Nurse Administered Propofol Sedation (NAPS) versus On-call Anesthesiologist Administered Propofol Sedation (OAPS) in Elective Colonoscopy.

BACKGROUND AND AIMS: As on-call anesthesiologist administered propofol sedation (OAPS) is costly and not readily available in all endoscopy units, endoscopy nurse administered propofol sedation (NAPS) can be an effective alternative. This study aimed to compare the dosage of propofol used by NAPS versus OAPS, cardiopulmonary adverse events and recovery time in low risk patients undergoing outpatient elective colonoscopy. METHODS: A retrospective propensity score-matched cohort study was conducted. Electronic medical records of elective colonoscopies performed by 3 experienced endoscopists from January 2016 to December 2019 were retrieved. OAPSs were performed by 10 certified anesthesiologists while NAPSs were performed by 8 experienced registered endoscopy nurses. Baseline characteristics, performing endoscopist, cecal intubation time, withdrawal time, propofol dosage per procedure, and adverse events were collected and analyzed using 3:1 (NAPS:OAPS) propensity score matching by age, performing endoscopist and difficulty of colonoscopy as co-variates with standardized mean deviation of <0.1. RESULTS: 278 eligible patients were included. After propensity score matching, there were 189 patients in NAPS and 63 in OAPS group for analysis. Demographic data were not different between the two groups. All procedures were technically successful with no difference in cecal intubation time (6.0±4 min vs 6.8±4 min; p=0.13) or total procedural time (17.2±16 min vs 16.3±6 min; p=0.66). Propofol dosage/kg/hour were significantly lower in the NAPS group, (11.4±4 mg/kg/hour vs. 16.6±8 mg/kg/hour; p<0.001). There were less minor cardiopulmonary adverse events in NAPS when compared to the OAPS group (2.2% vs 4.7%; p=0.014). CONCLUSIONS: NAPS in elective colonoscopy in low-risk patients is as effective as OAPS but requires a significant lower dosage of propofol. Minor cardiopulmonary adverse events were recorded in the NAPS group compared to OAPS.

Co-administration of multiple intravenous medicines: Intensive care nurses' views and perspectives.

BACKGROUND: Co-administration of multiple intravenous (IV) medicines down the same lumen of an IV catheter is often necessary in the intensive care unit (ICU) while ensuring medicine compatibility. AIMS AND OBJECTIVES: This study explores ICU nurses' views on the everyday practice surrounding co-administration of multiple IV medicines down the same lumen. DESIGN: Qualitative study using focus group interviews. METHODS: Three focus groups were conducted with 20 ICU nurses across two hospitals in the Thames Valley Critical Care Network, England. Participants' experience of co-administration down the same lumen and means of assessing compatibility were explored. All focus groups were recorded, transcribed verbatim, and analysed using thematic analysis. Functional Resonance Analysis Method was used to provide a visual representation of the co-administration process. RESULTS: Two key themes were identified as essential during the process of co-administration, namely, venous access and resources. Most nurses described insufficient venous access and lack of compatibility data for commonly used medicines (eg, analgesics and antibiotics) as particular challenges. Strategies such as obtaining additional venous access, prioritizing infusions, and swapping line of infusion were used to manage IV administration problems where medicines were incompatible, or of unknown or variable compatibility. CONCLUSIONS: Nurses use several workarounds to manage commonly encountered medication compatibility problems that may lead to delays in therapy. Organizations should review and tailor compatibility resources towards commonly administered medicines using an interdisciplinary approach. Developing a clinical decision-making pathway to minimise variability while promoting safe co-administration practice should be prioritised. RELEVANCE TO CLINICAL PRACTICE: This study highlights several ways ICU nurses are able to manage challenges associated with co-administration and the need for the development of a more robust and comprehensive compatibility resource that is relevant to everyday practice through collaboration between nurses and pharmacists.

