Erros de medicação e implicações na assistência de enfermagem / Medication errors and implications for nursing care / Errores de medicamentos e implicaciones en la atención de enfermería

Introdução: Erro de medicação é definido como qualquer evento evitável que ocorra em qualquer fase da terapia medicamentosa, podendo ou não a prescrição, a dispensação ou a administração causarem algum dano ao paciente. Objetivo: Identificar, com base em uma revisão de literatura, os erros mais frequentes associados ao processo medicação e quais suas causas. Método: Estudo realizado por meio de uma revisão integrativa da literatura onde foram usadas as bases de dados eletrônicas: SciELO, LILACS, BDENF e MEDLINE. Resultados: Diversos fatores podem estar associados aos erros na administração de medicamentos pela equipe de enfermagem. Os estudos analisados apontam como fatores de risco a sobrecarga de trabalho, falta de atenção e qualificação, erros na prescrição médica, dispensação errada do medicamento e o próprio sistema de trabalho. A enfermagem desempenha papel fundamental nas fases do que é compreendido como processo de medicação. Conclusão: É importante que os erros possam ser relatados pela equipe, para que ocorra o planejamento de medidas colaborativas junto a instituição de saúde a fim de implantar meios de capacitação e protocolos voltados a segurança do paciente.(AU)

Introduction: El error de medicación se define como cualquier evento prevenible que ocurre en cualquier etapa de la terapia con medicamentos, ya sea que la prescripción, dispensación o administración pueda o no causar daño al paciente. Objetivo: Identificar, a partir de una revisión de la literatura, los errores más frecuentes asociados al proceso de medicación y sus causas. Método: Estudio realizado mediante revisión integradora de la literatura donde se utilizaron bases de datos electrónicas: SciELO, LILACS, BDENF y MEDLINE. Resultados: Varios factores pueden estar asociados con errores en la administración de medicamentos por parte del personal de enfermería. Los estudios analizados señalan como factores de riesgo la sobrecarga laboral, la falta de atención y calificación, los errores en la prescripción médica, la dispensación incorrecta de medicamentos y el propio sistema de trabajo. La enfermería juega un papel fundamental en las fases de lo que se entiende por proceso de medicación. Conclusión: Es importante que los errores sean reportados por el equipo, de manera que se puedan planificar acciones colaborativas con la institución de salud para implementar medios de capacitación y protocolos orientados a la seguridad del paciente.(AU)

Introducción: El error de medicación se define como cualquier evento prevenible que ocurre en cualquier etapa de la terapia con medicamentos, ya sea que la prescripción, dispensación o administración pueda o no causar daño al paciente. Objetivo: Identificar, a partir de una revisión de la literatura, los errores más frecuentes asociados al proceso de medicación y sus causas. Método: Estudio realizado mediante revisión integradora de la literatura donde se utilizaron bases de datos electrónicas: SciELO, LILACS, BDENF y MEDLINE. Resultados: Varios factores pueden estar asociados con errores en la administración de medicamentos por parte del personal de enfermería. Los estudios analizados señalan como factores de riesgo la sobrecarga laboral, la falta de atención y calificación, los errores en la prescripción médica, la dispensación incorrecta de medicamentos y el propio sistema de trabajo. La enfermería juega un papel fundamental en las fases de lo que se entiende por proceso de medicación. Conclusión: Es importante que los errores sean reportados por el equipo, de manera que se puedan planificar acciones colaborativas con la institución de salud para implementar medios de capacitación y protocolos orientados a la seguridad del paciente.(AU)

Home oxygen therapy in patients with COPD: safety issues for nurse prescribers.

Two landmark studies demonstrated survival benefit in chronic obstructive pulmonary disease (COPD) complicated by chronic hypoxaemia with the prescription of long-term oxygen therapy (LTOT). Best practice evidence therefore recommends that individuals with stable COPD and resting hypoxaemia (PaO2≤7.3 kPa) should be assessed for long-term oxygen therapy. However, it is estimated that up to one-quarter of COPD patients prescribed LTOT continue to smoke. Oxygen therapy consequently presents an obvious fire hazard in the case of such patients, who are therefore at greater risk of death or sustaining devastating head and neck burns. This article critically analyses, through the context of a care study, the professional, ethical and legal issues involved in making a safe prescribing decision for LTOT in an individual with COPD who is a current smoker. Home oxygen prescription is a growing trend in the COPD population, and it is important for nurse prescribers to be aware of the issues highlighted in the article to ensure safe prescribing practices.

