Objective: to identify and summarize studies examining both drug-drug interactions (DDI) and adverse drug reactions (ADR) in older adults polymedicated. Methods: an integrative review of studies published from January 2008 to December 2013, according to inclusion and exclusion criteria, in MEDLINE and EMBASE electronic databases were performed. Results: forty-seven full-text studies including 14,624,492 older adults (≥ 60 years) were analyzed: 24 (51.1%) concerning ADR, 14 (29.8%) DDI, and 9 studies (19.1%) investigating both DDI and ADR. We found a variety of methodological designs. The reviewed studies reinforced that polypharmacy is a multifactorial process, and predictors and inappropriate prescribing are associated with negative health outcomes, as increasing the frequency and types of ADRs and DDIs involving different drug classes, moreover, some studies show the most successful interventions to optimize prescribing. Conclusions: DDI and ADR among older adults continue to be a significant issue in the worldwide. The findings from the studies included in this integrative review, added to the previous reviews, can contribute to the improvement of advanced practices in geriatric nursing, to promote the safety of older patients in polypharmacy. However, more research is needed to elucidate gaps.

Objective: Translate, adapt and validate the Medical Office Survey on Patient Safety Culture (MOSPSC). Methods: Methodological study for the cross-cultural adaptation of the MOSPSC, elaborated by the Agency for Healthcare and Research in Quality. The following steps were undertaken: translation, back-translation, expert analysis, target population group and pretest, in a sample of 37 professionals. Results: In the expert analysis, the tool reached a general content validity score of 0.85. Six professionals performed the assessment by the target population group, and the adaptation suggestions were analyzed and modified by consensus. The pretest involved 37 professionals, who assessed the tool as easy to understand. Cronbach's alpha coefficient corresponded to 0.95. Conclusion: The tool was translated and adapted to Brazilian Portuguese with a satisfactory content validity and high reliability.

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RESUMO Objetivo Avaliar a estrutura e a adesão às medidas de precauções-padrão e específicas dos profissionais de saúde em Unidade de Terapia Intensiva de hospital de ensino, no Distrito Federal. Método Estudo descritivo, transversal e prospectivo. Utilizou-se de questionário estruturado mediante observações que registraram as práticas dos profissionais com Equipamentos de Proteção Individual e indicações de precauções. Foi aplicado o teste Qui-quadrado, e calculado o p-valor . Resultados Participaram do estudo 52 profissionais, e foram observados 445 procedimentos assistenciais em 36 sessões de auditoria. A média da taxa de adesão ao uso de equipamentos foi de 72,72%, sendo 94,91% às luvas, 91,43% ao avental, 80% à máscara e 24,56% aos óculos de proteção. Quando não havia indicação e não foi utilizado o Equipamento de Proteção Individual, a média da taxa foi de 68,01%, sendo 30,77% em relação às luvas, 87,58% ao avental, 57,58% à máscara, e 96,13% aos óculos. As precauções de contato foram indicadas desnecessariamente em 35% dos pacientes. Conclusão Verificou-se boa adesão ao uso de luvas, avental e máscara, baixa adesão ao uso de óculos de proteção e uso desnecessário de máscaras e precauções de contato admissionais.

BackgroundAccording to the World Health Organization, the WHO surgical safety checklist can prevent complications, improve communication and contribute to postsurgical safety culture; hence, there is a need to investigate the attitudes and opinions of surgical teams regarding safety utilizing the WHO instrument. The aim of this study was to assess the attitudes and opinions towards surgical safety among operating room professionals in three public hospitals in the Brazilian Federal District.MethodsA cross-sectional study was conducted with the use of a checklist based on the safety attitudes questionnaire-operating room, sent out during the pre- and post-intervention surveys of the WHO surgical safety checklist (period I and period II) between 2012 and 2014.ResultsAbout 470 professionals, mostly nurse technicians, responded to the questionnaire in both periods. Regarding the perception of safety and agreement about the collaboration of the operating team, a significant statistical improvement of the nursing staff and anesthesiologists was observed in the operating room after the checklist was implemented. After utilizing the checklist before each surgical procedure, concerns about patient safety and compliance with standards as well as rules and hand-washing practices in the operating room statistically improved after the post-intervention, especially by the nursing staff. The checklist was considered easy and quick to use by most respondents. They also believed that the checklist inclusion improved communication, reflecting significant differences. At least 90.0 % of respondents from each team agreed that the checklist helps prevent errors in the operating room.ConclusionsThe study results showed progress in relation to the attitudes and opinions regarding surgical safety from operating teams in relation to the checklist response in the surveyed units. However, difficulties in its implementation are experienced, especially in relation to checklist use acceptance by the surgeons. New studies are needed to verify the sustainability of the surgical teams’ changes in attitudes in the hospitals studied.

