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Paes GO, Mesquita MGR, Moreira MB. Best practices applied to patient safety...
English/Portuguese
J Nurs UFPE on line., Recife, 10(Suppl. 6):4969-73, Dec., 2016 4969
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.8200-71830-3-SM.1006sup201633
BEST PRACTICES APPLIED TO PATIENT SAFETY IN THE ADMINISTRATION OF MEDICINES
MELHORES PRÁTICAS APLICADAS À SEGURANÇA DO PACIENTE NA
ADMINISTRAÇÃO DE MEDICAMENTOS
MEJORES PRÁCTICAS APLICADAS A LA SEGURIDAD DEL PACIENTE EN LA ADMINISTRACIÓN DE MEDICAMENTOS
Graciele Oroski Paes. PhD Professor, Department of Fundamental Nursing, Anna Nery School of Nursing, Federal University of Rio de Janeiro/UFRJ. Rio de Janeiro (Rio de Janeiro), Brazil. Email:
Maria Gefé da Rosa Mesquita. PhD Professor, Department of Methodology in Nursing, Anna Nery School of Nursing, Federal University of Rio de Janeiro/UFRJ. Rio de Janeiro (Rio de Janeiro), Brazil. Email:
Maiara Benevides Moreira. Nurse, Master’s Student of Nursing, Anna Nery School of Nursing, Federal University of Rio de Janeiro/UFRJ. Rio de Janeiro (Rio de Janeiro), Brazil. Email:
ABSTRACT
Objectives: to identify how the nursing team handles medication administration in low and medium complexity hospital admission units, to analyze the practice of medication administration by the nursing team in light of the best practices focused on patient’s safety and to develop protocols directed to practice of medication administration as a subsidy to nursing teams. Method: translational research, quantitative approach, descriptive and exploratory typology subsidized by practice based on evidence, based on a University Hospital of Rio de Janeiro/RJ, Brazil and as participants the nursing professionals. The data will be produced through non-participant observation along with semi-structured interview. Expected results: the optimization of the work process in drug administration mediated by guiding and updated instruments incorporates qualified recommendations appropriate to the reality investigated, and essentially guarantees that the precepts aimed at patient safety are implemented and validated. Descriptors: Patient’s Safety;
Nursing; Administration of Medicinal Therapy.
RESUMO
Objetivos: identificar como processa a administração de medicamentos pela equipe de enfermagem nas unidades de internação hospitalar de baixa e média complexidade, analisar a prática de administração de medicamentos pela equipe de enfermagem a luz das melhores práticas voltadas para segurança do paciente e elaborar protocolos direcionados a prática de administração de medicamentos como subsídio as equipes de enfermagem. Método: pesquisa translacional, de abordagem quantitativa, tipologia descritiva e exploratória subsidiada pela prática baseada em evidência, tendo como cenário um Hospital Universitário do Rio de Janeiro/RJ, Brasil e como participantes os profissionais de enfermagem. Os dados serão produzidos por meio de observação não participante juntamente com entrevista semiestruturada. Resultados esperados: que a otimização do processo de trabalho na administração medicamentosa mediada por instrumentos norteadores e atualizados incorpore recomendações qualificadas e apropriadas à realidade investigada, e garanta essencialmente que os preceitos voltados para segurança do paciente sejam implementados e validados.
Descritores: Segurança do Paciente; Enfermagem; Administração de Terapia Medicamentosa.
RESUMEN
Objetivos: identificar como procesa la administración de medicamentos por parte del personal de enfermería en unidades de hospitalización de complejidad baja y mediana, analizar la práctica de la administración de medicamentos por parte del personal de enfermería a la luz de las mejores prácticas relativas a la seguridad del paciente y desarrollar protocolos específicos a la práctica de la administración de medicamentos como apoyo para el personal de enfermería. Método: una investigación traslacional, de enfoque cuantitativo, de tipología descriptiva y exploratoria subvencionada por la práctica basada en la evidencia, en el contexto de un hospital universitario de Río de Janeiro/RJ, Brasil, y como participantes los profesionales de enfermería. Los datos se produjeron a través de la observación no participante con la entrevista semi-estructurada. Resultados esperados: que la optimización del proceso de trabajo en la administración del fármaco mediada guía e instrumentos actualizados incorpore las recomendaciones cualificadas y adecuadas a la realidad investigada y garantiza esencialmente que los preceptos centrados en la seguridad del paciente sean implementados y validados. Descriptores: Seguridad del Paciente; Enfermería; Gestión de la Terapia con
Medicamentos.
NOTE PREVIEW ARTICLE
Paes GO, Mesquita MGR, Moreira MB. Best practices applied to patient safety...
English/Portuguese
J Nurs UFPE on line., Recife, 10(Suppl. 6):4969-73, Dec., 2016 4970
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.8200-71830-3-SM.1006sup201633
In hospital environment patient’s safety
has generated worldwide debate and has
received a number of interpretations, for
example, that safety consists in reducing risk
and unnecessary harm to the patient
associated with health care to the least
acceptable level. This refers to what is viable
in the face of current knowledge, available
resources and the context in which assistance
was provided. Among available resources,
drug use is one of the most commonly used;
however, adverse events and drug-related
errors are frequent in the hospital setting. 1
Among the various stages foreseen in the
process involving the manipulation of
medications, the nursing team is generally
responsible for scheduling, preparing and
administering medications. Drug
administration is the final phase of the
medication system and offers the last
opportunity to avoid the error in the process.
