Actions for safety in the prescription, use and administration of medications in emergency care units

Santos, Patricia Reis Alves dos; Rocha, Fernanda Ludmilla Rossi; Sampaio, Camila Santana Justo Cintra

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Original Article • Rev. Gaúcha Enferm. 40 (spe) • 2019 • https://doi.org/10.1590/1983-1447.2019.20180347 copy

Actions for safety in the prescription, use and administration of medications in emergency care units

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify what risks and incidents related to the drug therapy process are presented in an Emergency Care Unit (UPA) and to present proposals for management actions and safe practices, in the perception of the nursing team.

Method:

Qualitative research, in the research-action modality, developed in the scenario of UPA, located in the interior of São Paulo. Data collection was done through interviews and focus groups with 33 professionals, between June 2015 and April 2016. For the data treatment, the Content Analysis Technique was used.

Results and discussion:

From the participants' reports, thematic categories were organized, with the risks and incidents related to the drug therapy process being one of the listed categories, as well as proposals for actions.

Conclusion:

The study allowed the implementation of patient safety actions related to the administration of drugs in a PAU, offering a higher quality of care.

Keywords:
Patient safety; Emergency hospital service; Medication errors

Check Items in Non-Compliance	Nursing team reports
Patient identification	Changing medication, a relatively commonplace thing; The exchange of medication is, in fact, neither was the exchange of medication, medication in the wrong patient, the medication was right, but the patient was wrong (E24).
Identification of allergies	Yes, I already witnessed, the clerk put the form on the counter, then another clerk came in a hurry, took the plug, prepared the medication and called another patient, the employee went and did and the patient was allergic to the prescription of the other patient (E5).
Manual prescription	The risk for patients is also the letters of the doctors, how often the doctor writes badly and we find it hard to understand, we often must go there and ask him, so he is at risk of making the wrong medication (E15).
Verbal prescription	I have already lived risks, I have already experienced risks for the doctor asking for medication by speech, only talking, the medication being done twice, a doctor not prescribing, just talking and the medication being made in the wrong way of administration (E17).
Route of administration	I have already experienced that a doctor does not prescribe and only talk, and the medication is made in the wrong route of administration already had risk, had an incident (E17).
Dosage calculation	Already, I think with more risk than with incident, wrong medication, the doctor prescribed medication and sometimes the dose was unnecessary, greater than can be prescribed (E23).”
Infusion time	I think it is inappropriate to take the medication because sometimes we must do it in a very fast time, because there is always another time that needs to be filled (E7).
Dilution	The prescription is for you to make two applications. Only you have medication that you can inhale and can associate, and you have no medication. It just does not have something showing you that you can do it or not [...] certain medications lose the biochemical effect, right?
Selection and distribution of medicines	Drug therapy has several examples of risks, since I took the medication mixed in the box, in the box (form of storage of medicines in the service), has happened to take dipyrone instead of ranitidine (GF2-P2). When I worked at another institution, I went to the pharmacy to get the medicine, only the medication I was going to administer, it was not all exposed as it is here, there was one person doing it, and she was distributing the medicines per patient (GF2-P3).
Post administration monitoring	[...] Are you okay? Oh, I'm not feeling well, the patient replied. Did you take any injections in your vein? Yes, but I'm not feeling good (GF2-P1).
Potentially dangerous drugs	He is a patient with hyperglycemia, the patient stayed three hours without checking the glycemia. The amount of insulin can interfere, so the patient then has hypoglycemia, as some have already, and then they must make glucose (E18). I have lived the risk of the patient being unaccompanied and taking some psychotropic medication, in these cases he does not have conditions for example, going to the bathroom, getting up alone may have a fall (E5).

Safepractices in the drug therapy process	Nursing team testimonials	Goals to be achieved
Implantation of wristbands for patient identification	[...]could even, thus, the implantation of that identification bracelet, which is a way of identifying this patient (E4).	-Minimize the risks of medication errors by changing patients.
Implantation of colored bracelets to identify risks	As prevention strategy of incidents we can implant colored bracelet for risks of falls, allergies (GF1-P4).	-Minimize the risks of prescription and administration of medicine of which the patient is allergic and other risks that may be present in an emergency service.
Identify risk of drug allergy	[...] many times professionals point out that the patient is allergic to plastic, has an allergy to buscopan ... and this question of safety also when the patient arrives at the doctor, knows how to inform also what he has already taken, which he has allergy (E15).	-Minimize the risks of administering medication of which the patient is allergic. - Involve the patient and family in the care.
Checking all safety items	“It is always to confirm if it is the same patient, if it is the record, if everything corresponds to the patient, to see if there is no change of medication, what we call in the nursing of the “five corrects”, five C” (E11).	- To ensure the safe administration of medicinal products (right patient, right medication, right track, right time, right dose, right record, right action, right form, right answer).
Elaborate institutional protocols	All patients I ask if they have allergy to medications but need to turn protocol ask if the patient is allergic (GF1- P2).	- Standardize safety checking of all items for safe practices in the drug therapy process.
Education in service	As a measure of error prevention, perform professional orientation work, to be giving this name in all sectors, from the host, doctor's office, when to take the medication, check name and surname, full name (E19).	- Involve and train staff to implement safe practices in drug administration.
Computerization of medical prescription	I strongly believe that if it is computerized, even in terms of revenue, not to have medication error, error in the way, because of illegible letters, will also help a lot (E21). [...] if a doctor could open the computer and visualize the history, he would know that the patient was in the emergency room four times with the same complaint, had taken and that he did not improve with any medication [...] would sometimes have a more attentive view of the patient” (E21).	- Ensure legibility in prescription and items necessary for safe prescription. - Ensure access to patient history and systematized information.
Restructure drug storage location	And this question of how to organize medication also has to do with organization [...] (GF2-P4).	- Ensure safety at the drug selection and dispensation stage.
Hiring a pharmaceutical professional	For dispensing, for example, you would need to have a pharmacist for every hour, to spare, to work twenty-four hours, is a top-level professional, and does not have (GF2-P4).	- Ensure safety at the drug selection and dispensation stage.
List with standardized drugs and their possible interactions	It's a chart that tells us which medication can be mixed with another. It has medication that cannot be mixed with any other (GF2-P1).	- Increase the safety of the use and prevention of adverse reactions through drug interaction, due to the greater familiarity of the health team with these drugs.
Clarification to the patient about the medication to be administered.	[...] clarification of the patient for me is fundamental in the beginning, because through this I can avoid various incidents (E1).	-Involve the patient and family in care as a barrier to error in administering the medication
Surveillance as for potentially dangerous or highly vigilant substances.	For example, it installed the serum, made insulin, the correct one in case the insulin is to monitor the blood glucose, sixty, ninety minutes, does again the test already arrived at the ideal value (E18). Because very patient has the companion, most patients who sometimes come for hyperglycemia has companion, who can stand beside giving support (E18).	- Minimize the risks of prescription and administration of potentially dangerous drugs. - Involve the patient and family in monitoring post-administration of potentially dangerous medications.

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[1] Corresponding author:
Patricia Reis Alves dos Santos. patreisenf@gmail.com