Thesis (Ph.D.)--Memorial University of Newfoundland, 2004. / Bibliography: leaves 337-351.

<p>Läkemedelshanteringen är ett av sjuksköterskans ansvarsområden inom hälso- och sjukvården. Utifrån kunskap och lagar skall den bedrivas på ett patientsäkert sätt men trots det sker läkemedelshanteringsfel vilket innebär risker i patientsäkerheten.</p><p>Syftet med studien var att beskriva faktorer som påverkar säkerheten i samband med sjuksköterskans läkemedelshantering. Studien genomfördes som en litteraturstudie. Resultatet visade att vanliga läkemedelshanteringsfel är utebliven dos, fel administreringstid, fel dos, fel administreringssätt, fel läkemedel och läkemedel till fel patient. Faktorer som påverkar sjuksköterskans läkemedelshantering är felaktiga och dåligt skrivna läkemedelsordinationer, distraktion under läkemedelshanteringen, bristande rutiner samt införande av ny teknologi. Sjuksköterskor upplever mer problem kring läkemedelsordinationer än läkarna. Annan vårdpersonal stod för den största orsaken till sjuksköterskans distraktion men vid införande av ett säkerhetssystem från flygindustrin reducerades distraktionen. Att följa rätt patient, rätt läkemedel, rätt dos, rätt administreringssätt och rätt tid (5 R) är en bra rutin för att läkemedelshanteringen kan bli säkrare. För att göra läkemedelshanteringen säkrare införs ny teknologi som datoriserade läkemedelsordinationer och då är rätt utbildning viktig för att det ska bli ett säkert hjälpmedel. Vidare forskning och utveckling bör bedrivas på sjukhusen i Sverige samt inom den teknologiska industrin med hjälp av sjuksköterskan för att utveckla säkrare läkemedelshantering och hjälpmedel till dem.</p><p>A central part of nursing is the drug administration. This administration is to be carried out in a manner which is conducive to patient safety. This science is the product both of knowledge and of legal provisions, yet errors still occur within the drug administration that create considerable risk for patient safety. </p><p>The purpose of this literary study has been to indicate factors that affect the safety of nurses’ drug administration. The results indicate that common errors in medicines administration are the result of the following: missed dosage, dosage at wrong time, wrong dosage, wrong method of administration, wrong medicine and giving medicine to the wrong patient. Factors contributing to these errors include erroneous or poorly written ordination, distraction during drug administration, poor routines as well as the introduction of new technology. Nurses’ consider the problems relating to ordination as being greater than doctors generally perceive them to be. Other healthcare personnel are seen to contribute to nurses’ distraction and this was greatly reduced in cases where security routines were adapted from the airline industry. The routine of right patient, right drug, right dosage, right administration and right time (5 R) is effective in creating greater safety in the drug administration. New technology is used to this end, computers being used, for example, for writing ordinations. In order for these methods truly to contribute to safety it is important that appropriate training is provided. In order to develop safer drug administration together with necessary tools and facilities it is recommended that more research is carried out, with the assistance of nurses, in hospitals here in Sweden as well as within the technology industries.</p>

Läkemedelshanteringen är ett av sjuksköterskans ansvarsområden inom hälso- och sjukvården. Utifrån kunskap och lagar skall den bedrivas på ett patientsäkert sätt men trots det sker läkemedelshanteringsfel vilket innebär risker i patientsäkerheten. Syftet med studien var att beskriva faktorer som påverkar säkerheten i samband med sjuksköterskans läkemedelshantering. Studien genomfördes som en litteraturstudie. Resultatet visade att vanliga läkemedelshanteringsfel är utebliven dos, fel administreringstid, fel dos, fel administreringssätt, fel läkemedel och läkemedel till fel patient. Faktorer som påverkar sjuksköterskans läkemedelshantering är felaktiga och dåligt skrivna läkemedelsordinationer, distraktion under läkemedelshanteringen, bristande rutiner samt införande av ny teknologi. Sjuksköterskor upplever mer problem kring läkemedelsordinationer än läkarna. Annan vårdpersonal stod för den största orsaken till sjuksköterskans distraktion men vid införande av ett säkerhetssystem från flygindustrin reducerades distraktionen. Att följa rätt patient, rätt läkemedel, rätt dos, rätt administreringssätt och rätt tid (5 