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Este estudo teve como objetivo analisar o sistema de medicação de um hospital especializado do Município do Rio de Janeiro. Tratase de um estudo de avaliação de natureza descritiva. Foram selecionados alguns dos principais processos do sistema de medicação: prescrição, dispensação, preparo e administração dos medicamentos. A fim de descrever o sistema de medicação foram utilizadas para coleta de dados: entrevista, observação não participante e análise de prontuários. Foi identificado um grande número de etapas e profissionais envolvidos, assim como problemas relacionados à segurança e ao ambiente durante a prescrição, dispensação, preparo e administração dos medicamentos. Sistemas inseguros podem gerar várias consequências para os pacientes e as instituições de saúde; neste sentido, é necessária a implementação de estratégias visando à mudança na cultura de detecção das falhas, de forma a auxiliar os profissionais na prevenção de erros através de medidas que garantam a qualidade dos processos executados.Este estudio tuvo como objetivo analizar el sistema de medicación en un hospital especializado de Rio de Janeiro. Se trata de un estudio de evaluación de carácter descriptivo. Hemos seleccionado algunos de los procesos clave del sistema de medicación: prescripción, dispensación, preparación y administración de los medicamentos. Con el fin de describir el sistema de medicación, fueron utilizados para la recogida de datos: entrevistas, observación del participante y análisis de registros médicos. Hemos identificado un gran número de pasos y los profesionales implicados, y los problemas relacionados con la seguridad y el medio ambiente durante la prescripción, dispensación, preparación y administración de los medicamentos. Sistemas inseguros pueden generar consecuencias diferentes para los pacientes y las instituciones de salud, en este sentido es necesario aplicar estrategias dirigidas a cambiar la cultura de la detección de deficiencias con el fin de ayudar a los profesionales en la prevención de errores a través de medidas que aseguren la calidad de procedimientos realizados.This study aimed to analyze the medication system in a specialized hospital in Rio de Janeiro. This is an evaluation study of a descriptive nature. We selected some of the key processes of the medication system: prescribing, dispensing, preparation and administration of medicines. In order to describe the system of medication were used for data collection: interviews, non-participant observation and analysis of medical records. We identified a large number of steps and involved professionals, and problems related to safety and the environment during the prescribing, dispensing, preparation and administration of medicines. Insecure systems can generate different consequences for patients and health institutions, in this sense is necessary to implement strategies aimed at changing the culture of detecting faults in order to help professionals in the prevention of errors through measures that ensure quality of procedures performed.

Os benzodiazepínicos são medicamentos que podem causar riscos aos idosos. Este estudo teve como objetivo verificar e analisar a prevalência da utilização de benzodiazepínicos por idosos cadastrados em uma Estratégia Saúde da Família de Diamantina - Minas Gerais. Trata-se de estudo descritivo, realizado com 27 idosos, de maio a julho de 2010, por meio de questionário semiestruturado. Utilizou-se a análise descritiva junto aos dados. Como resultados, destacaram-se a faixa etária de 71 a 75 anos (25,92%), gênero feminino (88,88%) e, em relação à escolaridade, o primeiro grau incompleto (66,66%). Os medicamentos mais usados foram: Diazepam (37,03%), Clonazepam (25,92%), Bromazepam (18,51%) e Alprazolam (11,11%). 88,90% dos entrevistados possuíam receita e 11,10% não a possuíam. Dentre os idosos que possuíam receita, 33,33% não a seguiam. Faz-se presente a necessidade de reorganizar o processo de trabalho na instituição investigada, de forma que se propicie uma adequação das prescrições e um seguimento mais eficaz destas.Las benzodiazepinas son medicamentos que pueden causar riesgos a los ancianos. Este estudio tuvo como objetivo verificar y analizar la prevalencia del uso de benzodiazepinas en ancianos registrados en una Estrategia de Salud Familiar de Diamantina - Minas Gerais - Brasil. Este es un estudio descriptivo con 27 ancianos, que ocurrió de mayo a julio de 2010, a través de cuestionario seme estructurado. El análisis descriptivo fue utilizado. Como resultados, se destacó la faja etaria de 71 a 75 años (25,92%), sexo femenino (88,88%) y escolaridad primaria incompleta (66,66%). Los medicamentos más usados fueron: diazepam (37,03%), clonazepam (25,92%), bromazepam (18,51%) y alprazolam (11,11%). El 88,9% de los entrevistados tienen receta médica, mientras 11,10% no la poseen. Entre los ancianos con receta, 33,3% no la siguen. Se hace necesario reorganizar el proceso de trabajo en la institución investigada, para hacer propicia la adecuación de las prescripciones y seguimiento optimizado de las mismas. Palabras clave: Sistemas de Medicación. Utilización de Medicamentos. AncianoBenzodiazepines are drugs that may cause risks to the elderly. The purpose of this study was to verify and analyze the prevalence of the use of benzodiazepines among elderly patients enrolled in a Family Health Strategy in Diamantina, Minas Gerais, Brazil. This descriptive study was performed with 27 elderly individuals, from May to July 2010, using a semi-structured questionnaire. A descriptive analysis of the data was performed. Results show that most participants were between 71 and 75 years old (25.92%), female (88.88%) and had incomplete primary education (66.66%). The most common drugs were: Diazepam (37.03%), Clonazepam (25.92%), Bromazepam (18.51%) and Alprazolam (11.11%). Of all participants, 88.90% had prescriptions for their medication and 11.10% did not. Among those with prescriptions, 33.33% did not comply with recommendations. There is a need to reorganize the working process at the studied institution to promote an adaptation of the prescriptions and a more effective compliance.

