Safety Culture in the ICU: diagnosis of structural and behavioral failures in multidisciplinary care

Abstract

Objective: To analyze the challenges and barriers that permeate the implementation of patient safety practices in the context of the Intensive Care Unit (ICU), from the perspective of management and multidisciplinary care. Methodology: This is an integrative literature review structured in six stages. The search was conducted in the LILACS, BDENF, and SciELO databases, using inclusion criteria for primary studies published between 2020 and 2025, in Portuguese, English, and Spanish. The selection process followed the recommendations of the PRISMA method, resulting in a final sample of 11 articles for review. Results: The analysis revealed an exponential growth in recent publications, with a productive peak in the 2023-2024 biennium (54.54% of the sample). Descriptive and cross-sectional studies predominated (54.54%) focused on diagnosing adherence to protocols. The main findings highlighted failures in the compliance of catheter maintenance bundles (63.95% adherence), serious deficiencies in hand hygiene, and heterogeneity in the application of safety protocols, such as those for sepsis and fall prevention. Human factors, such as failures in interprofessional communication and inadequate staffing levels, were identified as critical barriers. Final considerations: safety in the ICU depends on an integrated network between technical rigor, infrastructure, and human factors. The nurse plays a central leadership role in risk management. Improving care required a transition to a non-punitive safety culture and constant investments in continuing education to align theory with clinical practice.