Objetivo: Analisar a influência da complexidade da farmacoterapia (CFT) na adesão ao tratamento imunossupressor. Métodos: Trata-se de um estudo analítico, observacional e transversal, baseado nos registros do atendimento farmacêutico de pacientes transplantados renais de um hospital universitário (Fortaleza/Ceará). A CFT foi avaliada em consulta farmacêutica no período de janeiro a julho/2014, utilizando-se o Índice de Complexidade da Farmacoterapia (ICFT). A análise da adesão foi realizada através do nível sérico dos inibidores da calcineurina e imTor. Resultados: Analisou-se o acompanhamento de 36 pacientes: sendo 52,78% (n=19) homens; 27,80% (n=10) entre 41 e 50 anos; 41,70% (n=15) com ensino fundamental incompleto e 72,22% (n=26) possuíam cuidador. A média de medicamentos foi nove e de pontos no ICFT foi de 50,94. O ICFT máximo foi registrado na faixa de 31-60 dias pós-transplante. Analisando o nível sérico dos imunossupressores, observou-se prevalência de pacientes classificados como “não aderentes” maior no período menor de 60 dias pós-transplante. Conclusão: Concluiu-se que no pós-transplante renal a adesão dos pacientes ao tratamento imunossupressor aumenta com a diminuição da CFT, sendo necessária uma maior e melhor orientação dos pacientes no inicio do pós-transplante.
Objective:The medication follow-up in infants with extremely low birth-weight in a neonatal intensive care unit is described, identifying drug-related problems (DRP), drug-related negative outcomes, and the relationship between the occurrence of DRP and birth-weight of newborns and their impact on pharmacotherapy and length of hospital stay.Methods:A descriptive and exploratory study was performed in which medication follow-up of a population of infants with extremely low birth-weight admitted to the neonatal intensive care unit of a government-run maternity hospital was carried out by clinical pharmacists. Monitoring comprised assessment of patients’ pharmacotherapy needs through visits to the neonatal unit, evaluation of prescriptions and information on medical records, identification of issues associated with pharmacotherapy and follow-up of the newborns’ clinical evolution to determine whether desired results were achieved.Results:The subjects were 33 infants characterized by extremely low weight at birth. Analysis of patients’ pharmacotherapy showed that 39.4% (n=13) of the neonates presented some type of DRP, totaling 37 DRPs and a mean of 2.8 problems/patient. Fourteen drugs were identified with the occurrence of DRP. Vancomycin and cefepime were the most prevalent, with 18.9% (n=7). Occurrence of DRPs and several clinical characteristics of newborns and their pharmacotherapy were compared. The most prevalent drug-related negative outcomes identified were “untreated health problem” (40%, n=10) and “quantitative ineffectiveness” (32%, n=8). Pharmaceutical interventions were performed for all problems associated with pharmacotherapy, with a prevalence of “treatment day count correction” and “dose correction”, both with 21.6% (n=8), and “correction of dosage” (16.2%, n=6).Conclusion:The research evidenced the role of the clinical pharmacist in the solution and prevention of drug-related problems, contributing with the multidisciplinary team to obtain a safe and effective pharmacotherapy. Further, current study confirmed that there is an association between the characteristics of the newborns under analysis (eg. birth-weight, pharmacotherapy) and the occurrence of drug-related problems.
Objective: To describe failure modes and establish contingency measures related to the clinical medication process using medical prescriptions of patients admitted to an Intensive Respiratory Therapy Unit (UTIR), using the Failure Mode and Effects Analysis (FMEA) tool. Methods: This is a descriptive and cross-sectional study carried out in an Intensive Care Unit of a public hospital in Fortaleza, Brazil, from November/2015 to March/2016. Study population included adults aging ≥ 18 years in intensive care at the UTIR. The study included the medical prescriptions released on Mondays, Wednesdays, and Fridays. The study was divided in five phases: situational diagnosis, formation of a multiprofessional team, assessment of failure modes (FM), monitoring of FM and calculation of the priority coefficient (PC). In the FM assessment, scoring of the three indicators of the FMEA was used within a range of 1-10, whereas a score of 10 characterized the most concerning situation. Therefore, the indicators gravity (G), prevalence (P) and detection (D) were analyzed. The study was carried out with an active interaction between the subjects of the group and several in-person and virtual sessions were performed. Drugs used in the study were categorized for therapeutic class, according to the Anatomical Therapeutic Chemical Classification System. Data analysis was performed using Microsoft Office Excel® 2013 software. Results: 301 prescriptions were analyzed, with the identification of 452 FMs, which related mostly to systemic antibacterials (21.6%, n = 8), psycholeptics (13.5%, n = 5) and antithrombotic agents (10.8%, n = 4). FMs were divided in eleven categories, from which “drug interaction” (36.8%; n = 14), “dose adjustment” (21.1%, n = 8) and “food-drug interaction” (7.9%, n = 3) were the most frequent. The PC of the detected FMs varied between 28 and 294, and 42.1% (n = 16) of them presented PC above 100. Median of the indicators G (6 – min: 3; max: 9), D (7 – min: 3; max 7) and priority coefficient (72 – min: 28; max: 294) indicate that FM had generally moderate gravity, low prevalence and low detection. For the majority of FMs (72.7%, n = 28), the chosen conduct was ‘not to accept’ and the established contingency measure included a sentinel event notification. Conclusion: The use of FMEA enabled the identification, classification, and prioritization of risks of the clinical medication process in the UTIR. This study indicates the need to implement measures that increase safety in the clinical practice of the study Intensive Care Unit.
