Etiquetado de dispositivos de terapia intravenosa en Unidades de Cuidados Intensivos: revisión integradora

Nunes, Geovane de Kassio; Campos, Juliana Faria; Silva, Rafael Celestino da

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Enfermagem

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Brasil

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Sumário

REVIEW • Rev. Bras. Enferm. 75 (06) • 2022 • https://doi.org/10.1590/0034-7167-2022-0049 copiar

Etiquetado de dispositivos de terapia intravenosa en Unidades de Cuidados Intensivos: revisión integradora

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

sintetizar las evidencias sobre el etiquetado de dispositivos intravenosos utilizados para identificar medicamentos administrados a pacientes en Unidades de Cuidados Intensivos, con el objetivo de prevenir errores de medicación.

Métodos:

revisión integradora, en las bases de datos LILACS, IBECS, Embase, MEDLINE, Scopus, Web of Science y CINAHL, de noviembre a diciembre de 2021, utilizando descriptores y criterios de selección. Los datos fueron recolectados en 11 artículos y posteriormente clasificados, resumidos y agregados.

Resultados:

etiquetas prediseñadas, con colores e información predefinidos, ayudan a prevenir errores de identificación de medicamentos. Todavía hay una falta de estandarización en la práctica de etiquetado de jeringas, líneas intravenosas, bombas de infusión y bolsas de suero. Hay errores relacionados con la falta de etiquetado de los dispositivos o con su realización con información incompleta.

Conclusiones:

el etiquetado de los dispositivos es una barrera para defender la seguridad del sistema de medicamentos y debe ser estandarizado.

Descriptores:
Infusiones Intravenosas; Etiquetado de Medicamentos; Cuidados Críticos; Seguridad del Paciente; Enfermería.

Descriptors
Type	Problem	Concept	Context
DeCS	“Segurança do Paciente” OR “Prevenção de Acidentes” OR “Erros Médicos” OR “Erros de Medicação”	“Rotulagem de Medicamentos”	“Cuidados Críticos” OR “Enfermagem de Cuidados Críticos”
MeSH	“Patient Safety” OR “Accident Prevention” OR “Medical Errors” OR “Medication Errors”	“Drug Labeling”	“Critical Care” OR “Critical Care Nursing”
CINAHL Subject Headings	“Patient Safety” OR “Adverse Drug Event” OR “Medication Errors” OR “Health Care Errors” OR “Treatment Errors”	“Drug Labeling” OR “Product Labeling”	“Critical Care” OR “Critical Care Nursing” OR “Intensive Care Units”
Emtree	‘Patient safety’/de OR ‘Accident Prevention’/de OR ‘Medical Error’/de OR ‘Medication Error’/de OR ‘Potentially Inappropriate Medication’/de	‘Drug Labeling’/de	‘Intensive Care’/de OR ‘Intensive Care Nursing’/de

