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      Análise do Planejamento dos Horários de Administração de Medicamentos em Unidade de Terapia Intensiva Cardiológica Translated title: Análisis de la Planeación de los Horarios de Administración de Medicamentos en Unidad de Terapia Intensiva Cardiológica Translated title: Analysis of the Time Schedule for Administration of Drugs in the Cardiologic Intensive Care Unity

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          Abstract

          Objetivou-se investigar a incidência de associações medicamentosas no planejamento do enfermeiro para os horários de administração ao paciente dos medicamentos prescritos pelo médico. Estudo transversal, com análise documental, realizado com 65 prontuários em uma unidade de terapia intensiva de Fortaleza, em 2003. Foram prescritos 550 medicamentos, com média de 12,9 por prontuário. A administração de medicamentos ocorreu preferencialmente às 22 horas (42,6%) e 6 horas da manhã (32%). A faixa etária de 60-80 anos (47,7%) foi a que recebeu mais medicamentos. A via oral foi a mais utilizada (62,1%); os anti-hipertensivos foram os mais prescritos (20,7%). A associação mais freqüente foi captopril e propranolol (6,8%); ocorreram 40 associações questionáveis por sua importância clínica. Foram identificados 272 horários de medicações não administradas. Conclui-se que é necessário ao enfermeiro o aprofundamento de seus conhecimentos em farmacologia para evitar associações medicamentosas indevidas e seus efeitos adversos no paciente.

          Translated abstract

          Se objetivó investigar la incidencia de asociaciones medicamentosas en la planeación del enfermero para los horarios de suministración al paciente de los medicamentos prescritos por el médico. Estudio transversal, con análisis documental, cumplido con 65 prontuarios en una unidad de terapia intensiva de la ciudad de Fortaleza-Ceará-Brasil, en 2003. Fueron prescritos 550 medicamentos , con media de 12,9 por prontuario. La suministración de medicamentos acaeció de preferencia a las 22 horas (42,6%) y a las 6 horas de la mañana (32%). La franja etaria de 60-80 años fue la que recibió más medicamentos. La via oral fue la más utilizada (62,1%); los antihipertensivos fueron los más prescritos (20,7%). La asociación más frecuente fue captopril y propanolol (6,8%); acaecieron 40 asociaciones cuestionables por su importancia clínica. Fueron identificados 272 horarios de medicaciones no suministradas. Se concluye que es necesario al enfermero la profundización de sus conocimientos en farmacología para evitar asociaciones medicamentosas indebidas y sus efectos adversos en el paciente.

          Translated abstract

          The purpose of this study was to investigate the incidence of drug associations in the time schedule built by the nurse for the administration of drugs prescribed for the patients by the physician. It is a cross-sectional study, based in documental analysis. Data have been collected from 65 clinical registers of an ICU (Intensive Care Unit) in Fortaleza city, in 2003. Five hundred and fifty (550) drugs have been prescribed, with a mean of 12,9 per clinical register. Drug administrations occurred most commonly at 10 p.m. (42,6%) and 6 a.m. (32%). The largest incidence of drug administration has been in the age group of 60-80 (47,7%). Oral administration has been the most frequent route (62,1%). Antihypertensive drugs (20,7%) have been more prescribed than other medicine classes. The mostly found drug association has been of captopril and propanolol (6,8%); in addition, other forty drug associations of questionable clinical relevance have been found. It has also been found 272 unchecked schedules, which indicate that the medicines were not administrated. From the results, it may be concluded that nursing staff needs a deeper understanding and knowledge about pharmacology in order to minimize or to prevent accidental drug associations and their consequent adverse effects.

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          Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients.

          To ascertain the current burden of adverse drug reactions (ADRs) through a prospective analysis of all admissions to hospital. Prospective observational study. Two large general hospitals in Merseyside, England. 18 820 patients aged > 16 years admitted over six months and assessed for cause of admission. Prevalence of admissions due to an ADR, length of stay, avoidability, and outcome. There were 1225 admissions related to an ADR, giving a prevalence of 6.5%, with the ADR directly leading to the admission in 80% of cases. The median bed stay was eight days, accounting for 4% of the hospital bed capacity. The projected annual cost of such admissions to the NHS is 466m pounds sterling (706m Euros, 847m dollars). The overall fatality was 0.15%. Most reactions were either definitely or possibly avoidable. Drugs most commonly implicated in causing these admissions included low dose aspirin, diuretics, warfarin, and non-steroidal anti-inflammatory drugs other than aspirin, the most common reaction being gastrointestinal bleeding. The burden of ADRs on the NHS is high, accounting for considerable morbidity, mortality, and extra costs. Although many of the implicated drugs have proved benefit, measures need to be put into place to reduce the burden of ADRs and thereby further improve the benefit:harm ratio of the drugs.
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            Bioestatística: tópicos avançados

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              Medication errors in hospitalized cardiovascular patients.

              The Institute of Medicine's report To Err Is Human: Building a Safer Health System recommends pharmacist participation in patient rounds as an immediate approach to reducing medical errors. In the same report and in prior publications, cardiovascular drugs have been commonly associated with severe adverse drug events. We systematically reviewed the experience of a clinical pharmacist on the cardiology wards between September 1, 1995, and February 18, 2000. We classified medication errors according to the type of error, medications involved, personnel involved, stages of drug administration involved, and time of year most frequently associated with errors. Among 14983 pharmacist interventions, 4768 were related to medication errors, or 24 medication errors per 100 admissions. The most common errors involved the wrong drug (36.0%) or wrong dose (35.3%), and cardiovascular medications were involved in 41.2% of the errors. Prescribers were associated with most of the errors, and the transition from outpatient to inpatient was the most common point in the system for the occurrence of these medication errors. Higher numbers of errors were also identified during the transition period of house staff, and the total number of errors increased during the study period. Through the clinical pharmacist's identification and correction of medication errors, 2 areas of improvement that may reduce medication errors were identified. The first is ensuring accurate knowledge of a patient's outpatient medication regimen. The second involves improving the education and support of new interns during their initial months of training. This work exemplifies the approach recommended by the Institute of Medicine to reduce medical errors through systematic analyses rather than ascribing fault to individuals.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                reuerj
                Revista Enfermagem UERJ
                Rev. enferm. UERJ
                Universidade do Estado do Rio de Janeiro
                0104-3552
                September 2006
                : 14
                : 3
                : 342-349
                Affiliations
                [1 ] CNPq
                [2 ] Universidade Federal do Ceará
                Article
                S0104-35522006000300004
                aa944894-0451-4b06-ad37-18b4b04ab094

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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                Self URI (journal page): http://revodonto.bvsalud.org/scielo.php?script=sci_serial&pid=0104-3552&lng=en

                Interacción de medicamento,incompatibilidad de medicamento,efecto adverso,enfermería,Drug interaction,drug incompatibility,adverse effect,nursing,Interação de medicamento,incompatibilidade de medicamento,efeito adverso,enfermagem

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