R) är en bra rutin för att läkemedelshanteringen kan bli säkrare. För att göra läkemedelshanteringen säkrare införs ny teknologi som datoriserade läkemedelsordinationer och då är rätt utbildning viktig för att det ska bli ett säkert hjälpmedel. Vidare forskning och utveckling bör bedrivas på sjukhusen i Sverige samt inom den teknologiska industrin med hjälp av sjuksköterskan för att utveckla säkrare läkemedelshantering och hjälpmedel till dem. A central part of nursing is the drug administration. This administration is to be carried out in a manner which is conducive to patient safety. This science is the product both of knowledge and of legal provisions, yet errors still occur within the drug administration that create considerable risk for patient safety. The purpose of this literary study has been to indicate factors that affect the safety of nurses’ drug administration. The results indicate that common errors in medicines administration are the result of the following: missed dosage, dosage at wrong time, wrong dosage, wrong method of administration, wrong medicine and giving medicine to the wrong patient. Factors contributing to these errors include erroneous or poorly written ordination, distraction during drug administration, poor routines as well as the introduction of new technology. Nurses’ consider the problems relating to ordination as being greater than doctors generally perceive them to be. Other healthcare personnel are seen to contribute to nurses’ distraction and this was greatly reduced in cases where security routines were adapted from the airline industry. The routine of right patient, right drug, right dosage, right administration and right time (5 R) is effective in creating greater safety in the drug administration. New technology is used to this end, computers being used, for example, for writing ordinations. In order for these methods truly to contribute to safety it is important that appropriate training is provided. In order to develop safer drug administration together with necessary tools and facilities it is recommended that more research is carried out, with the assistance of nurses, in hospitals here in Sweden as well as within the technology industries.

Cuidados paliativos podem ser vistos como uma prioridade de saúde pública diante da transição demográfica que vem ocorrendo a nível mundial. Estudos preliminares indicam que o acesso precoce a esses cuidados pode melhorar o controle dos sintomas e a qualidade de vida dos pacientes, sendo que a compreensão da forma como os medicamentos estão sendo utilizados é imprescindível para atingir o alívio do sofrimento. Objetivo: diante da escassez de referenciais bibliográficos nesta temática, o presente estudo teve como objetivo descrever o perfil de utilização dos medicamentos mais utilizados por pacientes em cuidados paliativos internados no Hospital de Clínicas de Porto Alegre e relatar as características demográficas e clínicas destes pacientes. Métodos: estudo observacional, transversal, retrospectivo realizado com uma amostra de 267 pacientes internados na unidade de cuidados paliativos de um hospital universitário geral de grande porte com capacidade instalada de 843 leitos. Resultados: as prescrições totalizaram 178 medicamentos diferentes; dentre estes, os mais prescritos foram: dipirona, morfina, metoclopramida, ondansetron, heparina sódica, paracetamol, lactulose, omeprazol, cloreto de sódio 0,9%, clonazepam, dexametasona, docusato + bisacodil, amitriptilina, enema de glicerina 12%, metadona, haloperidol, cefepime, codeína, escopolamina, dimenidrinato, glicose 50%, óleo mineral líquido, furosemida, ranitidina, amoxicilina + ácido clavulânico e clorpromazina. O percentual de polifarmácia foi de 94,5%. Conclusões: conhecer a terapia medicamentosa e compreender a forma de utilização desta é fundamental para proporcionar o alívio dos diversos sintomas que impactam na qualidade de vida dos pacientes internados em cuidados paliativos. / Palliative care can be seen as a public health priority in the face of the demographic transition that is happening at a global level. Preliminary studies indicate that early access to these care can improve the control of symptoms and the quality of life of patients, therefore, understanding how drugs are used is essential to achieve the relief of suffering. Aim: in the face of the scarcity of bibliographic references on this topic, the aim of the present research is to describe the profile of use of drugs most often adopted by patients in palliative care admitted to Hospital de Clínicas de Porto Alegre and to report the demographic and clinical characteristics of these patients. Methods: observational, transversal, retrospective study was conducted with a sample of 267 patients admitted to palliative care of a large general university hospital with an installed capacity of 843 beds. Results: the prescriptions totaled 178 different drugs; among these, the most frequently prescribed ones were: dipyrone, morphine, metoclopramide, ondansetron, sodium heparin, paracetamol, lactulose, omeprazole, sodium chloride 0.9%, clonazepam, dexamethasone, docusate + bisacodyl, amitriptyline, glycerin enema (12%), methadone, haloperidol, cefepime, codeine, scopolamine, dimenhydrinate, glucose (50%), mineral oil liquid, furosemide, ranitidine, amoxicillin + clavulanic acid and chlorpromazine. The percentage of polypharmacy was 94.5%. Conclusions: it is essential to gain knowledge of drug therapies and to understand how to use them in order to provide the relief of several symptoms that impact the quality of life of hospitalized patients in palliative care.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 146-157). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Cuidados paliativos podem ser vistos como uma prioridade de saúde pública diante da transição demográfica que vem ocorrendo a nível mundial. Estudos preliminares indicam que o acesso precoce a esses cuidados pode melhorar o controle dos sintomas e a qualidade de vida dos pacientes, sendo que a compreensão da forma como os medicamentos estão sendo utilizados é imprescindível para atingir o alívio do sofrimento. Objetivo: diante da escassez de referenciais bibliográficos nesta temática, o presente estudo teve como objetivo descrever o perfil de utilização dos medicamentos mais utilizados por pacientes em cuidados paliativos internados no Hospital de Clínicas de Porto Alegre e relatar as características demográficas e clínicas destes pacientes. Métodos: estudo observacional, transversal, retrospectivo realizado com uma amostra de 267 pacientes internados na unidade de cuidados paliativos de um hospital universitário geral de grande porte com capacidade instalada de 843 leitos. Resultados: as prescrições totalizaram 178 medicamentos diferentes; dentre estes, os mais prescritos foram: dipirona, morfina, metoclopramida, ondansetron, heparina sódica, paracetamol, lactulose, omeprazol, cloreto de sódio 0,9%, clonazepam, dexametasona, docusato + bisacodil, amitriptilina, enema de glicerina 12%, metadona, haloperidol, cefepime, codeína, escopolamina, dimenidrinato, glicose 50%, óleo mineral líquido, furosemida, ranitidina, amoxicilina + ácido clavulânico e clorpromazina. O percentual de polifarmácia foi de 94,5%. Conclusões: conhecer a terapia medicamentosa e compreender a forma de utilização desta é fundamental para proporcionar o alívio dos diversos sintomas que impactam na qualidade de vida dos pacientes internados em cuidados paliativos. / Palliative care can be seen as a public health priority in the face of the demographic transition that is happening at a global level. Preliminary studies indicate that early access to these care can improve the control of symptoms and the quality of life of patients, therefore, understanding how drugs are used is essential to achieve the relief of suffering. Aim: in the face of the scarcity of bibliographic references on this topic, the aim of the present research is to describe the profile of use of drugs most often adopted by patients in palliative care admitted to Hospital de Clínicas de Porto Alegre and to report the demographic and clinical characteristics of these patients. Methods: observational, transversal, retrospective study was conducted with a sample of 267 patients admitted to palliative care of a large general university hospital with an installed capacity of 843 beds. Results: the prescriptions totaled 178 different drugs; among these, the most frequently prescribed ones were: dipyrone, morphine, metoclopramide, ondansetron, sodium heparin, paracetamol, lactulose, omeprazole, sodium chloride 0.9%, clonazepam, dexamethasone, docusate + bisacodyl, amitriptyline, glycerin enema (12%), methadone, haloperidol, cefepime, codeine, scopolamine, dimenhydrinate, glucose (50%), mineral oil liquid, furosemide, ranitidine, amoxicillin + clavulanic acid and chlorpromazine. The percentage of polypharmacy was 94.5%. Conclusions: it is essential to gain knowledge of drug therapies and to understand how to use them in order to provide the relief of several symptoms that impact the quality of life of hospitalized patients in palliative care.

