Percepções sobre o erro de medicação: análise de respostas da equipe de enfermagem

El error de medicación se define como cualquier error en el proceso de prescripción, dispensación o administración de una medicación, pudiendo o no traer consecuencias serias. En este estudio, de carácter descriptivo y exploratorio, son evaluados cuatro escenarios con situaciones de práctica de enfermería. El grupo profesional fue constituido de 256 personas y fueron estudiados 89 cuestionarios. Fueron comparadas las respuestas dadas por los enfermeros con las de técnicos y auxiliares de enfermería que deberían opinar si las situaciones representaban o no un error de medicación, si había necesidad de notificación al médico o de completar un informe de ocurrencias. Los resultados demostraron una uniformidad en las respuestas, que traducían dudas si la situación era un error o no, y cuales medidas deberían ser tomadas, evidenciando la necesidad de discutir el tema dentro de las instituciones.O erro de medicação é definido como qualquer erro no processo de prescrição, dispensação ou administração de medicamentos, podendo ou não trazer conseqüências adversas. Neste estudo, de caráter descritivo e exploratório, são avaliados quatro cenários, com situações da prática de enfermagem. O grupo profissional foi constituído por 256 pessoas e foram analisados 89 questionários. Foram comparadas as respostas dadas pelos enfermeiros com as dos técnicos e auxiliares de enfermagem nas quais deveriam opinar se as situações representavam ou não um erro de medicação, se havia necessidade de notificação ao médico e do preenchimento de um relatório de ocorrências. Os resultados demonstraram uniformidade nas respostas, que traduziam dúvidas se a situação era um erro ou não e quais medidas deveriam ser tomadas, evidenciando a necessidade de discutir o tema dentro das instituições.Medication error is defined as any type of error in the prescription, transcription, dispensing and administration process which could bring about serious consequences or not. This descriptive and exploratory study assesses four scenarios showing situations from nursing practice. The study group was composed of 256 professionals and 89 questionnaires were analyzed. The answers given by the registered nurses were compared with those of licensed practical nurses and care aids. They should express their opinion if the situations represented a medication error or not, if it had to be communicated to the physician or an incident report had to be written. The two groups showed uniform answers. They expressed the same doubts to label the situation as an error and which measures should be taken, suggesting the need for further discussion on the matter within the institution

Gestão de serviços de saúde

A unidade introduz algumas reflexões sobre ações de gerenciamento de natureza técnico-assistencial que se operacionalizam no terreno da Atenção Primária e materializam os princípios do Sistema Único de Saúde (SUS), pilares da Estratégia Saúde da Família (ESF). A unidade, assim, aborda questões como habilitação de equipes de saúde da família (geral e bucal), o processo de implantação das mesmas, gerenciamento de ações e avaliação. A gestão dos sistemas é apresentada, assim, através do conceito do pacto pela saúde (2006) e seus três componentes: pacto pela vida, pacto em defesa do SUS e pacto de gestão.Versão 2Organização Pan-Americana da Saúde - OPA

Caracterização de pacientes dependentes de tecnologias de um serviço de internação domiciliar

