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      Influência da redação da prescrição médica na administração de medicamentos em horários diferentes do prescrito Translated title: Influence of the writing of the medical orders on the administration of medications at the wrong schedule time Translated title: Influencia de la redación de la prescripción médica en la administración de medicamentos en horarios diferentes al prescripto

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          Abstract

          OBJETIVO: Analisar a influência da redação da prescrição médica na administração de medicamentos em horários diferentes do prescrito ocorridas em unidades de clínica médica de cinco hospitais brasileiros. MÉTODOS: Trata-se de estudo descritivo que utilizou dados secundários obtidos de uma pesquisa multicêntrica realizada em 2005. A amostra foi composta por 1084 doses de medicamentos administradas em horários diferentes do prescrito. RESULTADOS: Do total analisado, 96,2% apresentavam siglas e/ou abreviaturas; 7,8% apresentavam o registro do horário de administração incompleto e 4,8% destes registros estavam rasurados. Ainda, faltou o horário e/ou a freqüência de administração em 1,9% das prescrições. CONCLUSÃO: Com a implantação do sistema computadorizado de prescrições, associada à prática da educação permanente será possível minimizar a administração de medicamentos em horários diferentes do prescrito.

          Translated abstract

          OBJECTIVE: To evaluate the influence of the writing of medical orders on the administration of medications in medical units from five brazilian hospitals. METHODS: This descriptive study used a secondary analysis of data from a multicenter study conducted in 2005. the sample consisted of 1,084 medication orders that had been administered at the wrong schedule time. RESULTS: The great majority of medical orders (96.2%) had acronyms and/or abbreviations, 7.8% of them had incomplete schedules for administration of the medication, and 4.8% had been marked out. in addition, there was no schedule for the administration of the medication in 1.9% of the medical orders. CONCLUSION: Implementation of electronic prescribing and continuing education of health care providers can minimize the administration of medication at the wrong schedule time.

          Translated abstract

          OBJETIVO: Analizar la influencia de la redacción de la prescripción médica en la administración de medicamentos en horarios diferentes al prescripto ocurridas en unidades de clínica médica de cinco hospitales brasileños. MÉTODOS: Se trata de un estudio descriptivo que utilizó datos secundarios obtenidos de una investigación multicéntrica realizada en el 2005. La muestra estuvo compuesta por 1084 dosis de medicamentos administradas en horarios diferentes al prescripto. RESULTADOS: Del total analizado, el 96,2% presentaba siglas y/o abreviaturas; el 7,8% presentaba el registro del horario de administración incompleto y el 4,8% de estos registros estaban borrados. Aun más, faltó el horario y/o la frecuencia de administración en el 1,9% de las prescripciones. CONCLUSIÓN: Con la implantación del sistema computarizado de prescripciones, asociada a la práctica de la educación permanente será posible minimizar la administración de medicamentos en horarios diferentes al prescripto.

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          Most cited references14

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          Errors in the medication process: frequency, type, and potential clinical consequences.

          To investigate the frequency, type, and consequences of medication errors in more stages of the medication process, including discharge summaries. A cross-sectional study using three methods to detect errors in the medication process: direct observations, unannounced control visits, and chart reviews. With the exception of errors in discharge summaries all potential medication error consequences were evaluated by physicians and pharmacists. A randomly selected medical and surgical department at Aarhus University Hospital, Denmark. Eligible in-hospital patients aged 18 or over (n = 64), physicians prescribing drugs and nurses dispensing and administering drugs. Frequency, type, and potential clinical consequences of all detected errors compared with the total number of opportunities for error. We detected a total of 1065 errors in 2467 opportunities for errors (43%). In worst case scenario 20-30% of all evaluated medication errors were assessed as potential adverse drug events. In each stage the frequency of medication errors were-ordering: 167/433 (39%), transcription: 310/558 (56%), dispensing: 22/538 (4%), administration: 166/412 (41%), and finally discharge summaries: 401/526 (76%). The most common types of error throughout the medication process were: lack of drug form, unordered drug, omission of drug/dose, and lack of identity control. There is a need for quality improvement, as almost 50% of all errors in doses and prescriptions in the medication process were caused by missing actions. We assume that the number of errors could be reduced by simple changes of existing procedures or by implementing automated technologies in the medication process.
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            Adverse drug events and medication errors: detection and classification methods.