Cuidados paliativos podem ser vistos como uma prioridade de saúde pública diante da transição demográfica que vem ocorrendo a nível mundial. Estudos preliminares indicam que o acesso precoce a esses cuidados pode melhorar o controle dos sintomas e a qualidade de vida dos pacientes, sendo que a compreensão da forma como os medicamentos estão sendo utilizados é imprescindível para atingir o alívio do sofrimento. Objetivo: diante da escassez de referenciais bibliográficos nesta temática, o presente estudo teve como objetivo descrever o perfil de utilização dos medicamentos mais utilizados por pacientes em cuidados paliativos internados no Hospital de Clínicas de Porto Alegre e relatar as características demográficas e clínicas destes pacientes. Métodos: estudo observacional, transversal, retrospectivo realizado com uma amostra de 267 pacientes internados na unidade de cuidados paliativos de um hospital universitário geral de grande porte com capacidade instalada de 843 leitos. Resultados: as prescrições totalizaram 178 medicamentos diferentes; dentre estes, os mais prescritos foram: dipirona, morfina, metoclopramida, ondansetron, heparina sódica, paracetamol, lactulose, omeprazol, cloreto de sódio 0,9%, clonazepam, dexametasona, docusato + bisacodil, amitriptilina, enema de glicerina 12%, metadona, haloperidol, cefepime, codeína, escopolamina, dimenidrinato, glicose 50%, óleo mineral líquido, furosemida, ranitidina, amoxicilina + ácido clavulânico e clorpromazina. O percentual de polifarmácia foi de 94,5%. Conclusões: conhecer a terapia medicamentosa e compreender a forma de utilização desta é fundamental para proporcionar o alívio dos diversos sintomas que impactam na qualidade de vida dos pacientes internados em cuidados paliativos. / Palliative care can be seen as a public health priority in the face of the demographic transition that is happening at a global level. Preliminary studies indicate that early access to these care can improve the control of symptoms and the quality of life of patients, therefore, understanding how drugs are used is essential to achieve the relief of suffering. Aim: in the face of the scarcity of bibliographic references on this topic, the aim of the present research is to describe the profile of use of drugs most often adopted by patients in palliative care admitted to Hospital de Clínicas de Porto Alegre and to report the demographic and clinical characteristics of these patients. Methods: observational, transversal, retrospective study was conducted with a sample of 267 patients admitted to palliative care of a large general university hospital with an installed capacity of 843 beds. Results: the prescriptions totaled 178 different drugs; among these, the most frequently prescribed ones were: dipyrone, morphine, metoclopramide, ondansetron, sodium heparin, paracetamol, lactulose, omeprazole, sodium chloride 0.9%, clonazepam, dexamethasone, docusate + bisacodyl, amitriptyline, glycerin enema (12%), methadone, haloperidol, cefepime, codeine, scopolamine, dimenhydrinate, glucose (50%), mineral oil liquid, furosemide, ranitidine, amoxicillin + clavulanic acid and chlorpromazine. The percentage of polypharmacy was 94.5%. Conclusions: it is essential to gain knowledge of drug therapies and to understand how to use them in order to provide the relief of several symptoms that impact the quality of life of hospitalized patients in palliative care.

