Erros mais comuns e fatores de risco na administração de medicamentos em unidades básicas de saúde Errores mas comunes y factores de riesgo en la administración de medicamentos en las unidades básicas de salud Common errors and risk factors in medicine administration at basic health units

Este estudo identificou e analisou as opiniões de enfermeiros e profissionais de enfermagem sobre os fatores de risco mais comuns à ocorrência dos erros na administração de medicamentos, as conseqüências, intervenções tomadas e medidas que minimizariam essa ocorrência. Para tanto, aplicou-se um instrumento para coleta de dados contendo questões sobre as opiniões de profissionais de enfermagem, atuantes em Unidades Básicas de Saúde de uma cidade do interior paulista. Os resultados indicaram que os fatores de risco associados ao próprio profissional foram a falta de atenção e dificuldade de entender prescrições médicas. As intervenções tomadas estão relacionadas à punição e educação e as propostas para minimizar as ocorrências dos erros foram a orientação e reciclagem dos profissionais envolvidos.<br>Este estudio, de carácter cuantitativo, identificó y analizó los factores de riesgo mas comunes para la aparición de errores durante la administración de medicamentos, las consecuencias y medidas que disminuían la ocurrencia de los mismos, según las opiniones de los profesionales de enfermería de las unidades básicas de salud de una cuidad del interior de São Paulo. Los factores de riesgo asociados al propio profesional fueron la falta de atención y dificultad para entender las prescripciones médicas. Las intervenciones tomadas frente al error fueron el castigo, y la educación. Dentro de las propuestas para disminuir las ocurrencias de errores para este grupo de personas fueron la orientación, y la educación de los profesionales involucrados.<br>The present study identified and analyzed the opinions of nurses and nursing professionals about the more common risk factors regarding errors in medicine administration as well as the consequences, interventions and measures to minimize this problem. Therefore, the authors applied an instrument of data collection with questions on the opinions of the nursing professionals who work at the Basic Health Units from a city of the state of São Paulo. Results showed that the risk factors associated to the professional were lack of attention and difficulty to understand medical prescriptions. The interventions were related to punishment and education and the proposals to minimize the occurrences were orientation and up-date of the involved professionals

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group

BACKGROUND: The past two decades have witnessed a surge in the use of lumbar facet blocks and radiofrequency ablation (RFA) to treat low back pain (LBP), yet nearly all aspects of the procedures remain controversial. METHODS: After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, letters were sent to a dozen pain societies, as well as representatives from the US Departments of Veterans Affairs and Defense. A steering committee was convened to select preliminary questions, which were revised by the full committee. Questions were assigned to 4-5 person modules, who worked with the Subcommittee Lead and Committee Chair on preliminary versions, which were sent to the full committee. We used a modified Delphi method, whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chair, who incorporated the comments and sent out revised versions until consensus was reached. RESULTS: 17 questions were selected for guideline development, with 100% consensus achieved by committee members on all topics. All societies except for one approved every recommendation, with one society dissenting on two questions (number of blocks and cut-off for a positive block before RFA), but approving the document. Specific questions that were addressed included the value of history and physical examination in selecting patients for blocks, the value of imaging in patient selection, whether conservative treatment should be used before injections, whether imaging is necessary for block performance, the diagnostic and prognostic value of medial branch blocks (MBB) and intra-articular (IA) injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for a prognostic block, how many blocks should be performed before RFA, how electrodes should be oriented, the evidence for larger lesions, whether stimulation should be used before RFA, ways to mitigate complications, if different standards should be applied to clinical practice and clinical trials and the evidence for repeating RFA (see table 12 for summary). CONCLUSIONS: Lumbar medial branch RFA may provide benefit to well-selected individuals, with MBB being more predictive than IA injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of more false-negatives. Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice