Percepção dos profissionais e perfil das discrepâncias na conciliação de medicamentos na pediatria : estudo multicêntrico

Abstract

Introduction. Discrepancies in the patient's pharmacotherapy during transition between different health environments are common. However, some of these can cause medication errors if unintentional and/or not documented by the healthcare team. To avoid such errors and improve communication between health professionals, it’s recommended that health institutions adopt medication reconciliation service. In addition, the professionals' perception of medication reconciliation of medicines provides us with an overview of the importance and significance of this service for them. Most studies with children assess the rates of discrepancies only at a only transition of care, and a study that follows patients from admission to discharge is valid. Objective. Assess the rates of discrepancies at each point of transition of care and the perception of professional nurses, pharmacists and doctors about the reconciliation of medicines. Methods. In the first stage, a survey was carried out with professional nurses, pharmacists and doctors from the pediatric clinics of four teaching hospitals in Brazil. The professionals were asked to answer the instrument “Questionnaire for the assessment of medication reconciliation in Brazil” via email or in print. In the second stage, a survey of discrepancy rates was carried out at all points of care transition (admission, internal transfers and hospital discharge) at the pediatric clinic of four teaching hospitals in Brazil. Children from 1 month to 12 years old were included. The two stages took place from February to July 2019. This project was approved by the Research Ethics Committee of the HU/UFS with the opinion number: 3.097.029. Results. In the first stage, 76 professionals agreed to participate in the research, 14 (18.4%) of whom were nurses, 18 (23.7%) pharmacists and 44 (57.9%) physicians. There was a lack of clarity in current medication reconciliation practices, as well as different perceptions between the three professions. Doctors and pharmacists considered their professions to be primarily responsible for carrying out conciliation, while nurses attributed this responsibility to doctors and pharmacists. In the second stage, 248 children were included, 112 (45.2%) being female and 136 (54.8%) being male. There were 191 (77.0%) patients who had at least one intentional discrepancy, 50 (20.2%) patients had at least one unintended discrepancy and 38 (15.3%) patients had at least one intentional discrepancy and an unintended one. Flaws in the documentation of intentional discrepancies were observed, while the most frequent unintentional discrepancies were omission of drugs, mainly on hospital admission. In relation to medications, the ones that had the highest rates of medication errors were the medications of the alimentary tract and metabolism. Conclusion. It can be concluded that the medication reconciliation service needs to be better grounded among health professionals through the definition of the duties of each profession and periodic training that fosters the importance of this practice for patient safety. In addition, it is still necessary to improve the documentation and continuity of information about medications in care transitions and, consequently, to avoid unintentional discrepancies that can cause risk to children's health.