Fatores associados ao comprometimento da segurança do paciente na unidade de terapia intensiva / Factors associated with the commitment of patient safety in the intensive care unit / Factores asociados al compromiso de la seguridad del paciente en la unidad de cuidados intensivos

Objetivo: conhecer os fatores associados ao comprometimento da segurança do paciente. Método: trata-se de um artigo de revisão integrativa da literatura a partir das bases de dados Scientific Electrônic Library Online, PubMed e Literatura Latino-americana e do Caribe em Ciências da Saúde, realizada entre abril e maio de 2022. Resultados: foi visto os principais fatores que corroboram para o comprometimento da segurança, sendo a utilização inadequada dos equipamentos, falta de rotina e ausência de protocolo no setor. Foi detectado a problemática da carga exacerbada de trabalho. Conflitos na equipe também foi tido como um preditor para existência de evento adverso. E por fim, o quesito da subnotificação dos erros. Conclusão: é visto a necessidade da gestão reverter esses problemas, para que a assim a porcentagem de erros seja diminuída.

Objective: to know the factors associated with compromised patient safety. Method: this is an integrative literature review article based on the Scientific Electronic Library Online, PubMed and Latin American and Caribbean Literature in Health Sciences databases, carried out between April and May 2022. Results: it was seen the main factors that corroborate for the compromise of safety, being the inadequate use of equipment, lack of routine and lack of protocol in the sector. The problem of exacerbated workload was detected. Conflicts in the team was also considered a predictor for the existence of an adverse event. And finally, the issue of underreporting of errors. Conclusion: the need for management to reverse these problems is seen, so that the percentage of errors is reduced.

Objetivos:conocer los factores asociados a la seguridad del paciente comprometida. Método: este es un artículo de revisión integradora de la literatura basado en las bases de datos Scientific Electronic Library Online, PubMed y Latin American and Caribbean Literature in Health Sciences, realizado entre abril y mayo de 2022. Resultados: se vieron los principales factores que corroboran para el compromiso de seguridad, siendo el uso inadecuado de equipos, falta de rutina y falta de protocolo en el sector. Se detectó el problema de la sobrecarga de trabajo. Los conflictos en el equipo también fueron considerados predictores de la existencia de un evento adverso. Y por último, el tema del subregistro de errores. Conclusión: se ve la necesidad de que la gestión revierta estos problemas, de modo que se reduzca el porcentaje de errores.

Monoclonal Antibody Approved to Treat Ebola.

Ansuvimab-zykl (Ebanga), a human monoclonal antibody, has been approved to treat Zaire ebolavirus (Ebolavirus) infection.The most common adverse effects of the drug are fever, tachycardia, diarrhea, vomiting, hypotension, tachypnea, and chills; these are also common symptoms of Ebolavirus infection.

First Oral Hormone for Treating Prostate Cancer.

Relugolix (Orgovyx) has been approved for the treatment of advanced prostate cancer. It is the first oral gonadotropin-releasing hormone receptor antagonist.As with other androgen deprivation therapy, there is a risk of prolonging the QT or QTc interval with relugolix. The drug may also cause embryo-fetal toxicity.

Local anesthetic systemic toxicity: What nurses should know.

ABSTRACT: Local or regional anesthetics are becoming more common pain management options for patients, especially considering concerns regarding opioid use disorders. Though mostly safe, these interventions may carry serious risks such as local anesthetic systemic toxicity (LAST). This article discusses LAST and the importance of recognizing its signs and symptoms.

Extracorporeal treatment for calcium channel blocker poisoning: systematic review and recommendations from the EXTRIP workgroup.