Impacts of nurse-led clinic and nurse-led prescription on hemoglobin A1c control in type 2 diabetes: A meta-analysis.

BACKGROUND: To evaluate the impacts of nurse-led clinic and nurse-led prescription on hemoglobin A1c (HbA1c) control in type 2 diabetes. METHODS: We searched relevant publications in English and Chinese database and conducted meta-analysis by Stata 12.0. We divided the case groups of included studies into 2 categories according to the role of nurse: nurse-led clinic and nurse-led prescription. Nurse-led clinic was implemented on the basis of standard diabetes care provided by doctor, and control group also receive the standard diabetes care but without nurse-led clinic. The doctor mentioned above might work alone or in a health care team. Nurse-led prescription was prescribed by nurse independently and compared with that of doctor. RESULTS: The meta-analysis shown that, compared with the standard diabetes care, nurse-led clinic significantly decreases HbA1c level (standard mean difference [SMD] = -0.767; 95% confidence interval [CI]: -1.062, -0.471; P < .001). In subgroup analysis, nurse-led clinic also had positive impacts on controlling HbA1c level, no matter in developed countries (SMD = -0.353; 95% CI: -0.6, -0.106; P = .005) or developing countries (SMD = -1.114; 95% CI: -1.498, -0.73; P < .001). Additionally, there was no significant difference between nurse-led prescription and doctor prescription in controlling HbA1c levels (SMD = -0.203; 95% CI: -0.434, 0.029; P = .086). CONCLUSION: The nurse-led clinic had positive significance for HbA1c control. Meanwhile, the impact of nurse-led prescription on controlling HbA1c is comparable to that of doctor. It is valuable to provide nurse-led clinic on the basis of standard diabetes care provided by doctor to better control HbA1c, and nurse-led prescription should be provided when doctor-led service is limited.

Embedding knowledge into non-medical prescribing education.

This article focuses on the non-medical prescribing (NMP) module for community prescribers in a nurse education context. The module mainly attracts registered nurses (RNs) from community settings (such as health visiting, school nursing, district nursing and practice nursing), and is provided in higher education institutions (HEIs) as part of a specialist programme or a continuing workforce development module. The article discusses changes to the way the module was taught that can enhance student learning within the NMP module and facilitate wider success and confidence among community nurse prescribers. The move from Nursing and Midwifery Council standards for prescribing to a single competency framework from the Royal Pharmaceutical Society (RPS) has encouraged academics to revisit teaching strategies and consider an approach that offers wider student participation in learning. The use of technology-enhanced learning (TEL) in HEIs is part of national recommendations to improve the student experience and increase success.

Decreto mal llamado 'prescripción enfermera' / No disponible

No disponible

Espironolactona en pacientes con insuficiencia cardiaca y fracción de eyección preservada / Spironolactone in patients with heart failure and preserved ejection fraction

No disponible

Colorectal cancer metastatic to the brain: analysis of prognostic factors and impact of KRAS mutations on presentation and outcome

Background. Treatment concepts for metastatic colorectal cancer continue to evolve. While the presence of RAS mutations impacts systemic therapy, little is known about the influence of such mutations in patients with brain metastases. Patients and methods. Pooled retrospective analysis was conducted of 57 patients with brain metastases from colorectal cancer treated in two different institutions (2005-2013). Results. The only mutations analyzed in a relatively large subgroup were KRAS mutations (14 wild type, 12 mutated). Mutation status was not associated with baseline characteristics such as number or location of metastases, and did not impact prognosis. Three factors were significantly associated with survival in multivariate analysis: Karnofsky Performance Status (KPS), management strategy, and systemic treatment. Median survival was 0.6 months with best supportive care, 3.0 months with initial whole-brain radiotherapy (WBRT), and 12.7 months if initial treatment included surgery or stereotactic radiosurgery (SRS), p = 0.0001. The survival difference between the WBRT and surgery/SRS groups was largest in patients with KPS 80-100. Conclusion. Effective local treatment was a prerequisite for improved survival. The only significant prognostic baseline factor was KPS, which forms the basis of the diagnosis-specific graded prognostic assessment (DS-GPA) score. Thus, our results validate the DS-GPA in this patient population. So far, neither this nor other studies suggest a clinically important impact of KRAS mutations beyond their previously reported association with development of brain metastases. Studies focusing on patients who develop brain metastases early during the course of metastatic disease might be warranted, because the influence of different systemic therapies might be larger in this subgroup (AU)