Riscos potenciais no processo de preparo e administração de medicamentos por via intravenosa: revisão literária de ações integradas para alívio da dor e educação em saúde / Potential risks in the preparation and administration of intravenous drugs: a literary review of integrated actions for pain relief and health education / Riesgos potenciales en el proceso de preparación y administración de medicamentos por vía intravenosa: revisión literaria de acciones integradas para alivio del dolor y educación en salud

Objective: The study's main purpose has been to analyze scientific articles on the world scenario about nursing interventions in the process of preparation and administration of intravenous drugs, risks inherent in professional practice and actions integrated with medical prescription. Methods: It is a research of literary nature that was carried out through the main databases of online indexed studies. For the development of this research, books related to the practice of intravenous therapy and current legislation were consulted. Results: This investigation describes the main urgent and emerging pathologies in the hospital service, nursing actions aimed at intravenous therapy and pain relief. Conclusion: Finally, it is needed to improve the instruments used to measure acute pain, because they have limitations in its implementation, either for evaluating the size of a single aspect or to be extensive in its application in the level of hospital care

Objetivo: Objetivo do estudo consiste em analisar artigos científicos no cenário mundial acerca das intervenções de enfermagem no processo de preparo e administração de medicamentos por via venosa, riscos inerentes a pratica profissional e ações integradas à prescrição médica. Método: pesquisa de natureza literária, realizada através dos principais bancos de dados online de pesquisas indexadas. Para desenvolvimento do estudo foram consultados livros relacionados à prática da terapia intravenosa e legislações vigentes. Resultados: descrição das principais patologias urgentes e emergentes no serviço hospitalar, ações de enfermagem voltadas para terapia intravenosa e alivio da dor. Conclusão: necessidade de aprimoramento dos instrumentos utilizados para mensurar a dor aguda, pois possuem limitações em sua implementação, seja por avaliar a dimensão de um único aspecto ou serem extenso em sua aplicação em nível de atendimento hospitalar

Objetivo: El objetivo del estudio consiste en analizar artículos científicos en el escenario mundial acerca de las intervenciones de enfermería en el proceso de preparación y administración de medicamentos por vía venosa, riesgos inherentes a la práctica profesional y acciones integradas a la prescripción médica. Método: investigación de naturaleza literaria, realizada a través de las principales bases de datos en línea de investigaciones indexadas. Para el desarrollo del estudio se consultó libros relacionados con la práctica de la terapia intravenosa y las legislaciones vigentes. Resultados: descripción de las principales patologías urgentes y emergentes en el servicio hospitalario, acciones de enfermería dirigidas a terapia intravenosa y alivio del dolor. Conclusión: necesidad de perfeccionamiento de los instrumentos utilizados para medir el dolor agudo, pues poseen limitaciones en su implementación, sea por evaluar la dimensión de un solo aspecto o ser extenso en su aplicación a nivel de atención hospitalaria

Nurses' decision-making about intravenous administration set replacement: A qualitative study.

AIMS AND OBJECTIVES: To explore nurses' decision-making regarding intravenous administration set replacement for vascular access device infusions in paediatric and adult clinical settings. BACKGROUND: Intravenous administration sets are routinely replaced at regular intervals in clinical practice with the goal of preventing catheter-related bloodstream infection; however, emerging evidence is challenging traditional hang-time durations. Nurses' perceptions and contextual factors affecting decision-making for administration set replacement have not been assessed previously. DESIGN: Qualitative study using focus groups with contextualism methodology and inductive analysis. METHOD: During November-December 2016, eight semi-structured focus groups were conducted with 38 nurses at two metropolitan hospitals in Queensland, Australia. Interviews were audio-recorded and transcribed. Two authors independently reviewed transcripts and extracted significant statements using Braun and Clarke's 7-step method of thematic analysis. The COREQ checklist provided a framework to report the study methods, context, findings, analysis and interpretation. RESULTS: Five key themes emerged from the analysis: (a) infection prevention, (b) physical safety, (c) patient preference, (d) clinical knowledge and beliefs, and (e) workload. Administration set replacement can be a complex task, particularly when patients have multiple infusions and incompatible medications. Nurses drew on perceptions of patient preference, as well as previous experience, knowledge of peer experts and local policies, to aid their decisions. CONCLUSIONS: Nurses use clinical reasoning to balance patient safety and preferences with competing workplace demands when undertaking administration set replacement. Nurses rely on previous experience, hospital and medication manufacturer policies, and peer experts to guide their practice. RELEVANCE TO CLINICAL PRACTICE: Nurses at times deviate from clinical guidelines in the interests of patient acuity, nurses' experience and workload. The findings of this study indicate nurses also balance considerations of patient preference and safety with these competing demands.