BACKGROUND: Calcium channel blockers (CCBs) are commonly used to treat conditions such as arterial hypertension and supraventricular dysrhythmias. Poisoning from these drugs can lead to severe morbidity and mortality. We aimed to determine the utility of extracorporeal treatments (ECTRs) in the management of CCB poisoning. METHODS: We conducted systematic reviews of the literature, screened studies, extracted data, summarized findings, and formulated recommendations following published EXTRIP methods. RESULTS: A total of 83 publications (6 in vitro and 1 animal experiments, 55 case reports or case series, 19 pharmacokinetic studies, 1 cohort study and 1 systematic review) met inclusion criteria regarding the effect of ECTR. Toxicokinetic or pharmacokinetic data were available on 210 patients (including 32 for amlodipine, 20 for diltiazem, and 52 for verapamil). Regardless of the ECTR used, amlodipine, bepridil, diltiazem, felodipine, isradipine, mibefradil, nifedipine, nisoldipine, and verapamil were considered not dialyzable, with variable levels of evidence, while no dialyzability grading was possible for nicardipine and nitrendipine. Data were available for clinical analysis on 78 CCB poisoned patients (including 32 patients for amlodipine, 16 for diltiazem, and 23 for verapamil). Standard care (including high dose insulin euglycemic therapy) was not systematically administered. Clinical data did not suggest an improvement in outcomes with ECTR. Consequently, the EXTRIP workgroup recommends against using ECTR in addition to standard care for patients severely poisoned with either amlodipine, diltiazem or verapamil (strong recommendations, very low quality of the evidence (1D)). There were insufficient clinical data to draft recommendation for other CCBs, although the workgroup acknowledged the low dialyzability from, and lack of biological plausibility for, ECTR. CONCLUSIONS: Both dialyzability and clinical data do not support a clinical benefit from ECTRs for CCB poisoning. The EXTRIP workgroup recommends against using extracorporeal methods to enhance the elimination of amlodipine, diltiazem, and verapamil in patients with severe poisoning.

Nursing Considerations for Patients With HIV in Critical Care Settings.

Infection with HIV is a chronic condition that requires daily medication to suppress viral replication. With appropriate treatment, people living with HIV have a life expectancy approaching that of the general population. However, they are at increased risk for comorbidities including cardiovascular disease, renal disease, type 2 diabetes, neurologic conditions, and cancers, often with worse outcomes than in patients without HIV. When they are admitted to critical care settings, care considerations, particularly regarding antiretroviral therapy, must be addressed. Antiretroviral therapy is critical for successful management of HIV infection and should be continued when possible during intensive care unit stays. However, many antiretroviral regimens result in drug-drug interactions, adverse drug-related events, and secondary complications such as insulin resistance and prolonged QT intervals. Critical care nurses have unique opportunities to provide safe, unbiased, and compassionate care that promotes health for a population of people who have a history of being stigmatized.

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses.

Nurses are central to the care of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. Patients with these conditions present with nuanced symptoms and have complex nursing care needs. Although much of the exact pathophysiology of these diseases is not known, all nurses benefit from a fundamental understanding of the genesis of skin manifestations, associated pharmacology, and prognosis. The care of patients hospitalized with Stevens-Johnson syndrome and toxic epidermal necrolysis consists of wound care, infection prevention, comfort management, hydration and nutrition, psychosocial support, and the prevention of long-term complications. This article provides an overview of these diseases, including clinical diagnosis, history and physical assessment, related pharmacology, and nursing care priorities. A description of the current state of the science in clinical management for nurses at all levels is provided, with an emphasis on nursing's contribution to the best possible patient outcomes.

Oncology Nursing Considerations in a Clinical Trials Environment.

OBJECTIVE: To provide non-research-trained oncology nurses with targeted information they need to know when caring for research participants on clinical trials. DATA SOURCES: Professional scopes and standards, published literature, and governmental websites. CONCLUSION: To optimize the safe care of research participants enrolled in cancer clinical trials, oncology nurses must have knowledge of the study team composition, protocol navigation, grading of adverse events, patient education, and communication with clinical research nurses and study teams. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses are integral to the success of clinical trials and the development of new therapies for cancer patients.

Durvalumab Immunotherapy: Nursing Management of Immune-Related Adverse Events During the Journey of Patients With Stage III Non-Small Cell Lung Cancer.

BACKGROUND: When resection is not an option, platinum-based chemoradiotherapy (CRT) has been the historic standard of care in non-small cell lung cancer (NSCLC). Prognosis remains poor with CRT alone. Durvalumab has shown significant improvement (versus placebo) in progression-free and overall survival in patients with unresectable stage III NSCLC without progression following CRT. OBJECTIVES: This article aims to provide an overview of the efficacy and safety outcomes with durvalumab in patients with stage III NSCLC and identify management strategies for potential adverse events (AEs). METHODS: A review of published literature and guidelines was performed to evaluate durvalumab clinical outcomes and AE management strategies. FINDINGS: Durvalumab has established efficacy in patients with unresectable stage III NSCLC and is now the standard of care following CRT. Nurses need to be trained to recognize potential immune-related AEs in patients treated with immune checkpoint inhibitors.

Recent Advances in Antiemetics: New Formulations of 5-HT3 Receptor Antagonists in Adults.