Este estudo objetivou identificar e analisar os erros no preparo de medicamentos em unidade pediátrica de uma instituição hospitalar. Trata-se de estudo descritivo, realizado com quatro profissionais responsáveis pelo preparo dos medicamentos de um hospital do interior do Estado de Minas Gerais, que foram submetidos à técnica de observação estruturante e formulário. Utilizou-se a análise descritiva junto aos dados. Como resultados, destacam-se a inexistência de diretrizes para o preparo de medicamentos, presença de interrupções durante o processo, não utilização das técnicas de lavagem das mãos e de desinfecção de frascos e ampolas. Faz-se necessária a conscientização dos profissionais para a ocorrência e consequências dos erros cometidos pela equipe, como forma de estímulo para a prevenção dos mesmos, através de práticas seguras e efetivas, a fim de ampliar a qualidade da assistência.Este estudio tuvo como objetivo identificar y analizar los errores en la preparación de medicamentos en la unidad de pediatría de un hospital. Este es un estudio descriptivo con 04 personas responsables de la preparación de medicamentos en una institución hospitalaria del interior de Minas Gerais, Brasil, que se sometieron a la técnica de observación estructurante y un formulario. El análisis descriptivo fue utilizado junto a los datos. Los resultados destacan la falta de directrices para la preparación de las drogas, la presencia de las interrupciones durante el proceso, no utilice las técnicas de lavado de manos y desinfección de botellas y frascos. Es necesario la toma de consciencia de los profesionales a la ocurrencia y las consecuencias de los principales errores realizados por el equipo, como un estímulo para la prevención a través de prácticas seguras y eficaces para mejorar la calidad de la atención.This study aimed to identify and analyze errors in the preparation of medicines in the pediatric unit of a hospital. This descriptive study was performed with 04 professionals responsible for preparation of medicines developed in a hospital in the interior of Minas Gerais, Brasil, that were submitted to the technique of structural observation and formulary. A descriptive analysis of the data was performed. The results highlight the lack of guidelines for the preparation of drugs, presence of interruptions during the process failure of utilization of recommended hand washing techniques, and disinfection of bottles and vials. It is necessary to make professionals aware of the occurrence and consequences of the main mistakes made by the team, as a stimulus for prevention through safe and effective practices to improve the quality of care.

OBJECTIVE: To analyze the prevalence and types of prescribing and dispensing errors occurring with high-alert medications and to propose preventive measures to avoid errors with these medications. INTRODUCTION: The prevalence of adverse events in health care has increased, and medication errors are probably the most common cause of these events. Pediatric patients are known to be a high-risk group and are an important target in medication error prevention. METHODS: Observers collected data on prescribing and dispensing errors occurring with high-alert medications for pediatric inpatients in a university hospital. In addition to classifying the types of error that occurred, we identified cases of concomitant prescribing and dispensing errors. RESULTS: One or more prescribing errors, totaling 1,632 errors, were found in 632 (89.6%) of the 705 high-alert medications that were prescribed and dispensed. We also identified at least one dispensing error in each high-alert medication dispensed, totaling 1,707 errors. Among these dispensing errors, 723 (42.4%) content errors occurred concomitantly with the prescribing errors. A subset of dispensing errors may have occurred because of poor prescription quality. The observed concomitancy should be examined carefully because improvements in the prescribing process could potentially prevent these problems. CONCLUSION: The system of drug prescribing and dispensing at the hospital investigated in this study should be improved by incorporating the best practices of medication safety and preventing medication errors. High-alert medications may be used as triggers for improving the safety of the drug-utilization system.

In this qualitative study, we adapted photographic research methods from earlier nursing research to identify factors related to organization, storage and distribution that could lead to errors in the selection, preparation and administration of medications. The research excerpt presented here was developed in a clinical unit of an urban Brazilian public hospital. The research participants were nurses working at that unit and students from the two final semesters of the Undergraduate Nursing Course. We collected digital photographs of the medication system and subsequently used photo elicitation to review the images with research participants, so as to obtain their perceptions and narratives of working with medications in the unit. We report selected findings here on the organization, storage and distribution of medications, which indicate there is room to improve the safety of the medication system.En este estudio cualitativo, se adoptó el método de investigación fotográfica de estudios anteriores, para identificar factores relacionados a la organización, acondicionamiento y distribución, los que podrían conducir a errores en la selección, preparación y administración de medicamentos. Esta parte de la investigación que se presenta fue desarrollada en una unidad de clínica médica de un Hospital Público, en Brasil. Los participantes de la investigación fueron enfermeros que trabajaban en aquella unidad y estudiantes de los dos últimos semestres del Curso de Graduación en Enfermería. Fueron obtenidas fotografías digitales del sistema de medicación y subsecuentemente, se obtuvieron las fotos para analizar las imágenes con los participantes de la investigación, a fin de obtener sus percepciones y narrativas al respecto del trabajo con medicamentos en aquella unidad. Se presenta una selección de los principales hallazgos de la investigación sobre organización, acondicionamiento y distribución de medicamentos, indicando que hay espacio para mejorar la seguridad del sistema de medicación.Neste estudo qualitativo, adaptou-se o método de pesquisa fotográfica de estudos anteriores, para identificar fatores relacionados à organização, acondicionamento e distribuição que poderiam levar a erros na seleção, preparo e administração de medicamentos. O recorte da pesquisa apresentado foi desenvolvido em unidade de clínica médica de um hospital público, Brasil. Os participantes da pesquisa foram enfermeiros que trabalhavam naquela unidade e acadêmicos dos dois últimos semestres do curso de graduação em Enfermagem. Obtiveram-se fotografias digitais do sistema de medicação e, subsequentemente, utilizou-se a elicitação das fotos para rever imagens com os participantes da pesquisa, a fim de obter suas percepções e narrativas a respeito do trabalho com medicamentos, naquela unidade. Apresenta-se uma seleção dos principais achados da pesquisa sobre organização, acondicionamento e distribuição de medicamentos, indicando que há espaço para melhorar a segurança do sistema de medicação.