Nurses' Indications for Administration of Perioperative Intravenous Fluid Therapy-A Prospective, Descriptive, Single-Center Cohort Study.

PURPOSE: To examine whether nurse anesthetists and postanesthesia nurses' administration of intravenous (IV) fluid therapy during surgery and in the postanesthesia care unit is based on evidence. Secondarily to investigate if providing indications for IV fluid administration changed nursing practice. DESIGN: Prospective, descriptive, single-center study in Scandinavia comparing two cohorts. METHODS: Descriptive, fluid volume, and type data were obtained in both cohorts. Cohort 1 (n = 126) was used as baseline data. In cohort 2 (n = 130), nurses recorded indications for type and volume of fluid therapy using a validated list. Analysis compared median volumes of crystalloid or colloid fluids of surgical types by cohort. Analysis compared frequency of given indication reasons for each IV fluid by surgical type. FINDINGS: Basic static variables were chosen most frequently for indications of IV fluid needed for all surgeries except high-risk abdominal surgery where dynamic variables were more frequent. Signs and symptoms of inadequate tissue perfusion were only sparsely indicated. The volume of intraoperative crystalloid fluids was statistically different for patients with hip fracture surgery in cohort 2. Volumes of both colloid and crystalloid fluids were significantly higher for high-risk abdominal surgery in cohort 2. CONCLUSIONS: Nurse anesthetists and nurses in the postanesthesia care unit rely more on basic static parameters than signs of inadequate tissue perfusion when they make decisions about fluid administration. The indications cited for fluid administered to high-risk abdominal surgery and hip fracture patients did not always fit guidelines. This indicates the need of a stronger intervention to change practice to follow evidence-based clinical guidelines.

Analisis de actividad del Equipo de Terapia Intravenosa en el Hospital Universitario Donostia (2011-2017)La competencia política enfermera / Analysis of the the intravenous therapy team activity at the Donostia University Hospital (2011-2017) and the maintenance/sealing protocol of average and long-term catheter

Un porcentaje muy alto de pacientes hospitalizados (se estima más de un 90 %) requiere un acceso vascular durante su ingreso para administración de medicación, extracción de analíticas, soporte hematológico, nutrición parenteral, etc. Como profesionales enfermeros se nos plantea un reto importante a la hora de implantar nuevos dispositivos (líneas medias, catéteres centrales de inserción periférica, reservorios braquiales...) con nuevas técnicas (inserción ecoguiada, tunelización...) y, si cabe y más importante aún, el mantenimiento de estos para conseguir un correcto funcionamiento y evitar las complicaciones derivadas de su uso

A very high percentage of hospitalized patients (estimated to be more than 90 %) re-quire vascular access during their admission for medication administration, analytical extraction, hematological support, parenteral nutrition, etc. As nursing professionals, we face an important challenge when implanting new de-vices (midlines, peripherally insertion central catheters, brachial reservoirs...) with new techniques (echoguided insertion, tunneling...) and if possible and more important the maintenance of these to get a correct operation and avoid complications arising from its use

Manejo de la ferroterapia para enfermería / Use of ferrotherapy for nursing

El hierro es esencial para el mantenimiento de la salud. Su disminución está asociada con una reducción en la calidad de vida y un aumento en el número de hospitalizaciones. La terapia oral es económica y cómoda, pero no siempre bien tolerada, poco efectiva en presencia de ciertas enfermedades y con una adherencia muy pobre. Las nuevas moléculas de hierro intravenoso muestran mayor eficacia y seguridad. Esto ha hecho que se conviertan en la vía de elección cuando se trata de repleciones rápidas y con altos requerimientos, así como en procesos renales o digestivos inflamatorios crónicos. El hierro a altas dosis permite reducir el número de infusiones, preservando los accesos venosos del paciente, además de reducir el coste sanitario

Iron is essential for maintaining health. Its decrease is associated with a reduction in the quality of life and an increase in the number of hospitalizations. Oral therapy is economical and convenient but not always well tolerated, ineffective in the presence of certain diseases and with a high rate of low adherence. New molecular intravenous iron preparations show greater effectiveness and safety. This has made it the route choice when it comes to rapid high demanding repletion, as well as in chronic inflammatory renal or digestive processes. High-dose iron decreases the frequency of hospital visits and preserves venous access by reducing the number of punctures, resulting in lower healthcare costs

