Fernanda Raphael Escobar Gimenes

Prescription errors in Brazilian hospitals: a multi-centre exploratory survey

In Brazil, millions of prescriptions do not follow the legal requirements necessary to guarantee the correct dispensing and administration of medication. This multi-centre exploratory study aimed to analyze the appropriateness of prescriptions at four Brazilian hospitals and to identify possible errors caused by inadequacies. The sample consisted of 864 prescriptions obtained at hospital medical clinics in January 2003. Data was collected by three nurse researchers during one week using a standard data sheet that included items about: the type of prescription; legibility; completeness; use of abbreviations; existence of changes and erasures. There were statistically significant differences between incomplete electronic prescriptions at hospital A, and handwritten ones from hospitals C (C2 = 12.703 and p < 0.001) and D (C2 = 14.074 and p < 0.001). Abbreviations were used in more than 80% of prescriptions at hospitals B, C and D. Changes were found in prescriptions at all hospitals, with higher levels at hospitals B (35.2%) and A (25.3%). This study identified a range of vulnerable points in the prescription phase of the medication system at the hospitals. Physicians, pharmacists and nurses should therefore jointly propose strategies to avoid these prescription errors.

A prescrição médica eletrônica em um hospital universitário: falhas de redação e opiniões de usuários

Este estudo analisou as falhas de redacao da prescricao medica eletronica e opinioes dos usuarios acerca das suas vantagens e desvantagens. Foram analisadas 1.351 prescricoes medicas de um hospital universitario e entrevistados 84 profissionais da area da enfermagem e medicina. Os resultados indicaram que 17,7% das prescricoes apresentavam rasuras, em 16,8 % havia medicamentos suspensos, em 28,2% havia informacoes que podiam deixar os profissionais em duvida e em 25% havia medicamentos prescritos manualmente. Os profissionais indicaram as seguintes vantagens: facilidade de leitura dos dados e rapidez com que a prescricao e feita e liberada e como desvantagens: repeticao de prescricoes de dias anteriores sem revisao e informacoes digitadas de forma incorreta. Conclui-se que apesar de ser uma estrategia importante na reducao de erros, e preciso revisao desse sistema e educacao dos profissionais na sua utilizacao.This study analyzed the writing failure of the computerized physician order entry system and its advantages and disadvantages according to users. At a university hospital 1,351 physician orders were analyzed and 84 nursing and medical professionals were interviewed. The results showed that 17.7% of the orders presented erasures, medication had been suspended in 16.8%, in 28.2% there was dubious or misleading information and in 25% medication had been prescribed manually. The professionals indicated advantages such as: ease of data reading and the quickness with which the order is entered and released, among others. They also reported disadvantages such as the repetition of orders from previous days without a review and incorrectly typed information. Therefore, it is concluded that, despite representing an important strategy for error reduction, this system must be overhauled and professionals must be trained to use it.This study analyzed the writing failure of the computerized physician order entry system and its advantages and disadvantages according to users. At a university hospital 1,351 physician orders were analyzed and 84 nursing and medical professionals were interviewed. The results showed that 17.7% of the orders presented measures, medication had been suspended in 16.8%, in 28.2% there was dubious or misleading information and in 25% medication had been prescribed manually. The professionals indicated advantages such as: ease of data reading and the quickness with which the order is entered and released, among others. They also reported disadvantages such as the repetition of orders from previous days without a review and incorrectly typed information. Therefore, it is concluded that, despite representing an important strategy for error reduction, this system must be overhauled and professionals must be trained to use it.

