Análise de Incompatibilidades de Medicamentos Intravenosos no Centro de Tratamento Intensivo Adulto do Hospital de Clínicas de Porto Alegre

Introdução: As incompatibilidades medicamentosas quando ocorrem são consideradas erro de medicação, e o produto resultante pode afetar a eficácia e a segurança da terapia, sendo que conhecer seus fundamentos pode ajudar a prevenir sua ocorrência diminuindo, assim, seus riscos.Objetivo: Identificar e quantificar as incompatibilidades físico-químicas entre medicamentos administrados através da via intravenosa em pacientes internados no Centro de Tratamento Intensivo (CTI) do Hospital de Clínicas de Porto Alegre (HCPA), observar a possibilidade de orientações farmacêuticas para a administração dos medicamentos incompatíveis.Metodologia: Estudo transversal, no qual foram avaliadas as prescrições de Março a Maio de 2010, a partir dos prontuários eletrônicos, verificando a ocorrência de incompatibilidades medicamentosas entre as formas farmacêuticas intravenosas. Foi realizada uma intervenção farmacêutica por meio de orientações quanto à administração dos medicamentos identificados como incompatíveis.Resultados: Foram analisadas 65 prescrições médicas, destas 51 apresentaram incompatibilidade entre os medicamentos. A média de medicamentos intravenosos foi de sete (DP±1,6) por prescrição. Foram identificadas 177 incompatibilidades entre 35 medicamentos diferentes, que levaram a 71 possibilidades de interação. Os medicamentos mais envolvidos nas incompatibilidades foram o Midazolam (18,1%) e a Insulina (10,5%). As incompatibilidades mais encontradas foram entre Midazolam e Piperacilina+Tazobactam (9,6%) e entre Insulina e Noradrenalina (7,9%). Das 51 prescrições que geraram orientação farmacêutica, 13 destas puderam ser realizadas pela equipe de enfermagem.Conclusão: As incompatibilidades medicamentosas podem ser identificadas e evitadas com a presença do farmacêutico na unidade de internação, diminuindo a ocorrência de efeitos indesejáveis ao paciente.

The pharmaceutical care bundle: development and evaluation of an instrument for inpatient monitoring

Introduction: Care bundles help healthcare professionals provide the best care possible in a structured and reliable way.  The purpose of this study was to develop and apply an instrument for inpatient follow-up by clinical pharmacists, and evaluate its results in a general hospital.  Methods: The care bundle was based on previously validated instruments. The population consisted of patients being monitored by clinical pharmacists at a general hospital. The study was conducted in two phases: the first involved the development and implementation of the bundle, and the evaluation of pharmaceutical interventions; the second involved analyzing data from patients treated with the bundle over the course of one year. Results: The bundle included fourteen pharmaceutical follow-up criteria used in different patterns by each area of care. In the first phase of the study, 3263 patients were monitored and 536 pharmaceutical interventions were performed, with an 85.3% compliance rate. Medication review was associated with the highest percentage of pharmaceutical interventions (53.4%), followed by medication reconciliation (16.8%).  In the second phase of the study, follow-up data was collected from 21,214 patients. The bundle criteria were used in a similar way in the treatment of clinical, surgical and cancer patients with pharmacotherapy review identified as the most prevalent intervention in all cases (60.1%). Hospital discharge planning and medication reconciliation were performed with a similar frequency in clinical, surgical, pediatric and general patients. Conclusions: The development and validation of a bundle aimed at guiding the clinical activities of pharmacists helped standardize procedures and interventions. Pharmacotherapy review was the bundle criterion with the highest rate of application and interventions due to the hospital’s complexity and the need to consider individual patient needs and follow institutional policies

Adverse drug reactions in patients hospitalized in the Intensive Care Unit of a University Hospital in Southern Brazil

To identify and characterize suspected adverse drug reactions in adult patients admitted to the Intensive Care Unit, we conducted a retrospective study from January to June 2007 in a university hospital. Through intensive monitoring of medical records we collected data related to the patient, hospitalization, suspected adverse drug reactions, and prescription drugs. The adverse drug reactions were classified according to their causation and predictability. A total 270 patients were monitored, 20 of whom (7.4%) showed had at least one suspected adverse drug reaction. The gender, number of diagnoses, mean number of medications prescribed per day, and length of hospital stay were associated with the development of adverse drug reaction. Suspected adverse drug reactions were classified as having predominantly possible causality and predictability of type A. Most suspected adverse drug reactions could be avoided by the use of doses as low as possible, respecting the patient's pathophysiological status.Colegio de Farmacéuticos de la Provincia de Buenos Aire