Preventive Strategies of Adverse Events With Potentially Dangerous Medications

Abstract

Objective: To describe the strategies adopted by nurses for safe administration of a potentially dangerous drug in the intensive care unit. Method: This is an exploratory study literature which included articles about potentially dangerous drugs and medication errors in intensive care units published in the period 1998 to 2009. Results: The study included 16 items that resulted in three categories of potentially dangerous medications (amines, heparin and insulin), which were described the light of error prevention strategies. Conclusion:The occurrence of adverse events with potentially dangerous medications is mostly preventable, and that for each class of potentially dangerous medications can be taken specific measures to prevent possible adverse events. Descriptors: Nursing care, Intensive care, Medication errors, Adverse drug reaction and security. RESUMOObjetivo: Descrever as estratégias adotadas pelo enfermeiro para uma administração segura de um medicamento potencialmente perigoso em unidade de terapia intensiva. Método: Trata-se de estudo exploratório bibliográfico onde foram incluídos artigos sobre medicamentos potencialmente perigosos e erros de medicação em unidades de terapia intensiva publicados no período de 1998 a 2009. Resultado: Foram analisados 16 artigos que resultaram em três categorias de medicamentos potencialmente perigosos (aminas, heparinas e insulinas), que foram descritas a luz das estratégias preventivas de erros. Conclusão: A ocorrência de eventos adversos com medicamentos potencialmente perigosos é na maioria das vezes, evitável, e que para cada classe de medicamentos potencialmente perigosos podem ser adotadas medidas específicas a fim prevenir possíveis eventos adversos. Descritores: Assistência de enfermagem, Cuidados intensivos, Erros de medicação, Reação adversa a medicamento e segurança. RESUMENObjetivo: Describir las estrategias adoptadas por las enfermeras para la administración segura de una droga potencialmente peligrosa en la unidad de cuidados intensivos. Método: Se trata de una literatura estudio exploratorio que incluyó artículos acerca de las drogas potencialmente peligrosas y los errores de medicación en unidades de cuidados intensivos publicados en el período 1998 a 2009. Resultados: El estudio incluyó 16 artículos que dieron lugar a tres categorías de medicamentos potencialmente peligrosos (aminas, la heparina y la insulina), que fueron descritos a la luz de las estrategias de prevención de errores. Conclusión: la ocurrencia de eventos adversos con medicamentos potencialmente peligrosos es en su mayoría prevenibles, y que para cada clase de medicamentos potencialmente peligrosos se pueden tomar medidas específicas para prevenir posibles efectos adversos. Descriptores: Cuidados de enfermeira, Cuidados intensivos, Los errores de medicación, Reacciones adversas a medicamentos y seguridad.

Preventive Strategies of Adverse Events With Potentially Dangerous Medications

“…Based on these considerations, we have drawn as the study object the establishment of some strategies for a safe administration of a potentially dangerous medication in intensive care unit environment and with the aim at describing the strategies adopted by the nursing professional for a safe administration of a potentially dangerous medication in intensive care unit scope. The results emerged from selection of 16 papers, relevant to the issue and the study object, which were analyzed and, subsequently, grouped into three medication categories: amines 7,11,14 , anticoagulants 17,20,22,23 and insulins 24,25,26,27,28,29,30 , being that such a grouping guided the study discussion. The aforementioned categories were created from the reading of papers.…”

“…and Norepinephrine (pH=4.5). 14,15 With regard once more to the vasoactive medications administration, it was observed that there is a convention in clinical practice regarding the use of deep venous catheters, where we should give preference to always insert these medicinal drugs through the proximal route (which should be identified to provide exclusivity) since this has a "prime" (gauge), gravitational flow and infusion rate (ml/hr) lower than the other lumen (distal and medial), with a view to avoiding "flushes" of these medications and, consequently, their overdosage.…”

“…That said, we recommend some strategies necessary for a safe administration of the single insulin type that can be intravenously administered (regular insulin), which will be hereinafter considered. 28 The intravenous regular insulin administration should strictly occur in continuous infusion pump and its dosage should strictly be controlled, with sights to avoid hypoglycemia. 28 According to Van propose some important strategies for the safe administration of this class of potentially dangerous medications, which will be hereinafter publicized.…”

“…28 The intravenous regular insulin administration should strictly occur in continuous infusion pump and its dosage should strictly be controlled, with sights to avoid hypoglycemia. 28 According to Van propose some important strategies for the safe administration of this class of potentially dangerous medications, which will be hereinafter publicized. 30 According to Clayton, to prevent abscess and/or necrosis of subcutaneous tissue, pain at the injection site and promote a quick absorption of insulin by means of subcutaneous route, according to the application site, depending on the need of the absorption speed thereof in the body, one should implement and maintain the rotation of sites for applying thereof.…”

Glycemic control in patients receiving insulin critics: integrative review

“…However, studies have shown that glycemic digital collection may be inaccurate in critically ill patients due to the injury of peripheral perfusion, caused by the use of vasoactive drugs, the presence of edema and microcirculation disorders, as well as the collection of blood through venous access contaminated by intravenous solutions rich in glucose. 24 It is recommended that during the IV insulin infusion, the nurse should measure blood glucose every hour; this interval be increased every 2 or 3 hours in individuals with glucose control within the target in the last 6 to 12 hours, respectively.…”