No disponible

Medication regimen complexity in adults and the elderly in a primary healthcare setting: determination of high and low complexities / Complejidad del regimen de medicación en adultos y ancianos en un centro de cuidados primaries: determinación de la complejidad alta y baja

Background: The complexity of a medication regimen is related to the multiple characteristics of the prescribed regimen and can negatively influence the health outcomes of patients. Objective: To propose cut-off points in the complexity of pharmacotherapy to distinguish between patients with low and high complexities seen in a primary health care (PHC) setting to enable prioritization of patient management. Methods: This is a cross-sectional study, which included 517 adult and elderly patients, analyzing different cut-off points to define the strata of low and high pharmacotherapy complexities based on percentiles of the population evaluated. Data collection began with the solicitation of prescriptions, followed by a questionnaire that was administered by an interviewer. The complexity of a medication regimen was estimated from the Medication Regimen Complexity Index (MRCI). High complexity pharmacotherapy scores were analyzed from patient profiles, the use of health services, and pharmacotherapy. The criteria for subject inclusion in the sample population were as follows: inhabitant of the area covered by the municipality, 18 years or older, and being prescribed at least one drug during the collection period. Exclusion criteria at the time of collection were the use of any medication whose prescription was not available. All medications were accessed through the Primary Healthcare Service (PHS). Results: The median total pharmacotherapy complexity score was 8.5. High MRCI scores were correlated with age, medications taken with in the Brazilian PHS, having at least one potential drug-related problem, receiving up to eight years of schooling, number of medications and polypharmacy (five or more medicines), number of medical conditions, number of medical appointments, and number of cardiovascular diseases and endocrine metabolic diseases. We suggest different complexity tracks according to age (e.g., adult or elderly) that consider the pharmacotherapy and population coverage characteristics as high complexity limits. For the elderly patients, the tracks were as follows: MRCI≥25.4, MRCI≥20.9, MRCI≥17.5, MRCI≥15.7, MRCI≥14.0, and MRCI≥13.0. For adult patients, the limits of high complexity were MRCI≥25.1; MRCI ≥ 23.8; MRCI≥21.0; MRCI≥17.0; MRCI≥16.5; and MRCI≥15.5. Conclusion: The medication regimen complexity is associated with the patient's illness profile and problems with the use of drugs; therefore, the proposed scores can be useful in prioritizing patients for clinical care by pharmacists and other health professionals (AU)

Antecedentes: La complejidad de un régimen de medicación se relaciona con las múltiples características del régimen prescrito que pueden influenciar negativamente los resultados en salud de los pacientes. Objetivo: Proponer puntos de corte en la complejidad de la farmacoterapia para diferenciar entre pacientes de baja y alta complejidad que permita la priorización de la gestión de los pacientes entre los atendidos en un centro de cuidados primarios. Métodos: Este es un estudio transversal que incluyó 517 adultos y ancianos analizando diferentes puntos de corte para definir los estratos de alta y baja complejidad de la farmacoterapia basándose en los percentiles de la población evaluada. La recogida de datos comenzó con la solicitud de las prescripciones, seguida de un cuestionario administrado por un entrevistador. La complejidad de la medicación se estimó mediante el Medication Regimen Complexity Index (MRCI). En las farmacoterapias de alta complejidad se analizó los perfiles de los pacientes, el uso de servicios de salud, y la farmacoterapia. Los criterios para la inclusión de la muestra fueron: habitantes del área cubierta por el municipio, 18 años o más, y tener prescrito al menos un medicamento durante el periodo de recogida de datos. Los criterios de exclusión durante la recogida de datos fue el uso de algún medicamento que no estaba disponible. Todos los medicamentos eran del Servicio de Cuidados Primarios (PHS). Resultados: La mediana total de puntuación de complejidad de la farmacoterapia fue de 8,5. Las puntuaciones altas del MRCI se correlacionaban con la edad, medicamentos tomados del PHS, tener al menos una interacción potencial medicamento-medicamento, tener más de 8 años de escolaridad, numero de medicamentos, polimedicación (cinco o más medicamentos), número de problemas de salud, número de visitas al médico, y numero de enfermedades cardiovasculares o metabólicas. Sugerimos diferentes tramos de complejidad de acuerdo a la edad (e.g. adultos o ancianos) que tienen en cuenta las características de la población y la farmacoterapia como límites de alta complejidad. Para los ancianos los tramos eran: MRCI≥25,4, MRCI≥20,9, MRCI≥17,5, MRCI≥15,7, MRCI≥14,0, y MRCI≥13,0. Para los pacientes adultos los límites de complejidad eran: MRCI≥25,1; MRCI ≥ 23,8; MRCI≥21,0; MRCI≥17,0; MRCI≥16,5; y MRCI≥15,5. Conclusión: La complejidad del régimen de medicación se asocia con el perfil de enfermedad del paciente y sus problemas de uso de medicamentos; por tanto, los limites propuestos pueden ser útiles para priorizar pacientes en cuidados clínicos de los farmacéuticos u otros profesionales de la salud (AU)