PRN is the acronym for ‘pro re nata,’ written against prescriptions whose administration should be based on patients’ needs, rather than at set times. The aim of this systematic review was to explore safety issues and adverse events arising from PRN prescription and administration. Electronic databases including Scopus, PubMed [including Medline], Embase, Cinahl, Web of Science and ProQuest were systematically searched to retrieve articles published from 2005 to 2017. Selection criteria: we included all randomized controlled trials (RCTs) and studies with comparison groups, comparing PRN prescription and administration with scheduled administration, where safety issues and adverse events were reported. The authors independently assessed titles, abstracts and full-texts of retrieved studies based on inclusion criteria and risk of bias. Results were summarised narratively. The search identified 7699 articles. Title, abstract and full-text appraisals yielded 5 articles. The included studies were RCTs with one exception, a pre-test post-test experimental design. Patient populations, interventions and outcomes varied. Studies compared patient-controlled or routine administration with PRN and one trial assessed the effect of a practice guideline on implementation of PRN administration. More analgesia was administered in the patient-controlled than the PRN arms but pain reduction was similar. However, there was little difference in administration of psychotropic medicines. No differences between patient-controlled and PRN groups were reported for adverse events. The PRN practice guideline improved PRN patient education but non-documentation of PRN administration increased. This systematic review suggests that PRN safety issues and adverse events are an under-researched area of healthcare practice. Variations in the interventions, outcomes and clinical areas make it difficult to judge the overall quality of the evidence. Well-designed RCTs are needed to identify any safety issues and adverse events associated with PRN administration.

This study aimed to identify and categorize publications about themes related to medication administration in Brazilian nursing journals between 1987 and 2008. From a survey in the main health databases, we reviewed literature about the theme in six Brazilian journals, classifying the articles into care, teaching, research, technique, medication errors, communication and specific drugs. One hundred eight articles were identified, particularly in the Revista Latino-Americana de Enfermagem and the Revista Brasileira de Enfermagem. The author Cassiani and the category specific drugs stand out as responsible for the largest number of articles published. Efforts need to be added up with a view to a more expressive production of articles on medication administration.Este estudio objetivó identificar y categorizar los artículos de periódicos nacionales de enfermería que abordan temas referentes a la administración de medicamentos en el período de 1987 a 2008. A partir de la búsqueda realizada en las principales bases de datos de la salud, se utilizó la revisión de literatura acerca de la temática en seis periódicos nacionales, categorizando los artículos en lo referente a: asistencia; enseñanza; investigación; técnica y errores de medicación; comunicación; y, medicamentos específicos. Fueron identificados 108 artículos, destacándose la Revista Latino-Americana de Enfermería y la Revista Brasileña de Enfermería y el autor Casiani y la categoría medicamentos específicos, como aquellos responsables por la cantidad más expresiva de artículos publicados. Es necesario sumar esfuerzos para realizar una producción más expresiva de artículos relacionados a la administración de medicamentos.Este estudo objetivou identificar e categorizar os artigos de periódicos nacionais de enfermagem que abordam temas referentes à administração de medicamentos no período de 1987 a 2008. A partir da busca realizada nas principais bases de dados da saúde, utilizou-se a revisão de literatura acerca da temática em seis periódicos nacionais, categorizando os artigos em assistência, ensino, pesquisa, técnica e erros de medicação, comunicação e medicamentos específicos. Foram identificados 108 artigos, destacando-se a Revista Latino-Americana de Enfermagem e a Revista Brasileira de Enfermagem e o autor Cassiani e a categoria medicamentos específicos, como aqueles responsáveis pelo mais expressivo quantitativo de artigos publicados. É necessária a soma de esforços para uma mais expressiva produção de artigos relacionados à administração de medicamentos.

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 (Ç2 = 12.703 and p < 0.001) and D (Ç2 = 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.No Brasil, milhões de prescrições não apresentam os requisitos legais necessários para garantir a correta dispensação e administração dos medicamentos. Este estudo multicêntrico exploratório objetivou analisar a adequação das prescrições em quatro hospitais brasileiros e identificar eventuais erros causados pelas inadequações. A amostra consistiu de 864 prescrições obtidas nas clínicas médicas dos hospitais em janeiro de 2003. Os dados foram coletados por três enfermeiras durante uma semana através de instrumento estruturado com variáveis sobre: tipo de prescrição; legibilidade; completude; presença de abreviações, alterações e rasuras. Houve diferenças estatisticamente significativas entre prescrição eletrônica no hospital A e manuscritas nos C (Ç2 = 12,703 e p < 0,001) e D (Ç2 = 14,074 e p < 0,001). Abreviações foram usadas em mais de 80% das receitas nos hospitais B, C e D. Alterações foram encontradas em prescrições de todos os hospitais, com níveis mais elevados no B (35,2%) e A (25,3%). Este estudo identificou uma série de pontos vulneráveis na fase prescrição dos sistemas de medicação dos hospitais. Portanto, médicos, farmacêuticos e enfermeiros deverão juntos propor estratégias para evitar erros de prescrição.

