Definição de dados essenciais para software que sinalizará condições de desospitalização para a internação no domicílio / Definition of essential data to software which will point out thedehospitalization conditions for home care / Definición de los datos esenciales para el software que señalará lascondiciones de desempeño de los pacientes a la atención domiciliaria

Objetivou-se aplicar formulário para identificação de dados essenciais à gestão da desospitalização com vistas na elaboração de software. Depois de revisados os documentos, um grupo de discussão propôs lista inicial de dados estruturados em formulário para definição de subgrupo de dados essenciais, cuja validade de conteúdo foi definida por profissionais da internação domiciliar no Distrito Federal. O formulário foi então concebido reunindo dois conjuntos de dados iniciais, cuja essencialidade foi definida por escolha ou qualificação. Foram considerados essenciais 15 dos 29 dados para escolha e 27 dos 45 dados para qualificação. Dados essenciais foram aqueles cuja validade de conteúdo foi definida pelos futuros usuários, que estabeleceram os requisitos iniciais para elaboração de um software. Entretanto, um dado importante (procedência) não foi considerado essencial pelo método, o que reforça a necessidade de análise qualitativa no final do processo para a propriada definição da essencialidade e dos requisitos para desenvolvimento do software...

The aim was to apply a form to identify essential data for dehospitalization management, breaking new groundto design software. Documents were used to propose an initial data list by discussion group which elaboratesthe form to define a subset of essential data whose content validity was defined by home care professionalsin the Distrito Federal. The form was then designed in two initial datasets whose essentiality was defined bychoice or qualification. In the form, it was considered essential 15 among 29 chose data and 27 among 45qualification data. The data considered essential had their content validity defined by future users informinginitial requirements for a software. Nevertheless, an important data (origin) was not considered essential bythe applied method, reinforcing the need for qualitative analysis at the end of the process for appropriatedefinition of essentiality and requirements which will give support to software development...

Su objetivo era implementar formulario para identificar datos esenciales a la deshospitalización. Despuésde documentos revisados, un grupo de discusión ha propuesto lista de datos que se ha estructurado en formulariopara definir subconjunto de datos cuya validez fue definida por profesionales de la hospitalizacióndomiciliaria en el Distrito Federal. El formulario está diseñado en dos conjuntos de datos cuya esencialidadha sido definida por elección o calificación. Fueron considerados 15 de 29 concernientes a la elección dedatos y 27 de los 45 datos de calificación. Datos esenciales fueran aquellos cuya validez de contenido hasido definida por los futuros usuarios, los cuales estableceron los requisitos iniciales para el desarrollodel software. Uno dato importante (procedencia), sin embargo, no ha sido esencial por el método, lo quemuestra la necesidad de un análisis cualitativo al final del proceso para obtener una definición apropiadade esencialidad y requisitos para software...

impact of lack of pharmacist contribution on the prescription patterns and the appropriateness of indications of nsaids, a cross-sectional study

Non-steroidal anti-inflammatory drugs [NSAIDs] are among the most commonly used medications worldwide. However, recent literature strongly points to gastrointestinal [GI] and cardiovascular [CV] risks associated with NSAIDs use. The current study was carried out in Jordan University Hospital. The main objective was to evaluate the role of pharmacists in directing the current prescription patterns and appropriateness of NSAID therapiesto establish strategies for medication reconciliation in the healthcare systems in the region. This is a prospective cross-sectional qualitative study that enrolled a total of 400 patients over a period of 10 months. The NSAID use was evaluated in patients with and without established CVD and various GI risk stratifications. In addition, 30 physicians were recruited into the study to determine the current prescription patterns. A structured questionnaire was validated and handed to physicians to determine strengths and weaknesses in the current system. NSAID-related drug interactions were evaluated in 200 of the patients. Sixty five percent of the patients without CVD were at moderate GI risk and 12% were at high risk. Sixty nine percent of patients with CVD were at high GI risk and 28% were at moderate risk. Pharmacists were not involved in decision therapies pertaining to NSAIDs, which led to serious drug-related problems in the therapeutic regimens for patients using the NSAIDs. In 64% of the patients without CVD, NSAID therapy did not meet the recommendations of current guidelines. There was no drug therapy monitoring or patient counseling by a proficient clinical pharmacist, which led to virtually no identification of potential drug interactions or optimization of medication therapy. The study unraveled a great opportunity to improve the clinical outcomes in patients on NSAID therapy. The lack of pharmacist involvement puts patients at major health risks. Updating physicians on practice guidelines, including a clinical pharmacist in therapy decisions, and modifying hospital formularies are the most urgent recommendations.