Errors in medicine administration - profile of medicines: knowing and preventing

Objectives: To describe the pharmacological characteristics of medicines involved in administration errors and determine the frequency of errors with potentially dangerous medicines and low therapeutic index, in clinical units of five teaching hospitals, in Brazil. Methods: Multicentric study, descriptive and exploratory, using the non-participant observation technique (during the administration of 4958 doses of medicines) and the anatomical therapeutic chemical classification (ATC). Results: Of that total, 1500 administration errors were identified (30.3%). The administration of pharmacological groups - ATC (cardiovascular system, nervous system, alimentary tract and metabolism system and anti-infectives for systemic use) showed a higher frequency of errors. In 13.0% of errors were involved potentially dangerous medicines and in 12.2% medicines with low therapeutic index. Conclusion: The knowledge of the pharmacological profile could be an important strategy to be used in the prevention medication errors in health institutions.OBJETIVOS: Descrever as caracteristicas farmacologicas dos medicamentos envolvidos em erros de administracao e determinar a frequencia desses erros com medicamentos potencialmente perigosos e de baixo indice terapeutico em unidades de clinica medica de cinco hospitais de ensino brasileiros. METODOS: Estudo multicentrico, descritivo/exploratorio utilizando a tecnica de observacao nao participante durante a administracao de 4958 doses de medicamentos e a classificacao anatomica terapeutica quimica (ATC). RESULTADOS: Dentre esse total, foram identificados 1500 erros de administracao de medicamentos (30,3%). A administracao dos farmacos dos grupos ATC - sistema cardiovascular, sistema nervoso, trato alimentar e metabolismo e antinfecciosos de uso sistemico apresentou maior frequencia de erros. Em 13,0% dos erros estavam envolvidos medicamentos potencialmente perigosos e em 12,2% medicamentos de baixo indice terapeutico. CONCLUSAO: O conhecimento do perfil farmacologico pode ser uma importante estrategia a ser utilizada na prevencao de erros de medicacao em instituicoes de saude.

Influência da redação da prescrição médica na administração de medicamentos em horários diferentes do prescrito

OBJECTIVE: To evaluate the influence of the writing of medical orders on the administration of medications in medical units from five brazilian hospitals. METHODS: This descriptive study used a secondary analysis of data from a multicenter study conducted in 2005. the sample consisted of 1,084 medication orders that had been administered at the wrong schedule time. RESULTS: The great majority of medical orders (96.2%) had acronyms and/or abbreviations, 7.8% of them had incomplete schedules for administration of the medication, and 4.8% had been marked out. in addition, there was no schedule for the administration of the medication in 1.9% of the medical orders. CONCLUSION: Implementation of electronic prescribing and continuing education of health care providers can minimize the administration of medication at the wrong schedule time.Objective: To evaluate the influence of the writing of medical orders on the administration of medications in medical units from five brazilian hospitals. Methods: This descriptive study used a secondary analysis of data from a multicenter study conducted in 2005. the sample consisted of 1,084 medication orders that had been administered at the wrong schedule time. Results: The great majority of medical orders (96.2%) had acronyms and/or abbreviations, 7.8% of them had incomplete schedules for administration of the medication, and 4.8% had been marked out. in addition, there was no schedule for the administration of the medication in 1.9% of the medical orders. Conclusion: Implementation of electronic prescribing and continuing education of health care providers can minimize the administration of medication at the wrong schedule time. Descriptors: Medication errors; Drug prescriptions; Nursing records; Medical records

Erros de administração de antimicrobianos identificados em estudo multicêntrico brasileiro

Medication administration errors (MAE) are the most frequent kind of medication errors. Errors with antimicrobial drugs (AD) are relevant because they may interfere in patient safety and in the development of microbial resistance. The aim of this study is to analyze the AD errors detected in a Brazilian multicentric study of MAE. It was a descriptive and exploratory study carried out in clinical units in five Brazilian teaching hospitals. The hospitals were investigated during 30 days. MAE were detected by observation technique. MAE were classified in categories: wrong route(WR), wrong patient(WP), wrong dose(WD) wrong time (WT) and unordered drug (UD). AD with MAE were classified by Anatomical-Therapeutical-Chemical Classification System. AD with narrow therapeutic index (NTI) were identified. A descriptive statistical analysis was performed using SPSS version 11.5 software. A total of 1500 errors were observed, 277 (18.5%) of them were errors with AD. The types of AD error were: WT 87.7%, WD 6.9%, WR 1.5%, UD 3.2% and WP 0.7%. The number of AD found was 36. The mostly ATC class were fluoroquinolones 13.9%, combinations of penicillin 13.9%, macrolides 8.3% and third-generation cephalosporins 5.6%. The parenteral drug dosage form was associated with 55.6% of AD. 16.7% of AD were NTI. 47.4% of WD and 21.8% WT were with NTI drugs. This study shows that these errors should be considered potential areas for improvement in the medication process and patient safety plus there is requirement to develop rational drug use of AD.