Background: The dose of anaesthetic and opioid drugs must be continuously adjusted after the induction of general anaesthesia to maintain an adequate depth of anaesthesia. The TI.VA algorithm is a multiple-input/multiple-output algorithm designed to optimise the balance between anaesthetic and opioid concentrations during general anaesthesia. It applies vector analysis to a two-dimensional matrix to quantify any inadequacy of the depth of anaesthesia at any given moment and determine any drug dose adjustments required to achieve an adequate depth of anaesthesia. This study aimed to capture preliminary data on the performance and safety of the TI.VA algorithm during total i.v. anaesthesia in patients., Methods: This prospective study enrolled nine patients with breast cancer scheduled to undergo surgery. General anaesthesia was induced under manual control using propofol and remifentanil. Anaesthesia was guided using the TI.VA algorithm from skin incision until surgical resection was completed. The quality of anaesthesia was assessed through an analysis of performance errors. A bispectral index global score (GS BIS ) <50 was considered an acceptable target for algorithm performance., Results: All nine procedures were completed without any adverse events and none of the patients recalled any intraoperative event. Overall, we analysed 3417 monitoring points corresponding to 285 min of surgery. All patients presented a GS BIS below the cut-off value of 50., Conclusions: The TI.VA algorithm provides adequate control of clinical anaesthesia. A more sophisticated prototype needs to be developed before the trial is expanded to include larger patient populations., Clinical Trial Registration: NCT05199883., (© 2023 The Authors.)

This study analyzed questions presented by nursing technicians and auxiliaries during medication preparation and administration. Data were collected through a form in which nurses who worked in the hospitalization unit of a general hospital in São Paulo, Brazil, were asked to take notes of any questions asked to them. Most of the 255 questions were related to medication dilution (103). Regarding the answers source, only 7.5% of answers were obtained from pharmaceutical professionals, 35.5% of the answers given by nurses was incorrect or partially correct, which can constitute a factor for medication administration errors. In addition, there are no pharmacists present in hospitalization units of Brazilian hospitals. These professionals could, jointly with nurses, facilitate medication orientation to nursing professionals during preparation and administration, as well as to patients themselves.Este estudio analizó las preguntas presentadas por técnicos y auxiliares de enfermería a los enfermeros durante la preparación y administración de medicamentos. Para recopilar los datos, se utilizó un formulario entregue a los enfermeros de unidades de internación de un hospital general del interior del Estado de São Paulo, Brasil, solicitando que anotaran las dudas que recibieran. La mayoría de las 255 preguntas estaba relacionada a la disolución del medicamento (103). Respecto a las respuestas, solamente el 7,5% de estas fue obtenido a través de los profesionales de la farmacia. Se destaca que el 35,5% de las respuestas emitidas por los enfermeros estaban incorrectas o parcialmente correctas, lo que puede constituir un factor para errores en la administración de medicamentos. Además, no existen farmacéuticos en las unidades de internación en los hospitales brasileños. Estos podrían, en conjunto con los enfermeros, facilitar la orientación de los profesionales de enfermería en cuanto a los medicamentos, en el momento de su preparación y administración, y también de los propios pacientes.Este estudo analisou os questionamentos apresentados por técnicos e auxiliares de enfermagem aos enfermeiros durante o preparo e administração de medicamentos. Para coleta dos dados utilizou-se um formulário entregue aos enfermeiros de unidades de internação de um hospital geral do interior paulista, solicitando que anotassem as dúvidas dos profissionais da equipe que lhe fossem endereçadas. Foram registrados pelos enfermeiros 255 questionamentos sendo que a maioria destes estava relacionada à diluição do medicamento (103). Com relação às respostas dos enfermeiros às dúvidas, somente 7,5% destas foram obtidas através dos profissionais da farmácia. Ressalta-se que 35,5% das respostas emitidas pelos enfermeiros estavam incorretas ou parcialmente corretas podendo constituir fator para erros na administração de medicamentos. Somado a isto, inexistem farmacêuticos nas unidades de internação nos hospitais brasileiros, os quais poderiam, juntamente com o enfermeiro, facilitar a orientação dos profissionais de enfermagem quanto aos medicamentos, no momento do preparo e administração dos mesmos, bem como ao próprio paciente.

