Erros de administração de medicamentos em um Hospital Universitário: incidência, natureza, gravidade e fatores associados.

Abstract

Introduction: Medication administration errors are frequent and have a high economic and social impact worldwide. Recently, WHO launched the global " Medication without Harm" challenge with the goal of reducing drug damage by 50% by 2022. Although patient safety problems are already recognized and dimensioned in developed countries, studies of this type are still necessary in Brazilian or Latin American reality. This thesis is aimed to determine the incidence, nature, severity and risk factors associated with medication administration errors (MAE) in a Brazilian hospital. Article 1 – Drug administration errors in Latin America: A systematic review. Objective: To determine the frequency and nature of MAEs identified through the direct observation method in hospitals in Latin America. Methods: systematic review of studies published between 1946 and March 2021 conducted by two independent reviewers in seven databases: LILACS via Bireme, PubMed, SciELO, Scopus, Latindex, Embase, and CINAHL. Searches were also performed in references of articles and in grey literature. Results: 1615 articles were found, and 10 studies were included in the final review. The mean MAE rate identified was 32% (IQR: 16–35.8%) and 9.7% (IQR: 7.4%–29.5%) after excluding time errors. The most frequent MAEs were time errors (8.3% to 77.3%), followed by dose errors (1.7% to 26.4%) and omission errors (5.3% to 10.5%). (Assunção-Costa L, Costa de Sousa I, Alves de Oliveira MR, Ribeiro Pinto C, Machado JFF, Valli CG, et al. (2022) Drug administration errors in Latin America: A systematic review. PloS ONE 17(8): e0272123. https://doi.org/10.1371/journal.pone.0272123.) Article 2– Observational study on medication administration errors at a university hospital in Salvador, Brazil: incidence, nature and associated factors. Objective: To identify the prevalence, nature and factors associated with MAE in a University Hospital in Brazil. Methods: Observational, prospective study through the technique of disguised direct observation in the administration of medications, performed in two hospital units (clinical and surgical). The total error rate was calculated by dividing the number of doses with one or more errors by the total opportunity errors observed (TOE). Results: 203 errors were observed in 400 doses administered. The total MAE rate was 36.2% (95% CI: 32.3-40.2). Excluding time errors, the total error rate was 25.1% (95% CI 24.3-32.4). The most frequent errors were technical errors (15.5%), time (11.1%), dose (4.8%) and omission (4.5%). The risk factors associated with MAE were administration, interruptions, workload and ANATOMICAL-THERAPEUTICAL-CHEMICAL (ATC) class of medications. Article 3– Validation of a method to assess the severity of medication administration errors in Brazil: a study protocol. Objective: To establish the validity of an existing method for assessing the severity of drug administration errors in Brazil. This is the first validation of this method for use in Brazil, which will allow researchers to conduct more standardized evaluations of interventions to reduce the impact of medication errors (Assunção-Costa L, Ribeiro Pinto C, Ferreira Fernandes Machado J, Gomes Valli C, Portela Fernandes de Souza LE, Dean Franklin B. Validation of a method to assess the severity of medication administration errors in Brazil: a study protocol. J Public Health Res. 2022 Mar 14;11(2):2623. Doi: 10.4081/jphr.2022.2623. Article 4 – Validation of a method to assess the severity of Medication Administration Errors in Brazil. Objective: To validate the existing method of evaluating the potential clinical significance of MAE developed in the United Kingdom for use in Brazil. Methods: Thirty health professionals from hospitals in 5 regions of Brazil scored 50 cases of medication errors in terms of potential damage to the patient on a scale of 0 to 10, where 0 represented a case without potential effect and 10 a case that would result in death. The validity of the scores was assessed through sixteen cases with the results of the actual known damages, which was compared to the scores given by the professionals. Reliability was evaluated through 10 errors scored on two occasions. Results: excellent G coefficients (≥ 0.8) and a good correlation were found between the known severity values and the average scores attributed by the judges. Conclusion: The Dean and Barber scale (1999) is valid and reliable for use in the Unified Health System in Brazil. Article 5 – Severity of Medication Administration Errors in a teaching hospital in Brazil. Objective: To evaluate the potential severity of administration errors identified through direct observation in a Brazilian university hospital. The 203 errors previously identified were grouped according to similarity in 67 errors, which were submitted to a potential severity assessment by 4 health professionals. An average score was calculated, being considered as a severity index. The professionals judged the potential clinical significance of errors as mild in 8.8% (18), moderate in 82.8% (168) and severe in 8.4% (17) of the cases. The mean score of potential severity was 5.2 (minimum score 2.6 and maximum score 7.7; SD 1.2).