Tratamento cirúrgico dos carcinomas basocelular e espinocelular: experiência dos Serviços de Cirurgia Plástica do Hospital Ipiranga / Surgical cirurgico dos carcinomas basocelular e espinocelula: experiência dos Serviços de Cirurgia Plástica do Hospital Ipiranga", "_e": "n

INTRODUÇÃO: Os tumores de pele malignos não-melanoma são o tipo de câncer de maior incidência e prevalência no Brasil. Dentre eles, o carcinoma basocelular (CBC) é o mais comum, correspondendo entre 70% e 75% dos casos. O carcinoma epidermoide (CEC) responde por 20% dos casos. Este trabalho tem por objetivo analisar os casos de câncer de pele não-melanoma operados, entre os anos de 2005 e 2010, no Serviço de Cirurgia Plástica do Hospital Ipiranga. MÉTODO: Foi realizada análise de prontuários de pacientes submetidos a exérese de carcinoma de pele não-melanoma em centro cirúrgico, avaliados quanto a idade, sexo, profissão, raça, localização anatômica, fatores de risco, número de lesões e subtipo histológico. RESULTADOS: Foram analisados 145 pacientes, dos quais 15,9% apresentavam lesões múltiplas, totalizando 168 tumores. Houve predomínio de CBC, correspondendo a 87,6% dos casos, seguido de CEC, com 26,2%. Os CBCs sólidos ou nodulares predominaram, com 44,1%, e os CECs Broders I representaram 42,1% dos CECs. Dos pacientes, 80,7% possuíam lesão em face e 12,4%, em membros superiores. A média de idade dos pacientes foi de 69,5 anos, sendo 59,4% do sexo feminino. A raça branca foi mais frequente e o tabagismo foi o principal fator de risco, presente em 79,3% dos casos. CONCLUSÕES: Observou-se predomínio de CBC e do sexo feminino nos pacientes estudados, demonstrando a tendência atual desse tumor. O número significativo de pacientes com lesões múltiplas ressalta a importância do exame periódico dessa população. A alta prevalência de tabagismo entre os pacientes não pode deixar de ser observada.

BACKGROUND: A higher incidence and prevalence of non-melanoma skin cancers has been reported in Brazil. Among them, basal cell carcinoma (BCC) is the most common, accounting for 70%-75% of all cases. Squamous cell carcinoma (SCC) constitutes 20% of non-melanoma skin cancers. The aim of this study was to examine the patients who underwent surgery for the treatment of non-melanoma skin cancer between 2005 and 2010 at the Plastic Surgery Service of Hospital Ipiranga. METHODS: The medical records of the patients who were treated for non-melanoma skin cancer at the surgical center were reviewed and classified according to age, gender, occupation, race, anatomical location, risk factors, number of lesions, and histological subtype. RESULTS: A total of 145 patients were evaluated; 15.9% exhibited multiple lesions, which resulted in a total of 168 tumors. BCC was most commonly detected (87.6% of the tumors), whereas 26.2% of tumors were SCC. Solid or nodular BCC comprised 44.1% of all skin cancers, whereas Broders I SCC accounted for 42.1% of SCC cases. The lesions were present on the face in 80.7% of the patients and on the upper limbs in 12.4%. The average patient age was 69.5 years, and 59.4% of the patients were female. The tumors were more commonly observed in Caucasians, and smoking was the major risk factor recorded in 79.3% of cases. CONCLUSIONS: The patients with cancer in this study tended to have BCC and/or were predominantly female - observations that reflect the current tendency of this tumor. The presence of a significant number of patients with multiple lesions emphasizes the importance of undergoing a periodic examination. Moreover, high smoking rates were observed among these patients.