Erros de administração de medicamentos em unidades de terapia intensiva neonatal / Medication administration errors in neonatal intensive care units

A terapia medicamentosa é responsável pela maioria dos erros ocorridos durante a assistência à saúde, sendo que os erros de medicação são os mais frequentes e mais graves. O presente estudo identificou o tipo e a frequência de erros na administração de medicamentos intravenosos em duas Unidades de Terapia Intensiva Neonatais. Pesquisa transversal de natureza observacional realizada por meio de observação sistemática direta do processo de administração de medicamentos. A coleta ocorreu no segundo semestre de 2012 a partir da observação de 100 doses de medicamentos intravenosos. Os erros de administração de medicamentos se mostraram frequentes, sendo que os mais observados foram os de técnica incorreta de administração (51%) e erro de horário (16%). Conclui-se que há necessidade da incorporação de uma cultura de segurança por parte das instituições e dos profissionais de saúde que nelas atuam para diminuição dos índices de erros e garantia de segurança dos pacientes.

Drug therapy is responsible for most of the errors occurred during the health care, and medication errors are the most frequent and severe.The present study identified the type and the frequency of errors in the administration of intravenous medications in two Neonatal Intensive Care Units. This is a cross-sectional research of observational nature performed by systematic direct observation of medication administration process. Data collection occurred in the second half of 2012 from the observation of 100 doses of intravenous drugs. The errors of medicines administration showed frequent, and the most observed were the incorrect technic administration (51%) and error time (16%). It concludes that there is need of the incorporation of a culture of safety by the part of the institutions and health professionals that in them act for decrease the rates of errors and ensuring patient safety.

RxmindMe Prescription/Medicine Reminder and Pill Tracker.

Tablets, capsules, injections, inhalers… it never fails to surprise me how many medications some of our patients have to take every day, just to stay healthy.

"I Want a New Drug": Exercise as a Pharmacological Therapy.

Skeletal muscle can be considered a secretory organ that produces myokines and other humoral factors having autocrine-, paracrine-, and endocrine-like signaling effects throughout the body. Exercise has such profound pharmacological and physiological effects that it should be considered a drug therapy. Exercise has documented benefits for preventing or treating many physical and mental disorders or their sequelae, and it has a potential role in managing adverse effects associated with drug therapies. If exercise were a drug evaluated by the Food and Drug Administration, it might be approved for a large number of therapeutic indications. Exercise can be appropriately prescribed for virtually anyone for primary, secondary, or tertiary prevention of many mental and physical disorders.

