Validation of a method to assess the severity of medication administration errors in Brazil.

INTRODUCTION: Medication errors are frequent and have high economic and social impacts; however, some medication errors are more likely to result in harm than others. Therefore, it is critical to determine their severity. Various tools exist to measure and classify the harm associated with medication errors; although, few have been validated internationally. METHODS: We validated an existing method for assessing the potential severity of medication administration errors (MAEs) in Brazil. Thirty healthcare professionals (doctors, nurses and pharmacists) from Brazil were invited to score 50 cases of MAEs as in the original UK study, regarding their potential harm to the patient, on a scale from 0 to 10. Sixteen cases with known harmful outcomes were included to assess the validity of the scoring. To assess test-retest reliability, 10 cases (of the 50) were scored twice. Potential sources of variability in scoring were evaluated, including the occasion on which the scores were given, the scorers, their profession and the interactions among these variables. Data were analysed using generalisability theory. A G coefficient of 0.8 or more was considered reliable, and a Bland-Altman analysis was used to assess test-retest reliability. RESULTS: To obtain a generalisability coefficient of 0.8, a minimum of three judges would need to score each case with their mean score used as an indicator of severity. The method also appeared to be valid, as the judges' assessments were largely in line with the outcomes of the 16 cases with known outcomes. The Bland-Altman analysis showed that the distribution was homogeneous above and below the mean difference for doctors, pharmacists and nurses. CONCLUSION: The results of this study demonstrate the reliability and validity of an existing method of scoring the severity of MAEs for use in the Brazilian health system.

Assessing the severity of medication administration errors identified in an observational study using a valid and reliable method.

BACKGROUND: Epidemiological data on medication errors severity are scarce. The assessment of the prevalence and severity of medication errors may be limited because of several reasons, including a lack of standardization in the method of identifying medication administration errors and little knowledge about the appropriate assessment tools to measure severity. Thus, in this study, we aim to assess the potential severity of errors identified by direct observation in a teaching hospital. METHODS: We used a validated method for assessing the potential severity of medication administration errors. Responses are scored on a 10-point scale. The 203 errors identified in a previous study were organized per similarity, resulting in 67 errors. This list was assessed by a panel of a physician, a nurse, and two pharmacists. The average score for each of the 67 errors was estimated considering the scores given by the 4 judges. Errors with a severity index < 3, between 3 and 7, and > 7 were considered minor, moderate, and severe, respectively. RESULTS: Professionals classified the potential clinical significance of the errors as minor, moderate, and severe in 8.8% (18/203), 82.8% (168/203), and 8.4% (17/203) of the cases, respectively. Most errors considered potentially serious (41%, 7/17) were technical errors. Most potentially serious errors involved insulin. Regarding the administration route, nine (53%) potentially serious errors involved medications administered intravenously. CONCLUSIONS: Most of the errors were considered as potentially moderated by the expert panel; however, the frequency of potentially serious errors was higher than that in previous studies using the same methodology, which highlights the need for strategies to reduce their occurrence.

Observational study on medication administration errors at a University Hospital in Brazil: incidence, nature and associated factors.

BACKGROUND: Medication administration errors are frequent and cause significant harm globally. However, only a few data are available on their prevalence, nature, and severity in developing countries, particularly in Brazil. This study attempts to determine the incidence, nature, and factors associated with medication administration errors observed in a university hospital. METHODS: This was a prospective observational study, conducted in a clinical and surgical unit of a University Hospital in Brazil. Two previously trained professionals directly observed medication preparation and administration for 15 days, 24 h a day, in February 2020. The type of error, the category of the medication involved, according to the anatomical therapeutic chemical classification system, and associated risk factors were analyzed. Multivariate logistic regression was adopted to identify factors associated with errors. RESULTS: The administration of 561 drug doses was observed. The mean total medication administration error rate was 36.2% (95% confidence interval 32.3-40.2). The main factors associated with time errors were interruptions. Regarding technique errors, the primary factors observed were the route of administration, interruptions, and workload. CONCLUSIONS: Here, we identified a high total medication administration error rate, the most frequent being technique, wrong time, dose, and omission errors. The factors associated with errors were interruptions, route of administration and workload, which agrees well with the results of other national and international studies.

