Incidentes clínicos relacionados a medicamentos potencialmente inapropriados em pacientes críticos: estudo transversal

Abstract

Introduction: The use of medicines in the hospital environment requires safe practices, which aim to prevent the occurrence of health incidents. Potentially inappropriate medicines are those medicines where prolonged use may pose more risks than benefits. In this sense, the importance of monitoring the use of these drugs stands out, aiming for safe drug therapy. General objective: To analyze the prevalence of the use of potentially inappropriate medications in critically ill patients based on clinical incidents. Method: This is a cross-sectional study with a quantitative approach, carried out in a university hospital located in the city of Rio de Janeiro. Data collection took place between March 2024 and July 2024 in the general intensive care sector of the aforementioned hospital. The units of analysis were the medication prescriptions present in the medical records of patients over 18 years of age with a hospital stay of more than 24 hours, when clinical incidents associated with the use of potentially inappropriate medications were investigated. Results: 341 prescriptions were analyzed with a median of 10 medications per prescription, with a minimum of 2 and a maximum of 21, totaling 3,752 medications analyzed. The most frequent potentially inappropriate medications were omeprazole 290 (85.04%), enoxaparin 231 (67.74%), clonazepam 125 (36.66%) and prednisone 90 (26.39%). The occurrence of at least one incident was identified in 163 (47.80%) prescriptions. The main incidents were hyperglycemia 70 (42.94), bleeding 28 (17.17%), diarrhea 23 (14.11%) and constipation 20 (12.26%). The potentially inappropriate medications that showed a significant association with the occurrence of incidents were: insulin (p-value < 0.001), fentanyl (p-value < 0.001), mineral oil (p-value 0.001), metoclopramide (p-value 0.003), domperidone (p-value < 0.001). Conclusion: The “hyperglycemia” incident showed a significant association with the use of insulin and prednisone. Bleeding was also significant in relation to the use of enoxaparin and fentanyl. Additionally, diarrhea has been associated with prednisone use. Considering the findings, it is highlighted that nurses play an essential role in the early identification of these incidents and contribute to encouraging the prescription of potentially inappropriate medications. Considering this, the application of the Beers criteria and the adoption of institutional protocols are measures that can contribute to minimizing the risks of using some drugs and improving the safety of the use of drugs in intensive care.