Segurança do paciente no uso de medicamentos após a alta hospitalar: estudo exploratório1

Abstract

Few Brazilian studies have focused on patient safety strategies for safe use of medications after discharge leading to limited knowledge of current safety practices developed in Brazilian hospitals. The present study aimed to understand the dynamics and challenges of care provided to patients by hospital providers focusing on safe use of medications after discharge. An exploratory study was conducted and data was collected through interviews with physicians, nurses, pharmacists and social workers at the Hospital Universitário da Universidade de São Paulo, in São Paulo, southeastern Brazil. Care practices regarding medication use during and following hospital stay including access to medicines after discharge, follow-up plans for coordinated, ongoing care, and barriers were investigated. The main strategy for safe use of medications after hospital discharge is to provide structured counseling for patients and particularly for caregivers of pediatric patients. The care team works to ensure access to the medications prescribed at discharge in special situations. Medication reconciliation is being implemented and home visits are limited to patients in critical condition with mobility problems. The main barriers identified in the study were limited information technology and human resources. It was concluded that there are some patient safety strategies in place but they are limited in scope and do not ensure coordinated, ongoing care after discharge. These findings point to a need to strengthen efforts to overcome the barriers identified to improve patient safety at the interface of hospital, primary care and the home setting. Keywords: Drugs; Medication Errors; Adverse Events; Hospital Discharge; Patient Safety; Public Health. Liete de Fátima Gouveia Marques ResumoNo Brasil, são escassos os estudos sobre estratégias para a segurança do paciente no processo de uso de medicamentos após a alta hospitalar, o que dificulta o conhecimento sobre a atuação de hospitais brasileiros nessa área. Neste artigo, buscou-se compreender a dinâmica e os desafios do cuidado fornecido ao paciente pela equipe hospitalar, visando à segurança no processo de uso de medicamentos após a alta hospitalar. Realizou-se pesquisa exploratória por meio de entrevistas com médicos, enfermeiros, farmacêuticos e assistentes sociais do Hospital Universitário da Universidade de São Paulo. Foram pesquisadas as atividades de cuidado com a farmacoterapia durante e após a hospitalização, incluindo o acesso a medicamentos após alta, a existência de articulação do hospital com outros serviços de saúde, e barreiras para desenvolver essas atividades. A principal estratégia adotada é a orientação de alta, realizada de forma estruturada, principalmente para cuidadores de pacientes pediátricos. Em situações específicas, ocorre mobilização da equipe para viabilização do acesso a medicamentos prescritos na alta. Reconciliação medicamentosa está em fase de implantação, e visita domiciliar é realizada apenas para pacientes críticos com problemas de locomoção....

Care transition strategies in Latin American countries: an integrative review

“…Five studies were found related to discharge planning (17)(18)(19)(24)(25) . Planning was centered on the health conditions of patients (19) , cognitive capacity (17,19) , social support, and the needs of patients (19) .…”

“…Planning was centered on the health conditions of patients (19) , cognitive capacity (17,19) , social support, and the needs of patients (19) . Care plans included drug lists and instructions (18,(24)(25) , social support to access health care services (19) , underlying illnesses, warning signs and symptoms, nutritional care, instructions regarding continued use of medications, and clinical follow-ups (18,25) . One study developed a discharge planning guide around safe medication usage for pediatric patients and their caregivers due to their complex health needs (24) .…”

“…Patient education and promotion of self-management activities were identified in ten studies of this review (15)(16)(17)(18)(19)(20)(21)(22)(24)(25) . Instructions related to self-care and the treatment prescribed at discharge were provided most of the time by nurses (15)(16)20) , multi-professional teams (18)(19)(21)(22)24) , pharmacists for drug use (17,25) .…”

“…Patient education and promotion of self-management activities were identified in ten studies of this review (15)(16)(17)(18)(19)(20)(21)(22)(24)(25) . Instructions related to self-care and the treatment prescribed at discharge were provided most of the time by nurses (15)(16)20) , multi-professional teams (18)(19)(21)(22)24) , pharmacists for drug use (17,25) . Educational actions were focused on the use of central venous catheters (19) , potential adverse effects of drugs (16)(17)25) , use of medications (17)(18)20,22,(24)(25) , selfcare and proper diet (18) , individual needs (15,(20)(21)24) and educational materials (22,25) .…”

“…The actions carried out by multidisciplinary teams focused primarily on educational activities (17,20) , such as the use of personalized files or plans with a detailed de-scription of the drugs in use, and the use of the feedback method to review understanding of medication safety (22) , to facilitate understanding and reduce possibilities of post-discharge drug use errors (18,25) . The intervention activities of clinical pharmacists, who collected data about drugs in use before medical consultations in emergency departments (23) and performed daily reviews of prescriptions for joint adjustments with physicians (24) were described as activities that promote patient safety in relation to drug use during hospital stays.…”