            Investigating the incidence, type, and preventability of adverse drug events (ADEs) and medication errors is crucial to improving the quality of health care delivery. ADEs, potential ADEs, and medication errors can be collected by extraction from practice data, solicitation of incidents from health professionals, and patient surveys. Practice data include charts, laboratory, prescription data, and administrative databases, and can be reviewed manually or screened by computer systems to identify signals. Research nurses, pharmacists, or research assistants review these signals, and those that are likely to represent an ADE or medication error are presented to reviewers who independently categorize them into ADEs, potential ADEs, medication errors, or exclusions. These incidents are also classified according to preventability, ameliorability, disability, severity, stage, and responsible person. These classifications, as well as the initial selection of incidents, have been evaluated for agreement between reviewers and the level of agreement found ranged from satisfactory to excellent (kappa = 0.32-0.98). The method of ADE and medication error detection and classification described is feasible and has good reliability. It can be used in various clinical settings to measure and improve medication safety.
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              Drug administration errors and their determinants in pediatric in-patients.

              . To quantify the type and frequency of drug administration errors to pediatric in-patients and to identify associated factors. Prospective direct-observation study of drug administration errors from April 2002 to March 2003. Four clinical units in a pediatric teaching hospital. Twelve observers accompanied nurses giving medications and witnessed the preparation and administration of all drugs to all patients on all weekday mornings. None. Discrepancies between physicians' orders and actual drug administration. During the 1719 observed administrations to 336 patients by 485 nurses, 538 administration errors were detected, involving timing (36%), route (19%), dosage (15%), unordered drug (10%), or form (8% form). These errors occurred for 467 (27%) of the 1719 administrations. Intravenous drugs (OR = 0.28; CI = 0.16-0.49; versus miscellaneous) were associated with fewer errors. Error rates were higher for cardiovascular (OR = 3.38; CI = 1.24-9.27; versus miscellaneous) and central nervous system drugs (OR = 2.65; CI = 1.06-6.59; versus miscellaneous); unspecified dispensing system (OR = 2.06; CI = 1.29-3.29; versus store in the unit); non-intravenous non-oral administration (OR = 4.44; CI = 1.81-10.88; versus oral administration); preparation by the pharmacy (OR = 1.66; CI = 1.10-2.51); and administration by a hospital pool nurse, temporary staffing agency nurse, or nurse intern (OR = 1.67; CI = 1.04-2.68; versus registered full-time nurse). Each additional management procedure in the patient increased the risk of error (OR = 1.22; CI = 1.01-1.48). The risk factors identified in our study should prove useful for designing preventive strategies, thereby improving the quality of care.
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                Author and article information

                Journal
                ape
                Acta Paulista de Enfermagem
                Acta paul. enferm.
                Escola Paulista de Enfermagem, Universidade Federal de São Paulo (São Paulo, SP, Brazil )
                0103-2100
                1982-0194
                2009
                : 22
                : 4
                : 380-384
                Affiliations
                [01] orgnameUniversidade Castelo Branco Brasil
                [02] Campinas orgnameHospital Vera Cruz Brasil
                [04] orgnameUniversidade Federal do Acre Brasil
                [03] Goiânia GO orgnameUniversidade Federal de Goiás Brasil
                [05] Fortaleza CE orgnameUniversidade de Fortaleza Brasil
                [06] São Paulo SP orgnameUniversidade de São Paulo orgdiv1Escola de Enfermagem de Ribeirão Preto Brasil
                Article
                S0103-21002009000400005 S0103-2100(09)02200405
                10.1590/S0103-21002009000400005
                b928bc76-7301-435d-abe6-8971ab338a07

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 22 July 2008
                : 18 November 2008
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 14, Pages: 5
                Product

                SciELO Revista de Enfermagem

                Categories
                Artigos Originais

                Erros de medicação,Medication errors,Drug prescriptions,Nursing records,Medical records,Errores de medicación,Prescripción de medicamentos,Registros de enfermería,Prescrição de medicamentos,Registros de enfermagem,Registros médicos

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