Sistema de informação dos centros de testagem e aconselhamento: dificuldades, divergencias e padronização no preenchimento / Sistema de informacion de los centros de testy consejo: dificultades, divergencias y estandarizacion en el relleno / Information system of testing and counseling centers: difficulties, divergences and standardization

O sistema de informação implantado nos Centros de Testagem e Aconselhamento (SI-CTA), em 1996, é importante naprodução de indicadores do perfil de seus usuários e na definição de estratégias para a redução de vulnerabilidade àsDST/HIV/Aids. Falhas no seu preenchimento conferem perdas para o alcance desses resultados. O objetivo com estapesquisa foi analisar as divergências e as dificuldades no preenchimento do formulário SI-CTA, versão 2005, tendo emvista a padronização dos registros. Trata-se de estudo descritivo e exploratório, realizado de janeiro a dezembro de 2009,com toda a equipe multiprofissional do CTA de Belo Horizonte. Utilizou-se a técnica de grupo focal em 12 encontrosmensais. Dados secundários foramempregados paraadetecção de falhasnopreenchimento. Asprincipaisdivergênciasreferiram-se aos registros nos campos“Encaminhamento pós-teste”,“Usodedrogas”,“Recorte populacional”e“Legendade resultados”.Aconvenção dos itens conflitantespermitiuaelaboração deumformulário complementar às Instruçõesde Preenchimento já existentesdoMS.Tambémcontribuiu para a redução da perda de dadoseareflexão sobreapráticado aconselhamento. Após a realização deste estudo, a permanência de determinadas falhas nos registros sinalizou anecessidade de os profissionais desenvolverem o hábito de consulta aos formulários de Instrução do Preenchimento,de treinamentos periódicos e de esforço contínuo para a assimilação das mudanças. A interlocução com os demaisCTAs e com a Coordenação Nacional de DST/aids foi considerada pertinente para aperfeiçoar a utilização do SI-CTAparaadivulgaçãoeoplanejamento de açõeseestratégias calcadasemdados confiáveis, bemcomoparaas adaptaçõesnecessárias à realidade de cada serviço.

Launched in 1996 theTesting and Counseling Centre Information System(IS-TCC) representsakey tool to the delineationof users profile indicators and to the definition of strategies for reducing vulnerability toSTD/HIV/AIDS. Failure tofill outits formproperly hampers the achievement of those goals.This research aimed to analyzediscrepancies and difficultieswhen filling out the IS-TCC 2005 Version, in view of the standardization of records. It is a descriptive and exploratorystudy conducted with a CTA (Portuguese acronym for Testing and Counseling Centre) multidisciplinary team in BeloHorizonte from January to December 2009. Focus group technique was used in 12 monthly sessions. Secondary datawere applied for detecting errors in filling the form. The main discrepancies were detected in the fields “post-testreferral”, “Drug Use,”“ Population Profile” and “ Legend of Results”. The conflicting items standardization helped thepreparation of a supplementary form for the field“Instructions”already in use for filling out the Department of Healthform and contributed in reducing data loss and evaluating the counseling practice. The persistence of certain errorson registers indicates the professionals need to get used to consult the Filling Instructions Form, to receive periodictraining, and to adapt themselves to continuous changes. The interaction with other CTA’s and with the National STD/AIDS Programis vital to optimize the use of the SI-CTA in the planning and promotion of actions and strategies basedon reliable data, as well as the customization of services.

El sistema de información instalado en 1996 en los Centros de Prueba y Aconsejamiento (SI-CTC) es importante enla producción de indicadores de perfil de los usuarios del servicio y en la definición de estrategias para la reducciónde la vulnerabilidad al VIH/SIDA. Fallos en la inserción de datos causan pérdidas en el alcance de estos resultados. Seanalizaron las divergencias y dificultades en el registro del SI-CTC, versión 2005, considerando la estandarización delos registros. Se trata de un estudio exploratorio descriptivo realizado con el equipo multiprofesional del CTC de BeloHorizonte, deeneroadiciembrede2009. Fueron utilizadas las técnicas de grupo focal. Seemplearon datos secundariospara la detección de fallos para completar los registros. Las principales divergencias se referían a los campos de losregistros “Envíos post-test”, “Uso de drogas”, “Recorte de la población” y “Leyenda de los Resultados”. La convenciónde los puntos conflictivos permitió la elaboración de un formulario complementario a las actuales Instrucciones paraCompletar Formularios del Ministerio de Salud (MS). También ayudó a disminuir la pérdida de datos y a repensar lapráctica del aconsejamiento. Después de la realización de este estudio la permanencia de determinados fallos enlos registros señala la necesidad de que los profesionales se acostumbren a consultar la guía de instrucciones paracompletar los formularios, de realizar entrenamientos periódicos y de hacer esfuerzos continuos para asimilar loscambios. La interlocución con demás CTC’s y Coordinación Nacional de ETS/SIDA fue considerada pertinente paramejorar la utilización del SI-CTC y planear acciones y estrategias fundamentadas en datos confiables, sin considerarlas especificidades de cada servicio ni de su clientela.

