Erros de dispensação em hospital universitário: análise e contribuições para o uso seguro de medicamentos
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UERJ |
Texto Completo: | http://www.bdtd.uerj.br/handle/1/19447 |
Resumo: | The objectives of the present study were to analyze medication dispensing errors in a high-complexity public teaching hospital; to identify errors in the medication dispensing process; to classify dispensing errors by type; to determine the rate of medication dispensing errors; to analyze factors associated with the errors in the medication dispensing process; to analyze prescriptions of potentially dangerous medications; to identify practices adopted for dispensing potentially dangerous medications; and to propose strategies to prevent adverse events. In this study, the authors used medical prescriptions and the respective medication kits for dispensing, and a checklist based on the Protocol of Safety in Prescription, Use, and Administration of Medications of the Brazilian Ministry of Health and the Brazilian Health Regulatory Agency as an instrument for observing dispensing practices. In the first cross-sectional study, the kits were open for verification and identification of possible dispensing errors. Fitted hierarchical regression was used to analyze how the outcome variable, “medication dispensing error”, was influenced by the explanatory variables, and to identify factors associated with dispensing errors. Dispensing errors were found in 236 medications, and varied calculation methods resulted in the following rates: 4.2%, 7.3% and 24.9%. The main errors were related to content, due to quality deviation and omission. In the final regression model, the following variables remained associated with an increased chance of dispensing errors: night shift and presence of sources of interruptions/distraction. In the second cross-sectional study, the prescriptions of potentially dangerous medications were analyzed, and the practices adopted in their dispensing were identified, to propose strategies for the prevention of adverse events. The chi-square non-parametric test of independence was used to evaluate the association between prescriptions with and without potentially dangerous medications and hospitalization units. Over half the prescriptions had two or more potentially dangerous medications and almost all of them were injectable, mainly opioid analgesics, glucose 50% and insulin NPH and regular. The rate of potentially dangerous medications prescribed corresponded to 18.2%. The main practices that posed risks were: collective distribution of potassium chloride and insulin; lack of warning tags; absence of double-checking; and use of sources of interruptions/distraction in 43.9% of the prescriptions. The types of errors and associated factors showed a need for an effective quality program that considers the recommendations made in the protocol of the Brazilian Ministry of Health and the Brazilian Health Regulatory Agency. |
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Carneiro, Sueli Coelho da Silvahttp://lattes.cnpq.br/2806814483036209Batista, Rosângela Fernandes Lucenahttp://lattes.cnpq.br/3936205532436748Barcaui, Carlos Baptistahttp://lattes.cnpq.br/3492684800019943Fonseca, João Carlos Macedohttp://lattes.cnpq.br/8493129315232998Hossy, Bryan Hudsonhttp://lattes.cnpq.br/4396818060921737Januário, Viginia Fernandahttp://lattes.cnpq.br/5580122935516053http://lattes.cnpq.br/7672319333478111Maia, Jacione Lemos Botelhojacione.maia@huufma.br2023-04-26T13:51:42Z2020-02-03MAIA, Jacione Lemos Botelho. Erros de dispensação em hospital universitário: análise e contribuições para o uso seguro de medicamentos. 2020. 106 f. Tese (Doutorado em Ciências Médicas) – Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2020.http://www.bdtd.uerj.br/handle/1/19447The objectives of the present study were to analyze medication dispensing errors in a high-complexity public teaching hospital; to identify errors in the medication dispensing process; to classify dispensing errors by type; to determine the rate of medication dispensing errors; to analyze factors associated with the errors in the medication dispensing process; to analyze prescriptions of potentially dangerous medications; to identify practices adopted for dispensing potentially dangerous medications; and to propose strategies to prevent adverse events. In this study, the authors used medical prescriptions and the respective medication kits for dispensing, and a checklist based on the Protocol of Safety in Prescription, Use, and Administration of Medications of the Brazilian Ministry of Health and the Brazilian Health