BACKGROUND: Despite the availability of effective antiemetic regimens, patients still experience chemotherapy-induced nausea and vomiting (CINV). 5-Hydroxytryptamine 3 (5-HT3) receptor antagonists (RAs) are the mainstay of CINV prevention, and updated antiemetic guidelines include new options. OBJECTIVE: The aim of this study was to highlight advances in CINV management, focusing on new 5-HT3 RA formulations in adults, updated antiemetic guidelines, and the role of nurses. METHODS: MEDLINE searches were conducted for English-language publications for the past 15 years using relevant search terms ("serotonin receptor antagonist," "5-HT3 receptor antagonist," "antiemetic," "chemotherapy-induced nausea and vomiting") in the abstract or title. Abstracts at relevant major congresses for the past 3 years and additional pivotal publications were included. The most informative, relevant, and current publications were included. RESULTS: 5-Hydroxytryptamine 3 RAs are effective in preventing acute (0-24 hours) CINV but less effective in the delayed phase (24-120 hours) given their short half-lives. Updated antiemetic guidelines include fixed-dose intravenous fosnetupitant and palonosetron (IV NEPA) and granisetron extended-release subcutaneous injection, a recently approved 5-HT3 RA formulation providing slow, controlled release of therapeutic granisetron concentrations for 5 days or longer. Nurses play a pivotal role in implementing updated guideline-recommended antiemetic regimens for highly and some moderately emetogenic chemotherapy regimens, comprising a 4- or 3-drug regimen of 5-HT3 RA, neurokinin-1 RA, and dexamethasone, with/without olanzapine. CONCLUSION: Newer antiemetic combinations and formulations provide flexibility for CINV prevention. Granisetron extended-release subcutaneous injection is a convenient subcutaneous granisetron option. IMPLICATIONS FOR PRACTICE: Nurses play a critical role in understanding and using new antiemetic formulations and updated antiemetic guidelines in their practices.

Adverse reactions after the use of SonoVue contrast agent: Characteristics and nursing care experience.

The aim of this study was to analyze the clinical manifestations of adverse reactions after the use of SonoVue contrast agent from a large retrospective database, and to evaluate the nursing care strategies and the efficacy of standardized procedure for adverse reactions of SonoVue (SPARS).From January 1, 2012 to December 30, 2018, 34,478 cases of contrast-enhanced ultrasonography were performed in our center. The clinical manifestations of adverse reactions after the use of SonoVue contrast agent were identified and analyzed. The nursing care strategies were evaluated and the outcomes of patients with moderate and severe adverse reactions before and after the application of SPARS were compared.Of the 34,478 cases, 40 cases (0.12%) of adverse reactions after the use of SonoVue were identified. Adverse reactions included anaphylatic shock, skin allergies, nausea or vomiting, dizziness or headache, numbness, chest distress, back pain, and local reactions of the injection site. Most of the adverse reactions were mild and self-limited. Only 3 cases of anaphylatic shock and 2 cases of severe rash underwent further treatments. The 3 patients who were managed by SPARS recovered quicker and spent less comparing with the other 2 patients who were not.SonoVue was a safe contrast agent, with few and mostly mild adverse reactions. SPARS may be an efficient way in tackling moderate to severe adverse reactions, although of which the incidence was rare.

Acute acetaminophen toxicity in adults.

When taken in the recommended dosage, acetaminophen is a safe and effective analgesic and antipyretic agent. Its wide availability and easy accessibility make accidental or intentional overdose, leading to hepatotoxicity, a common occurrence. To prevent morbidity and mortality, prompt recognition of acetaminophen toxicity is essential. This article covers the stages of acetaminophen toxicity, recommended treatments, and NP considerations, including patient education recommendations.

Consensus Recommendations From the Children's Oncology Group Nursing Discipline's State of the Science Symposium: Symptom Assessment During Childhood Cancer Treatment.