Percepção da equipe de enfermagem em relação a implantação do prontuário eletrônico: contribuições da tecnologia no cuidado hospitalar / Perception of nursing staff about a the implementation of electronic medical records: contribuitions of technology in hospital care / Percepción del equipo de enfermería em relación a la implantacion del registro eletrónico: contribucines de la tecnologia em la atención hospitalaria

Estudo do tipo survey descritivo, realizado em hospital privado de Fortaleza (CE), no período de janeiro a maio de 2008, com objetivo de conhecer a opinião da equipe de enfermagem sabre as vantagens e desvantagens da prescrição eletrônica e a importância dos registros de enfermagem no prontuário eletrônico para a qualidade da assistência no serviço hospitalar. Este estudo mostrou que o prontuário eletrônico de forma geral tem vantagens,como elevada legibilidade, organização, registro e resgate rápido de informações, acesso fácil a prescrições anteriores, facilidade no arquivamento do prontuário e maior clareza para a auditoria e contas médicas. Por outro lado, apresentou como principais desvantagens a repetição de prescrições médicas sem avaliação adequada, possibilidade de falha eletrônica e a elevação de custos. Os enfermeiros relataram que os registros informatizados facilitaram a trabalho, pois o período gasto com prontuário é menor, aumentando 0 tempo de cuidado direto ao paciente. Concluiu-se que 0 prontuário eletrônico e um avanço tecnológico, pois traz diversas contribuições,dentre elas, o aumento da segurança em relação à prescrição médica, tornando-a um impresso legível e, consequentemente, minimizando os riscos de iatrogenias.

A survey, descriptive study conducted in a private hospital of Fortaleza (CE) from January to May 2008, in orderto know the opinion of the nursing staff about the advantages and disadvantages of electronic prescription andthe importance of the nursing records in electronic medical records-tor the quality of care in the hospital service. This study showed that the electronic medical record in general has advantages such as readability, organization, registration and fast recovery of information, easy access to previous prescriptions, easy archiving of medical records and facility for audit and medical accounts. On the other hand, it presented the repetition of prescriptions without appropriate evaluation, possibility of electronic failure and higher costs as main disadvantages. Nurses related that computer records facilitated their work, because the time spent with medical records is smaller, increasing the time for direct care to patients. It was concluded that the electronic record is a technological progress because it brings several contributions, among them increases safety for the prescription, making it readable andthus minimizing the risks of iatrogenic problems.

Estudio del tipo survey, descriptivo, hecho en hospital privado de Fortaleza-CE en período de enero a mayo 2008 con el objetlvo de conocer la opinión del equipo de enfermería sobre las vantajas y desvantajas de la prescripción eletrônica y de la importancia de los registros de enfermería en los sistemas de historias clínicas informatizadas para la cualidad de la asistencia hospitalaria. Este estudio o señaló que el registro eletrônico de general tiene vantajas, como mayor legibilidad, organización, registro y rescate rápida de informaciones, acceso facil a las prescripciones anteriores, facilidad en el fichero y mayor seguridad para la auditoria y cuentas médicas, por otro lado, presente como principales desvantajas la repetición de prescripciones médicas sin evaluación,posibilidad de falla eletrônica y la elevación de los custeos. Los enfermeros relataron que los registros informatizados facilitaron el trabajo, pues el periodo perdido con los registros es menor, 10 que aumenta el tiempo para la atención directa al paciente. Se concluye que et sistema informatizado es un avanzo tecnologico, pues trae diversas contribuciones, dentre ellas, aumenta la seguridad en relación a la prescripción médica,cambiándola en un impreso legible y consecuentemente disminuye los riesgo de iatrogenias.