Aim: to characterize the technology-dependent patients cared for in home care services of a University Hospital in the central region of Rio Grande do Sul, Brazil. Method: quantitative research, with descriptive and cross-sectional design developed with 57 patients dependent on technologies at home. The data were submitted to descriptive statistical analysis. Results: it was found that most patients were male, married, average age of 58 years, low income and education and made use of more than a technological device. And 73.7% used probes to aid in feeding, 24.6% tracheostomy and 22.8% oxygen. It was identified that 56.2% were discharged, 26.3% another hospitalization and 17.5% died. Conclusions: we need to consider that an increasing number of people use technologies at home. Health professionals should be attentive to the health needs of these people making comprehensive and continuous care.Objetivo: caracterizar los pacientes dependientes de tecnología atendidos en un servicio de atención domiciliaria de un Hospital Universitario en la región central del Rio Grande do Sul, Brasil. Método: investigación cuantitativa, diseño descriptivo y transversal, desarrollado con 57 pacientes dependientes de tecnologías en el domicilio. Los datos fueron sometidos a los análisis estadísticos descriptivos. Resultados: se encontró que la mayoría de los pacientes eran hombres, casados, promedio de edad de 58 años, de bajo ingreso y escolaridad y utilizaba más de un dispositivo tecnológico. Siendo que el 73,7% utilizan sondas para ayudar en la alimentación, el 24,6% traqueotomías y el 22,8% oxigenoterapia .Identificó que el 56,2% recibió alta, el 26,3% internan de nuevo y el 17,5% murió. Conclusiones: tenemos que considerar que un número creciente de personas utilizan tecnologías en casa. Profesionales de salud deben ser atentos a las necesidades de estas personas haciendo un cuidado completo y continuo.Objetivo: caracterizar os pacientes dependentes de tecnologias atendidos no serviço de internação domiciliar de um Hospital Universitário da região central do Rio Grande do Sul. Método: pesquisa quantitativa, de delineamento transversal e descritivo, desenvolvida com 57 pacientes dependentes de tecnologias no domicílio. Os dados foram submetidos à análise estatística descritiva. Resultados: verificou-se que a maioria dos pacientes era do sexo masculino, casados, idade média de 58 anos, baixa renda e escolaridade e fazia uso de mais de um dispositivo tecnológico. Sendo que 73,7% utilizavam sondas para auxiliar na alimentação, 24,6% traqueostomia e 22,8% oxigenioterapia. Identificou-se que 56,2% receberam alta, 26,3% reinternaram e 17,5% faleceram. Conclusões: é preciso considerar que um número crescente de pessoas utilizam tecnologias no domicílio. Os profissionais de saúde devem estar atentos às necessidades de saúde destas pessoas possibilitando um cuidado integral e contínuo

Measurement of the J/ψ pair production cross-section in pp collisions at s=13 \sqrt{s}=13 TeV

The production cross-section of J/ψ pairs is measured using a data sample of pp collisions collected by the LHCb experiment at a centre-of-mass energy of $\sqrt{s}=13$ TeV, corresponding to an integrated luminosity of 279 ±11 pb$^{−1}$. The measurement is performed for J/ψ mesons with a transverse momentum of less than 10 GeV/c in the rapidity range 2.0 < y < 4.5. The production cross-section is measured to be 15.2 ± 1.0 ± 0.9 nb. The first uncertainty is statistical, and the second is systematic. The differential cross-sections as functions of several kinematic variables of the J/ψ pair are measured and compared to theoretical predictions.The production cross-section of $J/\psi$ pairs is measured using a data sample of $pp$ collisions collected by the LHCb experiment at a centre-of-mass energy of $\sqrt{s} = 13 \,{\mathrm{TeV}}$, corresponding to an integrated luminosity of $279 \pm 11 \,{\mathrm{pb^{-1}}}$. The measurement is performed for $J/\psi$ mesons with a transverse momentum of less than $10 \,{\mathrm{GeV}}/c$ in the rapidity range $2.0<y<4.5$. The production cross-section is measured to be $15.2 \pm 1.0 \pm 0.9 \,{\mathrm{nb}}$. The first uncertainty is statistical, and the second is systematic. The differential cross-sections as functions of several kinematic variables of the $J/\psi$ pair are measured and compared to theoretical predictions

Measurement of the B0s→μ+μ− Branching Fraction and Effective Lifetime and Search for B0→μ+μ− Decays

A search for the rare decays Bs0→μ+μ- and B0→μ+μ- is performed at the LHCb experiment using data collected in pp collisions corresponding to a total integrated luminosity of 4.4  fb-1. An excess of Bs0→μ+μ- decays is observed with a significance of 7.8 standard deviations, representing the first observation of this decay in a single experiment. The branching fraction is measured to be B(Bs0→μ+μ-)=(3.0±0.6-0.2+0.3)×10-9, where the first uncertainty is statistical and the second systematic. The first measurement of the Bs0→μ+μ- effective lifetime, τ(Bs0→μ+μ-)=2.04±0.44±0.05  ps, is reported. No significant excess of B0→μ+μ- decays is found, and a 95% confidence level upper limit, B(B0→μ+μ-)<3.4×10-10, is determined. All results are in agreement with the standard model expectations.A search for the rare decays $B^0_s\to\mu^+\mu^-$ and $B^0\to\mu^+\mu^-$ is performed at the LHCb experiment using data collected in $pp$ collisions corresponding to a total integrated luminosity of 4.4 fb$^{-1}$. An excess of $B^0_s\to\mu^+\mu^-$ decays is observed with a significance of 7.8 standard deviations, representing the first observation of this decay in a single experiment. The branching fraction is measured to be ${\cal B}(B^0_s\to\mu^+\mu^-)=\left(3.0\pm 0.6^{+0.3}_{-0.2}\right)\times 10^{-9}$, where the first uncertainty is statistical and the second systematic. The first measurement of the $B^0_s\to\mu^+\mu^-$ effective lifetime, $\tau(B^0_s\to\mu^+\mu^-)=2.04\pm 0.44\pm 0.05$ ps, is reported. No significant excess of $B^0\to\mu^+\mu^-$ decays is found and a 95 % confidence level upper limit, ${\cal B}(B^0\to\mu^+\mu^-)<3.4\times 10^{-10}$, is determined. All results are in agreement with the Standard Model expectations