Administración de fármacos en el adulto en el ámbito hospitalario / Drug administration in adult hospital inpatients

La seguridad del paciente es una prioridad dentro del ámbito hospitalario. Los nuevos fármacos, la complejidad de los tratamientos o su duración favorecen la aparición de eventos adversos. Las terapias intravenosas son muy frecuentes, pero su aplicación no está exenta de complicaciones debido a la manipulación de los fármacos y catéteres para hacer viable su administración. Por ello, uno de los mayores retos y responsabilidades de la enfermera es la administración de medicamentos y la prevención y detección de posibles efectos adversos, debido a la relevancia de las potenciales lesiones sobre el paciente. El presente artículo revisa los criterios y las buenas prácticas clínicas basadas en la evidencia referentes al manejo de la terapia intravenosa en lo que respecta a aspectos tan importantes como las diferentes formas de administración de medicamentos, las compatibilidades e interacciones farmacológicas y las complicaciones más frecuentes que se pueden presentar

Maintaining patients' safety is a priority within the hospital setting. The appearance of adverse events is encouraged by the use of new drugs, the complexity of treatments and their duration. Intravenous therapies are very frequent; however, their delivery is not exempt from complications, due to the handling techniques necessary for the administration of drugs and catheters. Therefore, one of nursing's major challenges and responsibilities is medication management, together with the prevention and detection of possible adverse effects, due to the relevance that these may have on patients' potential injuries. The present article offers a review on the criteria and evidence-based best clinical practice for intravenous therapy management, regarding important aspects such as: the different ways of drug administration, compatibilities and pharmacological interactions, along with the most common complications that may occur

Tejiendo una red de enfermeras formadas: la labor de un equipo de terapia intravenosa / Weaving a network of trained nurses: the work of an intravenous therapy team

En abril de 2016 se forma el Equipo de Terapia Intravenosa (ETI) de la Organización Sanitaria Integrada (OSI) Barrualde-Galdakao con el objetivo de implantar catéteres (Peripherally Inserted Central Catheter PICC/midline) tanto en pacientes hospitalizados como en tratamiento ambulatorio (Hospital de Día Oncológico) con la finalidad de preservar el capital venoso del paciente subsidiario de terapia intravenosa, reducir el número de venopunciones, aportar confort y, por lo tanto, mejorar su calidad de vida. Desde el primer momento queda patente la necesidad no solo de difundir la existencia y actividad del ETI, desarrollar protocolos de actuación del este y rutas asistenciales para los pacientes implantados, sino también de desarrollar protocolos y actividades formativas e informativas que engloben por un lado al resto de profesionales de la OSI Barrualde-Galdakao que van a estar implicados en el mantenimiento correcto de los nuevos catéteres y, por otro lado, al propio paciente portador de catéter y su familia o cuidador. El objetivo de este artículo es describir las diferentes acciones educativas que se han llevado a cabo por parte de los miembros del ETI de la OSI Barrualde-Galdakao y el contenido de las mismas

The Barrualde-Galdakao Integrated Health Organization, established in April 2016 an Intravenous Therapy Team (ITT), with the objective of implanting catheters (Peripherally Inserted Central Catheter PICC/Midline), both for inpatients and outpatients from the Oncology Day Hospital, in order to preserve venous capital of patients needing intravenous treatment, reducing the number of punctures, providing comfort and therefore improving their quality of life. From the very beginning of the team’s establishment, the need of disseminating the existence and activities of the ITT became prominent, together with the need of developing action protocols and care routes for implanted patients; an imperative need was also noted, especially with regards to developing protocols, training and informative activities for the rest of the nurses within the Integrated Health Organization, who would be involved in managing the new catheters and caring for catheter-carrying patients, their families and/or caregivers. The objective of this article is to describe the different educational activities that have been carried out by the ITT members and the content of the activities

Beneficios, complicaciones y mantenimiento de los catéteres Midline / Benefits, complications and maintenance of Midline catheters

