Simone Perufo Opitz

Problemas na comunicação: uma possível causa de erros de medicação

OBJECTIVE: This descriptive study identified and analyzed weak points in the communication process during the prescription, dispensing, and administration of medication in a medical unit and pharmacy of a university hospital. METHODS: The data were collected by direct observations during a period of 21 days, review of 294 prescriptions, and interview of 40 health care professionals. RESULTS: Some prescriptions were incomplete, common use of abbreviations, and health care providers were often interrupted or distracted during prescription. During the dispensing phase, many requisition forms were incomplete or filled out wrongly. And, during the administration of medication, there were errors on transcribed labels for the preparation of medication as well as a lack of proper communication between nurses and patients. CONCLUSION: Communication process in place must be revised to guarantee a quality hospital medication system that provides safe patient care.OBJECTIVE: This descriptive study identified and analyzed weak points in the communication process during the prescription, dispensing, and administration of medication in a medical unit and pharmacy of a university hospital. METHODS: The data were collected by direct observations during a period of 21 days, review of 294 prescriptions, and interview of 40 health care professionals. RESULTS: Some prescriptions were incomplete, common use of abbreviations, and health care providers were often interrupted or distracted during prescription. During the dispensing phase, many requisition forms were incomplete or filled out wrongly. And, during the administration of medication, there were errors on transcribed labels for the preparation of medication as well as a lack of proper communication between nurses and patients. CONCLUSION: Communication process in place must be revised to guarantee a quality hospital medication system that provides safe patient care.

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.

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.

Communication problems: a potential cause for medication error-rates

OBJECTIVE: This descriptive study identified and analyzed weak points in the communication process during the prescription, dispensing, and administration of medication in a medical unit and pharmacy of a university hospital. METHODS: The data were collected by direct observations during a period of 21 days, review of 294 prescriptions, and interview of 40 health care professionals. RESULTS: Some prescriptions were incomplete, common use of abbreviations, and health care providers were often interrupted or distracted during prescription. During the dispensing phase, many requisition forms were incomplete or filled out wrongly. And, during the administration of medication, there were errors on transcribed labels for the preparation of medication as well as a lack of proper communication between nurses and patients. CONCLUSION: Communication process in place must be revised to guarantee a quality hospital medication system that provides safe patient care.OBJECTIVE: This descriptive study identified and analyzed weak points in the communication process during the prescription, dispensing, and administration of medication in a medical unit and pharmacy of a university hospital. METHODS: The data were collected by direct observations during a period of 21 days, review of 294 prescriptions, and interview of 40 health care professionals. RESULTS: Some prescriptions were incomplete, common use of abbreviations, and health care providers were often interrupted or distracted during prescription. During the dispensing phase, many requisition forms were incomplete or filled out wrongly. And, during the administration of medication, there were errors on transcribed labels for the preparation of medication as well as a lack of proper communication between nurses and patients. CONCLUSION: Communication process in place must be revised to guarantee a quality hospital medication system that provides safe patient care.

Breast Cancer Awareness among Women in Western Amazon: a Population Based Cross-Sectional Study

Background: A general lack of women`s awareness of breast cancer has been one of the barriers to screening and early presentation. Thus, the aim of this study was to evaluate levels of knowledge about risk factors, and early warning signs of breast cancer, and to determine factors associated with better levels of comprehension. Methods: A population-based cross-sectional study was carried out among 478 women over 40 years old, living in Rio Branco city, western Amazon. All were interviewed using the “Breast cancer knowledge, attitudes and practice scale”, developed by American Cancer Society. Results: Among the respondents, only 28.6% of women were aware that advanced age highly increases the risk. Around 30% of participants recognized nipple retraction as a sign of breast cancer. Breast cancer knowledge varied according to age in such a way that the mean scores were high from 40-69 years and decreased dramatically among those aged ≥70 (β=-0.06, p=0.031). Access to health services such as the Pap-test (β=2.45, p=0.027) and attending a gynecologist in the past two years (β=1.88, p=0.005) were statistically associated with the score of breast cancer knowledge. Conclusion: The findings indicate that women living in urban areas, having gynecological assessment, considering herself at high risk of developing breast cancer and thinking that breast cancer is a fatal disease are statistically associated with good knowledge of breast cancer risk factors, signs and symptoms, even adjusting for age and education.