Estudio piloto en una farmacia comunitaria sobre la eficiencia y la efectividad de la prescripción de estatinas / A pilot study in a community pharmacy to determine the efficiency and the effectiveness of statin prescriptions

ANTECEDENTES: La eficacia de las estatinas para reducir los niveles de LDL-colesterol es elevada, aunque sus costes son importantes y su efectividad en ámbitos reales, limitada. OBJETIVO: Analizar la eficiencia y la efectividad de las prescripciones de estatinas y su relación con características del paciente en un estudio piloto en una farmacia comunitaria. DISEÑO: Estudio transversal. Emplazamiento: Farmacia comunitaria. Prescripciones procedentes de 2 Centros de Salud de Lorca (Área III del Sistema Murciano de Salud). PARTICIPANTES: Ciento cuarentaiún pacientes y 32 médicos. MEDICIONES PRINCIPALES: Se recogieron variables sociodemográficas y clínicas de los pacientes, e información sobre el tipo y la dosis de estatina. En cada paciente se determinó: efectividad del tratamiento, en función del RCV y niveles de LDL-colesterol previos al tratamiento, y eficiencia, comparando el coste de la estatina prescrita con el de aquellas de igual potencia famacológica. RESULTADOS: El 57,4% de las prescripciones fueron de atorvastatina. El 63,9% de las prescripciones se consideraron ineficientes y el 17,3% inefectivas. En el análisis bivariado, los pacientes con eventos cardiovasculares previos (8/38; 21% vs.41/103; 39,8%, p = 0,040) y los fumadores (42/114; 36,8% vs.4/23; 17,4%, p = 0,047) tenían más riesgo de recibir una prescripción ineficiente. En el análisis multivariable, los fumadores tenían más probabilidad de recibir prescripciones ineficientes comparados con los no fumadores (OR ajustada 3,76; IC del 95%, 1,03-0,77; p = 0,012). CONCLUSIONES: Los pacientes alcanzaron mayoritariamente los objetivos de LDL-colesterol propuestos, aunque más de la mitad de las prescripciones se consideraron ineficientes

BACKGROUND: The efficacy of statins to reduce LDL-cholesterol serum levels is high, but effectiveness is limited and costs are elevated. OBJECTIVE: The efficiency and effectiveness of prescriptions were analyzed in a pilot study in a community pharmacy. DESIGN: A cross-sectional study. LOCATION: Community pharmacy. Prescriptions from two Murcian Health Service Centers in Lorca, Murcia (Spain). PARTICIPANTS: A total of 141 patients and 32 general practitioners were included. The efficiency was analyzed in 141 and effectiveness in 110 PATIENTS: MAIN MEASUREMENTS: Socio-demographic characteristics and clinical history of patients and information about statin type and dosage were collected. Each patient was analyzed to determine the effectiveness of treatment according to cardiovascular risk and previous LDL-cholesterol level, and efficiency comparing the statin prescribed against other statins with equal pharmacological power. RESULTS: The most prescribed statin was atorvastatin (57.4%). Almost two-thirds (63.9%) of prescriptions were inefficient, and 17.3% were ineffective. In a bivariate analysis, patients with previous cardiovascular events (8/38; 21% vs 41/103; 39.8%. P=.040) and smokers (42/114; 36.8% vs 4/23; 17.4%, P=.047) were more likely to receive an inefficient prescription than patients with no cardiovascular events and non-smokers. In a multivariate analysis, smokers were more likely to receive an inefficient prescription than non-smokers (OR ajusted 3.76; 95% CI;1.03-0.77, P=.012). CONCLUSIONS: Most of the participants reached therapeutic objectives for LDL-Cholesterol levels, but more than half of the prescriptions were considered inefficient

Investigating the exercise-prescription practices of nurses working in inpatient mental health settings.

Nurses working in mental health are well positioned to prescribe exercise to people with mental illness. However, little is known regarding their exercise-prescription practices. We examined the self-reported physical activity and exercise-prescription practices of nurses working in inpatient mental health facilities. Thirty-four nurses completed the Exercise in Mental Illness Questionnaire - Health Practitioner Version. Non-parametric bivariate statistics revealed no relationship between nurses' self-reported physical activity participation and the frequency of exercise prescription for people with mental illness. Exercise-prescription parameters used by nurses are consistent with those recommended for both the general population and for people with mental illness. A substantial number of barriers to effective exercise prescription, including lack of training, systemic issues (such as prioritization and lack of time), and lack of consumer motivation, impact on the prescription of exercise for people with mental illness. Addressing the barriers to exercise prescription could improve the proportion of nurses who routinely prescribe exercise. Collaboration with exercise professionals, such as accredited exercise physiologists or physiotherapists, might improve knowledge of evidence-based exercise-prescription practices for people with mental illness, thereby improving both physical and mental health outcomes for this vulnerable population.