Observation of preparation and administration of drugs by nursing assistants in patients with enteral feeding tube

Este estudo objetivou conhecer o padrão de preparo e administração de medicamentos a pacientes em uso de sondas de nutrição enteral (SNE) internados em hospital universitário de Porto Alegre. Foram acompanhados sessenta auxiliares de enfermagem, em duas unidades de internação, em suas rotinas de trabalho e observadas as suas técnicas, estas foram comparadas com os procedimentos que fazem parte das normas de administração de medicamentos a pacientes em terapia enteral. Os auxiliares realizavam a trituração em 90% dos casos de derivação de forma farmacêutica sólida e para este procedimento, utilizavam preferencialmente os materiais almofariz e pistilo (63,3%). A diluição dos medicamentos era feita principalmente com água da torneira (78,3%). A maioria dos profissionais (91,1%) preparava e administrava juntamente todos os medicamentos que eram prescritos ao paciente. Somente quatro auxiliares realizaram o procedimento em separado. A lavagem da SNE após a administração dos medicamentos foi feita por 75% dos auxiliares. Constatou-se grande diversidade de métodos de trabalho utilizados no momento da derivação, diluição e administração dos medicamentos pelos auxiliares de enfermagem.This study aimed to know the standard of preparation and administration of medicines to patients using probes of enteral nutrition (SNE) hospitalized in a university hospital in Porto Alegre. Were accompanied sixty nursing auxiliaries, in two units of hospital, in their routine work and observed their techniques. The practice was compared with procedures that are part of the rules for administration of medicines to patients on enteral therapy. The auxiliary held a grinding in 90% of cases of solid pharmaceutical preparation. For this procedure they used preferably the mortar and pistil (63.3%). The dilution of the drugs was made mainly with tap water (78.3%). Most professionals (91.1%) prepare and administer together all medications that were prescribed to the patient. Only four assistants performed the procedure separately. The washing of the SNE after administration of drugs was made for 75% of assistants. It was observed a great diversity of working methods used at the derivation, dilution and administration of medicines by nursing auxiliaries

Therapeutic itinerary: trajectory for resolution of adverse events of patients using warfarin in Southern Brazil

Warfarin is the most used anticoagulant in primary health care. Due to the narrow therapeutic index, its users are more susceptible to adverse events. The objective of this study was to describe the itinerary of the public health sector patients for resolution of adverse events related to warfarin. It is a prospective open cohort, held for a period of 18 months with warfarin users of the Brazilian public health system. Data were collected by monthly interviews and from patient records. Results: Sixty nine patients were interviewed, 64 of them completed monitoring and five died. Bleeding and venous thromboembolism were more frequent in patients starting treatment. It was observed that when adverse events have occurred, in most cases the patient held self-care at home (57%). During the follow-up, five patients were hospitalized for bleeding. Approximately half of the patients did not present their INR exams to the doctor. Conclusions: This study demonstrates weaknesses in caring for these patients and the need to accompany them, aiming to standardize and guide the itinerary of the anticoagulated patient to solve their problems and improve safety in drug treatment, with less cost to the public health system

Uso de medicamentos extraformulario en niños en un hospital universitario brasileño : estudio descriptivo

Objectives: To characterise the prescription of nonformulary drugs to children and neonates at a Brazilian teaching hospital and identify adverse drug reactions (ADRs), drug interactions, and prescription of potentially hazardous medicines. Methods: A prospective exploratory study was carried out between January and May 2011 at the general paediatric wards and paediatric oncology, paediatric intensive care, and neonatal care units of the study hospital. Non-formulary drugs were categorised as approved, off-label, or not approved for use in children according to Brazilian compendia. Electronic health records were actively searched for ADRs and the possibility of moderate to severe interactions between non-formulary drugs and other medicines was determined with the Micromedex® database. Results: Overall, 109 children or neonates received non-formulary drugs. Of these drugs, 54% were approved for use in children, 12.2% were used offlabel, and 33.8% were not approved for use in children. Non-formulary drugs accounted for 13.4% of total prescriptions; 5.3% of drugs had a potential for interactions and five were possibly associated with ADRs. Conclusion: Prescription of non-formulary drugs not approved for use in children was common at the study hospital. Studies such as this provide information on the use of medicines for special indications and permit assessment of the relevance of hospital formularies for the paediatric population.Objetivos: Caracterizar la prescripción de medicamentos extra-formulario en niños y neonatos en un hospital universitario brasileño e identificar las reacciones adversas (RAM), interacciones y prescripción de medicamentos potencialmente peligrosos. Métodos: Se realizó un estudio prospectivo exploratorio entre enero y mayo de 2011 en el servicio general de pediatría, oncología pediátrica y cuidados intensivos pediátricos del hospital en estudio. Los medicamentos extra-formulario se clasificaron en autorizados, off-label o no autorizados para uso en niños de acuerdo con el vademécum brasileño. Se buscó activamente en las historias clínicas electrónicas RAM y se determinó la posibilidad de interacciones moderadas o severas entre los medicamentos extra-formulario y otros medicamentos usando la base de datos Micromedex®. Resultados: En total 109 niños o neonatos recibieron medicamentos extra-formulario. De estos medicamentos, el 54% estaban autorizados para uso en niños, el 12,2% eran off-label y el 33,8% no estaban autorizados para uso en niños. Los medicamentos extra-formulario representaron el 13,4% del total de prescripciones; el 5,3% tuvo potenciales interacciones y 5 estuvieron posiblemente asociados a RAM. Conclusión: La prescripción de medicamentos extra-formulario no autorizados para uso en niños fue común en el hospital analizado. Estudios como este proporcionan información sobre el uso de medicamentos para indicaciones especiales y permiten evaluar la relevancia de los formularios hospitalarios para la población pediátrica