Background: Recognizing and addressing illness-related distress has long been a priority for pediatric oncology nurses and the Children's Oncology Group. Although symptoms are known to be highly prevalent during treatment for childhood cancer, there is currently no guidance for how often symptoms should be assessed, which symptoms should be prioritized for assessment, and how the data should be collected. Methods: The Nursing Discipline, within Children's Oncology Group, hosted a one-day Interprofessional seminar titled "Symptom Assessment During Childhood Cancer Treatment: State of the Science Symposium." Following the symposium, an expert panel was assembled to review all available evidence, including information presented and collected during the symposium. Consensus-building discussions were held to identify common themes and to produce recommendations for clinical practice. Results: Four recommendations emerged including (1) the identification of priority "core" symptoms for assessment; (2) inclusion of the child's voice through self-report, when possible; (3) consistent documentation and communication of symptom assessment results; and (4) implementation of patient/family education related to symptoms. Discussion: Symptom recognition, through appropriate assessment, is the first step in symptom management. The goal for developing and sharing these recommendations is to promote consistent and comparable clinical practice across institutions in regard to symptom assessment during childhood cancer therapy. Integration of these recommendations will set the stage for future studies related to the frequency of symptoms across disease groups, projection of anticipated symptom trajectories, development of evidence-based teaching tools for common symptoms, and evaluation of patient outcomes with enhanced symptom assessment and management.

Adverse reactions of fluoroquinolones to central nervous system and rational drug use in nursing care.

.Fluoroquinolones are a kind of synthetic drugs commonly used in clinical treatment. They have good broad-spectrum antimicrobial properties. They are not only convenient to administer, but also have remarkable therapeutic effects. In this paper, we selected 70 patients with adverse reactions of central nervous system during the use of fluoroquinolones as the research object. We reviewed and analyzed the basic data, main manifestations and outcomes of adverse reactions, and summarized the influencing factors. The results showed that dizziness, irritability and insomnia were the main symptoms in 42 patients with mild adverse reactions. In 28 patients with moderate to severe adverse reactions, neuropsychiatric symptoms such as restlessness, depression, nervous excitation, phonism and hallucination were found. 54 patients were able to recover after stopping the medication. The remaining 16 patients were treated with drugs, and the effective rate was 87.5%. By analyzing the related factors, it can be seen that elderly patients over 60 years old, intravenous administration, combination of drugs and past history of neurological diseases are the main factors leading to adverse reactions of the central nervous system. In this survey, there were 7 kinds of adverse drug reactions, of which 31 cases (44.28%) were caused by levofloxacin. Therefore, fluoroquinolones have adverse effects on the central nervous system in the course of treatment, and the occurrence of adverse reactions is related to patients' age, route of administration, drug combination and past history of illness. It is important to grasp the above factors and make rational use of drugs.

Use of an Evidence-Based Guideline for Management of Side Effects from Long-Acting Reversible Contraceptives: A Quality Improvement Report.

INTRODUCTION: Many health care providers believe that women who initiate long-acting reversible contraceptives (LARC) discontinue the method because of side effects too soon for the method to be economical. The purpose of this quality improvement project was to implement and evaluate an evidence-based telephone triage nursing guideline for management of side effects of LARC with an ultimate goal of reducing the number of early discontinuations. PROCESS: A telephone triage guideline was adapted from the Contraceptive Choice Project's Clinician Call Back System, supplemented with evidence-based resources, and approved by clinicians at 2 community women's health and midwifery offices. Baseline retrospective data were collected on all women over the age of 18 who had LARC inserted at the 2 sites in the year prior to guideline implementation and in the 3 months after implementation. Rates of LARC removal at or before 3 months postinsertion, before and after guideline implementation, were evaluated. OUTCOMES: Approximately 1 in 5 women called for help managing LARC side effects. Of the callers, 3 of 32 (9.4%) women receiving standard care discontinued their LARC prior to 3 months, whereas 0 of 24 women who were triaged using the guideline discontinued their LARC prior to 3 months (P = .12). Cramping, bleeding, and malposition or expulsion were the most common concerns and reasons for discontinuation. DISCUSSION: Fewer women than anticipated called to report side effects, and even fewer chose to discontinue their LARC early. There were fewer discontinuations with guideline use, but this was not a statistically significant difference. Most women did not discontinue their LARC early for any reason, including side effects.

Children with cancer nutrition at home

The children nutrition is one of the problems that parents have to manage at home, after treatment of an oncological disease. Nutritional commitment may prolong episodes of neutropenia and compromise the effectiveness of treatments. The goals of this study were: to identify the needs of parents/caregivers in the mana-gement of children/adolescents nutrition with cancer undergoing chemothera-py treatment, at home; to characterize parental strategies in the management of children's nutrition at home, after chemotherapy. A qualitative, exploratory, des-criptive and cross-sectional study was developed with eleven parents of children with cancer, who underwent chemotherapy treatment, after returning home. Data were collected through a semi-structured interview and analyzed according to Bar-din. From the analysis of content emerged the domain The Life at Home and the category Nutrition. Home Life for parents of the child with cancer presents seve-ral challenges, particularly in nutritional management, in the face of reduced food intake and the new rules imposed by the neutropenic diet. Thus, parents resort to several strategies to manage this problem: recourse to new practices in food confectionery; changes in the diet of the whole family; insistence/verbal pressure; distraction; reward after negotiation; supply a varied and nutritious diet; questio-ning/accepting the food preference; organic food. Despite appealing to the multi-plicity of strategies, the subjects of this study require the need for more structured support so that at home, they can respond to the challenges they face in their daily lives

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Pharmacologic Renal Therapy.

