Da Fita à Tecnologia

Da Fita à Tecnologia
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Um sistema impossível nos anos
1980
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A história da Fita
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Passos para a padronização
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Ainda um sistema ruim
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Parece familiar? Precisamos eliminar a
Matemática
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Fazendo com que as pessoas errem
“ Sou antiquada…
Fatos sobre Cálculo*
Taxa de
erro
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Condições normais
3%
Segunda verificação
10%
Sob estresse
25%
Acho que devemos fazer
cálculos em caso de
dúvidas...”
Os rótulos são confusos
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Reconhecendo os erros
Erro de 10 vezes em Adultos
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Erro de 10 vezes em uma criança
Morte pelo ponto decimal
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?
Solução mágica?
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Solicitando uma lasanha com
Legível
Não tem alergia ao tomate
Compatível com vinho tinto
É hora do jantar
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Alguém tem que
“preparar a lasanha”
Mas não se preocupe…
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Prescrevemos em mg Administramos em mL
Documentamos em mg
Nós sempre acertamos! (pelo menos de acordo com nossos
registros)
Infusão de Prostaglandina?
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. . . Exatamente o que você prescreveu!
Uma em cada duas doses é administrada com erro!
Critério
Comentários
Erros de prescrição
46 %
Erros de
administração*
28%
Erros de preparação
10 %
Gokhman R, et al. Resuscitation. 2012;83:482-487.
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Prescrição Eletrônica ignora 40 %
dos erros
A Pior Parte
Os erros de preparação e administração normalmente não são
identificados a tempo e tendem a ir direto ao paciente!
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3 regras
simples
1) Padronizar o processo
2) Simplificar a linguagem
3) Eliminar a matemática
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1. Padronizar o processo
Uma receita simples para cada paciente, fármaco e indicação
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Os 5 D’s de Administração segura na beira do leito
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2. Simplificar a linguagem
Use palavras, não números
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3. Eliminar a Matemática
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Matemática
Memorização
Decidir a indicação
Acessar o peso do paciente
Médico
Lembrar ou procurar a dose ou a fórmula da dose
Calcular a dose exata
Verificar a dose e a indicação
Obter a concentração correta
Calcular o volume correto do fármaco
Farmacêutico/
Enfermeiro
Verificar o volume da concentração do fármaco
Administrar a dose de forma correta
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Matemática
Memorização
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Trabalhamos em “Silos” (de
forma isolada).
Médico
Medico
Enfermeiro
Farmacêutico
Farmacêutico/
Enfermeira
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Aqui todos trabalham juntos, desde a mesma página!
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Sim, é baseada em evidências!
Consulta aos Farmacêuticos
Accuracy and Timeliness of Medication Preparation in Pediatric Emergencies:
Comparison
of a Barcodevs.
System
and Traditional Approach
Caso – Intervenção
Controle
Consultas/Ordens
Heather N. Whitehead, PharmD; Robert J. Kuhn, PharmD; Stephanie N. Baker, PharmD, BCPS
Kentucky Children’s Hospital
0/40 (0%)
Caso Respiratório
- Controle
Study Design & Methods
2/25 Results
(8%)
• Prescribing Errors in the Emergency Department (ED)
• Kozer et al1, reviewed 1,532 charts of children treated in the ED
• Prescribing errors occurred in 10% of reviewed charts
• 51% of incorrect doses prescribed were considered to be significant
or severe
• 44% of incorrect frequencies prescribed were considered to be
significant or severe
• Kozer et al2, performed 8 mock pediatric code resuscitations with 125
medication orders
• Dose was not specified in 17% of orders with 59% having no route of
administration identified
• 9 orders included a dosing errors with three being 10-fold errors
• 16% of prepared doses deviated by at least 20% of the expected
dose, 7% of doses deviated by ≥ 50%
Medication Requests
• Study Population
• Registered nurses in the emergency department with pediatric
advanced life support (PALS) training within the past 3 years
Caso Cardíaco - Intervenção
0/25 (0%)
N (Number of medication requests)
Respiratory Case (Intervention, Control)
• In 2010, the Pediatric Pharmacy Advocacy Group (PPAG) partnered with
Drs. James Broselow and Robert Luten in the development of the Artemis
Initiative, which serves as the underlying standard for Artemis software3
• Goal of Artemis Initiative
• Develop simple, safe and effective international standard for acute
pediatric administration of drugs
• Artemis Software
• Barcode, web-based system populates dosing information, dose
preparation, infusion and monitoring parameters for over 400
medications in seconds after initial scanning of medication
130
40, 25
Cardiac Case (Intervention, Control)
• Study Design
• This is a 2 – treatment, 2 – period crossover trial with randomization
to each treatment
• Each nurse participated in 2 simulated PALS scenarios
• Each participant was assigned to either the intervention or control
group during Period 1 then switched groups during Period 2
• Participants provided a total of 10 mediation interventions as
prompted by the simulation facilitator
• PALS Simulated Scenarios
• Asthma-induced respiratory failure
• Hyperkalemia induced ventricular fibrillation
• Participants in the intervention group were allowed to use the Artemis
system. Participants in the control group were allowed to use drug
references normally available in the emergency department.
