Analysis of antimicrobial prescriptions for hematological patients in relation to the safe medication protocol in a teaching hospital
DOI:
https://doi.org/10.30968/rbfhss.2022.134.0834Abstract
Objective: To analyze the adequacy of the antimicrobial prescription in relation to the safety protocol in the prescription, use and administration of medicines from Ministry of Health. Method: This is a cross-sectional study that evaluated prescriptions from patients admitted to the medical clinic of a teaching hospital between January 1, 2017 and December 31, 2018. The data collection form was prepared according to the requirements of safe medication prescription protocol. Data were entered into the RedCap software. Descriptive data analysis was performed using Stata 14.1 software, in order to obtain relative and absolute frequencies. Results: In total, 57 patients had their prescriptions evaluated. In the analysis of the items referring to the prescriptions, 9,70% was in compliance as recommended in the protocol. However, patient weight and drug allergy records were absent in 87.7% and 91.2% of prescriptions, respectively. Of the prescriptions analyzed, 115 antimicrobial prescriptions were identified, and 91.3% of these prescriptions contained at least one inadequacy in relation to what was recommended in the protocol. In total, 178 inadequacies were identified and the most frequent were medication prescribed by trade name (21.9%), absence of treatment duration (19.7%), similar names (18.5%), absence and inadequacy of time or infusion rate (both with 14.0%). Conclusion: Most antimicrobials were inappropriately prescribed in relation to the protocol, which can compromise patient safety, facilitate bacterial resistance, and increase health costs.
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References
Trentin KM. Patient safety in antibiotic use in hospitals: a literature review. Journal of Epidemiology and Infection Control. 2019;09 (4).
World Health Organization (WHO). Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2021. Available in: https://www.whocc.no/atc_ddd_index/. Accessed on: 3rd Jun 2021.
Pegoraro F, Gonçalves NMFM. Análise de erros no contexto das prescrições médicas de antimicrobianos em uma farmácia privada da cidade de Quedas do Iguaçu. Rev Uniandrade 2016;17(2):51-62. DOI: 10.18024/1519-5694.
Elbouti A, Rafai M, Chouaib N, et al. Evaluation of antibiotic prescriptions in the Emergency Department of the Military Hospital of Instruction Mohammed V (HMIMV)]. Pan Afr Med J. 2016;16(25):162. DOI: 10.11604/pamj.2016.25.162.7080.
Agency for Healthcare Research and Quality (AHRQ). Medication Errors and Adverse Drug Events. Available in: https://psnet.ahrq.gov/primers/primer/23/ medication-errors. Accessed on: 20 th Nov 2021.
Bizuneh GK, Adamu BA, Bizuayehu GT, et al. A Prospective Observational Study of Drug Therapy Problems in Pediatric Ward of a Referral Hospital, Northeastern Ethiopia. Int J Pediatr. 2020;2020:4323189. DOI: 10.1155/2020/4323189.
Saldanha V. Incidência, tipos e aceitabilidade de intervenções farmacêuticas sobre problemas relacionados a medicamentos em um hospital geral: uma coorte prospectiva aberta (Tese Doutorado em Ciências Farmacêuticas) Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, 2020.
Taplitz RA, Kennedy EB, Bow EJ, et al. Antimicrobial Prophylaxis for Adult Patients With Cancer-Related Immunosuppression: ASCO and IDSA Clinical Practice Guideline Update. J Clin Oncol. 2018;36(30):3043-3054. DOI: 10.1200/JCO.18.00374.
Trecarichi EM, Pagano L, Candoni A, et al. Current epidemiology and antimicrobial resistance data for bacterial bloodstream infections in patients with hematologic malignancies: an Italian multicentre prospective survey. Clin Microbiol Infect. 2015;21(4):337-343. DOI: 10.1016/j.cmi.2014.11.022.
Ministério da saúde. Portaria n° 2.095, de 24 de setembro de 2013. Aprova os Protocolos Básicos de Segurança do Paciente. Available in: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/prt2095_24_09_2013.html. Accessed on: 1st Jul 2020.
Miot HA. Tamanho da amostra em estudos clínicos e experimentais. J. vasc. bras. 2011;10(4):275-278. DOI: 10.1590/S1677-54492011000400001.
Harris PA, Taylor R, Minor BL, et al. REDCap Consortium. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208. DOI: 10.1016/j.jbi.2019.103208.
Costa DB, Macedo LLAD, Souto R. Medication prescription errors: an assessment of prescription in the pediatrics of a school hospital.Rev Bras Farm Hosp Serv Saude. 2018;9(2):e092.002. Available from: https://www.rbfhss.org.br/sbrafh/article/view/315. Accessed on: 3rd Jun 2021.
Rezende LHO, Gehrke FS, Silva MA, et al. Prescrição de medicamentos: uma análise para a implantação da prescrição eletrônica ambulatorial. REAS. 2020;12(9):e3638. DOI: 10.25248/reas.e3638.2020.
Charani E, Gharbi M, Hickson M, et al. Lack of weight recording in patients being administered narrow therapeutic index antibiotics: a prospective cross-sectional study. BMJ Open. 2015;5(4):e006092. DOI: 10.1136/bmjopen-2014-006092.