Fatores associados ao uso de medicamentos na gestação em primigestas no Município de Rio Branco, Acre, Brasil

Estudio transversal con 887 primigestas para analizar los factores asociados al consumo de medicamentos durante el embarazo en Rio Branco, Acre, Brasil. La informacion se baso en entrevistas y tarjeta prenatal. Los medicamentos se calificaron de acuerdo con el sistema anatomico terapeutico quimico (ATC), de la Organizacion Mundial de la Salud y con la categoria de riesgo del Food and Drug Administration (Estados Unidos). La media de edad fue de 21 anos; la media del uso de medicamentos fue de un 2,42; los medicamentos mas consumidos fueron los antianemicos (47,5%), los suplementos y vitaminas (18,7%), analgesicos (13,8%) y antibioticos (10,5%). En la clasificacion de riesgo, un 69,3% pertenecian a la categoria A; 22,3% a B; 7,6% a C y 0,8% a la D. La posibilidad de haber estado expuestas al riesgo en el consumo de medicamentos fue mayor en primigestas en la unidad B (OR = 2,10, IC95%: 1,26-3,50), con edades entre 19 y 24 anos (OR = 2,79, IC95%: 1,58-4,93) y con prescripcion (OR = 1,86, IC95%: 1,18-2,95). Los medicamentos esenciales fueron utilizados con menos frecuencia en las mujeres con mayores ingresos de los hogares (OR = 0,63, IC95%: 0,42-0,96) y que realizaron el cuidado prenatal en una red clinica privada (OR = 0,53, IC95%: 0,38- 0,74).This cross-sectional study in a sample of 887 primigravidae in Rio Branco, Acre State, Brazil aimed to analyze factors associated with the use of medicines during the first pregnancy. Information was obtained from interviews and prenatal cards. Medicines were classified according to the Anatomical Therapeutic Chemical (ATC) Classification System of the World Health Organization and risk categories according to the U.S. Food and Drug Administration. Mean age was 21 years and mean number of medicines used was 2.42. The most frequently consumed medicines were antianemics (47.5%), supplements and vitamins (18.7%), analgesics (13.8%), and antibiotics (10.5%). In the risk categorization, 69.3% belonged to category A, 22.3% to B, 7.6% to C, and 0.8% to D. The odds of having used risky medicines were higher among primigravidae in unit B (OR = 2.10; 95%CI: 1.26-3.50), in the 19 to 24-year age bracket (OR = 2.79; 95%CI: 1.58-4.93), and in the presence of a medical prescription (OR = 1.86; 95%CI: 1.18-2.95). Essential drugs were less used by women with higher family income (OR = 0.63; 95%CI: 0.42-0.96) and those who had received private prenatal care (OR = 0.53; 95%CI: 0.38-0.74).Estudo transversal, envolvendo 887 primigestas com o objetivo de analisar os fatores associados ao uso de medicamentos na gestacao no Municipio de Rio Branco, Acre, Brasil. As informacoes tiveram como base uma entrevista e o cartao de pre-natal. Os medicamentos foram classificados de acordo com o Sistema Anatomico Terapeutico Quimico (ATC), da Organizacao Mundial da Saude, e com a categoria de risco do Food and Drug Administration (Estados Unidos). A media de idade foi 21 anos, a media do uso de medicamentos foi 2,42; os medicamentos mais consumidos foram os antianemicos (47,5%), suplementos e vitaminas (18,7%), analgesicos (13,8%) e antibioticos (10,5%). Na categorizacao de risco, 69,3% pertenciam a categoria A; 22,3% a B; 7,6% a C e 0,8% a D. A chance de ter sido exposta a utilizacao de medicamentos de risco foi maior nas primigestas na unidade B (RC = 2,10; IC95%: 1,26-3,50), na faixa etaria de 19 a 24 anos (RC = 2,79; IC95%: 1,58-4,93) e com prescricao medica (RC = 1,86; IC95%: 1,18-2,95). Os medicamentos essenciais foram menos utilizados entre as mulheres com maior renda familiar (RC = 0,63; IC95%: 0,42-0,96), e que realizaram o pre-natal na rede privada (RC = 0,53; IC95%: 0,38-0,74).

Anomalias congênitas em nascidos vivos

Objective: To analyze the prevalence and factors potentially associated with congenital anomalies in a municipality of the State of Acre. Methods: Descriptive cross-sectional study of data from the Live Birth Information System (Sistema de Informacoes sobre Nascidos Vivos – SINASC) of the municipality of Rio Branco, Acre, Brazil, from 2001 to 2013. The outcome variable was the presence of congenital anomalies and the independent variables were related to the mother and the live birth. Odds Ratios (OR) and Confidence Intervals of 95% were estimated by logistic regression. Results: The prevalence of congenital anomalies was 0.2% in live births in the analyzed period, and the most frequent were musculoskeletal deformities (41.3%) followed by malformations of the nervous system (17.9%); they were associated with the age of the mother <15 and ≥35 years old (OR 1.72, 95%CI 1.03, 2.87), cesarean section (OR 1.85, 95%CI 1.29, 2.65), lower Apgar score at 1 (OR 3.54, 95%CI 1.69, 7.42) and 5 minutes (OR 13.65, 95%CI 4.00, 46.61) and birth weight ≤1.499g (OR 5.09; 95%CI 2.32, 11.19). Conclusion: The chance of having congenital anomaly was higher in the live births of mothers aged <15 and ≥35 years old; preterm births with less than 32 gestational weeks; cesarean births; live births who presented a degree of severe difficulty for Apgar 1 and for Apgar 5, and neonates who presented extreme low weight.

