Medicamentos potencialmente perigosos: a expertise dos enfermeiros que atuam em unidade de urgência e emergência / High-alert medications: the expertise of nurses who work in an emergency and emergency unit / Medicamentos potencialmente peligrosos: la experiencia de las enfermeras que trabajan en una unidad de emergencia y emergencia

Objetivo: Identificar o conhecimento dos enfermeiros de um setor de urgência e emergência sobre os medicamentos potencialmente perigosos. Métodos: Estudo descritivo quantitativo desenvolvido com 23 enfermeiros em hospital de nível terciário municipal. Foi aplicado o Questionário de Medicamentos Potencialmente Perigosos. Para a análise dos dados, foi utilizado o software SPSS e foram utilizadas as medidas de tendência central e as medidas de dispersão. Resultados: A média±(DP) do tempo de formação foi 9,7 ± 3,0 anos e o tempo de serviço na instituição obteve média±(DP) 3,9 ± 3,8 anos. A média±(DP) de acertos no domínio 1 foi de 7 ± 1,74 e no domínio 2 foi 6,9 ± 1,55. Muitos profissionais referiram ter alguma dúvida relacionada ao uso de Medicamentos Potencialmente Perigosos. O domínio 2 obteve menor número de acertos quando comparado ao domínio 1. Conclusão: Os enfermeiros possuem conhecimento sobre a temática, pois a média de acertos nos dois domínios foram satisfatórias, mas apresentaram o menor número de acertos quanto ao uso de alguns fármacos, como prometazina e amiodarona. Com isso, reforça-se a importância de capacitar esses profissionais visando a segurança do paciente. (AU)

Objective: To identify the knowledge of nurses in an urgency and emergency sector about potentially dangerous drugs. Methods: Quantitative descriptive study developed with 23 nurses in a municipal tertiary level hospital. The Questionnaire of High-Alert Medicationswas applied. For data analysis, the SPSS software was used and measures of central tendency and dispersion measures were used. Results: The mean ± (SD) time since graduation was 9.7 ± 3.0 years and the length of service at the institution had a mean ± (SD) 3.9 ± 3.8 years. The mean ± (SD) of correct answers in domain 1 was 7 ± 1.74 and in domain 2 its was 6.9 ± 1.55. Many professionals reported having some doubt related to the use of Potentially Dangerous Medicines. Domain 2 had a lower number of correct answers when compared to domain 1. Conclusion: Nurses have knowledge on the subject, as the average of correct answers in the two domains were satisfactory, but they had the lowest number of correct answers regarding the use of some drugs, such as promethazine and amiodarone. With this, the importance of training these professionals is reinforced with a view to patient safety. (AU)

Objetivo: Identificar el conocimiento de los enfermeros en un sector de urgencia y emergencia sobre medicamentos potencialmente peligrosos. Métodos: Estudio descriptivo cuantitativo desarrollado con 23 enfermeras de un hospital municipal de nivel terciario. Se aplicó el Cuestionario de medicamentos potencialmente peligrosos. Para el análisis de los datos se utilizó el software SPSS y se utilizaron medidas de tendencia central y medidas de dispersión. Resultados: El tiempo medio ± (DE) desde la graduación fue de 9,7 ± 3,0 años y el tiempo de servicio en la institución tuvo una media ± (DE) 3,9 ± 3,8 años. La media ± (DE) de respuestas correctas en el dominio 1 fue de 7 ± 1,74 y en el dominio 2 fue de 6,9 ± 1,55. Muchos profesionales informaron tener alguna duda relacionada con el uso de medicamentos potencialmente peligrosos. El dominio 2 tuvo un número menor de respuestas correctas en comparación con el dominio 1. Conclusión: Los enfermeros tienen conocimiento sobre el tema, ya que el promedio de aciertos en los dos dominios fue satisfactorio, pero tuvieron el menor número de aciertos en cuanto al uso de algunos fármacos, como prometazina y amiodarona. Con ello, se refuerza la importancia de formar a estos profesionales con miras a la seguridad del paciente. (AU)

Investigation and analysis on recognition of high-alert medications of physician's advice among clinical nurses from grade three and first-class hospital in chongqing / 中国实用护理杂志

Objective To investigate the recognition of physicians′ advice about high-alert medications among clinical nurses from grade three and first-class hospitals in Chongqing and to analyse the relevant training requirements. Methods Using a multistage stratified cluster sampling strategy, the physicians′ advice recognition questionnaire of High- alert medications for clinical nurses was administered to 3029 nurses in eight hospitals, to test the nurses′ advice recognition of high-alert medication and collecte training suggestions. Results More than 82.70％(1946/2353) of nurses responded correctly for 8 out of the 12 questions, the accuracy rate of pethidine hydrochloride injection test was 97.11％(2285/2353) and the dopamine hydrochloride injection test was only 28.56％(672/2353). The nurses′ recognition of physicians′ advice of high-alert medications in gender, department, working time and annual income was statistically significant (P<0.10). 81.34％(1914/2353) of the nurses were able to recognize 11 out of the total 24 wrong advices. Pre-job training、theoretical knowledge related to physicians′advice and case-based learning are the best training time, content and form. Conclusions The recognition level of high-alert medications by clinical nurses from grade three and first-class hospitals in Chongqing was not high and the clinical nurses with different gender, department, working time and annual income had different abilities, the targeted training for clinical nurses should be provided.