Regulatory Agency as an instrument for observing dispensing practices. In the first cross-sectional study, the kits were open for verification and identification of possible dispensing errors. Fitted hierarchical regression was used to analyze how the outcome variable, “medication dispensing error”, was influenced by the explanatory variables, and to identify factors associated with dispensing errors. Dispensing errors were found in 236 medications, and varied calculation methods resulted in the following rates: 4.2%, 7.3% and 24.9%. The main errors were related to content, due to quality deviation and omission. In the final regression model, the following variables remained associated with an increased chance of dispensing errors: night shift and presence of sources of interruptions/distraction. In the second cross-sectional study, the prescriptions of potentially dangerous medications were analyzed, and the practices adopted in their dispensing were identified, to propose strategies for the prevention of adverse events. The chi-square non-parametric test of independence was used to evaluate the association between prescriptions with and without potentially dangerous medications and hospitalization units. Over half the prescriptions had two or more potentially dangerous medications and almost all of them were injectable, mainly opioid analgesics, glucose 50% and insulin NPH and regular. The rate of potentially dangerous medications prescribed corresponded to 18.2%. The main practices that posed risks were: collective distribution of potassium chloride and insulin; lack of warning tags; absence of double-checking; and use of sources of interruptions/distraction in 43.9% of the prescriptions. The types of errors and associated factors showed a need for an effective quality program that considers the recommendations made in the protocol of the Brazilian Ministry of Health and the Brazilian Health Regulatory Agency.O presente estudo teve como objetivos: analisar erros de dispensação de medicamentos em hospital universitário público de alta complexidade; identificar os erros no processo de dispensação de medicamentos; classificar os erros de dispensação de acordo com o tipo; determinar a taxa de erro de dispensação de medicamentos; analisar os fatores associados aos erros no processo de dispensação de medicamentos; analisar as prescrições de medicamentos potencialmente perigosos; identificar as práticas adotadas na dispensação de medicamentos potencialmente perigosos; propor estratégias para prevenção de eventos adversos. Para o estudo, utilizou-se as prescrições médicas e respectivos kits de medicamentos para a dispensação e um checklist baseado no protocolo de prescrição, uso e administração de medicamentos do Ministério da Saúde (MS)/Agência Nacional de Vigilância Sanitária (ANVISA) como instrumento para observação das práticas de dispensação. No primeiro estudo, transversal, os kits foram abertos para conferência e identificação de possíveis erros de dispensação. Para analisar como a variável desfecho “erro de dispensação de medicamentos” foi influenciada pelas variáveis explicativas, utilizou-se regressão hierarquizada ajustada e identificou-se os fatores associados ao erro de dispensação. Os erros de dispensação ocorreram em 236 medicamentos e os vários métodos de cálculo permitiram as taxas: 4,2%, 7,3% e 24,9%. Os principais erros foram de conteúdo por desvio de qualidade e de omissão. No modelo final da regressão, permaneceram associadas ao aumento da chance de erros de dispensação as variáveis: turno da noite e presença de fonte de interrupção/distração. No segundo estudo tranversal, foram analisadas as prescrições de medicamentos potencialmente perigosos (MPP) e identificadas as práticas adotadas na dispensação, propondo estratégias para prevenção de eventos adversos. Utilizou-se teste não paramétrico do Qui-quadrado de Independência para avaliar a associação entre prescrições com e sem medicamentos potencialmente perigosos e unidades de internação. Mais da metade das prescrições continham dois ou mais medicamentos potencialmente perigosos e quase todos injetáveis, principalmente analgésicos opioides, glicose 50% e insulina NPH e regular. A taxa de MPP prescritos correspondeu a 18,2%. As principais práticas que representaram riscos foram: distribuição coletiva de cloreto de potássio e insulina; falta de etiquetas de alerta; inexistência de dupla conferência; uso de fontes de interrupção/distração em 43,9% das prescrições atendidas. Os tipos de erros e fatores associados mostraram a necessidade de um programa de qualidade efetivo que considere as recomendações feitas no protocolo do MS/ANVISA.Submitted