Notificações de incidentes no espaço hospitalar: criação de um sistema de notificação interno online em hospital público federal / Incident notifications in the hospital space: creation of an online internal notification system in a federal public hospital

Introdução: O processo de notificação visa monitorar a ocorrência de incidentes para melhor compreensão e desenvolvimento de estratégias de prevenção e redução de danos, assim como promover a melhoria contínua da qualidade e segurança do cuidado prestado. O presente estudo teve como meta a estruturação de três produtos, a saber: Produto 1 ­ Produto bibliográfico técnico e tecnológico intitulado "Caracterização dos incidentes em um hospital público federal entre os anos 2014 a 2019"; Produto 2 ­ Produto bibliográfico técnico e tecnológico intitulado "Criação de sistema interno online para notificação de incidentes no espaço hospitalar: relato de experiência". Produto 3 ­ Produção técnica intitulada "Guia orientador para o preenchimento adequado dos dados no sistema interno online para notificação de incidentes". Objetivo: Criar um sistema interno online para monitoramento dos incidentes em um hospital federal, a partir do FormSUS, bem como organizar um guia orientador para a sua utilização para auxiliar os profissionais no processo de notificações. Materiais e Métodos: O primeiro produto foi um estudo transversal após pesquisa em base de dados secundários de acesso restrito referente ao período de 2014 a 2019, que identificou 10.837 incidentes classificados segundo as Metas Internacionais de Segurança do Paciente: Eventos Adversos, Incidentes sem Dano, Quase Falhas, Circunstâncias Notificáveis. O sistema de notificação foi construído por meio da plataforma do Departamento de Informática do Sistema Único de Saúde para criação de formulários públicos, conhecida como FormSUS versão 3.0. O instrumento já é existente no Ministério da Saúde com base na interface do FormSUS organizado a partir de dados, tais como: dados da internação, data da ocorrência do incidente, descrição completa do incidente, identificação do profissional notificador, contato por e-mail, telefone ou presencial, cargo e função do profissional notificador. Resultados: Finalmente, foi estruturado um guia orientador para preenchimento das notificações de forma simples, baseado em dúvidas mais frequentes, no qual se explicam detalhadamente os incidentes e a forma de acessar o sistema interno online de notificação para o envio ao Núcleo de Segurança do Paciente. Conclusões: Caracterizar e analisar os dados relacionados aos incidentes ocorridos no hospital é um exercício fundamental, pois auxilia o processo de educação contínua sobre segurança do paciente. A partir desse conhecimento, a criação de um sistema online de notificação, e do manual para o preenchimento correto dos formulários, pode contribuir para aumentar a adesão dos profissionais às notificações e trazer informações fidedignas para o desenvolvimento de estratégias que reduzam os danos ao paciente

Introduction: The notification process aims to monitor the occurrence of incidents in order to better understand and develop strategies for preventing and reducing harm, as well as promoting continuous improvement in the quality and safety of the care provided. The present study aimed at structuring three products, namely: Product 1 ­ Technical and technological bibliographic product entitled "Characterization of incidents in a federal public hospital between the years 2014 and 2019"; Product 2 ­ Technical and technological bibliographic product entitled "Creation of an internal online system for notification of incidents in the hospital space: experience report". Product 3 ­ Technical production entitled "Guiding guide for the proper filling of data in the internal online system for notification of incidents". Objective: Create an internal online system for monitoring incidents in a federal hospital, using FormSUS, as well as organizing a guiding guide for its use to assist professionals in the notification process. Materials and methods: The first product was a cross-sectional study after searching a secondary database with restricted access for the period from 2014 to 2019, which identified 10,837 incidents classified according to the International Patient Safety Goals: Adverse Events, Incidents Without Damage, Almost Failure, Circumstances Notifiable. The notification system was built using the platform of the Informatics Department of the Unified Health System to create public forms, known as FormSUS version 3.0. The instrument already exists at the Ministry of Health based on the FormSUS interface organized from data, such as: hospitalization data, date of the incident, complete description of the incident, identification of the notifying professional, contact by e-mail, telephone or in person, position and function of the notifying professional. Results: Finally, a guiding guide for filling out notifications in a simple way was structured, based on the most frequent doubts, in which the incidents are explained in detail and how to access the internal online notification system for sending to the Patient Safety Center. Conclusions: Characterizing and analyzing the data related to the incidents that occurred in the hospital is a fundamental exercise, as it helps the process of continuous education on patient safety. Based on this knowledge, the creation of an online notification system, and the manual for the correct filling of forms, can contribute to increase the professionals' adherence to the notifications and bring reliable information for the development of strategies that reduce harm to the patient

The new oral anticoagulants: a challenge for hospital formularies.