Analysis of the Application Effects of High-alert Medications Management Review and Evaluation System Based on Tracer Methodology / 中国药房

OBJECTIVE:To explore the application and feasibility of tracer methodology in the continuous improvement of high-alert medications management in the hospital,and to improve the quality of high-alert medications management and ensure the safety of clinical medication. METHODS:According to the theory and requirements of tracer methodology,a series of interven-tions were applied to the management of high-alert medications in our hospital. The comparisons on the mastery of high-alert medi-cations knowledge,review and evaluation results and the incidence of adverse events were conducted before and after applying trac-er methodology,so as to evaluate the improvement effect of tracer methodology on high-alert medications management. RESULTS:After implementing intervention measures such as the reduction of high-alert medications list and medical staff training about high-alert medications,compared to before management,medical staffs had improved the knowledge level of high-alert medica-tions (the average awareness rate increased from 69.6% to 88.5%);the review and evaluation results had been improved signifi-cantly (the proportion of the terms with qualified level evaluation results or above increased from 66.67% to 88.89%);the inci-dence of adverse events was reduced(from 0.321% to 0.139%). CONCLUSIONS:The tracer methodology has a significant effect on the management of high-alert medications in our hospital. It is feasible and can be widely used in the management of high-alert medications in the hospitals.

Concomitant prescribing and dispensing errors at a Brazilian hospital: a descriptive study

OBJECTIVE: To analyze the prevalence and types of prescribing and dispensing errors occurring with high-alert medications and to propose preventive measures to avoid errors with these medications. INTRODUCTION: The prevalence of adverse events in health care has increased, and medication errors are probably the most common cause of these events. Pediatric patients are known to be a high-risk group and are an important target in medication error prevention. METHODS: Observers collected data on prescribing and dispensing errors occurring with high-alert medications for pediatric inpatients in a university hospital. In addition to classifying the types of error that occurred, we identified cases of concomitant prescribing and dispensing errors. RESULTS: One or more prescribing errors, totaling 1,632 errors, were found in 632 (89.6 percent) of the 705 high-alert medications that were prescribed and dispensed. We also identified at least one dispensing error in each high-alert medication dispensed, totaling 1,707 errors. Among these dispensing errors, 723 (42.4 percent) content errors occurred concomitantly with the prescribing errors. A subset of dispensing errors may have occurred because of poor prescription quality. The observed concomitancy should be examined carefully because improvements in the prescribing process could potentially prevent these problems. CONCLUSION: The system of drug prescribing and dispensing at the hospital investigated in this study should be improved by incorporating the best practices of medication safety and preventing medication errors. High-alert medications may be used as triggers for improving the safety of the drug-utilization system.

Application of Continuous Quality Improvement in Ward Management of High-Alert Medications / 中国药房

OBJECTIVE: To intensify ward management on high-alert medications ensure clinical medication safety.METHODS: The main problems encountered in ward management on high-alert medications were analyzed;the application of continuous quality improvement(CQI) in the management on high-alert medications was introduced and the outcome was evaluated.RESULTS: The continuous quality improvement has greatly enhanced the management quality on high-alert medications and reduced the number of problems from previous 158 times before practice to 2 times after the practice of the continuous quality improvement.CONCLUSION: CQI is a continuous activity and it is conducive to the improvement of management quality on high-alert medications.

Experience about Application of Risk Management in High-alert Medications in Ward Area of Our Hospital / 中国药房

OBJECTIVE: To provide reference for the improvement of management quality of high-alert medications in ward area. METHODS: Risk management was used to estimate risk factor of commonly used high-alert medications in ward area. Then the homologous management measures were formulated based on potential risk. RESULTS: With enforcement of risk management, risk awareness of relevant responsible person was strengthened. They knew more knowledge about high-alert medications and its rate increased from 60% to 96%. The phenomena such as nonstandard storage and placement of drugs, unclear identification had never happened again. CONCLUSION: The application of risk management in high-alert medications contributes to improve anti-distress awareness of relevant responsible person, guarantee safety of drug use and enhance the quality of care.

Supervising System on Hospital High-alert Medications:Theory and Practice / 中国药房

OBJECTIVE:To explore the approach and starting point for the management of hospital high-alert medications so as to enhance the level of drug safety control.METHODS:By reviewing pertinent literature,the background,concept and categories of high-alert medications as well as the practice and experiences of carrying out management on high-alert medications in our hospital were introduced.RESULTS & CONCLUSIONS:The management on hospital high-alert medications has effectively lowered the risks of it.In view of the frequent occurring drug safety events,it is necessary to implement the corresponding management on high-alert medications in medical institution.It is advisable to establish a corresponding list of high-alert medications as well as a supervising system in medical institutions to improve drug control safety level and risk prevention ability.