Preparo e administração de medicamentos por sondas em pacientes que recebem nutrição enteral

Abstract

This study s object was the medications preparation and administration by nursing probes in patients receiving enteral nutrition. The overall objective was to investigate the preparation pattern and drugs administration through tubes in patients receiving concomitant enteral nutrition. The specific objectives were to present the medications profile prepared and administered in accordance with the possibility to be administered by enteral probes and assess the errors type and frequency that occur in the medicines preparation and administration by probes. This was a cross-sectional survey of the observational nature without intervention model. It was developed in a hospital in Rio de Janeiro city, Brazil, observing practical nurses preparing and administering medications through tubes in the Intensive Care Unit. We observed the preparation of 350 medicines doses and subsequent administration to the patients. The prevalent drug groups were those acting on Cardiovascular Renal System with 164 doses (46.80%), followed by those acting on the Respiratory System and Blood with 12.85% and 12.56% respectively. We found 19 different drugs from the first group, two from the second group, and five in the third one. The error categories in the preparation were milling, mixing and dilution. We found a mean rate of 67.71% in medication preparation. Simple tablets were prepared by wrong way in 72.54% of the doses and all coated tablets and those of extended release were crushed incorrectly. Among solids, the prevalent error category was milling with 45.47%. The preparation by mixing drugs was an error in almost 40% from the solid drugs doses. The insufficient grinding occurred in 73.33% from the folic acid doses, amiodarone hydrochloride (58.97%), and from bromopride (50.00%). Mixing with other drugs occurred in 66.66% from bromopride doses, amlodipine besylate (53.33%), bamifilina (43.47%), folic acid (40.00%), and acetylsalicylic acid (33.33 %). The administration errors were no breaks and improper probe handling. The average errors rate of administration was 32.64%, being 17.14% for pause and 48.14% for the probe handling. Failure to wash the probe before administration was the most common mistake and not to wash the probe after that was the most unusual. The drugs most commonly involved in errors in the administration were amiodarone hydrochloride (n=39), captopril (n=33), hydralazine hydrochloride (n=7), and levothyroxine sodium (n=7). In 330 medication dosages, the probes were not washed, before the administration. The drugs inadequate preparation and administration can lead to losses in bioavailability, decreased serum levels, and risk of patient poisoning. Preparing and administering medications is a common procedure but showed high error rates, maybe reflecting little knowledge from these professionals about the best practices in drug therapy. There is a need for greater investment by all involved professionals, doctors, nurses, and pharmacists on issues involving the drug safety and rethink the process of nursing work.