Prescripción informatizada como factor contribuyente para la seguridad de los pacientes hospitalizados

www.pharmacypractice.org 13 RESUMEN * El presente estudio se realizó para identificar factores relacionados con los errores de medicación en las recetas informatizadas y sus ventajas y desventajas según los médicos, enfermeras y personal administrativo. Es un estudio descriptivo realizado en tres unidades de un hospital universitario del suroeste de Brasil. El estudio se dividió en dos fases. En la primera fase, analizamos un total de 1349 prescripciones de los servicios de medicina general, cirugía y ortopedia durante 30 días consecutivos. Se utilizó un instrumento semiestructurado, elaborado por un grupo de investigadores para este estudio. En la segunda fase, se aplicó un cuestionario semi-estructurado a los profesionales de la salud, que contenía preguntas abiertas y cerradas sobre sus opiniones sobre la prescripción electrónica, sus ventajas y desventajas, y sus sugerencias para mejorarla. De las 1349 prescripciones observadas, el 17,5% presentaban correcciones, el 25,0% estaba escrita manualmente y el 17,0% estaba incompleta. Algunas de las ventajas señaladas por los profesionales de la salud era su legibilidad (37,5%), poco tiempo empleado en elaborarla y emitirla (20,5%) y el modo práctico en que se organizaban (,0%). Las desventajas que se señalaban fueron la repetición de prescripciones previas (34,0%), los errores tipográficos (17,0%), la dependencia de los ordenadores (11,0%) y las alteraciones hechas manualmente (7,0%). En conclusión, la prescripción informatizada representa un gran progreso entre las estrategias utilizadas para minimizar los errores de medicación producidos por prescripciones mal formuladas. Sin embargo, no erradica la posibilidad la aparición de error, necesitándose algunas modificaciones.

Medication wrong-route administrations in relation to medical prescriptions

El objetivo fue analizar la influencia de la redaccion de la prescripcion medica en los errores de via de administracion ocurridos en la enfermeria de clinica medica de cinco hospitales brasilenos. Se trata de un estudio descriptivo que utilizo datos de investigacion multicentrica realizada en 2005. La poblacion fue compuesta por 1.425 errores de medicacion y la muestra por 92 errores de via. Las clases farmacologicas mas envueltas en el error fueron: 1) las cardiovasculares (31,5%), 2) las drogas que actuan en el sistema nervioso (23,9%), y 3) las que actuan en el sistema digestivo y metabolismo (13,0%). En lo que se refiere a los items de la prescripcion medica que podrian haber contribuido con los errores de via, se verifico que 91,3% de las prescripciones contenian siglas/abreviaturas; 22,8% no contenian datos del paciente, y 4,3% no presentaban fecha y contenian raspados. Errores de via son frecuentes en los hospitales brasilenos y alrededor del mundo y se sabe que estas situaciones pueden resultar en eventos adversos severos en los pacientes, incluyendo la muerte.

Patient Safety in Drug Therapy and the Influence of the Prescription in Dose Errors