Actualmente, en terapia intravenosa se están buscando alternativas que resuelvan las necesidades de los pacientes minimizando los problemas secundarios asociados a la utilización de catéteres venosos. El catéter venoso medial o Midline (MC) se ha convertido en un dispositivo seguro y eficiente para la administración de tratamientos intravenosos, ya que cada vez existen materiales más vasocompatibles que permiten prolongar su utilización. Sin embargo, existen ciertas limitaciones para su uso con sustancias vesicantes e irritantes. Los catéteres Midline son catéteres periféricos largos que se insertan en venas periféricas del brazo, cuya punta queda situada a nivel axilar, siendo de uso inmediato. Para asegurar la longevidad y el correcto funcionamiento de estos dispositivos, los profesionales enfermeros se deben formar en los cuidados de los sistemas, siendo conscientes de que muchos de los problemas potenciales desaparecerán con la correcta aplicación de protocolos

In the area of intravenous therapy, alternatives are being currently sought in order to cover the needs of patients, reducing as much as possible any secondary problems associated with the use of venous catheters. The medial or Midline Venous Catheter (MC) has become a safe and efficient device for the administration of intravenous treatment, as there are increasingly more vessel-compatible materials, which allow to prolong their use. However, there are certain limitations for their use with vesicant and irritant substances. These are long peripheral catheters which are inserted in peripheral arm veins: their tip remains lodged at axillary level, and their use is immediate. In order to ensure the long duration and adequate performance of these devices, nursing professionals must receive training in system care, and be aware that many potential problems will disappear with the correct implementation of protocols

Knowledge regarding noncytotoxic medication extravasation among registered nurses working in western Saudi Arabia.

Extravasation and infiltration are among the most common intravenous therapy complications. For noncytotoxic agents, the incidence of extravasation remains unknown. There has been little research into extravasation due to ethical considerations limiting controlled research; most evidences are based on small, uncontrolled trials or case reports. The purpose of this study was to assess the knowledge level regarding noncytotoxic medications extravasation and its associated factors among staff nurses.A descriptive correlational design using self-administered questionnaire was employed. A convenience sample of 387 nurses completed a questionnaire about noncytotoxic medication extravasation. Statistical Package for Social Sciences version 21 was used to analyze data by applying the chi-square test, t test, and the Mann-Whitney test to assess the knowledge difference between open and closed units' nurses.The results indicate that only 19.6% of nurses have a good knowledge about noncytotoxic medications extravasation. There was consistently poor staff knowledge regarding noncytotoxic medications extravasation. Although the closed units' nurses reported relatively higher level of knowledge than open units' nurses, their level of knowledge still inadequate. Health care organizations must consider developing specific policies regarding extravasation. Closed and open units' nurses should be enrolled in special education programs to improve their level of knowledge regarding noncytotoxic medication extravasation.

Incompatibilidade medicamentosa em terapia intensiva: revisão sobre as implicações para a prática de enfermagem / Drug incompatibility in the ICU: review of implications in nursing practice

Revisão integrativa de literatura realizada em sete bases de dados, com objetivo de analisar a produção científica sobre as potenciais incompatibilidades medicamentosas em terapia intensiva e mapear os medicamentos incompatíveis de maior prevalência descritos na literatura. Os filtros aplicados foram: artigos disponíveis na íntegra, publicações do período de 2009 a 2016 nos idiomas português, inglês e/ou espanhol, totalizando 11 artigos ao término da seleção. A partir da revisão, observou-se que os medicamentos fenitoína e pantoprazol são os principais responsáveis pelas incompatibilidades medicamentosas nas unidades de terapia intensiva. O bloqueio das incompatibilidades pode ser realizado por meio de medidas simples implementadas rotineiramente pela enfermagem, tais como o aprazamento de medicamentos otimizado, a administração em vias venosas separadas de medicamentos sabidamente incompatíveis, a padronização da forma de diluição e administração de medicamentos, focando, principalmente, nos medicamentos incompatíveis de maior prevalência encontrados no estudo.

This is an integrative review of the literature performed in seven databases, with the aim of analyzing the scientific production on potential drug incompatibilities in ICUs, and mapping the most prevalent incompatible drugs described in the literature. The filters applied were: articles available in full, and publications from 2009 to 2016 in Portuguese, English, and/or Spanish, totaling 11 articles at the end of the selection. From the review, it was observed that the medicines phenytoin and pantoprazole are the main drugs responsible for drug incompatibilities in intensive care units. Blocking of incompatibilities can be achieved through simple measures routinely implemented by the nursing team, such as optimization of drug scheduling, administration of drugs known to be incompatible in separate venous routes, and standardization of drug dilution and administration, focusing mainly on the most prevalent incompatible drugs found in the study.