Drug administration errors in Latin America: A systematic review.

PURPOSE: This study systematically reviewed studies to determine the frequency and nature of medication administration errors in Latin American hospitals. SUMMARY: We systematically searched the medical literature of seven electronic databases to identify studies on medication administration errors in Latin American hospitals using the direct observation method. Studies published in English, Spanish, or Portuguese between 1946 and March 2021 were included. A total of 10 studies conducted at 22 hospitals were included in the review. Nursing professionals were the most frequently observed during medication administration and were observers in four of the ten included studies. Total number of error opportunities was used as a parameter to calculate error rates. The administration error rate had a median of 32% (interquartile range 16%-35.8%) with high variability in the described frequencies (9%-64%). Excluding time errors, the median error rate was 9.7% (interquartile range 7.4%-29.5%). Four different definitions of medication errors were used in these studies. The most frequently observed errors were time, dose, and omission. Only four studies described the therapeutic classes or groups involved in the errors, with systemic anti-infectives being the most reported. None of the studies assessed the severity or outcome of the errors. The assessment of the overall risk bias revealed that one study had low risk, three had moderate risk, and three had high risk. In the assessment of the exploratory, observational, and before-after studies, two were classified as having fair quality and one as having poor quality. CONCLUSION: The administration error rate in Latin America was high, even when time errors were excluded. The variation observed in the frequencies can be explained by the different contexts in which the study was conducted. Future research using direct observation techniques is necessary to more accurately estimate the nature and severity of medication administration errors.

Produção tecnológica do protótipo cicatrizar: um sistema de registro eletrônico para pacientes com feridas: pesquisa aplicada / Technological production of CICATRIZAR prototype: an electronic register system for patients with wounds

Problema: Quando se versa sobre o tratamento fornecido a pacientes portadores de lesões cutâneas, todo registro dos achados clínicos e das ações realizadas pelo enfermeiro precisam estar dispostos de maneira meticulosa, abrangendo as anotações no prontuário e os registros fotográficos, com finalidade de documentar da melhor maneira a evolução das lesões e avaliar os procedimentos e coberturas adotados. Vale ressaltar que em diversos estudos estima-se que a enfermagem seja responsável por cerca de 50% das informações contidas no prontuário do paciente. Portanto, como o prazo para uma lesão cicatrizar é, na maioria das vezes, longo, observa-se um acúmulo de informações registradas em papel e que muitas vezes podem ser perdidas ou não encontradas com facilidade. A partir do exposto, o estudo propôs como objetivo construir o protótipo de um sistema informatizado denominado CICATRIZAR voltado para o cadastro e avaliação de enfermagem à pacientes com feridas. Método: Trata-se de uma pesquisa aplicada com produção tecnológica, que contou com a parceria do Ambulatório de Reparo de Feridas do Hospital Universitário Antônio Pedro com o Instituto de Computação da Universidade Federal Fluminense. A construção do protótipo se desenvolveu dentro das quatro etapas da prototipagem: comunicação, plano rápido, construção e feedback. O sistema conta com quatro aplicações principais: cadastros do profissional (usuário) e do paciente, do atendimento ambulatorial e da evolução do paciente. Após finalizar sua construção e transferi-lo online, o protótipo CICATRIZAR foi testado quanto à usabilidade e qualidade técnica, com a participação de oito avaliadores, compostos por duas categorias: C1 - Analistas de Sistemas; e E1 - Enfermeiros com experiência na avaliação de feridas. Resultados: O resultado da avaliação foi satisfatório. Os avaliadores contribuíram com sugestões relevantes para a versão final do sistema. Conclusão: Ao final do processo de construção pode-se concluir que um sistema informatizado deve ser considerado uma inovação tecnológica, que amplia seus benefícios com a melhoria da qualidade da informação e, consequentemente, do atendimento de enfermagem ao paciente com feridas