This article discusses some of the recommended pharmacologic treatments for patients with renal drug toxicity, acute kidney injury (AKI), and chronic kidney injury (CKI). The treatment of AKI often consists of treating patients in emergency departments. Renal pharmacologic management in an acute care setting consists of identifying the cause of AKI, reviewing serum creatinine levels, administration of crystalloids, and the elimination of nephrotoxic agents.

Importancia y grado de conocimiento percibido por las enfermeras de Cantabria sobre farmacología, reacciones adversas medicamentosas e interacciones farmacológicas / Importance and level of knowledge perceived by nurses from Cantabria about pharmacology, adverse reactions to drugs, and drug-drug interactions

OBJETIVO: conocer la importancia y el grado percibido de conocimientos de las enfermeras de Cantabria sobre farmacología, reacciones adversas a medicamentos (RAM) e interacciones farmacológicas (IF); y determinar si existen diferencias en relación con sus características profesionales. MÉTODO: estudio descriptivo transversal. Se diseñó un cuestionario en papel autocumplimentado y anónimo de seis preguntas, tras revisión de la literatura, consenso y pilotaje de la herramienta. Mediante una muestra de conveniencia fueron encuestados profesionales enfermeros de hospitales, Atención Primaria (AP) y Atención Sociosanitaria (AS) de Cantabria. Se realizó estadística descriptiva y prueba de contraste de hipótesis con Chi cuadrado de Pearson. RESULTADOS: se recogieron 132 cuestionarios. El 72% y el 90,9% de los encuestados consideraban insuficiente la formación pregrado y postgrado en Farmacología, respectivamente. Se consideraba capacitado para reconocer RAM el 60% con una antigüedad < 6 años frente al 84,3% en >15 años (p= 0,01), y el 59,7% de eventuales frente al 77,1% de los fijos (p= 0,03). El 41,9% de los eventuales conocía las principales IF frente al 62,9% de los fijos (p= 0,02). La Enfermería hospitalaria fue el ámbito con mayor percepción de recibir una formación continuada adecuada en farmacología (p= 0,001). CONCLUSIONES: hay un importante déficit percibido de formación en farmacología. Existen ciertas características profesionales diferenciales: las enfermeras de hospitales, con contratos fijos y con una mayor experiencia, manifiestan mejores resultados respecto a los colectivos de enfermeras de AP, AS, eventuales y con menor experiencia laboral

OBJECTIVE: to understand the importance and perceived level of knowledge by nurses from Cantabria about pharmacology, adverse reactions to drugs (ARDs) and drug-drug interactions (DDIs); and to determine if there are differences according to their professional characteristics. METHOD: a cross-sectional descriptive study. A printed self-completion questionnaire was designed, anonymous and including six questions, after a literature review, consensus and pilot trial of the tool. Through convenience sampling, a survey was conducted on nursing professionals from hospitals, Primary Care (PC) and Healthcare and Social Work (HSW) from Cantabria. Descriptive statistics was conducted, as well as Hypothesis Contrast Test through Pearson's Chi Square. RESULTS: in total, 132 questionnaires were collected; 72% and 90.9% of participants considered insufficient the undergraduate and post-graduate training on Pharmacology, respectively. Sixty per cent (60%) with < 6-year seniority considered they were qualified to identify ARDs vs. 84.3% with >15 years (p= 0.01), and 59.7% of temporary workers vs. 77.1% of permanent workers (p= 0.03); 41.9% of temporary workers were aware of the main DDIs vs. 62.9% of permanent workers (p= 0.02). Hospital nursing was the setting with a higher perception of receiving an adequate continuous training on Pharmacology (p= 0.001). CONCLUSIONS: there is an important deficit perceived in terms of Pharmacology training. There are certain differentiating professional characteristics: hospital nurses with permanent contracts and higher experience show better results vs. the nurses in PC and HSW, temporary and with lower work experience