Off-label drug use in children.

OBJECTIVE: To determine the extent and nature of off-label drug use in children admitted to a pediatric general ward in a tertiary health care centre METHODS: Consecutive patients aged 1 mo-12 years admitted to the general wards in a tertiary care center in Mumbai over a two-month period were prospectively enrolled in the study. British National Formulary [BNF] version 2005 was used to ascertain if the drug use was "off-label". The off-label use was categorized as: administration of a greater/lesser dose, administration at a higher/lower frequency than indicated, administration for indications not described, administration of a drug not licensed for use in that age group and/ or use of alternative routes of administration. Descriptive statistics was used for calculating the off-label drug use. RESULTS: Two thousand prescriptions received by 600 subjects (M:F= 1.47:1) were analyzed. One thousand and forty-five (50.62%) prescriptions were off-label. The off-label drug use rate was 1.74+/-1.56 per patient. The maximum rate of off-label drugs was in infants (2.33/patient). 'alteration in dosage' was by far the commonest reason for off-label use; followed by 'age' and 'indication'. Furosemide (i. v.), diazepam (i.v), cefotaxime (i.v), ethambutol (tab) and prednisolone (tab) were the five commonest off-label drugs used in the study population. CONCLUSIONS: Off-label drug use was highly prevalent in general pediatric ward of a tertiary care hospital in India.

Assessment of antibiotics use after introducing a hospital formulary by ATC/DDD methodology.

The objective of this study is to compare the use of antibiotics at the Metropolitan Medical Center Hospital in Jakarta, Indonesia (MMCH), before and after the implementation of a hospital formulary. All antibiotic data under J01 Anatomical Therapeutic Chemical (ATC) classification were collected from pharmacy inpatient and outpatient records. Quantitative antibiotic use was expressed in Defined Daily Doses/100 bed-days (DDDs/hbd) for inpatients and DDDs/1000 patients/day (DDDs/tpd) for outpatients. The general quality of drug use was assessed in number of drugs that account for 90% of the use (DU90%) and the adherence to hospital formulary by substance and brand name within the DU90% segment. Quantitative and qualitative antibiotic use were compared before and after implementation of the formulary (1999 to 2000). The Wilcoxon rank sign test was used to compare overall antibiotic use. Inpatient antibiotic usage decreased significantly by 23.1%, 124.96 DDDs/hbd in 1999 to 96.13 DDDs/hbd during 2000 (p= 0.03) and outpatient antibiotic usage decreased insignificantly by 4.9%, 3.49 DDDs/tpd during 1999 to 3.32 DDDs/tpd during 2000 (p=0.58).The most commonly antibiotic use was ciprofloxacin in inpatient setting during the study and in out-patient setting was amoxicillin in 1999 and ciprofloxacin in 2000. The adherence to the formulary by substance and by brand name in inpatient department was 100% and 90.5% and in outpatient department was 100% and 94.3% during the study. DU 90% by substance name and by brand name was considerably not improved in both settings. The conclusion is that the effectiveness of one year formulary implementation at MMCH was only revealed in inpatient setting.

Instructivi de llenado del formulario No.7 Traslado de emergencia obstétrica/pediátricas / Instructions of fill of the form No.7 Transfer emergency obstetrics/pediatric

Este formulario al igual que lo otros, es de uso delicado y sujeto a auditoría, sólo se usará este formulario para transporte, cuando el establecimiento de salud no posee ambulancia, ni existe una red o ambulancia de traslado gratuito en el municipio y cuando hay evidente riesgo de muerte del paciente.

Effects of managerial intervention on drug utilization pattern at King Chulalongkorn Memorial Hospital.