	Title/country/year	Objective	Design	Conclusion
S1(¹³13 Nayana MGS, Silva VM, Lopes MVO, Diniz CM, Ferreira GL. Evaluation of color-coded drug labeling to identify endovenous medicines. Rev Bras Enferm. 2019;72(3):715-20. http://doi.org/10.1590/0034-7167-2018-0242 http://doi.org/10.1590/0034-7167-2018-02... )	Avaliação da rotulagem com código de cores para identificação de medicamentos intravenosos Brazil/2019	Analyze the opinion of nursing professionals about the design, practicality of use and usefulness of color-coded labeling in a pediatric ICU.	Cross-sectional, quantitative Total number of participants: 42	The labeling technology was considered appropriate for the design and practicality for all devices, as well as useful in preventing medication errors, reducing the average time developing labeling tasks.
S2(¹⁸18 Pinkney SJ, Fan M, Koczmara C, Trbovich PL. Untangling infusion confusion: a comparative evaluation of interventions in a simulated intensive care setting. Crit Care Med. 2019;47(7):e597-e601. http://doi.org/10.1097/CCM.0000000000003790 http://doi.org/10.1097/CCM.0000000000003... )	Untangling Infusion Confusion: a comparative evaluation of interventions in a simulated intensive care setting Canada/2019	Assess the impact of interventions performed by participants in four different conditions in a simulated ICU scenario: current practice; using IV-line labels and infusion organizers; with infusion pump; and with an infusion route lighting system.	Experimental, quantitative Each participant should perform two tasks in each condition: correctly identify and disconnect an infusion. Total number of participants: 40	Using IV-line labels and infusion organizers may increase accuracy and efficacy in the correct identification of IV medication infusion.
S3(¹²12 Porat N, Bitan Y, Shefi D, Donchin Y, Rozenbaum H. Use of colour-coded labels for intravenous high-risk medications and lines to improve patient safety. Qual Saf Health Care. 2009;18(6):505-9. http://doi.org/10.1136/qshc.2007.025726 http://doi.org/10.1136/qshc.2007.025726... )	Standardized drug labelling in intensive care: results of an international survey among ESICM members USA/2009	Compare a color-coded label for high-risk medications with the current labeling practice in a simulated ICU scenario.	Quasi-experimental, quantitative Total number of participants: 61	Using color code improved identifying bags and IV lines, facilitated the identification of errors and decreased the average time in tasks. The task of color-coding the syringe did not show a significant difference when compared to the control scenario, as participants reported difficulty in handling syringe labels.
S4(¹⁹19 Balzer F, Wickboldt N, Spies C, Walder B, Goncerut J, Citerio G, et al. Standardised drug labelling in intensive care: results of an international survey among ESICM members. Intensive Care Med. 2012;38(8):1298-305. http://doi.org/10.1007/s00134-012-2569-1 http://doi.org/10.1007/s00134-012-2569-1... )	Standardized medication labelling in intensive care: results of an international survey among ESICM members Germany/2012	Investigate whether standardized medication syringe labeling is used in ICUs, whether these standards are similar in other countries, and whether intensivists expect standardized medication syringe labeling to be provided by the pharmaceutical industry.	Survey type, multinational, quantitative Total number of participants: 482	The adoption of standardized syringe labeling in terms of color, design and structure is still lacking among many ICUs, leading to variability in labeling policies between sectors within the same hospital and between hospitals in the same region. This failure can induce professionals to misidentify medications.
S5(¹⁴14 Fan M, Koczmara C, Masino C, Cassano-Piché A, Trbovich P, Easty A. Multiple intravenous infusions phase 2a: Ontario survey. Ont Health Technol Assess Ser [Internet]. 2014 [cited 2019 Aug 16];14(4):1-141. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522693/ https://www.ncbi.nlm.nih.gov/pmc/article... )	Multiple Intravenous Infusions Phase 2a: Ontario Survey Canada/2014	Investigate practices or policies that can help identify and prevent risks in patient safety.	Prospective, quantitative study Total number of participants: 64	Inconsistencies between policies and practices were found in some units. It was concluded that these non-conformities in label use can lead to erroneous handling of continuous infusions, erroneous disconnection of infusion, difficulty in administering medications through IV lines in the scenario of clinical emergencies.
S6(²⁰20 Levkovich BJ, Bui T, Bovell A, Watterson J, Egan A, Poole SG, et al. Variability of intravenous medication preparation in Australian and New Zealand intensive care units. J Eval Clin Pract. 2016;22(6):965-970. http://doi.org/10.1111/jep.12574 http://doi.org/10.1111/jep.12574... )	Variability of intravenous medication preparation in Australian and New Zealand Intensive Care Units Australia/2016	Examine variability in the preparation of continuous infusion medications.	Survey-type study, quantitative Participants: 40	There was little variability in device labeling among the investigated ICUs. Labeling, whether for syringes or medication bags, is color-coded and the medication name is handwritten.
S7(²¹21 Wheeler DW, Degnan BA, Sehmi JS, Burnstein RM, Menon DK, Gupta AK. Variability in the concentrations of intravenous drug infusions prepared in a critical care unit. Intensive Care Med. 2008;34(8):1441-7. http://dx.doi.org/10.1007/s00134-008-1113-9 http://dx.doi.org/10.1007/s00134-008-111... )	Variability in the concentrations of intravenous medication infusions prepared in a critical care unit The United Kingdom/2008	Check if there is a relationship between syringe label quality and medication preparation.	Audit study N=149 syringes The discarded syringe labels received a score on a scale of 11 points for quality, as well as the analysis of the concentration of residual solutions present in the syringes.	Better labeled syringes were more likely to contain the medication at the correct concentration.
S8(²²22 Summa-Sorgini C, Fernandes V, Lubchansky S, Mehta S, Hallett D, Bailie T, et al. Errors associated with IV infusions in critical care. Can J Hosp Pharm. 2012;65(1):19-26. http://doi.org/10.4212/cjhp.v65i1.1099 http://doi.org/10.4212/cjhp.v65i1.1099... )	Errors associated with IV infusions in critical care Canada/2012	Determine the most frequent type of error with IV medications.	Observational, prospective, quantitative study N=1,882 infusions	Incomplete labeling of IV lines was the most common error and posed a risk to patient safety.
S9(²³23 Yin TS, Said MM, Rahman RA, Taha NAB. An investigation of errors: the preparation and administration of parenteral medications in an intensive care unit of a tertiary teaching hospital in Malaysia. Int J Pharm Pharm Sci [Internet]. 2016 [cited 2020 Aug 19];8(3):325-29. Available from: https://innovareacademics.in/journals/index.php/ijpps/article/view/10098 https://innovareacademics.in/journals/in... )	An investigation of errors: the preparation and administration of parenteral medications in an intensive care unit of a tertiary teaching hospital in Malaysia Malaysia/2015	Investigate type, incidence and factors related to errors with IV medications.	Prospective observational study N= 122 IV medications prepared by 39 nurses	Not labeling the syringe is supposed to be an indicator for medication preparation failure, with more chances of dose errors.
S10(²⁴24 Holland CBC, Gaíva MAM. Erros no preparo de medicação intravenosa em uma unidade de terapia intensiva neonatal. Nursing [Internet]. 2018 [cited 2020 Aug 19];21(241):2223-28. Available from: http://www.revistanursing.com.br http://www.revistanursing.com.br... )	Erros no preparo de medicação intravenosa em uma unidade de terapia intensiva neonatal Brazil/2018	Analyze the occurrence of errors in IV medication preparation in the neonatal ICU.	Observational, quantitative study N= 70 medication doses	Labeling has not been commonly used in care practice.
S11(²⁵25 Julca CSM, Rocha PK, Tomazoni A, Manzo BF, Souza S, Anders JC.Use of safety barriers in the preparation of vasoactive drugs and sedatives/analgesics in pediatric intensive care. Cogitare Enferm. 2018; (23)4: e54247. http://doi.org/10.5380/ce.v23i4.54247 http://doi.org/10.5380/ce.v23i4.54247... )	Utilização de barreiras de segurança no preparo de drogas vasoativas e sedativos/analgésicos em terapia intensiva pediátrica Brazil/2018	Analyze safety barrier use in vasoactive medication and sedative/analgesic preparation in a pediatric ICU.	Observational, quantitative study N=17 professionals in 204 observations on medication preparation	Labeling practice has been carried out incompletely.

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[1] Corresponding author: Rafael Celestino da Silva E-mail: rafaenfer@yahoo.com.br