Erros de prescrição e de preparo de medicamentos em unidades de urgência e emergência: prevalência e fatores associados

Abstract

This study aimed to analyze errors in verbal, written and drug prescribing errors. An analytical study conducted in two urgency and emergency units in the State of Goiás, included doses of injectable drugs prescribed and prepared. The colletion totaled 480 hours of observation in both units and occurred by direct non- participant observation, in July and August, 2018 - the data was recorded in a Checklist and followed the following steps: observation of verbal and written prescription and observation of medication preparation. The analysis of variables related to patients and medication was performed in a descriptive way. To verify the factors associated to the number of errors (written and verbal) prescription and preparation was used Poisson Regression model. The Pearson Correlation Coefficient was used to analyse the relation between the number of errors of prescription and drug preparation. Study aproved by Ethics Committe of Pontifical Catholic University of Goiás, under the number 1.822.751, and the Ethics Committe of the Clinics Hospital of the Federal University of Goiás, under the number 2.631.336, and complied with all ethical aspects as recommended by the Brazilian legislation. There were 814 doses of drugs prescribed and prepared for 367 patients. Of the total doses observed, 112 were prescribed in verbal order 10.369 errors were found, this 5.646 of written prescription, 324 of verbal and 4.399 of drugs preparation. The errors of written prescription were absence of the full name of the prescriber (9,5%), the patients full name (3,1%); illegible prescriptions (8,6%); lack of differentiation of similar names (96,1%); use of abbreviations (70,4%). In verbal prescription were: omission of the full name of the drug (33,0%), and also the dose (19,6%); diluent¿s omission (58,5%). The most frequent errors in the preparation were: absence of hand hygiene (98,5%); absence of drug inspection (75,2%); drug association (33,1%). The factors associated with errors of written prescription were: potentially dangerous drug (p<0,00), drugs of the blood groups and hematopoietic organs (p<0,00) and musculoskeletal (p=0,01). Factors associated with verbal prescribing errors were: the presence of comorbidities (p=0,04), potentially dangerous drugs (p=0,01) from the group of systemic hormones preparation (p=0,00) and anti- infectives (p=0,03). The factors associated with the preparation errors were: urgent care (p=0,00), inadequate lighting (p<0,00), disorganized environment (p=0,03), intense flow of people (p=0,01) intravenous route (p=0,00) and subcutaneous (p=0,01) and medication of the musculoskeletal group (p=0,01). There was no correlation between the errors of prescription and preparation. The observed errors occur due to human and systemic failures, and should be corrected to provide greater patient safety. The results show important implications for practice and strategies that need to be implemented to limit the effects on the factors related to the occurrence of errors