Medication errors in critical patients during medication reconciliation: analyses and clinical management

Abstract Medication errors (ME) are frequent in the admission of patients to the ICU and can be identified and prevented through medication reconciliation (MR). Our aim was to evaluate the incidence, type and severity of MEs and associated factors, identified during MR in the ICU. This is a prospective, analytical approach, performed in the ICU of a private hospital, where the MRs were evaluated from April to June 2016. The SPSS and Stata programs were used to analyse the data. Logistic regression was performed to determine the factors associated with MEs. MR was performed with 136 patients, of whom 126 (92.6%) used drugs regularly. The incidence of MEs was 16.3% (95% CI 11.5-21.2). The main classes of drugs involved were those acting on the nervous and cardiovascular systems. There were 128 pharmaceutical interventions (acceptance: 71.1%). Regarding severity, 65.5% (n=80) of the errors reached the patient, but there was no harm. The risk factors for MEs identified were: age ≥60 years, number of comorbidities >1 and previous use of drugs ≥9. The incidence of MEs found and the significant association with age, comorbidities and polymedication alert to the need for specific attention to prevent admission errors in the most susceptible patient groups.

Elevação da razão normalizada internacional por interação medicamentosa em paciente crítico de unidade de terapia intensiva: relato de caso / Elevation of the International Normalized Ratio for drug interaction in critically ill intensive care unit patients: report of a clinical case

Relato de caso: o caso relatado apresenta uma paciente com uso de anticoagulantes e antimicrobianos que resultou na elevação dos valores do parâmetro de tempo de protombina e razão normalizada internacional, associados às condições hemodinâmicas. Conclusão: a interação medicamentosa foi identificada por um farmacêutico clínico e comunicada à equipe médica, que alterou a prescrição, observando-se melhora nos exames.

Case report: the case report shows a patient with anticoagulants and antimicrobials that resulted in the elevation of the values of the prothrombin time parameters and INR, associated with hemodynamic conditions. Conclusion: the drug interaction was identified by the clinical pharmacist; the medical team changed the prescription, and an improvement in the exam results was observed.

Direito à saúde: medicamentos mais solicitados por demandas administrativas e judiciais por uma secretaria estadual de saúde no biênio de 2013 a 2014 / Right to health: The most requested drugs for administrative and legal claims by a state health department in the biennium 2013 2014

Introdução: O uso da via judicial para o fornecimento de medicamentos presentes nas listas oficiais públicas é uma forma legítima de garantir o pleno exercício do direito à assistência individual terapêutica, que integra o direito à saúde na lei brasileira. Objetivo: Descrever o perfil dos processos administrativos e judiciais de solicitação de medicamentos à Secretaria de Saúde do Estado do Ceará, analisando a origem dessa demanda, os 10 princípios ativos mais solicitados em cada ano e suas principais indicações terapêuticas. Métodos: Estudo documental descritivo e retrospectivo de abordagem quantitativa. Foram analisadas as solicitações via processo administrativo e judicial ingressadas na Secretaria de Saúde do Estado do Ceará de janeiro de 2013 a dezembro de 2014. Nesse estudo as variáveis utilizadas foram adaptadas do Manual de Indicadores de Avaliação e Monitoramento das Ações Judiciais de Medicamentos. Para a análise dos dados, utilizou-se o SPSS® versão 15.0. A análise foi descritiva utilizando freqüência simples, média e porcentagem. Resultados: A Secretaria de Saúde do Estado do Ceará, através do CEIMED (Centro de Estudos e Informações Sobre Medicamentos) recebeu em 2013 um total de 1156 processos no total com um aumento de 33,91% no ano de 2014, totalizando 1548 processos. Os princípios ativos mais relevantes de 2013 foram: rituximabe (câncer) e teriparatida (osteoporose); em 2014 rituximabe (câncer) e insulinas (diabetes). Conclusão: O crescente processo de judicialização da saúde tem implicado grandes desafios às esferas municipal, estadual e federal por impactar diretamente nos orçamentos. Nota-se que assistência ao paciente com medicamentos já padronizados ainda necessita de eficácia prática, seja em não faltar nos locais de dispensação, seja em não gerar demanda processual desnecessária. O tratamento para diversos tipos de câncer, osteoporose e diabetes insulino-dependente necessitam de atençãoespecial quanto ao custo-beneficio imposto ao tratamento desses pacientes. (AU)

Introduction: The use of judicial channels for the supply of medicines on public official lists is a legitimate way to guarantee the full exercise of the right to individual therapeutic assistance, which integrates the right to health in Brazilian law. Objective: Describe the profile of administrative and judicial processes about demand of medicines from the Department of Health of Ceará Government, analyzing the origin of the demand, the 10 most requested active ingredients and their main therapeutic indications. Methods: Documental descriptive and retrospective study of quantitative approach. The applications submitted by administrative and judicial process were analyzed by the Department of Health from January/2013 to December/2014. During this study, the variables used were adapted from the Manual de Indicadores de Avaliação e Monitoramento das Ações Judiciais de Medicamentos (free translation: Manual of Evaluation Indicatives and Monitoring of Lawsuits of Medicines). In order to analyze the data it was used the SPSS® version 15.0. The analysis was descriptive using simple frequency, average and percentage. Results: Ceará's Department of Health by means of CEIMED (Study and Information Center about Medicines) received in 2013 1156 processes, and a raise of 33.91% of that in 2014, summing 1548 processes. The most relevant active ingredients in 2013 were: rituximab (cancer) and teriparatide (osteoporosis); in 2014: rituximab (cancer) and insulin (diabetes). Conclusion: the growth processes of judicialization of health has impacted with big challenges to the competences of cities, states and union due to the direct finance impact. It can be seen that the aid to patient with standard medicines still needs practice efficacy, such not missing at exempt places, as not generating unnecessary procedural demands. The treatment for several types of cancer, osteoporosis and insulin-dependent diabetes needs special attention about benefit-cost imposed to the treatment of these patients.