Avaliação do conhecimento da equipe de enfermagem sobre erros de medicação e terapêutica medicamentosa utilizada em um pronto-socorro infantil
Arquivos
Data
2014-06-25
Autores
Macedo, Giselle Pinto de Oliveira Sa 
Orientadores
D'Innocenzo, Maria D'Innocenzo
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Erros de Medicação estão presentes no cotidiano dos profissionais de saúde e acarretam graves consequências ao paciente, incremento no custo das internações, além de problemas no âmbito da organização hospitalar. A administração de medicamentos é um processo dinâmico e complexo, com várias etapas que contempla uma série de decisões específicas e ações inter-relacionadas, capazes de envolver profissionais de toda uma equipe multidisciplinar bem como o próprio paciente. Na faixa etária pediátrica, erros de medicação geram importantes complicações e têm sido relacionados a um maior risco para a ocorrência de iatrogenia. Objetivo: Analisar o grau de conhecimento da equipe de enfermagem sobre o conceito de erros de medicação e terapêutica medicamentosa de acordo com idade, tempo de formação, tempo de trabalho na instituição, categoria profissional, esquema de atuação, turno e regime de contrato. Método: Realizou-se um estudo exploratório e descritivo, no Pronto-Socorro Infantil (PSI) de um hospital universitário, no município de São Paulo. A coleta de dados foi realizada por um período de 60 dias, durante os meses de agosto e setembro de 2012, entre os profissionais de enfermagem do PSI, após a aprovação do projeto pelo Comitê de Ética em Pesquisa, autorização do Setor de Ensino e Pesquisa e submissão dos instrumentos de coleta para avaliação. Para a realização da avaliação do conteúdo dos instrumentos foi solicitada a participação de um comitê de consultores externos constituída por enfermeiros e professores universitários. Os dados foram armazenados em banco de dados do programa SPSS (Statistical Package for the Social Sciences). Para a comparação das variáveis quantitativas o teste utilizado foi o não paramétrico de Mann-Whitney e para a comparação das variáveis qualitativas foi utilizado o teste do Qui-Quadrado ou o Exato de Fisher. Considerou-se estatisticamente significante valores de p<00,5. Resultados: Os participantes da pesquisa constituíram-se por 37 profissionais de enfermagem, nove (24,3%) enfermeiros, nove (24,3%) técnicos de enfermagem e 19 (51,4%) de auxiliares de enfermagem. Destes participantes 91,9% eram do sexo feminino, 59,5% deles trabalhavam apenas na instituição da pesquisa e eram contratados em regime celetista, com média de idade de 38 anos, tempo médio de formação profissional de 11,3 anos e tempo médio de trabalho na instituição pesquisada de 7,2 anos. Pode-se evidenciar que os participantes da pesquisa demonstraram conhecimento uniforme e linear sobre o conceito erros de medicação. O quinto item do questionário registrou que 26 (72,9%) dos participantes discordaram e/ou discordaram completamente que atrasos superiores a uma hora correspondem a erro de medicação. Não foi possível observar diferença estatisticamente significativa entre profissionais de nível técnico e de nível superior com relação a esse tipo de erro de medicação. Quanto aos cenários elaborados, pode-se verificar que os participantes apresentam entendimento nivelado e uniforme sobre terapêutica medicamentosa. No entanto, no cenário 3 referente à administração de adrenalina e de outros fármacos, via cânula orotraqueal, devido à ausência de rede venosa, observou-se que houve diferença estatisticamente significante (p<0,05) segundo o teste do Qui-Quadrado, com relação a proporção de acertos entre os participantes da pesquisa e os diferentes esquema de atuação. O grupo de profissionais de enfermagem que trabalham na instituição da pesquisa e que estudam apresentou menor percentual de acertos (42,9%) da resposta esperada do que os demais grupos com diferente esquema de trabalho. Conclusões: A equipe de enfermagem do PSI apresentou maior conhecimento sobre erros de medicação do que terapêutica medicamentosa em situações de urgência. Porém, torna-se necessário a implantação de programas de treinamento e capacitação por parte da educação continuada das instituições, em unidades pediátricas, com o propósito de ampliar o conhecimento dos profissionais de enfermagem sobre o processo de medicação e assim, garantir a qualidade de assistência e segurança junto aos pacientes pediátricos.
Medication errors are present in the daily routine of health professionals and they cause serious consequences to the patient, besides increasing the cost of hospitalization, as well as problems within the hospital organization. The administration of medications is a dynamic and complex process with many stages and which includes a series of specific decisions and interrelated actions able to engage professionals from an entire multidisciplinary team and the patients themselves. Medication errors generate major complications in pediatric patients and they have been linked to an increased risk for the occurrence of iatrogenic conditions. Objective: To analyze the knowledge thoroughness of the nursing staff on the concept of medication errors and drug treatment according to age, length of training period and of time working for the institution, professional work category, action plan, shift arrangements and contract scheme. Methodology: An exploratory and descriptive study has been conducted at the Emergency Medical Services for Children (EMSC) of a university hospital in São Paulo. The data collection was held over a period of 60 days between the months of August and September 2012, among the nursing professionals of the EMSC, approval of the project by the Ethics in Research Committee, the authorization by the Education and Research Sector and the submission of the data collection instruments for evaluation. To perform the content?s evaluation of the instruments it was requested the participation of a committee formed by external experts like nurses and university teachers. The data was stored in the SPSS (Statistical Package for Social Sciences) program databases. To compare the quantitative variables it was used the nonparametric Wilcoxon Mann-Whitney test; and to compare qualitative variables it was chosen the chi-square or Fisher's exact test. Statistically significant values of p<00.5 were considered. Outcomes: The study participants were formed by 37 nursing professionals, being nine (24.3%) nurses, nine (24.3%) nursing technicians and 19 (51.4%) nursing assistants. A rate of 91.9% of these participants were females; 59.5% of them only worked in the researched institution and for an average period of 7.2 years and were hired under the public-sector employees? regime. They also showed an average age of 38 years old, and a length of training period of 11.3 years. It can be highlighted that the participants of the research showed uniform and linear understanding of the concept of medication errors. The fifth item on the questionnaire reported that 26 (72.9%) participants disagreed and/or completely disagreed that delays longer than one hour mean medication error. It was not possible to observe a statistically significant difference between technical and higher education professionals with respect to this type of medication error. As for elaborate scenarios, it was possible to verify that the participants present a leveled and uniform understanding about drug therapy. However, at scenario 3, concerning the administration of adrenaline and other drugs via the tracheal cannula due to the absence of venous network, it was observed a statistically significant difference (p<0.05) according to the chi-square test regarding the proportion of correct answers between the participants of the research and the different line of action they worked on. The group of nursing professionals working in the researched institution and who studies showed a lower percentage of the expected correct answers (42.9%) than the other groups with different lines of action. Conclusions: The nursing staff of the researched EMSC showed greater knowledge about medication errors than about drug therapy in emergency situations. Therefore, it is necessary that the continuing education institutions? departments implement training and education programs in pediatric units in order to increase the knowledge of nurses on the medication process and thus ensure the quality of care and security assistance among pediatric patients.
Medication errors are present in the daily routine of health professionals and they cause serious consequences to the patient, besides increasing the cost of hospitalization, as well as problems within the hospital organization. The administration of medications is a dynamic and complex process with many stages and which includes a series of specific decisions and interrelated actions able to engage professionals from an entire multidisciplinary team and the patients themselves. Medication errors generate major complications in pediatric patients and they have been linked to an increased risk for the occurrence of iatrogenic conditions. Objective: To analyze the knowledge thoroughness of the nursing staff on the concept of medication errors and drug treatment according to age, length of training period and of time working for the institution, professional work category, action plan, shift arrangements and contract scheme. Methodology: An exploratory and descriptive study has been conducted at the Emergency Medical Services for Children (EMSC) of a university hospital in São Paulo. The data collection was held over a period of 60 days between the months of August and September 2012, among the nursing professionals of the EMSC, approval of the project by the Ethics in Research Committee, the authorization by the Education and Research Sector and the submission of the data collection instruments for evaluation. To perform the content?s evaluation of the instruments it was requested the participation of a committee formed by external experts like nurses and university teachers. The data was stored in the SPSS (Statistical Package for Social Sciences) program databases. To compare the quantitative variables it was used the nonparametric Wilcoxon Mann-Whitney test; and to compare qualitative variables it was chosen the chi-square or Fisher's exact test. Statistically significant values of p<00.5 were considered. Outcomes: The study participants were formed by 37 nursing professionals, being nine (24.3%) nurses, nine (24.3%) nursing technicians and 19 (51.4%) nursing assistants. A rate of 91.9% of these participants were females; 59.5% of them only worked in the researched institution and for an average period of 7.2 years and were hired under the public-sector employees? regime. They also showed an average age of 38 years old, and a length of training period of 11.3 years. It can be highlighted that the participants of the research showed uniform and linear understanding of the concept of medication errors. The fifth item on the questionnaire reported that 26 (72.9%) participants disagreed and/or completely disagreed that delays longer than one hour mean medication error. It was not possible to observe a statistically significant difference between technical and higher education professionals with respect to this type of medication error. As for elaborate scenarios, it was possible to verify that the participants present a leveled and uniform understanding about drug therapy. However, at scenario 3, concerning the administration of adrenaline and other drugs via the tracheal cannula due to the absence of venous network, it was observed a statistically significant difference (p<0.05) according to the chi-square test regarding the proportion of correct answers between the participants of the research and the different line of action they worked on. The group of nursing professionals working in the researched institution and who studies showed a lower percentage of the expected correct answers (42.9%) than the other groups with different lines of action. Conclusions: The nursing staff of the researched EMSC showed greater knowledge about medication errors than about drug therapy in emergency situations. Therefore, it is necessary that the continuing education institutions? departments implement training and education programs in pediatric units in order to increase the knowledge of nurses on the medication process and thus ensure the quality of care and security assistance among pediatric patients.
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Citação
MACEDO, Giselle Pinto de Oliveira Sá. Avaliação do conhecimento da equipe de enfermagem sobre erros de medicação e terapêutica medicamentosa utilizada em um pronto-socorro Infantil. São Paulo, 2014. [140] p. Dissertação (Mestrado em Enfermagem) - Escola Paulista de Enfermagem (EPE), Universidade Federal de São Paulo (UNIFESP), São Paulo, 2014.