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Perceptions about medication errors: analysis of answers by the nursing team

Medication error is defined as any type of error in the prescription, transcription, dispensing and administration process which could bring about serious consequences or not. This descriptive and exploratory study assesses four scenarios showing situations from nursing practice. The study group was composed of 256 professionals and 89 questionnaires were analyzed. The answers given by the registered nurses were compared with those of licensed practical nurses and care aids. They should express their opinion if the situations represented a medication error or not, if it had to be communicated to the physician or an incident report had to be written. The two groups showed uniform answers. They expressed the same doubts to label the situation as an error and which measures should be taken, suggesting the need for further discussion on the matter within the institution

Exiquibility assessment of the public health nurse assignments, at the local level, at the State Department of Health of São Paulo

A exequibilidade das atribuições dos enfermeiros de Saúde Pública da Secretaria de Estado da Saúde de São Paulo foi avaliada mediante um questionário em que se solicitava aos respondentes que traduzissem seu julgamento quanto a esse grau de exequibilidade, consignando notas com o seguinte significado: O - totalmente inexequível, 1 - exequível com dificuldades, 2 - plenamente exequível. Também se solicitava que fossem indicadas as atribuições consideradas mais importantes, em cada função, e que fosse avaliada a importância relativa das funções. Foram incluídas 35 atribuições, distribuídas por cinco funções: administrativa (19); educativa (7); de pesquisa (2); assistencial (4) e de assessoria (3). Foram obtidas 122 respostas, sendo 59 (48 por cento ) provenientes de Centros de Saúde da Grande São Paulo e 63 (52 por cento ) do Interior. A plena exequibilidade das atribuições foi admitida, em 15 das 35, por menos de 50 por cento dos enfermeiros; em duas delas, essa percentagem não alcançou 30 por cento . Nas diferentes funções observou-se marcada discrepância entre o índice de exequibilidade de atribuições e o grau de importância que lhes foi conferido pelos enfermeiros. Fatores relacionados com caracteristicas dos Centros de Saúde (localização e tipo) e pessoais dos enfermeiros (idade, tempo de exercicio na Secretaria, formação profissional, especialização em Enfermagem de Saúde Pública e existência de obrigações familiares), mostraram-se capazes de influir, em graus variáveis, no julgamento, pelos enfermeiros, da exequibilidade das atribuições. Na avaliação pelos enfermeiros, a função assistencial foi considerada a mais importante, seguindo-se, na ordem, a educativa, a administrativa, a de pesquisa e a de assessoria. Foram examinadas as dificuldades arroladas pelos enfermeiros para a execução das atribuições, destacando-se a falta de recursos humanos e materiais, insuficiência de enfermeiros, despreparo de pessoal auxiliar, excesso de demanda e de reuniões, grande número de atribuições para a enfermeira e a pouca organização da comunidade.The assignments of Public Health Nurses belonging to the State Health Department were estimated as to their feasibility through a questionnaire where the respondents were asked to give their judgment on the degree of this feasibility, consigning scores according to the following criteria: O - totally unfeasible; 1 - feasible with some difficulties; 2 - completely feasible. The respondents were also asked to indicate, in each function, the assignments they considered more important as well as to evaluate the relative importance of their functions. Thirty five assignments were included, distributed among five functions: administrative (19); educative (7); researching (2); assistential (4) and of assessorship (3). A hundred and twenty two answers were achieved, being 59(48 per cent ) from Health Centers belonging to the Great São Paulo and 63(52 per cent ) from the Inland. The assignment \"complete feasibility\" was admitted in 15 of the 35 answers by less than 50 per cent of the nurses; in two of them, this percentage did not reach 30 per cent . Marked discrepancies were observed between the rates of feasibility of assignements and the degree to importance attributed by the nurses regarding the different functions. Factors related to the Health Centers characteristics (Localization and type) and those personal ones related to the nurses (age, time of practice along the Department, professional background, specialization in Public Health Nursing, and the existence of family responsibilities), showed themselves able to exercise influence, in variable degrees, upon the nurses\' judgment on the assignments feasibility. According to the nurses\' evaluation, the assistential function was considered the most important one, following, in a decreasing order, the educative, the administrative and those related to research and assessorship. The difficulties rolled up by the nurses for the feasibility of the assignments were examined, deserving being emphasized the following ones: lack on human and material resources; insufficience of nurses; inadequate preparation of the auxiliary personnel; excessive demand and number of meetings; an overload of assignments upon the nurse; and little community organization