Pimentel JCS, Urtiga VLSC, Barros AS, et al. Perfil dos erros nas prescrições e no aprazamento de antibacterianos. J. nurs. Health. 2020;10(3):e20103007.
Néri ED, Gadêlha PG, Maia SG, et al. Drug prescription errors in a Brazilian hospital. Rev Assoc Med Bras. 2011;57(3):301-308.
Rocha LPS. Relato de caso e revisão da literatura de síndrome de Stevens-Johnson associada a episódio de varicela. Arquivos Catarinenses de Medicina. 2018;47(3):226-234.
Lima MCS, Abreu BS. RDC 20/2011: análise de prescrições médica de antimicrobianos em uma drogaria do distrito federal. Rev. Cient. Sena Aires. 2017; 6(2):103-108.
Rodrigues FRM. Avaliação de prescrição médica em uma drogaria do município de Conquista (Graduação em Farmácia). Universidade de Uberaba, Uberaba/MG, 2021.
Ciociano N, Grisi L, Bagnasco L, et al. Risk assessment of look−alike, sound−alike (LASA) medication errors in an Italian hospital pharmacy: A model based on the ‘Failure Mode and Effect Analysis’. J Health Soc Sci. 2017;2(1):47-64. DOI: 10.19204/2017/rsks4.
Heck J, Groh A, Stichtenoth DO, et al. Look-alikes, sound-alikes: Three cases of insidious medication errors. Clin Case Rep. 2020;8(12):3284-3287. DOI: 10.1002/ccr3.3409.
Bryan R, Aronson JK, Williams AJ, et al. A systematic literature review of LASA error interventions. Br J Clin Pharmacol. 2021;87(2):336-351. DOI: 10.1111/bcp.14644.
Emmerton L, Curtain C, Swaminathan G, et al. Development and exploratory analysis of software to detect look-alike, sound-alike medicine names. Int J Med Inform. 2020;137:104119. DOI: 10.1016/j.ijmedinf.2020.104119.
Chaves GH. Erros de prescrição e intervenções farmacêuticas em oncologia. (Trabalho de conclusão de curso de graduação em farmácia). Instituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo, Diadema, 2020.
Drisyamol KA, Mahesh NM. Vancomycin induced Red Man Syndrome. Int J of Pharmc Res. 2016;6(4):127-32. DOI: 10.7439/ijpr.v6i4.3059.
Milosevits G, Mészáros T, Őrfi E, et al. Complement-mediated hypersensitivity reactions to an amphotericin B-containing lipid complex (Abelcet) in pediatric patients and anesthetized rats: Benefits of slow infusion. Nanomedicine. 2021;34:102366. DOI: 10.1016/j.nano.2021.102366.
Machado OVO, Patrocínio MCA, Medeiros MS, et al. Antimicrobianos revisão geral para graduandos e generalistas. Fortaleza: EdUnichristus, 2019.
Macvane SH, Kuti JL, Nicolau DP. Prolonging β-lactam infusion: a review of the rationale and evidence, and guidance for implementation. Int J Antimicrob Agents. 2014;43(2):105-113. DOI: 10.1016/j.ijantimicag.2013.10.021.
Diefenthaeler HS, Velentini MH, da Silva AC, et al. Análise da qualidade de prescrições de antimicrobianos comercializados em uma drogaria da Região Norte do Rio Grande do Sul. HU ver. 2017;43(1). DOI: 1982-8047.2017.v43.2596.
Mota IVR, Almeida PHRR, Lemos LB, et al. Prescription errors and administration of injectable antimicrobials in a public hospital. Rev Bras Farm Hosp Serv Saude. 2018;9(4):1-6. DOI: 10.30968/rbfhss.2018.094.002.
Gillani SW. Papel e serviços de um farmacêutico na prevenção de erros de medicação: uma revisão sistemática. Curr Drug Saf. 2021;10(3).
Santos AC, Mota JR, Muniz TR, et al. A atuação do farmacêutico clínico na prevenção de erros de medicação no ambiente hospitalar. Revista Multidisciplinar em Saúde. 2021;1(1).
Jaam M, Naseralallah LM, Hussain TA, et al. Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: A systematic review and meta-analysis. PLoS One. 2021;16(6):e0253588. DOI: 10.1371/journal.pone.
Reslan Z, Lindsay J, Kerridge I, et al. Pharmacist review of high-risk haematology outpatients to improve appropriateness of antifungal prophylaxis. Int J Clin Pharm. 2020;42(6):1412-1418. DOI: 10.1007/s11096-020-01090-5.
World Health Organization (WHO). Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2021. Available in: https://www.whocc.no/atc_ddd_index/. Accessed on: 3 rd Jun 2021.
Instituto para práticas seguras no uso de medicamentos (ISMP Brasil). Nomes de medicamentos com grafia ou som semelhantes: como evitar os erros?. ISMP. 2014; 3(6).
Micromedex® Neo fax. Version 3.1.1(290). Copyright 2013. 2021 IBM. Accessed on: 20 th Dec 2020.
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