Submitted by Biblioteca da Faculdade de Farmácia (bff@ndc.uff.br) on 2017-03-20T17:05:56Z No. of bitstreams: 1 Hofer, Ana Paula Barroso [Dissertação, 2015].pdf: 1799140 bytes, checksum: 36e28677babd928285b73b45ed328c2e (MD5) / Made available in DSpace on 2017-03-20T17:05:56Z (GMT). No. of bitstreams: 1 Hofer, Ana Paula Barroso [Dissertação, 2015].pdf: 1799140 bytes, checksum: 36e28677babd928285b73b45ed328c2e (MD5) / A lista de medicamentos essenciais é um instrumento de orientação das condutas clínicas e administrativas para medicamentos em determinada organização. Uma lista com medicamentos adequadamente selecionados favorece a sua utilização racional e os demais processos da assistência farmacêutica; sendo a adesão dos médicos prescritores às listas um indicador de sua qualidade. O objetivo do trabalho foi avaliar a adesão dos prescritores à lista de padronização de medicamentos de um hospital terciário do Estado do Rio de Janeiro, através da aplicação de um questionário aos prescritores, além da avaliação de prescrições médicas. O modelo de investigação se caracterizou como descritivo com delineamento transversal, sendo analisadas 1108 prescrições dos pacientes internados e aplicados 31 questionários aos médicos prescritores do hospital de estudo. Foram verificadas características das prescrições médicas e dos prescritores, além de condutas diante dos fatores relacionados à adesão à lista de padronização de medicamentos da instituição. A incidência de medicamentos não padronizados solicitados foi conferida e classificada de acordo com a Anatomical Therapeutic Chemical Classification (ATC) e quanto ao grau de recomendação para utilização em suas principais indicações. O indicador de prescrição médica proposto pela OMS referente à porcentagem de medicamentos prescritos que pertencem à lista de medicamentos essenciais (lista de medicamentos padronizados pela instituição) foi determinado, resultando no valor de 98,25%, referente à taxa de adesão dos prescritores à lista. Entre os medicamentos prescritos ou solicitados não incluídos na lista, aproximadamente 30% fazem parte da classe do sistema cardiovascular, sendo a valsartana, o mais frequente. Os resultados obtidos através da análise das prescrições médicas demonstraram que a adesão à lista ocorre de maneira expressiva, entretanto, foi verificado pelos questionários aplicados que uma grande parte dos médicos desconhece a lista. Desta maneira, a adesão à lista pode ser proveniente do fato do medicamento estar disponível para prescrever, ou ainda, pela grande variedade de itens presentes na lista. Esse desconhecimento da lista de medicamentos por parte dos prescritores parece compartilhado por outras instituições no país, devido a outros hábitos de prescrição, preconceito ou eventualmente pela falta de compromisso dos profissionais / The list of essential drugs is a policy instrument of clinical and administrative managements for drugs in a given organization. A list of properly selected medicines promotes the rational use of them, as well as organizes other pharmaceutical assistance processes. The adherence of prescribers to the lists is an indicator of its quality. The objective of this study was to evaluate the adherence of prescribing the medicine standardization list of a tertiary hospital in the state of Rio de Janeiro, through the analysis of a questionnaire to the prescribers. We also evaluated if the medical prescriptions are compliant with the list of properly selected medicines. It is a descriptive cross-sectional study. We analyzed 1108 prescriptions of patients admitted and applied the questionnaire to 31 medical doctors of the hospital. Were recorded characteristics of medical prescriptions and prescribers factors possibly related to the adherence to the list of properly selected medicines. It was given the incidence of non-standardized medications ordered, classifying them according to the Anatomical Therapeutic Chemical Classification (ATC) and the degree of recommendation for use in its main indications. The indicator, proposed by the WHO, i.e.; the percentage of prescription drugs that belong to the list of medicines essential (list of standardized medicines by the institution) was determined, 98.25% were adherent to the list. Among the medications prescribed or ordered not included in the list, about 30% are part of the cardiovascular system class, and valsartan, the most frequent. The results obtained by analyzing medical prescriptions showed that joining the list occurs more significantly, however, through the questionnaire to the prescribers, we verified that part of them is unaware of the list. Consequently, the adherence to the list is due to the several items available to the prescribers, even if they do not know its existence. The lack of knowledge of the list of drugs by prescribers is observed in other institutions in the country, we believe it was observed due to ancient prescription habits, prejudice or eventually by the lack of commitment of the professionals