Studies have shown that 38% of errors occur
during drug administration and only 2% of
errors are intercepted, which calls us
attention to the vulnerability of this phase of
the process. 2-3
In order for this phase of the drug process
to be not so defenseless and for the
professional to provide quality care, scientific
knowledge is of vital importance. The
multidisciplinary team, especially the nursing
team, needs to know the process as a whole
and how fragile it can be, so that they
identify potential failures and prevent them
from occurring. Thus, knowledge will be a
strong ally of safe and quality care. 4
Pharmacology is a very important field for
the training of nurses and sometimes this
knowledge is insufficient to subsidize
professional practice. Since the nursing team
is largely responsible for the follow-up of the
patient’s therapy, these professionals need
specific academic training in the field of
pharmacology. 5
Another way to make care safer is to adopt
professional practices based on protocols and
clinical evidences. The protocolized practice
follows a line established and standardized by
protocols established in health institutions for
the performance of procedures, which
contributes to the organization of the work
process and are strong allies in the decision-
making process. However, protocols should
only guide practice, since each case requires
a different solution, and thus, the use of
protocols cannot mechanize the work
process, but somewhat assists it. 6
In order for safety practices to be
discussed and implemented, it is necessary
for the leaders of the institutions to create a
patient-oriented safety culture and to
organize a multidisciplinary team to lead
these discussions, seeking to analyze and
evaluate each existing process, seeking
improvements and incorporation of new
technologies and evidence. 1
The use of techniques and technologies
applied to health care can have a positive
impact on the quality of care provided. It is
well known that in health care it is more
useful to define technology as tools in a
general sense, applications of different
knowledge, practices and strategies of
construction or deconstruction of knowledge,
care in its entire dimension. Considering that
technology is not merely applied science,
nursing praxis is also technology. 7
The protocols represent, from this
perspective, the application of a type of
technology directed directly to the care.
They should therefore be developed in a
systematic way to assist professionals and
clients in deciding on appropriate care in
meeting specific health conditions. 8
The establishment of care protocols
capable of early risk screening and the
application of timely interventions may
represent a gain in the quality of nursing care,
especially in situations where decisions should
be made on time, both in relation to the
diagnosis and possible health damages of the
customer.
This study expands the knowledge about
the drug preparation and administration
process and offers elements to contribute to
the care process, aiming at improving the
quality of care provided to the patient,
promoting the safe and rational use of
medications and subsidizing safe practices.
Facing the above, the object of the project
in question deals with the practice of
medication administration by the nursing
team in the hospital setting.
● To identify how the administration of
drugs by the nursing team is processed in the
hospital units of low and medium complexity.
● To analyze the practice of medication
administration by the nursing team in light of
the best practices focused on patient safety.
● To elaborate protocols directed to the
practice of administration of medicines as
subsidy to the nursing teams.
OBJECTIVES
INTRODUÇÃO
Paes GO, Mesquita MGR, Moreira MB. Best practices applied to patient safety...
English/Portuguese
J Nurs UFPE on line., Recife, 10(Suppl. 6):4969-73, Dec., 2016 4971
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.8200-71830-3-SM.1006sup201633
Type of study
It is a translational, descriptive and
exploratory research having as
methodological reference the practice based
on evidence, with a quantitative approach.
The general purpose will be the collection of
detailed information about the variable
process of drug preparation and
administration in hospital admission
scenarios.
Research scenario
The research will be conducted in hospital
units of low and medium complexity of a
University Hospital located in the city of Rio
de Janeiro, where the drug therapy is
composed of a great variety of medications
and most of the time it takes a long period.
The Hospital to be investigated is a center
of excellence in research and teaching, which
brings together health academics, including
nursing undergraduates, who act directly in
the care and research within the institution,
corroborating for intellectual production and
for the practice of health care. In addition,
this institution is part of the Network of
Sentinel Hospitals of ANVISA, which is of
paramount importance for Patient Safety.
Participants of the research
The population will be composed of
professionals of the nursing team who
participate in the process of preparation and
administration of drugs in the units
investigated. The sample will be made up of
all the nursing professionals who acted in the
process of preparation and administration of
medicines in the clinics under study during
the period of the investigation and who
accept, in writing, to be observed and
interviewed.
Data production
First stage
It will review the best evidence for the
practice of drug administration. For this
purpose we will use the databases and virtual
libraries: Portal Evidence - VHL, Cochrane -
VHL, BDEnf - VHL, Medline, PubMed, Scielo
and ISI Web of Science, Embase, SciVerse
Scopus, Cinahl. In addition, a dense
bibliographic review of the pathophysiology,
diagnostic and therapeutic procedures
recommended for drug administration cases
will be conducted, including a review of the
national and international consolidated
literatures in the area of knowledge. Next,
we will synthesize the knowledge applied
specifically to nursing care and the practice
of medication administration.
