

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

Mayara Lima Barbosa

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

Viviane Euzébia Pereira Santos

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

Corresponding author Suzane Gomes de Medeiros, E-mail: suzanegomesm@gmail.com

Conflicts of interest: nothing to declare.

Collaborations

Medeiros SG, Lima Neto AV, Saraiva COPO, Barbosa ML and Santos VEP declare that they contributed to the study design and the analysis and interpretation of data, the writing of the article and approval of the final version to be published.

Figures (2)
Tables (4)

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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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Source: Domansky RC. Elaboration of protocols. In: Domansky RC, Borges EL. (orgs.). Manual for prevention of skin lesions: recommendations based on evidence. 2. Ed. Rio de Janeiro: Rubio; 2014. p. 231-272.

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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.

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Chart 1
Summary of changes suggested by the judges in Delphi Stage I

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Table 1
Consensus between the judges in the stages of Delphi 1 and 2 for the items evaluated in the protocol

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References 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. Cold net for the conservation of vaccines in public units of the city of São Paulo: knowledge and practice. 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. Brazil. Cold Net Manual. Brasília, DF: Ministério da Saúde, 2013. Brazil. Manual of Norms and Procedures for vaccination. Brasília, DF: Ministério da Saúde, 2014. Cabral IC. Evaluation of the Local Cold Net of the Sanitary District III of João Pessoa -B [dissertation]. 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. Aspects related to the administration and conservation of vaccines in health centers in Northeast Brazil. 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. Patient safety in primary health care: systematic review. Cad Saude Publica. 2014;30(9):1-21. Marchon SG, Mendes Junior WV, Pavão ALB. Characteristics of adverse events in primary health care in Brazil. 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. Production of nursing team care in immunization services in family health care [dissertation]. Feira de Santana: State University of Feira de Santana; 2014. Oliveira VC, Gallardo MDPS, Arcêncio RA, Gontijo TL, Pinto IC. Evaluation of conservation quality of vaccines in primary health care. Cien e Saude Colet. 2014;19(9):3889-98. Oliveira VC, Guimarães EAA, Guimarães IA, Januário LH, Pinto IC. Nursing practice in the conservation of vaccines. Acta Paul Enferm. 2009;22(6):814-8. Oliveira VC. Evaluation of conservation quality of vaccines in Primary Health Care Units of the Central-West Region of Minas Gerais. Ribeirão Preto. Thesis [PhD in Health Sciences] - University of 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. Support for learning from the perspective of patient safety in primary health care. 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. Auditings in clinical safety for primary care centers. Pilot study. Primary Care. 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. Validation of a questionnaire to evaluate the patient safety culture of primary care professionals in Spain. Primary School. 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.

Protocol Items	Aspects included from the suggestions given by the judges in Delphi 1
Vaccination Room	Is there ambient air conditioning between +18°C and +20°C? Is there any way to control the temperature inside the room? Is there a routine for verifying the validity of immunizations and supplies (syringes and needles)? Add a footnote clarifying what it is part of Group A1. Is there only a refrigerator in the vaccination room or is there also a cooled chamber?
Conditions of the Refrigerator	Is the sealing rubber of equipment tested?
Cooling temperature control and recording	There were no items added.
Conducts of Nursing in the vaccination room	Is the person responsible and/or person vaccinated receiving advise on the immunizations administered, possible occurrence of adverse events, or being investigated about the possibility of pregnancy, immunosuppressive diseases, allergies, and carrying out the next vaccine schedules? Is the vaccination registration requested to those responsible and companions during the care? Is the vaccinator using the technique of leaving a needle and syringe in the vial/ampoule for them to aspirate? Is the “right-nine” checklist done before administering the vaccine?
Organization of vaccines in the refrigerator	Are the opened vials identified with the opening date? Are vaccines packaged on the second and third shelves (for domestic refrigerators)? Is the first shelf not used to pack vaccines (for domestic refrigerators)? Are the diluents next to the lyophiles?
Conducts with thermal boxes	There were no items added

	Stage Delphi 1			Stage Delphi 2
Items evaluated	Inappropriate n(%)	Partially Suitable / Suitable n(%)	CVC	Inappropriate n(%)	Partially Suitable / Suitable n(%)	CVC
Behavior	1(8.3)	11(91.7)	0.86	1(12.5)	7(87.5)	0.83
Objectivity/desirability	−(−)	12(100.0)	0.92	1(12.5)	7(87.5)	0.83
Simplicity	1(8.3)	11(91.7)	0.86	−(−)	8(100.0)	0.88
Clarity	−(−)	12(100.0)	0.86	−(−)	8(100.0)	0.92
Relevance/pertinence	−(−)	12(100.0)	0.89	2(25.0)	6(75.0)	0.79
Accuracy	1(8.3)	11(91.7)	0.86	1(12.5)	7(87.5)	0.79
Typicality	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

References
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. Cold net for the conservation of vaccines in public units of the city of São Paulo: knowledge and practice. 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.
Brazil. Cold Net Manual. Brasília, DF: Ministério da Saúde, 2013.
Brazil. Manual of Norms and Procedures for vaccination. Brasília, DF: Ministério da Saúde, 2014.
Cabral IC. Evaluation of the Local Cold Net of the Sanitary District III of João Pessoa -B [dissertation]. 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. Aspects related to the administration and conservation of vaccines in health centers in Northeast Brazil. 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. Patient safety in primary health care: systematic review. Cad Saude Publica. 2014;30(9):1-21.
Marchon SG, Mendes Junior WV, Pavão ALB. Characteristics of adverse events in primary health care in Brazil. 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. Production of nursing team care in immunization services in family health care [dissertation]. Feira de Santana: State University of Feira de Santana; 2014.
Oliveira VC, Gallardo MDPS, Arcêncio RA, Gontijo TL, Pinto IC. Evaluation of conservation quality of vaccines in primary health care. Cien e Saude Colet. 2014;19(9):3889-98.
Oliveira VC, Guimarães EAA, Guimarães IA, Januário LH, Pinto IC. Nursing practice in the conservation of vaccines. Acta Paul Enferm. 2009;22(6):814-8.
Oliveira VC. Evaluation of conservation quality of vaccines in Primary Health Care Units of the Central-West Region of Minas Gerais. Ribeirão Preto. Thesis [PhD in Health Sciences] - University of 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. Support for learning from the perspective of patient safety in primary health care. 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. Auditings in clinical safety for primary care centers. Pilot study. Primary Care. 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. Validation of a questionnaire to evaluate the patient safety culture of primary care professionals in Spain. Primary School. 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.

Referências
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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.

[1] Corresponding author Suzane Gomes de Medeiros, E-mail: suzanegomesm@gmail.com

Brasil

Brasil

Safety evaluation in vaccine care: elaborating and validating a protocol

Abstract

Objective:

Methods:

Results:

Conclusion: