Validação da prescrição oncológica: o papel do farmacêutico na prevenção de erros de medicação / Validation of the oncology prescription: the pharmacist's role in preventing medication errors

Erros de medicação são constantemente relatados na literatura médico-científica. Há casos clínicos em que a administração inadequada de doses altas de alguns citostáticos tem como consequência a toxicidade grave e a morte do paciente. As não conformidades presentes nas prescrições aos pacientes oncológicos podem ser catastróficas em função da estreita margem terapêutica dos medicamentos antineoplásicos. Prevenir erros de medicação torna-se uma prioridade na melhora do processo farmacoterapêutico em pacientes da oncologia. A multidisciplinaridade é um fator essencial de alerta aos erros de medicação de antineoplásicos e às maneiras de preveni-los. Os farmacêuticos e todos os profissionais que constituem uma equipe multidisciplinar de saúde contribuem para garantia do uso seguro dos medicamentos, o que auxilia no aprimoramento de uma assistência qualificada. Para isso, além das atividades já bem estabelecidas, esses profissionais devem (i) implantar um sistema de validação farmacêutica bem como (ii) estabelecer um sistema de verificação da prescrição médica, o qual consiste em diferentes etapas. O objetivo dessa revisão é relatar a validação da prescrição médica, considerando-se os erros de medicação na quimioterapia e o papel do farmacêutico na prevenção desses erros. São medidas que visam a melhorar a qualidade da assistência prestada aos pacientes oncológicos.

Medication errors have been frequently reported in the literature. There have been several clinical cases in which the improper administration of high doses of some cytostatics resulted in serious toxicity and patient’s death. Nonconformities in oncology patients’ prescriptions can lead to serious problems due to the narrow therapeutic range of antineoplastic drugs. Preventing medication errors has become a priority on improving the pharmacotherapeutic process in oncology patients. The presence of a multidisciplinary staff is an important instrument to improve awareness of medication errors and to prevent them. Pharmacists and other health providers that participate in the multidisciplinary team contribute to ensure the safe use of medications and to improve the delivery of quality care. In addition to their well established activities these professionals should: (i) set up a pharmaceutical validation system and (ii) establish a prescription verification system including several checkpoints. The objective of this review of the literature is to report on prescription validation, considering some chemotherapy medication errors and the pharmacist’s role in preventing them. These measures are aimed at improving the quality of the care provided to oncology patients.

Causes and outcome of medication errors in hospitalized patients

To develop better understanding of Medication Errors [MEs] in the health care sector, and to improve the error prevention services in the hospital. We conducted a retrospective study at the Hera General Hospital, Makkah, Saudi Arabia. The medical records were reviewed for adult hospitalized patients from June 1, 2000 to June 30, 2002. Patients demographic data, types, and causes of MEs, were recorded. The contributing factors, frequency and patient's outcome were also analyzed. A total of 2627 patient files were analyzed, 3963 errors were studied as follows: 1559 files contain one error, 800 files with 2 errors, and 268 with >3 errors. The most common type of error found was wrong strength [concentration] in 914 patients [34.79%], 807 patients [30.7%] had wrong route of administration, and 788 [30%] had wrong dosage form. On the other hand, the most common cause identified for MEs, was human factor, which accounted in 1223 patients [46.49%]. Miscommunication was the most common second cause in 920 patients [35.02%], and the third common cause was name confusion [484, [18.43%]]. Medication Errors were classified from a regulatory prospective into actual in 735 patient files [28%], potential in 1866 [71%] and serious in 26 [0.98%]. The study showed that wrong strength was the most common ME found and human factors were the most common cause contributing MEs. Therefore, focusing on these factors will definitely minimize MEs in hospitalized patients