FARMACOCINÉTICA E MECANISMOS DE TERATOGENICIDADE DOS MEDICAMENTOS NA GESTAÇÃO: UMA REVISÃO DA LITERATURA.

The presence of emerging contaminants in surface Physiological changes that occur during a gestational period on a female organism are greatly explored by researchers and it is well elucidated by scientific literature, however, the theme: pharmacokinetics and mechanisms of teratogenicity by medicines on female organisms passing by physiological changes, it is still poorly explored. The research’s purpose was to review and contribute to adding scientific knowledge about pharmacokinetics and mechanisms of teratogenicity by drugs used during gestation.

Phlebitis associated with peripheral intravenous catheters in adults admitted to hospital in the Western Brazilian Amazon

OBJECTIVE To identify the presence of phlebitis and the factors that influence the development of this complication in adult patients admitted to hospital in the western Brazilian Amazon. METHOD Exploratory study with a sample of 122 peripheral intravenous catheters inserted in 122 patients in a medical unit. Variables related to the patient and intravenous therapy were analyzed. For the analysis, we used chi-square tests of Pearson and Fisher exact test, with 5% significance level. RESULTS Complication was the main reason for catheter removal (67.2%), phlebitis was the most frequent complication (31.1%). The mean duration of intravenous therapy use was 8.81 days in continuous and intermittent infusion (61.5%), in 20G catheter (39.3%), inserted in the dorsal hand vein arc (36.9 %), with mean time of usage of 68.4 hours. The type of infusion (p=0.044) and the presence of chronic disease (p=0.005) and infection (p=0.007) affected the development of phlebitis. CONCLUSION There was a high frequency of phlebitis in the sample, being influenced by concomitant use of continuous and intermittent infusion of drugs and solutions, and more frequent in patients with chronic diseases and infection. OBJETIVO Identificar a presença de flebite e os fatores que influenciam o desenvolvimento desta complicação em pacientes adultos internados em hospital da Amazônia Ocidental Brasileira. MÉTODO Estudo exploratório, com amostra de 122 cateteres intravenosos periféricos instalados em 122 pacientes de uma unidade de clínica médica. Foram analisadas variáveis relacionadas ao paciente e à terapia intravenosa. Para a análise utilizaram-se os testes de Qui-quadrado de Pearson e Exato de Fisher, com nível de significância de 5%. RESULTADOS A complicação foi o principal motivo da retirada do cateter (67,2%), e a flebite a complicação mais frequente (31,1%). O tempo médio de uso de terapia intravenosa foi de 8,81 dias, em infusão contínua e intermitente (61,5%), em cateter calibre 20G (39,3%), inseridos nas veias do arco dorsal da mão (36,9%), com média de tempo de permanência de 68,4 horas. O tipo de infusão (p=0,044) e a presença de doença crônica (p=0,005) e de infecção (p=0,007) influenciaram o desenvolvimento de flebite. CONCLUSÃO Houve alta frequência de flebite na amostra estudada, sendo influenciada pelo emprego concomitante de infusão contínua e intermitente de fármacos e soluções, e mais frequente em pacientes com doenças crônicas e infecção.OBJETIVO Identificar la presencia de flebitis y los factores que influencian el desarrollo de esta complicacion en pacientes adultos ingresados en hospital de la Amazonia Occidental Brasilena. METODO Estudio exploratorio, con muestra de 122 cateteres intravenosos perifericos instalados en 122 pacientes de una unidad de clinica medica. Fueron analizadas variables relacionadas con el paciente y la terapia intravenosa. Para el analisis se utilizaron las pruebas de Chi cuadrado de Pearson y Exacta de Fisher, con nivel de significacion del 5%. RESULTADOS La complicacion fue el principal motivo de la retirada del cateter (67,2%), y la flebitis la complicacion mas frecuente (31,1%). El tiempo medio de uso de terapia intravenosa fue de 8,81 dias, en infusion continua e intermitente (61,5%), en cateter calibre 20G (39,3%), insertados en las venas del arco dorsal de la mano (36,9%), con promedio de tiempo de permanencia de 68,4 horas. El tipo de infusion (p=0,044) y la presencia de enfermedad cronica (p=0,005) y de infeccion (p=0,007) influenciaron el desarrollo de flebitis. CONCLUSION Hubo alta frecuencia de flebitis en la muestra estudiada, siendo influenciada por el empleo concomitante de infusion continua e intermitente de farmacos y soluciones, y mas frecuente en pacientes con enfermedades cronicas e infeccion.