Objective:To identify compatibility, types and frequency of errors in preparation and administration of intravenous drugs.Methods:A cross-sectional and descriptive study performed at the emergency department of a university hospital in the city of São Paulo (SP). The sample consisted of 303 observations of the preparation and administration of intravenous drugs by nursing aides, nursing technicians and registered nurses, using a systematized script, similar to a checklist. The following variables were collected: errors related to dispensing, omission, schedule, unauthorized administration, dosage, formulation, incompatibility, preparation and administration.Results:In the preparation stage, the following errors were identified: no hand hygiene (70.29%), and no use of aseptic technique (80.85%). Upon administration, no hand hygiene (81.18%), and no use of aseptic technique (84.81%). In 31.35% of observations, there was more than one medication at the same time for the same patient, of which 17.89% were compatible, 56.84% were incompatible and 25.26% were not tested, according to the Micromedex database.Conclusion:In both preparation and administration stages, the most frequent errors were no hand hygiene and no use of aseptic technique, indicating the need to develop and implement education programs focused on patient safety.
This panel discussion was funded by Relypsa and facilitated by Magellan Rx Management. Rafique is a principal investigator for Relypsa and serves as a consultant for Instrumentation Laboratory, Magellan Health, Relypsa, and ZS-Pharma. Butler serves as consultant for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, CardioCell, Janssen, Merck, Novartis, Relypsa, and ZS-Pharma. Lopes and Farnum are employed by Magellan Rx Management. Rafique designed the management protocol for this panel discussion and contributed to the writing and editing of this report document. The other authors report no conflicting interests. Relypsa is the manufacturer of Veltassa (patiromer).
Objective: To relate the level of functional health literacy with adherence and barriers to non-adherence, rehospitalization, readmission and death in patients with heart failure. Method: A cross-sectional, analytical study with patients admitted to the emergency room with a diagnosis of heart failure. Literacy was assessed by the Newest Vital Sign. Patient adherence to medication treatment and barriers to non-compliance were assessed 90 days after discharge by the Morisky-Green test and the Brief Medical Questionnaire, respectively. Results: 100 patients participated in the study. The mean age was 63.3 years (± 15.2), with a predominance of white women. Medication adherence was low in 41.1% of participants, of which 55.9% presented inadequate literacy. Re-hospitalization and death were present in patients with inadequate literacy (p<0.001). Conclusion: The low level of literacy was directly related to lower adherence and the presence of barriers to medication adherence, as well as higher rehospitalization rates and death.
Objective To assess knowledge of nurses of emergency services and intensive care units about Glasgow Coma Scale.Methods This cross-sectional analytical study included 127 nurses of critical units of an university hospital. We used structured interview with 12 questions to evaluate their knowledge about the scale. Association of Knowledge with professionals’ sociodemographic variables were verified by the Fisher-test, χ2 and likelihood ratio.Results Most of participants were women mean aged 31.1 years, they had graduated more than 5 years previously, and had 1 to 3 years of work experience. In the assessment of best score possible for Glasgow scale (question 3) nurses who had graduate more than 5 years ago presented a lower percentage success rate (p=0.0476). However, in the question 7, which evaluated what interval of the scale indicated moderate severity of brain trauma injury, those with more years of experience had higher percentage of correct answers (p=0.0251). In addition, nurses from emergency service had more correct answers than nurses from intensive care unit (p=0.0143) in the same question. Nurses graduated for more than 5 years ago had a lower percentage of correct answers in question 7 (p=0.0161). Nurses with more work experience had a better score (p=0.0119) to identify how assessment of motor response should be started.Conclusion Number of year since graduation, experience, and work at critical care units interfered in nurses’ knowledge about the scale, which indicates the need of training.
Objective: Identify association between sociodemographic, clinical and triage categories with protocol outcomes developed at Hospital São Paulo (HSP). Method: Retrospective cohort study conducted with patients older than 18 years submitted to the triage protocol in August 2012. Logistic regression was used to associate the risk categories to outcomes (p-value ≤0,05). Results: Men with older age and those treated in clinical specialties had higher rates of hospitalization and death. Patients in the high-priority group had hospitalization and mortality rates five and 10.6 times, respectively (p < 0.0001). Conclusion:The high-priority group experienced higher hospitalization and mortality rates. The protocol was able to detect patients with more urgent conditions and to identify risk factors for hospitalization and death.
Objective:to correlate classification in risk categories with the clinical profiles, outcomes and origins of patients. Method:analytical cross-sectional study conducted with 697 medical forms of adult patients. The variables included: age, sex, origin, signs and symptoms, exams, personal antecedents, classification in risk categories, medical specialties, and outcome. The Chi-square and likelihood ratio tests were used to associate classifications in risk categories with origin, signs and symptoms, exams, personal antecedents, medical specialty, and outcome. Results:most patients were women with an average age of 44.5 years. Pain and dyspnea were the symptoms most frequently reported while hypertension and diabetes mellitus were the most common comorbidities. Classifications in the green and yellow categories were the most frequent and hospital discharge the most common outcome. Patients classified in the red category presented the highest percentage of ambulance origin due to surgical reasons. Those classified in the orange and red categories also presented the highest percentage of hospitalization and death. Conclusion:correlation between clinical aspects and outcomes indicate there is a relationship between the complexity of components in the categories with greater severity, evidenced by the highest percentage of hospitalization and death.
Objective: To verify the adequacy of the professional nursing staff in the emergency room of a university hospital and to evaluate the association between categories of risk classification triage with the Fugulin Patient Classification System. Method: The classification of patients admitted into the emergency room was performed for 30 consecutive days through the methodology proposed by Gaidzinski for calculating nursing requirements. Results: The calculation determines the need for three registered nurses and four non-registered nursing for each six hour shift. However, only one registered nurse and four non-registered nurse were available per shift. There was no correlation between triage risk classification and classification of care by the Fugulin Patient Classification System. Conclusion: A deficit in professional staff was identified in the emergency room. The specificity of this unit made it difficult to measure. To find the best strategy to do so, further studies should be performed. Nursing staff sizing in the emergency room of a university hospital Dimensionamento de enfermagem em sala de emergência de um hospital-escola Dimensionamiento de enfermería en servicio de urgencias de un hospital escuela
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