Pharmaceutical interventions in medications prescribed for administration via enteral tubes in a teaching hospital

Abstract

Objective: to analyze the impact of guidelines regarding errors in medications prescribed for administration through enteral tubes. Method: quantitative study, in three phases, undertaken in internal medicine, neurology and an intensive care unit in a general teaching hospital. In Phase 1, the following was undertaken: a protocol for dilution and unit-dose repackaging and administration for 294 medications via enteral tubes; a decision flowchart; operational-standard procedures for dilution and unit-dose repackaging of oral pharmaceutical forms and for administration of medications through enteral tubes. In phase 2, errors in 872 medications prescribed through enteral tubes, in 293 prescriptions for patients receiving inpatient treatment between March and June, were investigated. This was followed by training of the teams in relation to the guidelines established. In Phase 3, pharmaceutical errors and interventions in 945 medications prescribed through enteral tubes, in 292 prescriptions of patients receiving inpatient treatment between August and September, were investigated prospectively. The data collected, in a structured questionnaire, were compiled in the Microsoft Office Excel(r) program, and frequencies were calculated. Results: 786 errors were observed, 63.9% (502) in Phase 2, and 36.1% (284) in Phase 3. In Phase 3, a reduction was ascertained in the frequency of prescription of medications delivered via enteral tubes, medications which were contraindicated, and those for which information was not available. Conclusion: guidelines and pharmaceutical interventions were determined in the prevention of errors involving medications delivered through enteral tubes.

Risks of enteral nutritional therapy: a clinical simulation

“…A study (2) also reports the incidence of tube obstruction in 0.021/100 patients using ENT due to failure to effectively clean the ENT. Similarly, as presented in our study, tube obstruction may be related to drug administration due to high viscosity and insufficient ENT flow, incompatibility between diet and drug, drug adherence to the tube wall, characteristics or form of the medication (15) .…”

Evaluation of prescription containing medication via enteral feeding tubes in an adult emergency unit

“…15 At another university hospital, in Paraná (Brazil), a research study that analyzed 585 prescriptions with 1,817 medications for administration via enteral feeding tubes found errors in 786 (43.25%) of the medications prescribed and indicated 574 pharmaceutical interventions perfomed. 2 Another study carried out in Turkey pointed out that 40.5% of the medications administered via enteral feeding tubes were conducted incorrectly and that 17% of the nurses and 24% of the physicians knew that formulations with enteral coating cannot be crushed. 16 A case report published by Iranian authors identified lack of professional knowledge about the prescription and, consequently, of drug administration through this route, causing harms to the patients.…”

“…By crushing a drug, its pharmacokinetic properties are changed, and it can consequently cause toxicity, gastrointestinal adverse reactions, interactions with enteral nutrition or among medications, sub-therapeutic effect, and tube obstruction. 2 One of the main complications related to the use of medications via a tube is obstruction. It can occur due to the viscosity and pH of the solution formed after crushing, to the excipients of the medication, to the non-pause of enteral nutrition before the administration of medications, to the mixture of various crushed oral solids for administration or to the improper hygiene of the tube before and after administration.…”

“…Additionally, pharmaceutical interventions are decisive to correct and recognize restrictions for the administration of medications prescribed via enteral feeding tubes. 2 In view of the above, this study aimed to verify existing incompatibilities in prescriptions of medications administered via enteral tubes, to describe the main pharmaceutical interventions performed, and to present synthesized evidence from the literature on the safety or not of drug administration by means of enteral tube devices at an adult emergency unit located in Southern Brazil.…”

Uso De Medicamentos Com Ação Anti-Infecciosa via Sonda Gastroenteral: Recomendações Para a Enfermagem

“…Somente os periódicos científicos, com pesquisas de foco principal nesse tema, apresentam algumas orientações. A divergência entre autores mostrou-se como dificuldade nesse e em outros estudos (7,25) , nos quais 30,4% e 39,5%, respectivamente, dos medicamentos apresentaram divergência de informações em relação a outras fontes.…”