Objective To analyze the process of recording transfusion monitoring at a public teaching hospital.Methods A descriptive and retrospective study with a quantitative approach, analyzing the instruments to record transfusion monitoring at a public hospital in a city in the State of Minas Gerais (MG). Data were collected on the correct completion of the instrument, time elapsed from transfusions, records of vital signs, type of blood component more frequently transfused, and hospital unit where transfusion was performed.Results A total of 1,012 records were analyzed, and 53.4% of them had errors in filling in the instruments, 6% of transfusions started after the recommended time, and 9.3% of patients had no vital signs registered.Conclusion Failures were identified in the process of recording transfusion monitoring, and they could result in more adverse events related to the administration of blood components. Planning and implementing strategies to enhance recording and to improve care delivered are challenging.
WPC intake ≥40% of DPR helped to reduce the severity and duration of OM. The use of WPC in patients undergoing HSCT was shown to be safe, encouraging new studies in this population to assess its action mechanism.
Aim: The aim of this evidence implementation project was to improve the documentation of chemotherapy administration by nursing staff in a bone marrow transplant unit, to improve patient care and safety, as well as meet the legal and educational responsibilities of the nursing staff. Methods: This evidence implementation project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback framework for the design and development of an evidence-based audit and feedback change project. A baseline audit was conducted to assess current practices against best practice and identify areas requiring improvement. Next, the project team reflected on the results of the audit to develop and implement strategies for documentation improvement. Lastly, a follow-up audit was conducted to assess changes in practice improvement. Results: The baseline audit results revealed practice areas requiring improvement; facilitators of and barriers to nursing documentation and practice improvement were identified. A checklist, educational session, Nursing Documentation Guidelines for Chemotherapy Administration, was implemented to improve nursing documentation. The follow-up audit demonstrated improved adherence across all audit criteria. Conclusion: The checklist implemented for nursing documentation and education contributed to improved practices. To promote additional improvements, nurses will continue to utilize the tools developed and receive continued education through formal training and staff meetings. Future auditing is planned to ensure sustainability.
Os pacientes em regime de condicionamento para o transplante de células tronco hematopoéticas (TCTH) apresentam elevada incidência das formas mais graves da mucosite oral. O isolado de proteínas do soro (IPS) é composto por uma série de fatores de crescimento celular, dentre eles os fatores de crescimento transformador beta que compreende uma família de peptídeos e contribuem para o reparo tecidual. A partir da hipótese de que a suplementação alimentar com IPS teria o potencial de reduzir a mucosite oral, desenvolvemos um estudo clínico randomizado com pacientes submetidos ao TCTH autólogo e alogênico no Hospital Universitário da Universidade Federal de Juiz de Fora, com diferentes protocolos de condicionamento. Os pacientes foram suplementados com uma dose diária de IPS contendo 50% das necessidades diárias de proteína conforme Dietary Reference Intakes e classificados, posteriormente, quanto a quantidade de suplemento ingerida. Os critérios do National Cancer Institute, versão 4.0, foram utilizados para a classificação dos eventos adversos ocorridos e para avaliação da mucosite oral, a partir da escala de toxicidade oral da Organização Mundial da Saúde. Um total de 40 pacientes submetidos ao transplante de células tronco hematopoéticas foram avaliados. Destes, 20 fizeram parte do grupo controle e 20 do grupo intervenção, os quais receberam IPS. A mucosite oral (MO) teve duração média de 7,52 dias (DP: 2,73), variando entre 4 a 14 dias. A média de início variou entre o 2º dia antes da infusão de células tronco até o 7º dia após infusão e mediana no 5º dia após infusão. A incidência de MO no grupo intervenção foi 40% e no grupo controle 65% (OR= 2,7857, IC= 2,3638 – 3,1962). A mucosite grave esteve presente em 10% dos pacientes do grupo intervenção e 30% dos pacientes do grupo controle (OR= 3,8571, IC= 3,4409 – 4,2734). Observou-se uma menor queda do fator de crescimento transformador beta (TGF-β) plasmático no grupo intervenção, a média foi de 452,81ng/mL (DP: 391,25) no início da neutropenia, enquanto no grupo controle foi de 172,90ng/mL (DP:110,68) (p=0,022). Estudos adicionais são necessários para contribuir com os atuais achados e ampliar as possibilidades de prevenção desta toxicidade.
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