The aims of this study were to analyze the redaction of the prescription in dose errors that occurred in general medical units of five Brazilian hospitals and to identify the pharmacological classes involved in these errors. This was a descriptive study that used secondary data obtained from a multicenter study conducted in 2005. The population consisted of 1,425 medication errors and the sample of 215 dose errors. Of these, 44.2% occurred in hospital E. The presence of acronyms and/or abbreviations was verified in 96.3% of prescriptions; absence of the patient registration in 54.4%; absence of posology in 18.1%; and omission of date of 0.9%. With respect to medication type, 16.8% were bronchodilators; 16.3% were analgesics; 12.1%, antihypertensives; and 8.4% were antibiotics. The absence of posology in the prescriptions may facilitate the administration of the wrong dose, resulting in inefficiency of the treatment, compromising the quality of care provided to hospitalized patients.Os objetivos foram analisar a redacao da prescricao medica nos erros de doses, ocorridos em unidades de clinica medica de cinco hospitais brasileiros, e identificar as classes farmacologicas envolvidas nesses erros. Este e estudo descritivo que utilizou dados secundarios, obtidos de pesquisa multicentrica, realizada em 2005. A populacao foi composta por 1425 erros de medicacao e a amostra por 215 erros de doses. Desses, 44,2% ocorreram no hospital E. Verificou-se presenca de siglas e/ou abreviaturas em 96,3% das prescricoes, ausencia do registro do paciente em 54,4%, falta de posologia em 18,1% e omissao da data em 0,9%. Com relacao ao tipo de medicamento, 16,8% eram broncodilatadores, 16,3% eram analgesicos, 12,1%, anti-hipertensivos e 8,4% eram antimicrobianos. A ausencia da posologia nas prescricoes pode favorecer a administracao de doses erradas, resultando em ineficiencia do tratamento, comprometendo a qualidade da assistencia prestada aos pacientes hospitalizados.

Segurança do paciente na terapêutica medicamentosa e a influência da prescrição médica nos erros de dose

The aims of this study were to analyze the redaction of the prescription in dose errors that occurred in general medical units of five Brazilian hospitals and to identify the pharmacological classes involved in these errors. This was a descriptive study that used secondary data obtained from a multicenter study conducted in 2005. The population consisted of 1,425 medication errors and the sample of 215 dose errors. Of these, 44.2% occurred in hospital E. The presence of acronyms and/or abbreviations was verified in 96.3% of prescriptions; absence of the patient registration in 54.4%; absence of posology in 18.1%; and omission of date of 0.9%. With respect to medication type, 16.8% were bronchodilators; 16.3% were analgesics; 12.1%, antihypertensives; and 8.4% were antibiotics. The absence of posology in the prescriptions may facilitate the administration of the wrong dose, resulting in inefficiency of the treatment, compromising the quality of care provided to hospitalized patients.Os objetivos foram analisar a redacao da prescricao medica nos erros de doses, ocorridos em unidades de clinica medica de cinco hospitais brasileiros, e identificar as classes farmacologicas envolvidas nesses erros. Este e estudo descritivo que utilizou dados secundarios, obtidos de pesquisa multicentrica, realizada em 2005. A populacao foi composta por 1425 erros de medicacao e a amostra por 215 erros de doses. Desses, 44,2% ocorreram no hospital E. Verificou-se presenca de siglas e/ou abreviaturas em 96,3% das prescricoes, ausencia do registro do paciente em 54,4%, falta de posologia em 18,1% e omissao da data em 0,9%. Com relacao ao tipo de medicamento, 16,8% eram broncodilatadores, 16,3% eram analgesicos, 12,1%, anti-hipertensivos e 8,4% eram antimicrobianos. A ausencia da posologia nas prescricoes pode favorecer a administracao de doses erradas, resultando em ineficiencia do tratamento, comprometendo a qualidade da assistencia prestada aos pacientes hospitalizados.

Engaging nurses to strengthen medication safety: Fostering and capturing change with restorative photographic research methods

We used participatory photographic research methods adapted from the field of ecological restoration to engage Brazilian intensive care unit nurses in a critical review of medication safety in their work environment. Using focus groups, practitioner-led photo walkabouts with photo narration, and photo elicitation focus groups in iterative phases of data collection and analysis, nurses developed and implemented several practical and cultural improvements for their unit. Participants focussed on organizing the medication room for efficient workflow and accessible supplies, improving reporting practices, and reconsidering how they could manage safety issues in their unit and in the hospital as a whole. Our results demonstrated that restorative photographic research methods enabled participants to (re)think and redesign their work environment in keeping with several recommended practices for improving medication management. It also validated the need for continuous evidence-informed improvements if nurses hope to optimize medication safety in the complex systems of intensive care.