Ferropenia y anemia ferropénica. Tratamiento con hierro intravenoso a altas dosis / Iron deficiency and iron deficiency anemia. High-dose intravenous iron treatment

La anemia por déficit de hierro puede ser habitual en diferentes patologías agudas y crónicas. La vía de primera elección para la reposición de hierro es la oral. Sin embargo, cuando esta vía resulta ineficaz, es mal tolerada o está contraindicada o, cuando hay que tratar una anemia grave o existe la necesidad de recuperación rápida de los niveles de hierro corporal, se recomienda la repleción de hierro por vía endovenosa. El hierro administrado por vía intravenosa permite una rápida y eficiente corrección de los niveles de hierro. Los preparados intravenosos actuales presentan el hierro asociado a moléculas de polisacáridos que facilitan su liberación lenta y controlada, biodisponible para su unión a las proteínas específicas de almacenaje o transportadoras. Gracias a ello, se reduce la toxicidad por hierro libre y se hace posible la administración de altas dosis en intervalos cortos de tiempo. La introducción de preparados que permiten la administración de hierro sin dosis techo, como el hierro isomaltósido, además de reponer eficazmente los niveles de hierro, incide significativamente en la calidad de vida de los pacientes, ya que reduce el número de visitas y desplazamientos a los centros sanitarios, disminuye el número de punciones preservando los accesos venosos, minimiza las interferencias en sus actividades cotidianas y mejora los recursos sanitarios (AU)

Iron deficiency anemia is common in different acute and chronic diseases. The current first line of therapy is oral iron supplementation. However, when this method is ineffective, poorly tolerated, contraindicated, when dealing with severe anemia or facing the need for rapid recovery of iron levels, it is recommended to replete iron intravenously. Administering intravenous iron allows for a fast and efficient correction of iron levels. Current injectable solutions contain iron in combination with polysaccharide molecules which facilitate slow and controlled iron release, making it bioavailable to bind with transport and storage proteins. As a result, toxicity is reduced allowing for high-dose administration in short time intervals. Administering high-dose solutions of intravenous iron, such as iron isomaltoside, apart from effectively replenishing iron levels, significantly improves patients quality of life, reduces the frequency of hospital or clinic visits and decreases punctures preserving the venous access, minimizes interference with daily activities and benefits health care resources (AU)

The implementation of the Vessel Health and Preservation framework.

Vascular access is an important component of health care but is not without associated risks, some of which can be life-threatening. The Vessel Health and Preservation (VHP) framework was developed with the intention of providing frontline staff with a resource to assist in assessing and selecting the best vascular access device to meet individual patient needs and to preserve veins for future use. This article examines the impact of the introduction of the framework into a haematology ward in an acute hospital in the North West of England during a 3-month pilot study. The results indicate that the VHP framework gave nursing staff more autonomy to choose the appropriate vascular access device for their patients and improved staff knowledge around pH and osmolality of intravenous drugs. However it is clear that more in-depth evaluations need to be conducted to assess the impact of VHP on patient care and outcomes.

Administração segura de medicamentos via endovenosa: uma proposta para o hospital universitário / Safe intravenous drug administration: a proposal for the university hospital