Exiquibility assessment of the public health nurse assignments, at the local level, at the State Department of Health of São Paulo

A exequibilidade das atribuições dos enfermeiros de Saúde Pública da Secretaria de Estado da Saúde de São Paulo foi avaliada mediante um questionário em que se solicitava aos respondentes que traduzissem seu julgamento quanto a esse grau de exequibilidade, consignando notas com o seguinte significado: O - totalmente inexequível, 1 - exequível com dificuldades, 2 - plenamente exequível. Também se solicitava que fossem indicadas as atribuições consideradas mais importantes, em cada função, e que fosse avaliada a importância relativa das funções. Foram incluídas 35 atribuições, distribuídas por cinco funções: administrativa (19); educativa (7); de pesquisa (2); assistencial (4) e de assessoria (3). Foram obtidas 122 respostas, sendo 59 (48 por cento ) provenientes de Centros de Saúde da Grande São Paulo e 63 (52 por cento ) do Interior. A plena exequibilidade das atribuições foi admitida, em 15 das 35, por menos de 50 por cento dos enfermeiros; em duas delas, essa percentagem não alcançou 30 por cento . Nas diferentes funções observou-se marcada discrepância entre o índice de exequibilidade de atribuições e o grau de importância que lhes foi conferido pelos enfermeiros. Fatores relacionados com caracteristicas dos Centros de Saúde (localização e tipo) e pessoais dos enfermeiros (idade, tempo de exercicio na Secretaria, formação profissional, especialização em Enfermagem de Saúde Pública e existência de obrigações familiares), mostraram-se capazes de influir, em graus variáveis, no julgamento, pelos enfermeiros, da exequibilidade das atribuições. Na avaliação pelos enfermeiros, a função assistencial foi considerada a mais importante, seguindo-se, na ordem, a educativa, a administrativa, a de pesquisa e a de assessoria. Foram examinadas as dificuldades arroladas pelos enfermeiros para a execução das atribuições, destacando-se a falta de recursos humanos e materiais, insuficiência de enfermeiros, despreparo de pessoal auxiliar, excesso de demanda e de reuniões, grande número de atribuições para a enfermeira e a pouca organização da comunidade.The assignments of Public Health Nurses belonging to the State Health Department were estimated as to their feasibility through a questionnaire where the respondents were asked to give their judgment on the degree of this feasibility, consigning scores according to the following criteria: O - totally unfeasible; 1 - feasible with some difficulties; 2 - completely feasible. The respondents were also asked to indicate, in each function, the assignments they considered more important as well as to evaluate the relative importance of their functions. Thirty five assignments were included, distributed among five functions: administrative (19); educative (7); researching (2); assistential (4) and of assessorship (3). A hundred and twenty two answers were achieved, being 59(48 per cent ) from Health Centers belonging to the Great São Paulo and 63(52 per cent ) from the Inland. The assignment \"complete feasibility\" was admitted in 15 of the 35 answers by less than 50 per cent of the nurses; in two of them, this percentage did not reach 30 per cent . Marked discrepancies were observed between the rates of feasibility of assignements and the degree to importance attributed by the nurses regarding the different functions. Factors related to the Health Centers characteristics (Localization and type) and those personal ones related to the nurses (age, time of practice along the Department, professional background, specialization in Public Health Nursing, and the existence of family responsibilities), showed themselves able to exercise influence, in variable degrees, upon the nurses\' judgment on the assignments feasibility. According to the nurses\' evaluation, the assistential function was considered the most important one, following, in a decreasing order, the educative, the administrative and those related to research and assessorship. The difficulties rolled up by the nurses for the feasibility of the assignments were examined, deserving being emphasized the following ones: lack on human and material resources; insufficience of nurses; inadequate preparation of the auxiliary personnel; excessive demand and number of meetings; an overload of assignments upon the nurse; and little community organization