Potenciais interações medicamentosas com dano grave e sua relação com o aprazamento estabelecido por enfermeiros

Abstract

This is a multicenter study, with retrospective review of medical records, which had as its object the association between the schedule of intravenous medications stated by nurses and potentially serious drug interactions (PDI) found in prescriptions of hospitalized critically ill adult patients. This work is aimed at presenting the drug groups and drug prevalent in each studied Intensive Care Unit (ICU), describe the schedule profile of intravenous drug in every researched ICU, and analyze the frequency of potentially serious drug interactions favored by the schedule stated by nurses. For data collection, an instrument was used which included the drug name, dose, via, administration frequency, and the schedule stated by the nurse, giving rise to a huge database. Data were collected in three ICUs belonging to Sentinel Network covenanted to Sistema Único de Saúde (SUS) (Health System). For PDIs survey, every prescription was analyzed, pairing up all intravenous medications according to inclusion criteria, and then listing all found interactions. PDIs were identified on Micromedex Drug-REAX system.12 and Drugs.com basis. A chance almost three times higher (OR: 2.96) of PDI was found in prescriptions with more than five medications. At 6 am, the greatest chance of PDI was found in ICU A and B. In the ICU C, significant prevalence nor OR was not found and the number of implicated doses with PDI was the lowest among all ICUs. There was a predominance of medications that act on the digestive system (31.99%) with emphasis on ranitidine (44.08%). ICU A and B follow the same pattern to accumulate the schedule preferentially at 2 pm, 6 pm, 10 pm, and 6 am. ICU C distributes its schedule for nine times, including during visiting hours (4 pm) and at starting the shift turn (8am and 8pm.). The nocturnal schedule dominated in ICU A and B; in ICU C, it was at afternoon and night, suggesting an organized routine according to the work scheme of doctors, nurses, and pharmacy. Forty-seven serious PDIs were found at prevalent times. ICU A had the highest number of serious PDIs (n=32). We highlight five drugs, haloperidol, metoclopramide, tramadol, furosemide, and promethazine that had repeatedly the schedule associated with serious PDI. It is concluded that ICU's routine activities favors the standardized and concentrated schedule in a few times, and hence the occurrence of serious PDIs, thus disregarding the pharmacokinetic and pharmacodynamic aspects of medications in concomitant use.