Caso Cardíaco - Controle
25, 40
14/40 (35%)
Primary Objective: Accuracy of Prepared Medications
Dosage Errors with I ntervention vs Control
Conclusões
Control
(Standard ED
references)
Percentage of Errors
Background
Lexington, KY
Caso Respiratório - Intervenção
(%)
100%
80%
60%
40%
20%
0%
I ntervention
Control
≥ 20% Errors
0%
100%
< 20% Errors
18.75%
81.25%
Secondary Objective: Timeliness of Medication Preparation
O uso de um sistema eletrônico padronizado de medicação, baseado no código de
Data Collection
barras:
• Aumenta a precisão das doses do medicamento preparado durante estimulações
Study Purpose
de código pediátrico
em 73%, sem erros considerados clinicamente significativos.
• Reduz o tempo requerido para a preparação do medicamento, permitindo ao
Conclusions
enfermeiro com menos experiência pediátrica preparar os medicamentos
tão rápido
Study Hypothesis & Objectives
quanto aqueles com maior experiência. Results
• To compare accuracy and timeliness of medication preparation during
pediatric code simulations when using the Artemis Pediatric System
compared to when using traditional pediatric dosing references
• To date, outcomes data on the use of the Artemis Pediatric System is
lacking in current medical literature
• All scenarios were digitally recorded using video capabilities in the
patient care exam rooms at the University of Kentucky College of
Pharmacy
• Drug: Accuracy of medication prepared was recorded as correct or
incorrect
• Dose: Prepared dose of medication was recorded for each medication
prepared during the scenario
• Doses were compared to reference values
• Variances greater than 20% were considered clinically significant
• Time: Recorded in minutes using time sequencing capability of
recording equipment in the patient care exam room
•Time zero equaled the time the request was made and was recorded
until medication was delivered to the facilitator
•Times were averaged for each treatment group and compared
• Hypothesis
Use of the Artemis system will result in a decrease in deviation from
recommended medication doses as well as a decrease in the time
required to prepare medications during pediatric code simulations
• Primary Objective
Accuracy of medication intervention including drug, drug concentration,
drug dose
• Secondary Objective
Time from medication request to delivery of medication to facilitator
Study Population
N (Number of nurses)
Years of Nursing Experience (average)
13
4.8
Years of Pediatric Nursing Experience (average)
1.5
Hours Worked in Pediatric Care Per Week (average)
4.2
Pharmacist Consultations
Case – Intervention vs Control
Respiratory Case – Intervention
Respiratory Case – Control
Consults/# Orders (%)
0/40 (0%)
2/25 (8%)
Cardiac Case – Intervention
0/25 (0%)
Cardiac Case – Control
14/40 (35%)
• The use of a standardized, bar-code based, electronic medication dosing
system:
• Increases accuracy of medication doses prepared during pediatric code
simulations by 73%, with no errors being considered clinically significant
• Reduces the time required for medication preparation, enabling nurses with
less pediatric experience to prepare medications as quickly as those with more
vast experience
1.
2.
3.
References
Kozer E, et al. Variables associated with medication errors in pediatric emergency medicine. Pediatrics. 2002;110:737.
Kozer E, et al. Prospective observational study on the incidence of medication errors during simulated resuscitation in a paediatric emergency
department. BMJ. 2004;329(7478):1321.
eBrowselow website. http://www5.ebroselow.com/php/static/home.php
Disclosure
Authors of this presentation have the following to disclose concerning possible financial or personal relationships with commercial entities that may have a
direct or indirect interest in the subject matter of this presentation: Heather N. Whitehead, Robert J. Kuhn, Stephanie N. Baker: Nothing to disclose.
Segurança do Paciente
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Dois
Padrões?
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Quando a vida está em jogo,
fazemos cálculos
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Quando o dinheiro está em jogo,
usamos código de barras!
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Um Checklist para cada frasco
Photo courtesy of Charlotte Observer
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