Issue: When writing about the treatment provided to patients with skin lesions, every record of the clinical findings and the actions performed by the nurse must be disposed meticulously covering the notes in medical and photographic records, with the aim of documenting the evolution of lesions in the best way possible, and the adopted procedures and coverings. It is relevant to register that in many studies it is estimated that nursing is responsible for about 50% of the information in the patient record file. Therefore, as the time for an injury to heal is normally long, there is an accumulation of information recorded on paper which can often be lost or not easily found. From the foregoing, the proposed study aims to build a prototype of a computer system called CICATRIZAR ("Heal", in Portuguese) for the recording and nursing analysis for patients with wounds. Method: This is an applied research with technological production, counting with the partnership of Wound Treatment Center of the Antônio Pedro University Hospital and the Institute of Computing of the Fluminense Federal University (UFF). The construction of the prototype was developed within the four stages of prototyping: communication, fast plan, building and feedback. The system has four main applications: the professional (user) and patient registers, outpatient care and patient status development. After completing its construction and transfering it online, the CICATRIZAR prototype was tested for its usability and technical quality, with the participation of eight evaluators, composed of two categories: C1 - Systems Analysts, and E1 - Nurses with experience in analyzing wounds. Results: The evaluation result was satisfactory. The evaluators contributed with suggestions relevant to the final version of the system. Conclusion: At the end of the construction process we concluded that a computer system should be considered a technological innovation that extends its benefits improving the quality of information and, consequently, the nursing care of patients with wounds

Technological production of a prototype of the electronic record system CICATRIZAR: an applied study

Introduction: The clinical evaluation of the development of a wound is done through a clear and objective organization of all registries of the findings and of the actions performed by the health professional. Aim: to test a prototype of the digitalized system CICATRIZAR destined to keep nursing records of wounded patients. Method: This is an applied study, which forecasts a final technical product, under development at Fluminense Federal University, from a partnership between the Wound Restoration Ward of Antonio Pedro College Hospital and the Computers Institute, both from the same University. To evaluate the feasibility of this system, a test with the prototype will be conducted with a group of evaluators, divided in two categories: C1 - computer analysts and E1 - nurses with experience in the evaluation of wounds...

Dispepsia funcional: diagnóstico e tratamento / Functional dispepsy: diagnosis and treatment

Dispepsia Funcional é a causa mais frequente das dispepsias. Sua fisiopatologia permanece obscura e ainda não dispomos de um método diagnóstico específico. Além disso, há uma ampla lista de diagnósticos diferenciais de doenças as quais também cursam com dispepsia. O tratamento muitas vezes tem benefícios discretos, e deve ser individualizado sempre que possível, juntamente com uma boa abordagem psicossocial, a qual pode auxiliar na terapêutica e no manejo destes pacientes.

Funcional Dyspepsia is the most frequent cause of dyspepsia. Its pathophysiology remains unclear and there is not still a specific diagnostic method. Moreover, there is an extensive list of differential diagnosis of diseases which also presents with dyspepsia. The treatment often has discrete benefits and must be individually whenever possible, with good psychosocial, which can aid in the treatment and the management of these patients.

Hemorragia digestiva alta: diagnóstico diferencial e abordagem / High digestive hemorrhage: differential diagnosis and approach

O objetivo desta publicação é realizar uma breve revisão sobre hemorragia digestiva alta. Além de citar as principais causas desta síndrome, será enfatizada a abordagem na emergência de um paciente nesse contexto: avaliação da estabilidade hemodinâmica e as primeiras medidas a serem realizadas com o intuito de diminuir a morbi-mortalidade. Por fim, serão citadas algumas formas de tratamento "curativo" das principais patologias que podem causar o sangramento digestivo alto.

The purpose of this publication is to conduct a brief review of upper gastrointestinal bleeding. In addition to citing the major causes of this syndrome is the approach emphasized in the emergence of a patient in this context: assessment of hemodynamic stability and the first approaches to be undertaken in order to decrease the morbidity and mortality. Finally, some will be mentioned treatment modalities "healing" of the main diseases that can cause upper gastrointestinal bleeding.