by Heloísa CB/A (helobdtd@gmail.com) on 2023-04-26T13:51:42Z No. of bitstreams: 1 Tese - Jacione Lemos Botelho Maia - 2020 - Completa.pdf: 3437510 bytes, checksum: 96fd3e109dc0da250eba0f4b86bf5d46 (MD5)Made available in DSpace on 2023-04-26T13:51:42Z (GMT). No. of bitstreams: 1 Tese - Jacione Lemos Botelho Maia - 2020 - Completa.pdf: 3437510 bytes, checksum: 96fd3e109dc0da250eba0f4b86bf5d46 (MD5) Previous issue date: 2020-02-03application/pdfporUniversidade do Estado do Rio de JaneiroPrograma de Pós-Graduação em Ciências MédicasUERJBrasilCentro Biomédico::Faculdade de Ciências MédicasMedication errorsPatient safetyMedication systemsRisk managementErros de medicaçãoSegurança do pacienteSistemas de medicaçãoGestão de riscosCIENCIAS DA SAUDE::FARMACIAErros de dispensação em hospital universitário: análise e contribuições para o uso seguro de medicamentosMedication dispensing errors in a teaching hospital: analysis and contributions to safe drug useinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UERJinstname:Universidade do Estado do Rio de Janeiro (UERJ)instacron:UERJORIGINALTese - Jacione Lemos Botelho Maia - 2020 - Completa.pdfTese - Jacione Lemos Botelho Maia - 2020 - Completa.pdfapplication/pdf3437510http://www.bdtd.uerj.br/bitstream/1/19447/2/Tese+-+Jacione+Lemos+Botelho+Maia+-+2020+-+Completa.pdf96fd3e109dc0da250eba0f4b86bf5d46MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82123http://www.bdtd.uerj.br/bitstream/1/19447/1/license.txte5502652da718045d7fcd832b79fca29MD511/194472024-02-26 15:59:54.108oai:www.bdtd.uerj.br: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Biblioteca Digital de Teses e Dissertaçõeshttp://www.bdtd.uerj.br/PUBhttps://www.bdtd.uerj.br:8443/oai/requestbdtd.suporte@uerj.bropendoar:29032024-02-26T18:59:54Biblioteca Digital de Teses e Dissertações da UERJ - Universidade do Estado do Rio de Janeiro (UERJ)false |
dc.title.por.fl_str_mv |
Erros de dispensação em hospital universitário: análise e contribuições para o uso seguro de medicamentos |
dc.title.alternative.eng.fl_str_mv |
Medication dispensing errors in a teaching hospital: analysis and contributions to safe drug use |
title |
Erros de dispensação em hospital universitário: análise e contribuições para o uso seguro de medicamentos |
spellingShingle |
Erros de dispensação em hospital universitário: análise e contribuições para o uso seguro de medicamentos Maia, Jacione Lemos Botelho Medication errors Patient safety Medication systems Risk management Erros de medicação Segurança do paciente Sistemas de medicação Gestão de riscos CIENCIAS DA SAUDE::FARMACIA |
title_short |
Erros de dispensação em hospital universitário: análise e contribuições para o uso seguro de medicamentos |
title_full |
Erros de dispensação em hospital universitário: análise e contribuições para o uso seguro de medicamentos |
title_fullStr |
Erros de dispensação em hospital universitário: análise e contribuições para o uso seguro de medicamentos |
title_full_unstemmed |
Erros de dispensação em hospital universitário: análise e contribuições para o uso seguro de medicamentos |
title_sort |
Erros de dispensação em hospital universitário: análise e contribuições para o uso seguro de medicamentos |
author |
Maia, Jacione Lemos Botelho |
author_facet |
Maia, Jacione Lemos Botelho jacione.maia@huufma.br |
author_role |
author |
author2 |
jacione.maia@huufma.br |
author2_role |
author |
dc.contributor.advisor1.fl_str_mv |
Carneiro, Sueli Coelho da Silva |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/2806814483036209 |
dc.contributor.advisor-co1.fl_str_mv |
Batista, Rosângela Fernandes Lucena |
dc.contributor.advisor-co1Lattes.fl_str_mv |
http://lattes.cnpq.br/3936205532436748 |
dc.contributor.referee1.fl_str_mv |
Barcaui, Carlos Baptista |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/3492684800019943 |
dc.contributor.referee2.fl_str_mv |
Fonseca, João Carlos Macedo |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/8493129315232998 |
dc.contributor.referee3.fl_str_mv |
Hossy, Bryan Hudson |
dc.contributor.referee3Lattes.fl_str_mv |
http://lattes.cnpq.br/4396818060921737 |
dc.contributor.referee4.fl_str_mv |
Januário, Viginia Fernanda |
dc.contributor.referee4Lattes.fl_str_mv |
http://lattes.cnpq.br/5580122935516053 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/7672319333478111 |
dc.contributor.author.fl_str_mv |
Maia, Jacione Lemos Botelho jacione.maia@huufma.br |
contributor_str_mv |
Carneiro, Sueli Coelho da Silva Batista, Rosângela Fernandes Lucena Barcaui, Carlos Baptista Fonseca, João Carlos Macedo Hossy, Bryan Hudson Januário, Viginia Fernanda |
dc.subject.eng.fl_str_mv |
Medication errors Patient safety Medication systems Risk management |
