Luciana Bento

Estratégias para administração segura de medicamentos

Ainda se ouve falar em erros na administração de medicamentos, e não são poucos. Infelizmente, alguns deles levam a resultados desastrosos e fatais.

Por esse motivo, quando se fala em segurança do paciente, deve-se voltar a atenção para este tópico. O grande número de casos divulgado na mídia a respeito de erros na administração de medicamentos preocupa a maioria dos profissionais de saúde, bem como a população em geral, que fica exposta a erros evitáveis por meio de estratégias específicas.

Definição

Segurança do Paciente (SP) é definida pelo Ministério da Saúde (MS) como a “redução a um mínimo aceitável do risco de dano desnecessário associado ao cuidado em saúde”. Este dano diz respeito ao comprometimento de estruturas ou funções do organismo humano, seja físico, social ou psicológico.

A administração de medicamentos é um processo complexo que envolve vários profissionais de saúde e deve ser realizada de forma segura, com o objetivo de reduzir a ocorrência de possíveis eventos adversos.

A publicação “Erros na administração de medicamentos: evidências e implicações na segurança do paciente”, apontou, após uma revisão integrativa, os tipos de erros encontrados e sua representatividade em percentual. (Gomes et al, 2016)

 

Dose errada  67,5 %
Medicação errada  62,5 %
Paciente errado  52,5 %
Horário errado  50 %
Via errada  42,5%
Erro documental  40%
Omissão na administração do medicamento  35%
Técnica incorreta  32,5%
Não observação de reações medicamentosas  15%
Velocidade errada  10%
Medicamento vencido  5%
Volume errado  2,5%
Distração durante a administração  2,5%

Acredito que, se cada profissional investisse um pouco de tempo para utilizar a metodologia de segurança na aplicação de medicamentos (9 certos), esses percentuais reduziriam drasticamente.

NOVE CERTOS (Protocolo de Segurança na Prescrição, Uso e Administração de Medicamentos – MS)

1 – PACIENTE CERTO

  • Utilize mais do que um identificador (nome na pulseira, nome no prontuário, nome na prescrição médica, nome na identificação do leito) para confirmar o paciente certo
  • Faça perguntas abertas para que o paciente responda o nome completo (se paciente consciente e orientado)
  • Não interne dois pacientes homônimos (mesmo nome) no mesmo quarto

2 – MEDICAMENTO CERTO

  • Confira o nome do medicamento a ser aplicado com o que está na prescrição médica, mais de uma vez
  • Identifique, no paciente a receber o medicamento, alergias ou efeitos adversos anteriores
  • Informe-se sobre as possíveis interações medicamentosas
  • Não interprete letras incompreensíveis, esclareça com o prescritor

3 – VIA CERTA

  • Identifique a via de administração prescrita e questione se tiver alguma dúvida técnica
  • Verifique se o diluente e a velocidade de infusão foram prescritos
  • Avalie a compatibilidade do medicamento com a via prescrita e com os insumos a serem utilizados, por exemplo, seringas, frascos, sondas, entre outros
  • Esclareça qualquer dúvida, que porventura apareça, com outro profissional técnico: enfermeiro, médico prescritor ou farmacêutico

4 – HORA CERTA

  • Prepare o medicamento próximo ao horário de administração e confira a recomendação do fabricante em relação a estabilidade depois de preparado.
  • Planeje as suas atividades adequadamente para que possa administrar o medicamento no horário estabelecido
  • Caso seja necessário antecipar ou postergar a administração do medicamento, converse com o enfermeiro ou médico prescritor

5 – DOSE CERTA

  • Confira cuidadosamente a dose prescrita, todos os detalhes
  • Fique atento e esclareça dúvidas quanto a prescrição de unidade de medida imprecisas, como colher de sopa, entre outras
  • Confira a velocidade de infusão e ajuste a bomba de infusão, se for o caso
  • Respeite o tempo de infusão previsto na prescrição. A infusão lenta ou rápida demais interfere na dose administrada.
  • Faça os cálculos e confira com outro profissional se estão corretos
  • Informe-se da dose, via e condições para uso dos medicamentos prescritos como “se necessário”, “a critério médico”

6 – REGISTRO CERTO DA ADMINISTRAÇÃO

  • Registre corretamente na prescrição o horário da administração dos medicamentos
  • Registre, se caso houver, as antecipações, postergações ou recusa na administração de medicamentos
  • Faça checagem do horário a cada dose administrada
  • Registre todos os efeitos adversos após a administração dos medicamentos

7 – ORIENTAÇÃO CORRETA

  • Esclareça dúvidas (indicação, posologia, efeitos adversos conhecidos) com o prescritor ou enfermeiro, antes de administrar o medicamento
  • Fornecer ao paciente informações sobre o medicamento e sua indicação
  • Peça a colaboração do paciente para a administração de medicamentos que necessitem da participação ativa dele, como por exemplo, os sublinguais. Certifique-se que ele entendeu a orientação.

8 – FORMA CERTA

  • Conferir se o medicamento prescrito possui a forma farmacêutica que foi prescrita. Caso contrário, não faça adaptações
  • Avalie se a forma farmacêutica é compatível com a condição clínica do paciente
  • Peça ao prescritor a substituição do medicamento caso não tenha apresentação compatível com o tipo de administração

9 – RESPOSTA CERTA

  • Observe atentamente se foi obtido o efeito desejado após a administração do medicamento
  • Comunique ao prescritor e registre no prontuário todos os efeitos inesperados após a administração dos medicamentos
  • Levar em consideração qualquer observação ou relato feito pelo paciente sobre os efeitos dos medicamentos administrados. Ele é o melhor conhecer dele mesmo
  • Estar atento as alterações nos parâmetros de monitorização após a administração dos medicamentos, ex: taquicardia, ansiedade, dispneia, hiper ou hipoglicemia, entre outros

Alguns pontos importantes

  • Ter um manual, disponível para consulta, com informações sobre compatibilidade, diluição, preparo, entre outros
  • Implementar o sistema eletrônico de prescrição de medicamentos
  • Disponibilizar local tranquilo para o preparo dos medicamentos
  • Ter um farmacêutico atuante na equipe multidisciplinar
  • Padronizar e estruturar o armazenamento dos medicamentos
  • Utilizar sistemas adequados de identificação dos paciente e leitos
  • Implementar programas de educação/treinamento da equipe multidisciplinar, centrados nos princípios de segurança na prescrição, uso e administração de medicamentos

A atualização constante, principalmente ligada à farmacologia, minimiza a possibilidade de erros, consequentemente, reduzindo os prejuízos à integridade dos pacientes e os custos hospitalares desnecessários.

Referências bibliográficas

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Prof. Dra. Elizabeth Galvão

Doutora em Ciências (EEUSP), pós-graduada em Administração Hospitalar (UNAERP) e Saúde do Adulto Institucionalizado (EEUSP), especialista em Terapia Intensiva (SOBETI) e em Gerenciamento em Enfermagem (SOBRAGEN). É professora titular da Universidade Paulista no Curso de Enfermagem, e professora do Programa de Especialização Lato-sensu em Enfermagem em Terapia Intensiva e Enfermagem do Trabalho na Universidade Paulista.

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