Introduction Over the past 60 years, clinicians have used vitamin K antagonists, primarily warfarin, as the sole oral anticoagulants for managing a variety of thrombotic disorders. Warfarin, which requires frequent monitoring, has a variable dose response, a narrow therapeutic index, and numerous drug and dietary interactions. However, intravenous and subcutaneous agents, such as unfractionated heparin, low-molecular-weight heparin, direct thrombin inhibitors, and pentasaccharide, have been introduced over the past 30 years for managing thromboembolic disorders. Recently, 5 new oral anticoagulants, dabigatran, rivaroxaban, apixaban, endoxaban, and betrixaban, have been introduced into clinical trials. Apixaban, rivaroxaban, endoxaban, and betrixaban are specific direct inhibitors of factor Xa, while dabigatran inhibits factor IIa. These drugs have a pharmacological profile that does not require monitoring in order to adjust therapy, which is the mainstay of warfarin management. In addition, these new medications have not shown any major issues regarding food interactions; rather, they demonstrate the potential for limited drug-drug interactions due to their limited metabolism through the cytochrome P450 system. This unique pharmacokinetic profile may provide clinicians with a new era of managing thromboembolic disorders. Two of these agents, dabigatran and rivaroxaban, have been approved by the US Food and Drug Administration (FDA) for stroke prevention in patients with nonvalvular atrial fibrillation (AF); in addition, rivaroxaban can be used in the prevention of venous thromboembolism (VTE) in total hip and knee arthroplasty during the acute and extended periods of risk. However, the challenge for hospital formularies will be the appropriate use and management of these new medications as they become integrated into outpatient care. In order to better understand the issues that pharmacy and therapeutics committees will encounter, a review of the 2 FDA-approved oral anticoagulants will be evaluated.

An interrupted time series analysis of parenteral antibiotic use in Colombia.

A University-based hospital in Bogotá, Colombia, developed and implemented an educational intervention to complement a new structured antibiotic order form. This intervention was performed after assessing the appropriateness of the observed antibiotic prescribing practices using a quasi-experimental study. An application of interrupted time series intervention analysis was conducted in three antibiotic groups (aminoglycosides, cephradine/cephalothin, and ceftazidime/cefotaxime) and their hospital weekly rate of incorrect prescriptions before and after the intervention. A fourth time series was defined on prophylactic antibiotic use in elective surgery. Preintervention models were used in the postintervention series to test for pre-post series level differences. An abrupt constant change was significant in the first, third, and fourth time series indicating a 47, 7.3, and 20% reduction of incorrect prescriptions after the intervention. We conclude that a structured antibiotic order form, coupled with graphic and educational interventions can improve antibiotic use in a university hospital.

[Trends in antimicrobial utilization in a university hospital, 1990-1996]. / Tendências na utilização de antimicrobianos em um hospital universitário, 1990-1996.

OBJECTIVE: There is a worldwide concern about rational drug use, more specifically related to antimicrobial utilization. In developing countries, few resources are intended for monitoring on rational drug use. Moreover, there are limited data on the use of antimicrobial agents in hospitals. A study was carried out to describe patterns of use of antimicrobial agents over a 7-year period (1990 to 1996). METHODS: The study was conducted in a 690-bed tertiary care university hospital in Porto Alegre, Brazil. Hospital records were reviewed to identify inpatient antibiotics use. Results were expressed in defined daily dose per 100-beds/day. Cluster analysis was performed to determine the trends in use of individual agents. RESULTS: Antimicrobials use increased year after year, from 83.8 DDD per 100 beds-day in 1990 to 124.58 DDD per 100 beds-day in 1996. Penicillins were the drug group mostly used (39.6%), followed by cephalosporins (15.0%), aminoglycosides (14.4%), sulfonamides (12.8%), glycopeptides (3.6%), and lincosamides (3.1%). These groups were responsible for around 90% of all agents used. The use of antimicrobial agents was divided into thirteen groups based on cluster analysis. CONCLUSIONS: Antimicrobial use increased dramatically in the study period, and this increase was significantly higher when compared to other studies. When newer alternative agents became available in the hospital, the use of already existing drugs decreased and in some cases remained relatively stable. After implementing specific interventions, such as an effort for the correct use of cefoxitin, the expected changes in use were observed.

Relationship between practice guidelines, formulary management, and pharmacoeconomic studies.

Pharmacy and therapeutics committees can use pharmacoeconomic and outcome studies as tools to evaluate and implement clinical guidelines for patient care. Results of studies help optimize the clinical effects and control the costs of drug therapy. Such data also assist in positioning products in competitive environments. A four-part classification of research studies is offered as an aid to strategic research planning.

The Drug Formulary Committee in a developing country.

Most developing countries suffer badly from misguided drug selection and purchases, erratic supplies and distribution, and wasteful or inappropriate drug use. Barbados is one of the few developing countries with an active Drug Formulary Committee. This committee develops a formulary that is revised and updated annually, providing guidance on rational prescribing. The Barbados Drug Formulary Committee has operated for 5 years on principles similar to those of a P & T Committee, but with a more restricted list and a flexible approach geared to specific local problems. The Drug Formulary and ongoing educational activities, which have been effective agents in promoting rational prescribing, are described.