Introdução: A assistência à saúde com qualidade e segurança é um tema atual e pertinente aos serviços de saúde, que tem se preocupado em aprimorar seus processos com base nos preceitos desta temática. Este estudo visa contribuir para qualidade e segurança na assistência aos pacientes no que concerne a administração de medicamentos. E também pretende contribuir com o ensino e pesquisa nesta área na medida em que trata um delineamento da realidade de uma Instituição de Ensino e busca propor uma uniformização do processo. Objetivos: Identificar a dinâmica de administração de medicamentos. Elaborar um Procedimento Operacional Padrão para administração de medicamentos via endovenosa. Elaborar Lista de Verificação (CheckList) com as etapas a serem seguidas para uma administração segura de medicamentos para avaliar adesão dos profissionais. Os produtos oriundos dessa pesquisa foram: Procedimento Operacional Padrão para administração de medicamentos via endovenosa e um CheckList com as etapas para administração segura de medicamentos.Método:Estudo descritivo com abordagem qualitativa para análise dos dados. Os participantes foram os membros da Equipe de Enfermagem da enfermaria de escolha, a coleta de dados foi realizada por meio da observação direta guiada por um roteiro de observação, no segundo semestre de 2015, de segunda a domingo, nos três turnos de trabalho após a assinatura do Termo de Consentimento Livre e Esclarecido, sendo a amostra não probabilística por conveniência. Este estudo foi aprovado pelo comitê de ética das instituições proponente e co-participante sob os pareceres n° 1.262.690 e 1.301.318. Resultados: Foi observado um total de 23 doses de medicamentos por via endovenosa. Foi observada adesão superior à 50% na maioria das etapas da administração de medicamentos. Porém ressaltou-se como pontos de atenção uma adesão de 17% ao uso de EPI durante a manipulação dos medicamentos, 17% à desinfecção das conexões antes da administração e 15% à higienização das mãos logo após o procedimento antes de retornar ao posto de enfermagem. Conclusão: Os achados desta pesquisa apontam para necessidade de intervenção em questões da prática dos profissionais como higienização das mãos e uso de EPI's. Esses dados corroboram a necessidade de uma uniformização da prática assistencial no que concerne a administração de medicamentos visando à qualidade e segurança da assistência de Enfermagem

Introduction: Health care with quality and safety is a current topic and pertinent to health services, which has been concerned with improving its processes based on the precepts of this theme. This study aims to contribute to quality and safety in patient care in drug administration. It also intends to contribute to teaching and research in this area insofar as it deals with a delineation of the reality of a teaching institution and seeks to propose a standardization of the process. Objectives: To identify the dynamics of drug administration. Elaborate a Standard Operating Procedure for intravenous drug administration. Elaborate Checklist with the steps to follow for safe administration of medications to assess adherence of professionals. The products that came from this research were: Standard Operating Procedure for intravenous drug administration and a CheckList with the steps for safe administration of drugs. Method: Descriptive study with qualitative approach for data analysis. Participants were members of the Nursing Team of the infirmary of choice, data collection was done through direct observation guided by an observation script, in the second half of 2015, from Monday to Sunday, in the three work shifts after the signature of the Free and Informed Consent Term, being the non-probabilistic sample for convenience. This study was approved by the ethics committee of the proposing institutions and co-participant under the reports no. 1,262,690 and 1,301,318. Results: A total of 23 intravenous drug doses were observed. Adherence was higher than 50% in most stages of drug administration. However, a 17% adherence to the use of PPE during the manipulation of medications, 17% to the disinfection of the connections before administration and 15% to the hygiene of the hands soon after the procedure before returning to the nursing station . Conclusion: The findings of this research point to the need for intervention in issues of professional practice such as hand hygiene and use of PPE. These data corroborate the need for a standardization of care practice regarding the administration of medicines aiming at the quality and safety of Nursing care

Brinquedo terapêutico na administração de medicação endovenosa em crianças: estudo exploratório / Use of therapeutic play during intravenous drug administration in children: exploratory study / Juguete terapéutico en la administración de medicamentos intravenoso en niños: estudio exploratorio

OBJETIVO: Identificar reações de crianças na administração de medicação endovenosa, realizada anterior e posteriormente à técnica do Brinquedo Terapêutico, e analisar percepção dos acompanhantes em relação à influência da técnica no preparo para administração da medicação endovenosa. MÉTODO: Estudo exploratório, com abordagem qualitativa, realizado por meio de observações de administração medicamentosa endovenosa e das sessões de Brinquedo Terapêutico com crianças, e entrevista semiestruturada com acompanhantes. Os dados foram submetidos à análise temática. RESULTADOS: Crianças com dificuldade em aceitar a medicação endovenosa apresentaram mudanças positivas no comportamento após realização Brinquedo Terapêutico, principalmente aquelas entre 4 e 6 anos. Acompanhantes recomendam a realização dessa prática para melhoria do cuidado e redução do estresse durante a administração. CONCLUSÃO: Brinquedo terapêutico é uma relevante intervenção de enfermagem para minimizar as reações da criança durante o uso de medicações endovenosas, sendo importante a capacitação dos enfermeiros e o fomento da técnica para qualificação da assistência.