Este estudo analisou, em quatro hospitais brasileiros, tipos, causas, providências administrativas tomadas e sugestões, em relação aos erros na medicação, na perspectiva dos profissionais envol-vidos no sistema de medicação. Trata-se de um estudo multicêntrico, do tipo survey exploratório. A amostra constou de profissionais de clínica médica e farmácia, dos referidos hospitais. Para coleta de dados, utilizou-se a técnica de entrevista semi-estruturada. Os resultados evidenciaram que os tipos de erros mais citados pelos profissionais foram aqueles relacionados à prescrição/transcrição dos medicamentos. A falta de atenção, falhas individuais e problemas na administração dos serviços constituíram importantes atributos das causas dos erros. Relatórios foram as prin-cipais providências tomadas ante os erros e mudanças nas atitudes individuais as mais citadas como forma de prevení-los.E este estudio se analizó, en cuatro hospitales brasileños, tipos, causas, providencias administrativas tomadas y sugerencias, en relación a errores en la medicación, en la pers-pectiva de los profesionales involucrados en el sistema de medicación. Se trata de un estudio multicéntrico, del tipo survey exploratorio. La muestra estuvo constituida por profesionales de la clínica médica y farmacia, de los referidos hospitales. Para la recolección de datos, se utilizó la técnica de la entrevista semi-estructurada. Los resultados evidenciaron que los tipos de errores más citados por los profesionales fueron aquellos relacionados a la prescripción/transcripción de los medica-mentos. La falta de atención, fallas individuales y problemas en la administración de los servicios constituyeron importantes atri-butos de las causas de los errores. Los informes fueron las prin-cipales providencias tomadas ante los errores y los cambios en las actitudes individuales las más citadas como forma de prevenirlos.This study analyzed the causes, types, administrative measures taken and suggestions concerning medication errors according to the perspective of professionals involved with the medication systems in four Brazilian hospitals. It is an exploratory, survey-type, multicentric study. The sample consisted of professionals from the medical clinic and pharmacy in the above-mentioned hospitals. Semi-structured interviews were used for data collection. Results showed that the most frequently error types mentioned by the professionals were related to medication ordering/transcription. Lack of attention, individual mistakes and problems in service management were the major causes of errors. Reports were the main measures taken in view of errors, and changes in individual attitudes were the most frequently mentioned form to prevent them.

Estudo de revisão que teve como objetivo analisar a produção científica da enfermagem acerca da administração de medicamentos, no período de 1999 a 2004. Para o levantamento dos artigos foram consultados periódicos de enfermagem indexados no sistema Medline e LILACS no período de abril a junho de 2005. Foram encontrados 25 artigos em 07 revistas indexadas em Qualis, periódicos nacionais e internacionais, categoria A e B. Optamos pela análise de conteúdo e sistema de categorização. Verificamos que as produções científicas versam sobre vários aspectos, havendo necessidade de estudos acerca das questões éticas. Concluímos que o cuidado deve ser expresso levando em consideração os diversos aspectos humanos.El estudio del tipo analisis documental tuvo como objetivo analizar la producción científica de la enfermería acerca de la administración de medicamentos, en el periodo de 1999 a 2004. Para el levantamiento de los artículos fueron consultados periódicos de enfermería indexados en el sistema Medline y LILACS en el periodo de abril a junio de 2005. Fueron encontrados 25 artículos en 07 revistas indexadas en Qualis, periódicos nacionales e internacionales, categoría A y B. Optamos por el analisis de contenido y sistema de categorización. Verificamos que las producciones científicas versan sobre varios aspectos, habiendo necesidad de estudios acerca de las cuestiones éticas. Concluimos que el cuidado debe ser expreso llevando en consideración los diversos aspectos humanos.The review had as objective to analyse the nursing scientific production about the medicine administration, during the period from 1999 to 2004. For the search of the articles it was consulted articles of nursing index in Medline and LILACS databases during the period from April to June 2005. It was found 25 articles in 7 journals indexed in Qualis, national and international articles, categories A and B. We chose content analysis and system of categorization. We verified that scientific production is about several aspects, pointing the need of studies about ethics issues. We concluded that care must be expressed taking in consideration the diverse human aspects.

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Smart infusion pump technology is a mainstay in health care, and the integration and use of those pumps is crucial for patient safety. An institution purchasing smart infusion pumps has the ability to trial the various vendors before purchase, however literature that documents a conversion from one pump to another is lacking. This article describes the conversion from one smart infusion pump platform to another at a government institution and a large multisite facility. The differences in 2 smart infusion pumps are described as well as lessons learned following the conversion in both organizations. [ABSTRACT FROM AUTHOR]

Objective: The impact of providing nursing staff access to data collected through a medication dose tracking technology (MDTT) web portal was investigated. Methods: A quasi-experimental, nonrandomized, pre-post intervention study was conducted in the Cardiothoracic Intensive Care Unit (CTICU) at Duke University Hospital. The change in the number of medication requests per dispense routed to the pharmacy electronic health record (EHR) in-basket was analyzed pre and post web portal access. Other endpoints included the number of MDTT web portal queries per day by nursing staff, change in nursing satisfaction survey scores, and technician time associated with processing medication requests pre and post web portal access. The pre web portal access phase of the study occurred from June 1, 2014 to August 31, 2014. The post web portal access phase occurred from October 1, 2014 to December 31, 2014. Results: An 11.4% decrease in the number of medication requests per dispense was exhibited between the pre and post web portal access phases of the study (0.0579 vs 0.0513, respectively; p < .001). Pre and post surveys showed a significant improvement in nurses' satisfaction regarding access to information on the location of medications ( p = .009). Additionally, CTICU nursing staff utilized the MDTT web portal for 3.21 queries per day from October 1, 2014 to December 31, 2014. Conclusion: Providing nurses access to data collected via an MDTT decreased the number of communications between nursing and pharmacy staff regarding medication availability and led to statistically significant improvements in nursing satisfaction for certain aspects of the medication distribution process. [ABSTRACT FROM AUTHOR]