topic |
Medication errors Patient safety Medication systems Risk management Erros de medicação Segurança do paciente Sistemas de medicação Gestão de riscos CIENCIAS DA SAUDE::FARMACIA |
dc.subject.por.fl_str_mv |
Erros de medicação Segurança do paciente Sistemas de medicação Gestão de riscos |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::FARMACIA |
description |
The objectives of the present study were to analyze medication dispensing errors in a high-complexity public teaching hospital; to identify errors in the medication dispensing process; to classify dispensing errors by type; to determine the rate of medication dispensing errors; to analyze factors associated with the errors in the medication dispensing process; to analyze prescriptions of potentially dangerous medications; to identify practices adopted for dispensing potentially dangerous medications; and to propose strategies to prevent adverse events. In this study, the authors used medical prescriptions and the respective medication kits for dispensing, and a checklist based on the Protocol of Safety in Prescription, Use, and Administration of Medications of the Brazilian Ministry of Health and the Brazilian Health Regulatory Agency as an instrument for observing dispensing practices. In the first cross-sectional study, the kits were open for verification and identification of possible dispensing errors. Fitted hierarchical regression was used to analyze how the outcome variable, “medication dispensing error”, was influenced by the explanatory variables, and to identify factors associated with dispensing errors. Dispensing errors were found in 236 medications, and varied calculation methods resulted in the following rates: 4.2%, 7.3% and 24.9%. The main errors were related to content, due to quality deviation and omission. In the final regression model, the following variables remained associated with an increased chance of dispensing errors: night shift and presence of sources of interruptions/distraction. In the second cross-sectional study, the prescriptions of potentially dangerous medications were analyzed, and the practices adopted in their dispensing were identified, to propose strategies for the prevention of adverse events. The chi-square non-parametric test of independence was used to evaluate the association between prescriptions with and without potentially dangerous medications and hospitalization units. Over half the prescriptions had two or more potentially dangerous medications and almost all of them were injectable, mainly opioid analgesics, glucose 50% and insulin NPH and regular. The rate of potentially dangerous medications prescribed corresponded to 18.2%. The main practices that posed risks were: collective distribution of potassium chloride and insulin; lack of warning tags; absence of double-checking; and use of sources of interruptions/distraction in 43.9% of the prescriptions. The types of errors and associated factors showed a need for an effective quality program that considers the recommendations made in the protocol of the Brazilian Ministry of Health and the Brazilian Health Regulatory Agency. |
publishDate |
2020 |
dc.date.issued.fl_str_mv |
2020-02-03 |
dc.date.accessioned.fl_str_mv |
2023-04-26T13:51:42Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/doctoralThesis |
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doctoralThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
MAIA, Jacione Lemos Botelho. Erros de dispensação em hospital universitário: análise e contribuições para o uso seguro de medicamentos. 2020. 106 f. Tese (Doutorado em Ciências Médicas) – Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2020. |
dc.identifier.uri.fl_str_mv |
http://www.bdtd.uerj.br/handle/1/19447 |
identifier_str_mv |
MAIA, Jacione Lemos Botelho. Erros de dispensação em hospital universitário: análise e contribuições para o uso seguro de medicamentos. 2020. 106 f. Tese (Doutorado em Ciências Médicas) – Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2020. |
url |
http://www.bdtd.uerj.br/handle/1/19447 |
dc.language.iso.fl_str_mv |
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por |
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Universidade do Estado do Rio de Janeiro |
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Programa de Pós-Graduação em Ciências Médicas |
dc.publisher.initials.fl_str_mv |
UERJ |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Centro Biomédico::Faculdade de Ciências Médicas |
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Universidade do Estado do Rio de Janeiro |
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