AIM: To identify the reactions of children during intravenous drug administration before and after the use of therapeutic play technique and to analyse their companions' perceptions regarding the technique's effects on the child's preparation for intravenous drug administration. METHOD: An exploratory study with a qualitative approach conducted through observations of intravenous drug administration and therapeutic play sessions with children and semi-structured interviews with their companions. The data were subjected to thematic analysis. RESULTS: Children who had difficulty accepting intravenous medication, especially those between 4 and 6 years, presented positive behavioural changes after the use of therapeutic play. The children's companions recommended the use of this technique to improve care and reduce stress during drug administration. CONCLUSION: Therapeutic play is a relevant nursing intervention for minimizing children's reactions during intravenous drug administration, and the training of nurses and the promotion of technique are important for improving care.

OBJETIVO: Identificar reacciones de niños en la administración de medicamentos intravenoso, realizada anterior y posteriormente a la técnica del Juguete Terapéutico, y analizar percepción de los acompañantes en relación a la influencia de la técnica en el preparo para la administración del medicamento intravenoso. MÉTODO: Estudio exploratorio, con enfoque cualitativo, realizado por medio de observaciones de administración medicamentosa intravenosa y de las sesiones de Juguete Terapéutico con niños, y entrevista semiestructurada con acompañantes. Los datos fueron sometidos al análisis temático. RESULTADOS: Niños con dificultad en aceptar el medicamento intravenoso presentaron cambios positivos en el comportamiento después la realización Juguete Terapéutico, principalmente aquellas entre 4 y 6 años. Acompañantes recomiendan la realización de esa práctica para mejora del cuidado y reducción del estrés durante la administración. CONCLUSIÓN: Juguete terapéutico es una relevante intervención de enfermería para minimizar las reacciones del niño durante el uso de medicamentos intravenosa, siendo importante la capacitación de los enfermeros y el fomento de la técnica para cualificación de la asistencia.

Metodologia da problematização: estratégia de ensino para a aprendizagem do procedimento de terapia intravenosa / Methodology of problematization: teaching strategy for learning the procedure of intravenoustherapy

This study aimed to report the experience of using the methodology of problematization for teaching the procedure of intravenous therapy to undergraduate nursing students. Four of the five steps proposed by the Maguerez Arc were followed: observation of reality and definition of a problem, key points, theorizing and hypotheses of solution. After completion of the steps, the students completed an assessment tool identifying the facilitating and inhibiting points. As facilitators, the following points were raised: effective participation of students in the search for new knowledge; decreased anxiety; experience of the hospital environment for the first time; interaction with the patient; more dynamicclasses; ability to think of solutions; and as inhibiting points: lengthy process; lack of clarity in explaining some steps; little time for the preparation of activities; development of clinical teaching without having the knowledge necessary for provision of assistance.The methodology of problematization, as an active strategy of learning was effective for teaching the procedure of intravenous therapy. It is up to the teacher to identify the needs of students as well as to implement new methods of teaching, in which students actively participate in their learning.

Este estudo objetiva relatar a experiência da utilização da metodologia da problematização no ensino do procedimento de terapia intravenosa para alunos de graduação em enfermagem. Foram seguidas quatro das cinco etapas propostas pelo Arco de Maguerez: observação da realidade e definição de um problema, pontos-chave, teorização e hipóteses de solução. Após a finalização das etapas, os alunos preencheram um instrumento de avaliação identificando pontos facilitadores e dificultadores. Foram levantados como pontos facilitadores: participação efetiva dos alunos na busca de novos conhecimentos, diminuição da ansiedade, vivência do ambiente hospitalar pela primeira vez, interação com o paciente, aulas mais dinâmicas, possibilidade de pensar em soluções; e pontos dificultadores: processo demorado, falta de clareza na explicação de algumas etapas, pouco tempo para o preparo das atividades, desenvolvimento do ensino clínico sem ter o conhecimento necessário para a prestação da assistência.A metodologia da problematização, como estratégia ativa de aprendizagem foi efetiva para o ensino do procedimento de terapia intravenosa. Cabe ao docente identificar as necessidades do aluno, bem como implementar novas metodologias de ensino, em que os alunos participem ativamente do seu aprendizado.