Este estudo exploratório analisou o processo do preparo e administração de medicamentos de unidades de clínica médica de quatro hospitais brasileiros, localizados nas Regiões Sudeste, Centro-oeste e Nordeste do Brasil. Identificou os problemas que podem contribuir para a ocorrência de erros de medicação e propôs medidas de melhorias. Os dados foram coletados através de observação não-participante e direta das atividades dos profissionais de enfermagem por uma semana. Os resultados revelaram como principais problemas o ambiente no Hospital B, falhas no preparo relacionadas à técnica e ao preparo antecipado dos medicamentos no C e D, falhas de técnica, comunicação e identificação do paciente no A. A formação de uma comissão multidisciplinar para avaliar o sistema, grupos de discussão entre a enfermagem, melhorias do ambiente, cursos e treinamento contínuos e presença efetiva da enfermeira no processo são algumas sugestões para maior qualidade e segurança na assistência aos pacientes.Estudio exploratorio que analizó el proceso de preparación y administración de medicamentos en los servicios clínicos de cuatro hospitales brasileños localizados en las regiones del sureste, centro-oeste y noreste del Brasil. Fueron identificados problemas que pueden contribuir en la ocurrencia de errores de medicación y se propusieron medidas de mejoría. Los datos fueron recolectados a través de observación directa y no participante de las actividades de los profesionales de enfermería durante una semana. Los resultados revelaron problemas como: el ambiente en el hospital B, fallas en la preparación relacionadas a la técnica y a la preparación anticipada de los medicamentos en el C y en el D, fallas en la técnica, comunicación e identificación del paciente en el hospital A. La formación de una comisión multidisciplinaria para evaluar el sistema, grupos de discusión entre enfermería, mejoría en el ambiente, cursos de capacitación continua y presencia efectiva de la enfermera en el proceso, son algunas de las sugerencias para mejorar la calidad y la seguridad en la atención a los pacientes.This exploratory study analyzed the medication preparation and administration process in medical-clinical units at four Brazilian hospitals located in the Southeast, Central-West and Northeast, identified problems that can contribute to the occurrence of medication errors and proposed improvement measures. Data were collected through non-participant and direct observation of nursing professionals' activities during one week. The results revealed the following main problems: the environment in Hospital B; preparation errors related to technique and anticipated medication preparation in C and D; technical, communication and patient identification mistakes in Hospital A. Suggestions to achieve greater quality and safety in patient care include the constitution of a multidisciplinary commission to evaluate the system, nursing discussion groups, environmental improvements, permanent courses and training and actual presence of a nurse during the process.

Background: Medication dose-tracking technologies have the potential to improve efficiency and reduce costs associated with re-dispensing doses reported as missing. Data describing this technology and its impact on the medication use process are limited. Objective: The purpose of this study is to assess the impact of dose-tracking technology on pharmacy workload and drug expense at an academic, acute care medical center. Methods: Dose-tracking technology was implemented in June 2014. Pre-implementation data were collected from February to April 2014. Post-implementation data were collected from July to September 2014. The primary endpoint was the percent of re-dispensed oral syringe and compounded sterile product (CSP) doses within the pre- and post-implementation periods per 1,000 discharges. Secondary endpoints included pharmaceutical expense generated from re-dispensing doses, labor costs, and staff satisfaction with the medication distribution process. Results: We observed an average 6% decrease in re-dispensing of oral syringe and CSP doses from pre- to post-implementation (15,440 vs 14,547 doses; p = .047). However, when values were adjusted per 1,000 discharges, this trend did not reach statistical significance ( p = .074). Pharmaceutical expense generated from re-dispensing doses was significantly reduced from pre- to post-implementation ($834,830 vs $746,466 [savings of $88,364]; p = .047). We estimated that $2,563 worth of technician labor was avoided in re-dispensing missing doses. We also saw significant improvement in staff perception of technology assisting in reducing missing doses ( p = .0003), as well as improvement in effectiveness of resolving or minimizing missing doses ( p = .01). Conclusion: The use of mobile dose-tracking technology demonstrated meaningful reductions in both the number of doses re-dispensed and cost of pharmaceuticals dispensed. [ABSTRACT FROM AUTHOR]

Summary Background There has been limited assessment of the impact that automated medication dispensing machines have on the medication administration process, particularly in Australian emergency departments. The aim of this study is to examine the change in medication retrieval times, number of medications retrieved and staff perceptions before and after the installation of automated dispensing machines in an Australian emergency and trauma centre. Methods A time and motion method recorded the time taken and number of medications retrieved from the medication room by emergency department staff, before and after the installation of two automated dispensing machines. Surveys were administered to staff members to elicit the perceived impact on clinical practice, utilising 5-point Likert scales. Results A total of 954 medication retrievals (1030 medications) were recorded in the pre-implementation period and 842 (991 medications) in the post-implementation period. The mean time taken to retrieve any medication was significantly longer in the post-implementation period (+5.7 s; p < 0.01). For schedules 2, 3, 4 or unscheduled medications, the mean time increased by 26.9 s ( p < 0.01), but decreased by 36.1 s ( p < 0.01) for schedule 8 or 11 medications. The mean number of medications per retrieval increased slightly in the post implementation period (+0.10; p < 0.01). Staff perceptions were that automated dispensing machines improve knowledge of medications on imprest ( p = 0.03) and reduced medication retrieval time ( p < 0.01). Conclusions This study found that the medication retrieval process was slower with automated dispensing machines for Schedules 2, 3, 4 and unscheduled medications, but quicker for Schedule 8 and 11 medications in an Australian emergency and trauma centre. Although retrieving medications took slightly longer overall, staff believed automated dispensing machines save time. [ABSTRACT FROM AUTHOR]