Objective: To characterize the drug quality deviation (DQM) notification and their financial impact of a sentinel network university hospital in Ceará. Methods: This is a cross-sectional observational pharmacovigilance study carried out in Fortaleza-CE, through spontaneous reports of DQM from January 2016 to June 2017. Data was obtained from the patient’s records, registered and analyzed using Excel spreadsheets. Results: A total of 49 (84.48%) reports were included in this study, with a monthly average of 2.72 notifications. These came mainly from the pharmacy (n=14; 28.57%) and medical clinics (n=12; 24.49%), with nurses (n=28; 57.14%) and pharmacists (n=13; 26.53%) being the largest notifiers. A total of 92 drugs were used, being blood substitutes and perfusion solutions (n=50; 54.35%), antibacterials for systemic use (n=12; 13.04%) and immunoglobulins (n=6; 6.52%) the most frequent. Injectable pharmaceutical formulations were more frequent (91,30%; n=84). The most frequently observed DQM were the presence of foreign body / material in suspension (n=16; 32.65%) and crack / bubble / leak (n=14; 28.57%). The supplier was contacted in em 65,31% (n=32), of the cases, with formal responses received in 65,62% (n=21) of them. The manufacturer took responsibility for DQM in 38,10% (n=8) of cases. The notification to the National Health Surveillance Agency (ANVISA) occurred in 20,41% of the cases. The reimbursement of the value of the drug by the producer laboratories contacted occurred in 25% (n=8) of the cases, corresponding to a value of R $ 4,254.97. Conclusions: The importance of conducting DQM notifications is evident since these can ensure better knowledge about health products on the market and safer products for patients and health professionals.
Objetivos: Avaliar as recomendações farmacêuticas de desprescrição realizadas aos pacientes internados em uma Unidade de Terapia Intensiva (UTI) clínica adulto. Métodos: Trata-se de um estudo transversal, descritivo e quantitativo desenvolvido com as recomendações farmacêuticas de desprescrição de medicamentos, na UTI adulto de um hospital universitário em Fortaleza – CE, de 2017 a 2018. Os dados dos pacientes e das recomendações foram coletados a partir de prontuários de pacientes. A aceitabilidade das recomendações foi mensurada a partir da visualização da alteração sugerida em 24 horas. Os medicamentos envolvidos nas recomendações foram categorizados de acordo com a classificação Anatomical Therapeutic Chemical (ATC) e com a de Medicamentos Potencialmente Perigosos (MPP). Os dados foram compilados e analisados usando o software Microsoft Office Excel® 2013. Resultados: Realizou-se um total de 388 recomendações de desprescrição de medicamentos a 210 pacientes adultos que eram majoritariamente do gênero masculino (58%) e com idade média de 56 anos ± 16,8. A aceitabilidade das recomendações foi de 93,3% (n=362) e a média de medicamentos desprescritos por paciente foi de 1,7 ± 0,7, sendo todos interrompidos de forma abrupta. Os problemas relacionados com as desprescrições foram principalmente, prescrição de medicamentos não necessários (77,6%) medicamentos contraindicados (8,0%) e duplicidade terapêutica (5,1%). As classes terapêuticas mais prevalentes foram os antibacterianos para uso sistêmico (11,3%), oftalmológicos (20,8%) e medicamentos para distúrbios gastrointestinais funcionais (9,5%). Os principais medicamentos desprescritos foram o colírio hipromelose + dextrano (9,6%), bromoprida (6,9%) e cloreto de potássio injetável (5,8%), sendo esse último considerado um MPP. A classe mais associada a não aceitação da desprescrição foi a dos corticosteroides para uso sistêmico (23,1%). Conclusão: Este estudo mostrou um elevado nível de aceitação das recomendações de desprescrição, especialmente entre os antibacterianos para uso sistêmico. O cloreto de potássio injetável, considerado um MPP, ocupou o terceiro lugar geral de desprescrição. Futuros estudos devem avaliar o impacto das recomendações de desprescrição na morbimortalidade na UTI e na redução de custos hospitalares.
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