Extemporaneous oral preparations: an alternative for hospitalized children

The lack of pharmaceutical formulations proper for children favors the manipulation of extemporaneous oral preparations by hospital pharmacies. The study aimed to identify the medications reformulated by the pharmacy of Hospital de Clínicas de Porto Alegre, as well as the availability for use in oral liquid formulations on Pediatrics. The drugs were classified according to the criteria approved by the Food and Drug Administration; for that, the DrugDex-Micromedex® database was used, while the reformulated items were classified as unlicensed. 2026 medicines in the 342 prescriptions were analyzed, while 35 % were classified as off-label use and 14.9 % as not approved. Extemporaneous preparations were made for 3.8 % of the items, whereas 95 % showed stability studies in the literature. The drugs most frequent compounded in extemporaneous formulations drugs were baclofen (18.9 %), furosemide (10 %) and ursodeoxycholic acid (7.6 %). The results of this and other studies highlight the problem occasioned by the lack of pharmaceutical formulations appropriate for children.Comunicación breveShort communicationComunicação breveColegio de Farmacéuticos de la Provincia de Buenos Aire

Therapeutic itinerary : trajectory for resolution of adverse events of patients using warfarin in Southern Brazil

Warfarin is the most used anticoagulant in primary health care. Due to the narrow therapeutic index, its users are more susceptible to adverse events. The objective of this study was to describe the itinerary of the public health sector patients for resolution of adverse events related to warfarin. It is a prospective open cohort, held for a period of 18 months with warfarin users of the Brazilian public health system. Data were collected by monthly interviews and from patient records. Results: Sixty nine patients were interviewed, 64 of them completed monitoring and five died. Bleeding and venous thromboembolism were more frequent in patients starting treatment. It was observed that when adverse events have occurred, in most cases the patient held self-care at home (57%). During the follow-up, five patients were hospitalized for bleeding. Approximately half of the patients did not present their INR exams to the doctor. Conclusions: This study demonstrates weaknesses in caring for these patients and the need to accompany them, aiming to standardize and guide the itinerary of the anticoagulated patient to solve their problems and improve safety in drug treatment, with less cost to the public health system

Estoque domiciliar de medicamentos na comunidade ibiaense acompanhada pelo Programa Saúde da Família, em Ibiá-MG, Brasil

The objective of this study was to examine the stock of drugs in the community that is assisted by Programa Saúde da Família (PSF - Family Health Programme) in the city of Ibiá, state of Minas Gerais. The purpose was to describe users' characteristics, storage conditions, therapeutic classes and pharmaceutical forms, the origin of the drugs, as well as the cost of the drugs provided by the Public Health System. A total number of 285 households were visited from July to September 2004. It was verified that the average number of drugs per household was 8.4 and that 93.5% of the surveyed families had at least one sort of drug in stock. The most stored drugs were: analgesics (11.15%), diuretics (6.42%), antibacterials for systemic use (5.82%), anti-inflamatory drugs (5.08%) and antacids (4.10%). Although there is a considerable number of drugs stored in the households, the number of drugs without prescription coming from the Public Health System was small. This is a good consequence of the Pharmaceutical Assistance services in the municipality. On the other hand, it was prescription (self-medication). In addition, 18.5% of the drugs were no longer valid for use. Part of the drug storage at home results from prescriptions in amounts that are higher than what is necessary for treatment (20.0%), from non-completion of the prescribed treatment (17.0%) and from acquisition of drugs for self-medication (9.0%).The study suggests the need to educate users in relation to drugs utilization and storage, and the need to systematize data records in order to manage the resources more efficiently, which will lead to adequate decisions related to the Pharmaceutical Assistance policy.O objetivo do estudo foi examinar o estoque de medicamentos na comunidade Ibiaense acompanhada pelo Programa Saúde da Família (PSF). Buscou-se descrever as características dos usuários, as condições de armazenamento, as classes terapêuticas, as formas farmacêuticas e a procedência dos medicamentos do estoque caseiro. Foram visitados 285 domicílios, no período de julho a setembro de 2004. Verificou-se que a média de medicamentos por domicílio foi de 8,4, e que 93,5% das famílias entrevistadas apresentaram pelo menos um medicamento em estoque. Os medicamentos estocados em maior número foram: analgésicos (11,15%), seguidos dos diuréticos (6,42%), antibacterianos para uso sistêmico (5,82%), anti-inflamatórios (5,08%) e antiácidos (4,10%). Embora seja considerável o número de medicamentos estocados nos domicílios, foi pequeno o número de medicamentos sem prescrição médica procedentes do Sistema Público de Saúde, sendo este um reflexo favorável dos serviços de Assistência Farmacêutica do Município. Apesar disso, foi verificado um elevado percentual (41,6%) de medicamentos adquiridos em farmácias sem a devida prescrição médica (automedicação). Foi encontrado um percentual de 18,5% de medicamentos vencidos. Verificou-se, também, que parte do estoque domiciliar resulta de prescrições com quantidades superiores às necessárias para o tratamento (20%), do não cumprimento do tratamento prescrito (17%) e da aquisição por conta própria (9%). O estudo sugere a necessidade de orientação dos usuários em relação à utilização e ao armazenamento dos medicamentos, à sistematização dos registros de dados e oferece subsídios para adoção de decisões vinculadas ao processo de planejamento e execução das ações na Assistência Farmacêutica