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Parliamentary Group

Draft Law No. 503 /X

Right of monitoring of users of the services of

urgency of the National Health Service (SNS)

Exhibition of reasons

Portuguese legislation enshrines a set of rights to SNS users,

notably, the right to visit and family accompani but, only, in the

internment. In the case of children and adolescents, the legislation allows and

defines with clarity the right of follow up in the wards of hospitals

Portuguese. The same is the case in the case of patients with disabilities.

The same does not take place with the services of urgency. Not existing any

specific legislation on the subject, hospitals adopt solutions very much

different. There are hospitals that inliminally prevent the follow-up of the

citizens admitted to the respective emergency service and, others, in which such

follow up is authorised, varying however the conditions under which this is

allowed.

In 2006 they were admitted to the urgencies of Portuguese hospitals about 6.5

millions of people. To this figure can still be added to the 5.5 million

of people who have resorted to SAP. Your clinical status is obviously very

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varied, ranging from agonic situations of extreme gravity to other cases well

less serious, in which there is no loss or limitation or autonomy

of the patient or of his / her abilities to communicate and understand.

Despite this variety of clinical situations the resource to an emergency service

it is always a moment of great fragilization of the patient who, in a way

general, gets dominated by feelings of insecurity, anguish and anxiety.

Too often the sick who gets into the urgency of a hospital feels lost

in an unfamiliar medium and confronts an environment that percepts

as hostile.

The urgency services of our hospitals are, still, the main door of

entry into SNS. The high number of patients who accordion to the urgencies-

usually overcrowded and where they almost always expect long hours to be

serviced or carry out all prescribed examinations or treatments, it is equally

a factor that much contributes to the disturbance felt by patients

admitted.

The impersonality of this kind of services where you want the professionals want

patients remain generally for short periods of time, contributes

also to aggravate and deteriorate the psychological condition of patients.

In short, the desired humanization of health services is particularly

difficult to achieve and ensure in the hospital urgencies where, for the reasons

described, almost everything is adverse and cumbersome to the patient.

Children, adolescents and the elderly are certainly the ones who most if

feel unsupported and unprotected when they give input in a service of

urgency.

The experience of hospital emergency services demonstrates in a way

unquestionable that an uneasy, insecure, and uncompromisable patient is an element

disturbing the organization and operation of an urgency. And, naturally,

is an increased difficulty for the success and effectiveness of care and

treatments provided.

The tranquility and emotional stability of the patient admitted in a service of

urgency can benefit from the presence along with you of a chaperone-

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family or friend, not just while waiting to be serviced but also

in the intervals-by long rule, between observations, examinations or treatments.

This accompaniment gives psychological comfort, generates trust in services and

reinforces the willingness of the patient to accept and comply with the guidelines

prescribed.

On the other hand, not rare times the chaperone is essential for a more

detailed knowledge of the background and clinical history of the patient,

facilitating the work of professionals in both the diagnosis and the

treatment.

In the particular case of patients who do not speak and / or do not listen and in those who do not

speak the Portuguese language, follow up is an indispensable means to

approach to your clinical situation.

It is evidence that, in the topicality, some emergency services lack

of facilities allowing the presence of accompaniments to the patients,

nuns cases by scarcity of space, in others by the organisation of the area

available.

The government has recently approved an requalification of the national network of

urgencies that provides for the existence and operation of three types of urgencies:

polyvalent, medico-surgical and basic. In a large number of these services

it will be necessary to carry out works of magnification, remodeling or adaptation,

as the cases, so that these urgencies can suit your new

status.

It is therefore the most opportune time to introduce and guarantee in the

respective requalification projects the logistical conditions permitting the

monitoring of patients.

Finally, it should be recognized that for many professionals in the services of

urgency, the presence of chaperones among the patients may raise some

fear and weirdness and even be understood as more of a perturbation factor of the

your work. So it happened a few years ago when the parents started the

follow up with your minor children in the Portuguese wards. However,

the good results checked and the experience however accumulated, early

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dissipated doubts and resistances on the part of health professionals.

The family monitoring of patients during their stay in the services of

urgency has great potentials as a factor of humanization of the

hospitals and instrument for a better and more effective assistecial relationship

between users and health services.

It should therefore be enshrined as a right of SNS users, exercised by

agreement with the instructions of the professionals and applied second to the best

practices of organization and operation of emergency services.

Thus being, and under the constitutional and regimental provisions

applicable, the Deputies and Deputies of the Left Bloc present the

following draft law:

Article 1º

Right of follow-up

It is recognised and guaranteed to any citizen admitted in a service of

urgency of the National Health Service the right of follow-up by

family or friend.

Article 2º

Companion

1-Any citizen who chooses to exercise the right of follow-up, has

authorising the family member or friend who will accompany you, except in the case provided for

in the following number

2-Whenever the clinical situation of the patient does not allow the declaration of his /

wishes, the services may request the demonstration of the kinship or the

relation invoked by the accompanist, but they cannot prevent the

follow up.

Article 3º

Limits to the right of follow-up

1-Unless exceptional situations, it is not allowed to accompany or watch the

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surgical interventions and other examinations or treatments that, by their nature,

be able to see their effectiveness and correctness impaired by the presence of the

companion.

2-In cases provided for in the preceding paragraph, it is incumbent on the health professional

responsible for the implementation of the clinical act in question-examination, technique or

treatment, inform and explain to the accompaniment the grounds that prevent the

continuity of follow-up.

Article 4º

Effectiveness of the provision of medical care

The monitoring may not prejudice the organization and operation of the

urgency services, nor compromise the technical conditions and requirements to

that must obey the provision of medical care for these to be

effective.

Article 5º

Duties of the accompanying person

1-The accompanying person shall respect and abide by the instructions and indications,

duly substantiated, of the service professionals.

2-In the case of disobedience or disrespect, services may prevent the

chaperone to remain together with the patient and determine his exit from the

emergency service.

Article 6º

Adaptation of services

The SNS institutions that have an emergency service must, on the deadline

of 180 days from the date of publication of this law, proceed to the changes

necessary in the facilities, organization and operation of the respective

urgent services, so as to enable patients to enjoy the

right of follow-up without causing any injury to normal

functioning of those services.

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Article 7º

Regulations

The right to follow up on emergency services must be enshrined

in the Regulation of the respective health institution, which it shall define with

clarity and stringency the respective standards and conditions of application.

Assembly of the Republic, April 3, 2008

The Deputies and Deputies of the Left Bloc,