Objective: There have been growing concerns about the impact of drug allergy alerts on patient safety and provider alert fatigue. The authors aimed to explore the common drug allergy alerts over the last 10 years and the reasons why providers tend to override these alerts.Design: Retrospective observational cross-sectional study (2004-2013).Materials and Methods: Drug allergy alert data (n = 611,192) were collected from two large academic hospitals in Boston, MA (USA).Results: Overall, the authors found an increase in the rate of drug allergy alert overrides, from 83.3% in 2004 to 87.6% in 2013 (P < .001). Alarmingly, alerts for immune mediated and life threatening reactions with definite allergen and prescribed medication matches were overridden 72.8% and 74.1% of the time, respectively. However, providers were less likely to override these alerts compared to possible (cross-sensitivity) or probable (allergen group) matches (P < .001). The most common drug allergy alerts were triggered by allergies to narcotics (48%) and other analgesics (6%), antibiotics (10%), and statins (2%). Only slightly more than one-third of the reactions (34.2%) were potentially immune mediated. Finally, more than half of the overrides reasons pointed to irrelevant alerts (i.e., patient has tolerated the medication before, 50.9%) and providers were significantly more likely to override repeated alerts (89.7%) rather than first time alerts (77.4%, P < .001).Discussion and Conclusions: These findings underline the urgent need for more efforts to provide more accurate and relevant drug allergy alerts to help reduce alert override rates and improve alert fatigue. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives The implementation of automated dispensing cabinets ( ADCs) in healthcare facilities appears to be increasing, in particular within Australian hospital emergency departments ( EDs). While the investment in ADCs is on the increase, no studies have specifically investigated the impacts of ADCs on medication selection and preparation error rates in EDs. Our aim was to assess the impact of ADCs on medication selection and preparation error rates in an ED of a tertiary teaching hospital. Methods Pre intervention and post intervention study involving direct observations of nurses completing medication selection and preparation activities before and after the implementation of ADCs in the original and new emergency departments within a 377-bed tertiary teaching hospital in Australia. Medication selection and preparation error rates were calculated and compared between these two periods. Secondary end points included the impact on medication error type and severity. Results A total of 2087 medication selection and preparations were observed among 808 patients pre and post intervention. Implementation of ADCs in the new ED resulted in a 64.7% (1.96% versus 0.69%, respectively, P = 0.017) reduction in medication selection and preparation errors. All medication error types were reduced in the post intervention study period. There was an insignificant impact on medication error severity as all errors detected were categorised as minor. Conclusion The implementation of ADCs could reduce medication selection and preparation errors and improve medication safety in an ED setting. [ABSTRACT FROM AUTHOR]

Objective: this study aimed to identify how nurses assess Patient Safety in the medication system through photographic analysis. Methodology: a descriptive and quantitative study conducted in a teaching hospital, with a sample of 34 nurses from inpatient units. Data collection used the photographic method. This study addressed the safety assessment in 10 photographs by choosing a number in a scale from 1 (very unsafe) to 10 (very safe) and data analysis was performed using the Statistical Package for Social Scienses version 20.0. Results: by adapting the scores attributed to the scale, we were able to identify among the photographs: three Totally Unsafe (Level 1), three Unsafe (Level 2), three Partially Safe (Level 3), and one Safe (Level 4). Conclusion: the study highlights the weaknesses in the medication system, which requires that nursing review its work process to prevent errors, basing the care on Patient Safety. [ABSTRACT FROM AUTHOR]

Objective: to compare electronic and manual prescriptions of a public hospital of Brasilia, identifying risk factors for the occurrence of medication errors. Method: descriptive-exploratory, comparative and retrospective study. Data collection occurred from July 2012 to January 2013, using an instrument for the review of the information contained in medical records related to the medication process. A total of 190 manual and 199 electronic records composed the sample, with 2027 prescriptions each. Results: compared to the manual prescription, a significant reduction was observed in the risk factors after implantation of the electronic prescription, in items such as "lack of the form of dilution" (71.1% to 22.3%) and "prescription with brand name" (99.5% to 31.5%). Conversely, the risk factors "no check" and "lack of CRM of the prescriber" increased. The lack of the allergy registration and the occurrences related to medication were the same for both groups. Conclusion: generally, the use of the electronic prescription system was associated with a significant reduction in risk factors for medication errors, concerning the following aspects: illegibility, prescription with brand name and presence of essential items that provide a safe and effective prescription. [ABSTRACT FROM AUTHOR]