The economic crisis in Thailand since 1997 has a major impact on all sections of the country including health care. There were several suggestions for reducing the drug expenditure budget including restriction of hospital formulary, generic prescribing and generic dispensing. At King Chulalongkorn Memorial hospital, the new hospital formulary was established and implemented in March 1998. The generic dispensing policy was also in place at the same time. This study aimed to evaluate the impact of the new implementation by comparing the prescription patterns in out patient departments (OPDs) of the hospital before and after the new hospital formulary implementation. The prescriptions from several OPDs were systematically stratified samplings 5 weeks before and 5 weeks after March 1st, 1998. The information from the prescriptions including drug category, drug name, amount of dispensed drug, drug cost, etc. was collected and analyzed. The total number of prescriptions and the average number of drug items/prescription before and after the implementation were similar (2,049 vs 2,052, and 2.52 +/- 0.048 vs 2.45 +/- 0.03 respectively). The total cost of the prescription, the cost/prescription and the cost/item seemed to be different (1,690,484 baht vs 1,282,343 baht, 844 +/- 54.04 vs 633 +/- 41.11 and 332.58 +/- 29.59 vs 255.29 +/- 19.98 respectively). After the implementation, physicians in the hospital increasingly prescribed drugs by generic name (37.1% vs 44.85%). Locally made drugs were also prescribed by physicians and received by patients more than before (9.56% vs 84.27% and 28.15% vs 60.72%, respectively). Anti-infective agents were studied in depth as they contribute to significant amount of drug expenditure. The total cost of prescribed anti-infective agents and the cost/prescription were increased after the implementation (223,529 vs 274,435 Baht and 585.38 +/- 102.84 vs 772.71 +/- 147.59). The increased cost mainly came from the cost of anti-HIV drugs. Our data indicate that the new hospital formulary may have played a part on the impact of drug expenditure reduction and may have changed the prescribing attitude of physicians in King Chulalongkorn Memorial Hospital.

Estudo da qualidade de informação sobre morbidade através da ficha de atendimento ambulatorial em unidade públicas de municípios selecionados no Rio Grande do Sul / Study of the quality of the information regarding morbidity through the use of the out patients files in the cities selected in RS

Este trabalho trata do estudo da ficha de atendimento ambulatorial (FAA) que é o documento oficial de coleta de dados da rede prestadora de serviços do Sistema Únicos de Saúde (SUS) no Rio Grande do Sul. Verificar a eficácia deste documento como instrumento de informação de morbidade ambulatoial através da análise do preenchimento de seus campos, seu fluxo, produção e retorno das informações.

Normativa entrega de turno hospitalario / Normative handing over of hospitalary shift / Desarrollo de los Servicios de Salud

Normas elaboradas por el Ministerio de salud con el fin de garantizar una correcta entrega del turno hospitalario estableciendo para ello criterios técnico-administrativos que permitan realizar la entrega de manera uniforme; eleando así los niveles de organizaicón e incidiendo positivamente en la calidad de la atención en salud

Therapeutic redundancy as a measure of formulary system effectiveness

to investigate the assumption that formilary quality is reflected in the number of redundant therapeutic agents in competitive markets. This inquiry assumes that a formulary system that requires strict adherence to the published clinical research evidence in the drug selection process will minimize the number of redundant therapeutic agents in competitive drug markets by balancing manufacturers promotional influences. Possible explanations for redundant therapeutic products are discussed. Design: a telephone survey was used to compare the number of histamine-2 blockers, angiotensin converting enzyme [ACE] inhibitors, and the number of drugs added to formularies in 1993 in ten randomly selected an four nonrandomly selected university associated teaching hospitals to a similar institution in Saudi Arabia. the difference in the number of histamine -2 blockers in surveyed hospitals formularies and our formulary ranged from no difference in two hospitals to a difference of three more drugs in three institutions. For the ACE inhibitors, the range was from no difference in one hospital surveyed to three more drugs in two hospitals. The proportion of new drugs added to formularies in surveyed hospitals ranged from 25% to 92% versus 37% in our hospital. a formulary system that bases the drug selection process on strict adherence to the published clinical research evidence may reduce the number of drugs in highly competitive therapeutic classes in the formulary. Promotional influence is one possible explanation for redundant therapeutic agents seen in some surveyed hospitals formularies

A confiabilidade dos dados nos formulários de autorizaçäo de internaçäo hospitalar (AIH), Rio de Janeiro, Brasil / Reliability of data from authorization forms for hospital admittance, Rio de Janeiro, Brazil

Analisa uma amostra de formulários AIH preenchidos pelos hospitais privados contratados da cidade do Rio de Janeiro em 1986. O desenho do estudo baseia-se na confiabilidade entre entrevistadores e na análise de concordância utiliza-se o teste Kappa. A concordância entre os dados anotados nos formulários AIH pelos funcionários administrativos dos hospitais e as informaçoes contidas nos prontuários médicos foi medida para variáveis demográficas, administrativas e clínicas. De forma geral, as duas primeiras classes de variáveis apresentaram melhor confiabiladade do que a terceira. A confiabilidade do diagnóstico principal foi pior do que a confiabilidade do procedimento realizado, apesar desta última ser a unidade de pagamento de mecanismo de reembolso adotado pelo istema único de saúde. Entretanto, nos casos de discordância, observa-se uma maior chance do hospital anotar um procedimento com valor de reembolso maior do que aquele identificado a partir dos dados anotados no prontuário médico.