A review of the literature on blood stream infections caused by contaminated intravenous infusates which are prepared in clinical care settings found that this common nursing procedure poses at times a significant and life-threatening risk to patients. The guidance and regulations surrounding the preparation of intravenous drugs in clinical care settings suggests that this procedure is extremely complex and poses many different potential hazards to patients. This thesis set out to determine how the infection risks are being addressed in practice by asking the questions: ‘What is the system of intravenous drug preparation in clinical care settings in NHS Scotland?’ and, ‘How does it work in practice?’ Several data sources were utilised: six locations, in specialities where the literature identified significant outbreaks had occurred, were examined for potential contamination risk. Observations (78) of infusate preparations were undertaken and, where available, written procedures were compared with observed practices. Finally, analyses were made of 71 questionnaires, completed by the nurses who prepare intravenous drugs, regarding their opinions of the procedures’ safety and when they perform redundancy checks. The conclusion of this study is that the system of preparing intravenous drugs in clinical care settings by nurses is, as a consequence of potential infusate contamination, error-prone and unreliable. The reasons for this conclusion are now detailed. o Due to a lack of mandatory environmental standards, and the provision of poor environments, there is a risk of infusate contamination from environmental sources and consequently, a risk to patients of infusate-related blood stream infections (IR-BSI). o Some in use equipment poses contamination risks to patients’ infusates. Equipment that could reduce the contamination risk is not always available and in some instances such safety-enhancing equipment has been removed. o There are no complete written procedures which mirror what is done in practice. At present, from a human-factors perspective, it is not easy for the nurse to do the right thing, or to be sure exactly what is the right thing to do. o The procedure, in practice, has the required elements of an aseptic procedure, but the execution of the procedure is more often not performed aseptically. o The procedure of intravenous drug preparation as observed is mainly an interrupted aseptic procedure and as such the recommencement of the aseptic procedure requires repeated hand hygiene. o The nurses’ opinions of safety vary, as did their assessment of the infection risk to their patients, but it is clear that intravenous drug preparation is not a much-loved nursing procedure and some nurses find it very stressful. o There is no asepsis quality control built into the system. Aseptic steps are the least likely to be performed as a redundancy check compared to the mandatory checks of ‘right patient, right drug and right dose’. o The information available to the nurses, from the drug companies, from the makers of equipment and from national agencies does not identify with sufficient clarity the infection risks, or detail how to negate them. Suggestions for improvement to the six procedures and environments are clear once the procedure steps are colour-coded as either aseptic or non-aseptic; validity testing of these improvements is however, still needed. The systems’ vulnerabilities observed in this research appear to stem from a chain of external influences including an underestimation of the problem size and the actions needed to prevent it in evidence-based guidelines and mandatory guidance. This leads to poor recognition of the risk of IR-BSI in clinical practice. The problem of infusate contamination causing IR-BSIs is further compounded by the fact that it is not caused by a single organism and does not always present as a disease in real time, that is, over the lifetime of the infusion. As a consequence, this presents surveillance difficulties in terms of definitions, data collection and analysis. Finally, although the diagnosis of a blood stream infection for an individual patient remains relatively easy, it is not easy to recognise a contaminated infusate as the origin of the problem. All these challenges make both the recognition of the problem and agreement on prevention strategies, extremely challenging. In summary, the main conclusion of this thesis is that the preparation of infusates in clinical care settings, which occurs approximately 3,000,000 times a year in NHSScotland, is from an aseptic perspective, error-prone and unreliable. Recommendations to optimise patient safety include, changing the procedure locally and, with the utmost urgency, the production of minimum environmental standards. The results of this study are relevant to all hospitals in Scotland and throughout the United Kingdom where the current regulations apply and similar procedures are performed.