doi: 10.5216/ree.v12i3.11935Erros de medicação podem causar desfechos indesejáveis para pacientes, aumentar custos hospitalares e repercussões para os profissionais envolvidos. Com objetivo de verificar a ocorrência e caracterizar erros na administração de antibióticos, realizou-se estudo descritivo em uma Unidade de Terapia Intensiva (UTI) de hospital de ensino, na cidade de Brasília - Distrito Federal, entre setembro de 2006 e fevereiro de 2007. Para coleta de dados analisaram-se prescrições e observaram-se profissionais de enfermagem que administraram antibióticos. Observaram-se 35 prescrições de pacientes predominantemente do sexo feminino (54,3%), na faixa etária de 51 a 70 anos (60,0%), em tratamento pós-cirúrgico (54,3%), com tempo médio de hospitalização de dois a sete dias (40,0%). Foram encontradas 10 variedades de antibióticos, prevalecendo a vancomicina (28,9%), cefepima (13,3%), meropenem (11,1%) e amicacina (11,1%). A média de antibióticos por prescrição foi de 1,2, frequentemente na dosagem de 1000mg (42,2%) e ministrados por via intravenosa (100,0%). Quanto aos erros, foram constatados erros de preparo (87,6%), erros de horário (6,2%) e outros (6,2%). A visão sistêmica de prevenção e análise de ocorrências de erros de medicação deve ser implementada com finalidade de estabelecer cultura de segurança do paciente que permita contínua possibilidade de gerenciar riscos de eventos adversos com medicamentos no hospital. Descritores: Unidades de terapia intensiva; Antibioticoprofilaxia; Erros de medicação; Segurança.

Objective: to validate the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning in the stratification of risk for injury development in perioperative patients at a rehabilitation hospital. Method: analytical, longitudinal and quantitative study. An instrument and the scale were used in the three perioperative phases in 106 patients. The data were analyzed using descriptive and inferential statistics. Results: most patients showed high risk for perioperative injuries, both in the scale score with estimated time and in the real-time score, with a mean of 19.97 (±3.02) and 19.96 (±3.12), respectively. Most participants did not show skin lesions (87.8%) or pain (92.5%). Inferential analysis enabled us to assert that the scale scores are associated with the appearance of injuries resulting from positioning, therefore, it can adequately predict that low-risk patients are unlikely to have injuries and those at high risk are more likely to develop injuries. Conclusion: the scale validation is shown by the association of scores with the appearance of injuries, therefore, it is a valid and useful tool, and it can guide the clinical practice of perioperative nurses in rehabilitation hospitals in order to reduce risk for injuries due to surgical positioning.

RESUMO Objetivo: adaptar e validar um instrumento de segurança cirúrgica na cesárea, com base em revisão integrativa da literatura, e no protocolo e checklist de segurança cirúrgica da Organização Mundial da Saúde. Método: estudo metodológico, com triangulação de dados, envolvendo um total de 43 participantes, sendo oito juízes para a validação de conteúdo e aparente do instrumento, utilizando-se a técnica Delphi, e para a validação semântica outros 35 profissionais da equipe cirúrgica de um hospital público do Distrito Federal, Brasil. Foi aplicado o coeficiente de confiabilidade ao instrumento. Resultados: o instrumento alcançou índice de validade de conteúdo geral de 0,9 e concordância interavaliadores de 1. O coeficiente total do alfa de Cronbach foi de 0,86, e a média dos escores das dimensões obteve notas elevadas. Conclusão: o instrumento apresentou validade nos três critérios estudados e confiabilidade para ser aplicado em futuros estudos que avaliem a segurança cirúrgica na cesárea.