Second stage
We will give the field research, where we
choose two inter-involved and associated
techniques: the technique of non-participant
observation along with the application of a
semi-structured questionnaire.
In order to collect the data, non-
participant and direct observations will be
made following an observation script. To this
end, four research assistants, after receiving
16-hour training, will observe the activities of
the nursing professionals responsible for
receiving medication from the pharmacy,
packaging, conference, preparation,
administration, checking and registration of
medications in prescriptions and monitoring
of patients for adverse drug effects.In this
stage, the compilation of the data emanated
from the interviews together with the
synthesis of the best evidence extracted in
the first stage will allow the preparation of a
previous flowchart of the protocol to be
applied in the third stage.
Third stage
It will involve the application of the pilot
flowchart, through simulated situations that
allow the analysis and interpretation of
conditions involving patients who need the
practice of medication administration. The
members of the nursing team that answered
the questionnaire should participate in this
stage.
Data collection will be carried out
exclusively by the researcher, requested
scholars and research assistants responsible
for the project, in order to avoid bias arising
from the application process of the
questionnaires. The research team will
request the signature in the consent term for
participation in research, and will have the
function of explaining and clarifying doubts
about completing the questionnaire.
Participants will be guaranteed voluntary
participation and anonymity at all stages of
the research process (pre-test and data
collection proper).
Data analysis
The consistency of the information
contained in the second and third stages will
be evaluated; through the presented answers,
we will make a comparative test of validity of
measures, to identify the effectiveness /
efficiency of the use of the protocol of
interpretation of blood gases in the clinical
practice of the nursing team. The comparison
of the answers given in the test (first
application of the questionnaire) and in the
METHOD
Paes GO, Mesquita MGR, Moreira MB. Best practices applied to patient safety...
English/Portuguese
J Nurs UFPE on line., Recife, 10(Suppl. 6):4969-73, Dec., 2016 4972
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.8200-71830-3-SM.1006sup201633
retest (second application of the
questionnaire) will be done through the
Kappa Index.
After testing the flowchart, we will submit
it to an initial validation process, aiming at
the evaluation by a group of specialists.
Therefore, an opinion about the product will
be requested from ad hoc evaluators. With
vast experience and unquestionable
reputation in the area of performance related
to the dimension evaluated.
Three criteria will be adopted for
evaluation: relevance, probability and
validity of the instrument. Relevance takes
into account the applicability and relevance
of the protocol; Feasibility involves the
operational ease, costs, required data and
other barriers associated with the application
of the protocol; The validity verifies the
degree to which the protocol reaches its
objectives, that is, it reflects the event or
aspect that it proposes to measure. Three
aspects of validity can be evaluated
operationally: validity can be content
(legitimacy of measurement), construction
validity (degree of correlation with other
measures of the same event), and criterion
validity (logical sense for specialists). 9
After completing these steps, the
flowchart has undergone adjustments that
should consider institutional, administrative,
and scientific aspects, only then to take the
methodological design and all scope that
requires an assistance protocol.
We used as inclusion criteria: to have an
employment relationship with the
participating institution and to have
experience of at least one year in the
participating hospital and as criteria for
exclusion: you will be prevented from
exercising the profession due to official
licenses or extra offices.
Ethical aspects
In view of the ethical-legal issues
advocated by the National Health Council,
this research was approved by the CAAE
17589513.0.0000.5238 from the Research
Ethics Committee (CEP) of the University
Hospital Clementino Fraga Filho HUCFF/UFRJ
and the CEP of the School of Nursing Anna
Nery (Opinion N 336,436), pursuant to the
guidelines of Resolution 466/12, which seeks
to ensure the rights and duties of the
scientific community of research subjects and
the state, based on the four basic bioethics
references, not maleficence, beneficence,
and justice and equity.
It is expected, with the results of this
study, the optimization of the work process in
drug administration mediated by guiding and
updated instruments, to incorporate qualified
and appropriate recommendations to the
reality investigated, and essentially guarantee
that the precepts aimed at patient’s safety be
implemented and validated.
Researches of this feature generate a
potential impact on the quality of direct and
indirect nursing care and of all health care
body, confirming the scientific, ethical and
legal commitment, with the guarantee of the
promotion of a greater good for the patient.
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paciente: análise do preparo de medicação
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EXPECTED RESULTS
Paes GO, Mesquita MGR, Moreira MB. Best practices applied to patient safety...
English/Portuguese
J Nurs UFPE on line., Recife, 10(Suppl. 6):4969-73, Dec., 2016 4973
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.8200-71830-3-SM.1006sup201633
medicamentos pautado na segurança do
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Submission: 2016/05/11 Accepted: 2016/11/09 Publishing: 2016/12/15
Corresponding Address
Graciele Oroski Paes Universidade Federal do Rio de Janeiro Centro de Ciências da Saúde Avenida Carlos Chagas Filho, 373, Bloco K, 2º andar, sala 38 Cidade Universitária Ilha do Fundão CEP 21941-902 ― Rio de Janeiro (RJ), Brazil
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