Erro de medicação: a visão do enfermeiro neonatologista / Medication Error: the perspective of the neonatal nurse

O manejo da terapia medicamentosa em unidade de terapia intensiva neonatal é complexo e agrega inúmeras drogas. Nesse sentido, manter a atenção ao preparar e administrar corretamente os medicamentos é fundamental em todo o período de assistência ao recém-nascido. Portanto, faz-se necessário que os enfermeiros tenham o entendimento acerca do conceito do erro com medicação, para que possa identificá-lo, bem como os fatores contribuintes para sua ocorrência. Diante do exposto, esta pesquisa teve como objetivos: analisar o entendimento dos enfermeiros neonatologistas sobre o conceito do erro de medicação em uma unidade de terapia intensiva neonatal; conhecer na visão destes enfermeiros quais os fatores contribuintes para a ocorrência desse erro e discutir a partir desta visão como estes fatores podem afetar a segurança do neonato. Metodologia: trata-se de uma pesquisa qualitativa, do tipo descritiva. O cenário do estudo foi uma unidade de terapia intensiva neonatal de um hospital universitário, situado no município do Rio de Janeiro. Os sujeitos foram 14 enfermeiros entre plantonistas e residentes que atuavam no manejo da terapia medicamentosa. Para a coleta dos dados utilizou-se a entrevista semiestruturada, que foram analisadas através da análise de conteúdo de Bardin, emergindo 04 categorias: Diversos conceitos sobre erros de medicação; Fatores humanos contribuintes ao erro de medicação; Fatores ambientais contribuintes ao erro de medicação e Conhecendo como os fatores contribuintes ao erro podem afetar a segurança do paciente. Para as enfermeiras o erro de medicação significa errar um dos cinco certos na administração de medicamentos (paciente, dose, via, horário e medicamento certo), e este pode acontecer em alguma parte do sistema de medicação. Neste sentido, elas entendem que uma pessoa não pode ser considerada a única responsável pela ocorrência de um erro medicamentoso...

The management of drug therapy in a neonatal intensive care unit is complex and combines innumerous drugs. In this way, paying attention in the correct preparation and administration of drugs is fundamental in the whole period of assistance to the newborn infants. Therefore, is necessary that the nurses have the understanding of the concept of medication error, in order to be able to identify it as well as the contributing factors for its occurrence. In the presence of what was told, this research had as its aims: to analyze the understanding of the neonatal nurses of the concept of medication error in a neonatal intensive care unit; to apprehend from the perspective of these nurses, which contributing factor could affect the safety of the neonate. Methodology: it is a qualitative research with a descriptive design. The study setting was a neonatal intensive care unit from a university hospital in the city of Rio de Janeiro. The participants were 14 nurses, attending and resident physicians, which operate in the management of drug therapy. For the data collection a semi-structured interview was used, and then analyzed through the content analysis of Bardin, from what 04 categories emerged: different concepts of medication error; human contributing factors to the medication error; environmental contributing factors to the medication error; and understanding how the contributing factors to the medication error can affect the safety of the patient. For the nurses the medication error means making a mistake in one of the five rights in the medication administration (the right patient, the right dose, the right route, the right time, and the right drug), and this can happen in any part of the medication-use process. Thus, they understand that one person cannot be considered the only responsible for the occurrence of a medication error...

Parents' assessment of risk in sickle cell disease treatment with hydroxyurea.

Hydroxyurea is the only medication shown to reduce the severity of sickle cell disease (SCD), but its long-term risks are unknown. Families of 58 children with SCD were interviewed on their perception of the potential risks of hydroxyurea treatment, and whether disease severity was a major factor in their treatment decision. Parents rated the severity of their child's SCD (86% as severe, 26% moderate, and 47% mild) and then the highest levels of risk that they would tolerate for both potential cancer (range 1/1,000 to 1/2) and potential birth defects (range 1/1,000 to 1/3) to benefit their child with hypothetical hydroxyurea treatment. Parents of 29 of the 58 children were unwilling to take any cancer risk whatsoever as a potential side effect of treatment, and 29 of 58 (not all the same parents) were unwilling to take any risk for birth defects, including half the children with severe SCD. For those families who did accept some risk, higher acceptable risk correlated with higher disease severity in the child (P = 0.04). The study's mixed findings highlight the complexities of risk perception and suggest that future studies of risks and benefits from the parental viewpoint are needed as candidate therapies are developed for SCD.