Medication errors in emergency departments: is electronic medical record an effective barrier?

OBJECTIVE: To compare medication errors in two emergency departments with electronic medical record, to two departments that had conventional handwritten records at the same organization. METHODS: A cross-sectional, retrospective, descriptive, comparative study of medication errors and their classification, according to the National Coordinating Council for Medication Error Reporting and Prevention, associated with the use of electronic and conventional medical records, in emergency departments of the same organization, during one year. RESULTS: There were 88 events per million opportunities in the departments with electronic medical record and 164 events per million opportunities in the units with conventional medical records. There were more medication errors when using conventional medical record - in 9 of 14 categories of the National Coordinating Council for Medication Error Reporting and Prevention. CONCLUSION: The emergency departments using electronic medical records presented lower levels of medication errors, and contributed to a continuous improvement in patients´ safety.

Medication errors in emergency departments: is electronic medical record an effective barrier? / Erros de medicação em unidades de pronto atendimento: prontuário eletrônico, barreira eficaz?

ABSTRACT Objective: To compare medication errors in two emergency departments with electronic medical record, to two departments that had conventional handwritten records at the same organization. Methods: A cross-sectional, retrospective, descriptive, comparative study of medication errors and their classification, according to the National Coordinating Council for Medication Error Reporting and Prevention, associated with the use of electronic and conventional medical records, in emergency departments of the same organization, during one year. Results: There were 88 events per million opportunities in the departments with electronic medical record and 164 events per million opportunities in the units with conventional medical records. There were more medication errors when using conventional medical record - in 9 of 14 categories of the National Coordinating Council for Medication Error Reporting and Prevention. Conclusion: The emergency departments using electronic medical records presented lower levels of medication errors, and contributed to a continuous improvement in patients´ safety.

RESUMO Objetivo: Comparar os erros de medicações de duas unidades de pronto atendimento que possuíam prontuário eletrônico aos de duas unidades que possuíam prontuário convencional manual em uma mesma instituição. Métodos: Estudo transversal, retrospectivo, descritivo, que comparou a incidência de erros de medicações e sua classificação, segundo o National Coordinating Council for Medication Error Reporting and Prevention, associado ao uso do prontuário eletrônico e do convencional, em unidades de pronto atendimento de uma mesma instituição por um ano. Resultados: Foram observados 88 eventos por milhão de oportunidades nas unidades com prontuário eletrônico e 164 por milhão de oportunidades nas unidades com prontuário convencional. Houve mais erros de medicações nas unidades com prontuário convencional − em 9 das 14 categorias da National Coordinating Council for Medication Error Reporting and Prevention analisadas. Conclusão: Com a utilização do prontuário eletrônico, as unidades de pronto atendimento apresentaram menores índices de erros de medicações, contribuindo para melhoria continuada na segurança do paciente.

Using Positive Deviance to reduce medication errors in a tertiary care hospital.

BACKGROUND: The number of medication errors occurring in healthcare is large and many are preventable. To analyze medication errors and evaluate whether Positive Deviance is effective in reducing them. METHODS: The study was divided into three phases: (2011- Phase I, control period; 2012 - Phase II, manager intervention, and 2013 - Phase III, frontline healthcare worker intervention). In Phases II and III, the Positive Deviance method (PD) was used to mitigate medication errors classified as "C" and higher according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). The errors reported were compared across the three study phases, as well as by the location of the hospital unit, shift, cause, consequence, and the professional associated with the error. RESULTS: A total of 4013 reported medication errors were analyzed. The largest number of errors occurred at the time the medications were administered, accounting for 35.5 % of errors in Phase I; 43.1 % in Phase II, and 55.6 % in Phase III. Nursing staff was most commonly associated with errors; 46.4 % of errors in Phase I, 48.5 % in Phase II, and 58.7 % in Phase III. With each intervention, a decrease was observed in the reported error rate of 0.12 (CI 95 %, 0.18 to 0.07). CONCLUSION: Positive Deviance proved to be effective, primarily when healthcare professionals who were involved in errors participated, as was observed in Phase III of this study.

Assistência farmacêutica na administração de medicamentos via sonda: escolha da forma farmacêutica adequada / Pharmaceutical assistance in the enteral administration of drugs: choosing the appropriate pharmaceutical formulation

Objetivo: Analisar os medicamentos sólidos orais padronizados no Hospital Israelita Albert Einstein (HIAE), de acordo com a  possibilidade de serem administrados via sonda enteral e com as recomendações para administração adequada. Métodos: Estudo realizado por meio do levantamento dos medicamentos sólidos orais padronizados no HIAE e posterior análise da revisão da literatura publicada, monografia das drogas, informação do fabricante, e dados farmacotécnicos da forma farmacêutica, princípios ativos e excipientes. Foram considerados os fatores impeditivos e de complicação relacionados à administração de medicamentos via sonda enteral e elaborou-se um quadro  com informações sobre a possibilidade de administração por essa via e recomendações. Rresultados: Foram analisados 234 medicamentos, sendo que os principais fatores de complicação encontrados com a administração via sonda enteral foram: alteração da farmacocinética da droga (38); danos ao trato gastrintestinal (9); obstrução da sonda (40); interação droga-nutriente (7); risco biológico (5); sem informação (33). Cconclusões: A compilação dessas informações auxilia a equipe de saúde na escolha da forma farmacêutica adequada para administração via sonda enteral e pode contribuir para a identificação de eventos adversos relacionados à administração por esta via.