Effect of a selective restriction policy on antibiotic expenditure and use: an institutional model.

Strictly enforced antibiotic formulary restriction in combination with formulation of agreed guidelines for antibiotic use in common infection problems such as septicemia, febrile neutropenia, urinary tract infection, biliary sepsis, liver abscess, peritonitis, nosocomial pneumonia, soft tissue infection and purulent meningitis, generated a combined savings of 307,748.5 bahts or 13.5 per cent cost reduction over a 6 month period, and improved quality of use, appropriate 54.8 vs 67.5 per cent, statistically significance (P less than 0.002). Although this saving was offset in part by increased spending of unrestricted antibiotics, such as Penicillin and Gentamicin, an overall cost saving remained. In the months during the restrictions, no significant changes occurred regarding patients response and mortality. However, after the onset of the controls, it was revealed that antibiotics were more appropriately used afterwards. This study has shown, most importantly, that savings were achieved with no negative effect on good patient care. Moreover, the antibiotic use control was operationally successful, most house-staff and attending physicians, not only antibiotic evaluating team, have accepted the program in a very positive way. Overall, this program successfully achieved its initial goal, cost saving without compromising good medical practice. We are now continuing our program and also trying to modify so that it will be useful to all departments in the hospital.

Informatizaçäo de tarefas administrativo-burocráticas de enfermagem relacionadas com o preparo para cirurgias eletivas: uma proposta / The use of informatics to administrative nursing task with reference to planning of the surgery

O presente estudo propöe a utilizaçäo da informática por um serviço de enfermagem no desenvolvimento de algumas tarefas administrativo-burocráticas. A seleçäo dessas tarefas partiu de nossa experiência profissional ao notarmos que as enfermeiras do local estudado se envolvem sobremaneira com aquelas concernentes ao período pré-operatório de cirurgias eletivas. Objetiva, através da criaçäo de um sistema informatizado que as realize, liberar a enfermeira dessa atividade, o que propiciaria sua reaproximaçäo com o paciente. Para tanto, com um sistema gerenciador de banco de dados - KARDS(c) - com um editor de textos - RELATOR(c) - e com base no pradigma programaçäo orientada a objetos (POO), criamos um sistema informatizado. Este, que denominamos SITEC, consiste num fichário eletrônico, semelhante aos de aço, täo comuns em consultórios, com pastas e fichas de pacientes ( que seräo ou foram submetidos a três tipos de cirurgias eletivas) e de uma série de formulários que apresentam as tarefas administrativo-burocráticas a serem realizadas por três setores do hospital observado: Unidade de Internaçäo, Centro Cirúrgico e Farmácia.

Estudo de impressos de anotaçäo de enfermagem psiquiátrica / Study of kinds of psychiatric nursing notes

O estudo foi realizado para avaliar dois impressos de anotaçäo de enfermagem psiquiátrica. Os dados foram obtidos por meio das anotaçöes de enfermagem efetuadas pelas alunas que cursaram a disciplina Enfermagem Psiquiátrica em 1989. As alunas foram divididas em dois grupos: um deles fez anotaçöes utilizando o impresso do hospital e, o outro, o elaborado pela Autora. No impresso do hospital as alunas fizeram anotaçöes em forma de relatório e cometeram erros de redaçäo, rasuras e omissäo de dados. No impresso da Autora as atividades rotineiras como sono, eliminaçöes, desjejum, higiene e aparência foram mais assinaladas na primeira parte e menos descritas, na segunda. Os dados sobre as idéias que os pacientes expressaram e atividades foram mais descritos na segunda parte. As alunas também cometeram erros de redaçäo, rasuras, porém todos os dados foram mencionados.