Administrar medicamentos aos pacientes é um processo complexo, com várias etapas, contemplando uma série de decisões e ações inter-relacionadas, envolvendo profissionais de várias disciplinas bem como o próprio paciente. Erros podem ocorrer em quaisquer etapas desse processo. Este artigo descreveu os índices, as terminologias e classificações dos erros de medicação e determinou as abordagens que explicam a sua ocorrência quais sejam: a abordagem centrada na pessoa e a centrada no sistema. A finalidade do texto foi a de contribuir, através de elementos teóricos, com as discussões estratégicas de melhoria da qualidade de assistência nas instituições de saúde desse país, focalizando a segurança do paciente no que concerne à terapêutica medicamentosa.La administración de medicamentos en pacientes es un proceso complejo, que consta de varias etapas y que contempla una serie de decisiones y acciones interrelacionadas, envolviendo profesionales de diversas disciplinas, así como el propio paciente. Pueden ocurrir errores en cualquiera de las etapas de este proceso. Este artículo describe los índices, las terminologías y las clasificaciones de los errores en medicación y determinó los abordajes que explican su ocurrencia sea cual sea: el abordaje centrado en la persona y el centrado en el sistema. La finalidad del texto fue la de contribuir, a través de elementos teóricos, con las discusiones estratégicas de cómo mejor la calidad de la atención en las instituciones de salud de este país, enfocando la seguridad del paciente en lo que se refiere a terapeutica medicamentosa.Administering medication to patients is a complex process with various phases which contemplate a series of inter-related decisions and actions involving professionals from a number of disciplines as well as patients themselves. Errors may occur in any phase of such process. This article describes the indexes, terminology and classification of medication errors and determines the approaches which explain their occurrence, namely the person-centered approach and the system-centered approach. The aim of the paper was to contribute, through theoretical elements, to the strategic discussions concerning the improvement of care standards in health care institutions in our country, focusing on patient safety related to drug therapy.

Essa investigação identificou e analisou o sistema de medicação de 04 hospitais universitários, localizados nas cidades de Recife, Ribeirão Preto, Goiânia e São Paulo, após a aprovação nos Comitês de Ética em Pesquisa e da autorização da direção dos hospitais. Os dados foram coletados através de entrevista estruturada com um dos profissionais responsáveis pelo sistema de medicação e observação não participante e direta, por uma semana, nos vários sub-sistemas. Os resultados indicaram pontos que necessitam de aperfeiçoamentos como utilização de abreviações, falta de padronização de horários de administração de medicamentos, falta de informações atualizadas e completas do paciente, farmácia não funcionando 24 horas em um hospital, falta de centro de informações de medicamentos e outros. Evidenciou-se no hospital A 66 etapas, no B 58 etapas, no C 70 etapas e no D 80 etapas do sistema de medicação. Simplificar os processos, diminuindo o número de etapas, é a chave para a redução de erros de medicação.Esa investigación identificó y analizó el sistema de medicación en 04 hospitales universitarios en las ciudades de Recife, Ribeirão Preto, Goiânia y São Paulo, Brasil. Los datos fueron recopilados en dos etapas. En la primera etapa se realizó una entrevista estructurada con uno de los profesionales responsables por el sistema de medicación. En la segunda, se hizo observación no participativa y directa durante una semana. Los resultados indicaron los puntos que necesitan ser perfeccionados, tales como uso de abreviaciones, la falta de un padrón de horarios, falta de información actualizada y completa del paciente, farmacia que no funciona las 24 horas en un hospital, y otros. Se observó en el Hospital A 66 etapas, en el B 58 etapas, en el C 70 etapas y en el D 80 etapas respecto al sistema de medicación. Simplificar el proceso, diminuyendo el número de etapas, es la clave para reducir los márgenes de errores en la medicación.This study identified and analyzed the medication systems in 04 university hospitals located in Recife, Ribeirão Preto, Goiânia and São Paulo, Brazil, after approval by the Research Ethics Committee and authorization by the hospital directors. Data were collected through a structured interview with one of the professionals in charge of the medication system and non-participant and direct observation during one week. The results indicated the points requiring improvement, such as the use of abbreviations, lack of standardization in medication administration times, lack of updated and complete information about the patient, the pharmacy's not working 24 hours a day in hospitals and others. 66 phases were shown in Hospital A, 58 in B, 70 in C, and 80 in D concerning the medication system. Simplifying the processes by reducing the number of phases is the key to reducing medication errors.

Objective: The purpose of this overview (systematic review of systematic reviews) is to evaluate the impact of clinical decision support systems (CDSS) applied to medication use in the care process. Methods: A search for systematic reviews that address CDSS was performed on Medline following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane recommendations. Terms related to CDSS and systematic reviews were used in combination with Boolean operators and search field tags to build the electronic search strategy. There was no limitation of date or language for inclusion. We included revisions that investigated, as a main or secondary objective, changes in process outcomes. The Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) score was used to evaluate the quality of the studies. Results: The search retrieved 954 articles. Five articles were added through manual search, totaling an initial sample of 959 articles. After screening and reading in full, 44 systematic reviews met the inclusion criteria. In the medication-use processes where CDSS was used, the most common stages were prescribing (n=38 (86.36%) and administering (n=12 (27.27%)). Most of the systematic reviews demonstrated improvement in the health care process (30/44 – 68.2%). The main positive results were related to improvement of the quality of prescription by the physicians (14/30 – 46.6%) and reduction of errors in prescribing (5/30 - 16.6%). However, the quality of the studies was poor, according to the score used. Conclusion: CDSSs represent a promising technology to optimize the medication-use process, especially related to improvement in the quality of prescriptions and reduction of prescribing errors, although higher quality studies are needed to establish the predictors of success in these systems.