Prescription errors in brazilian hospitals 2014,diabetes free legit 2014,type 1 diabetes having a baby,latest news on diabetes type 1 - PDF Review


April 30, 2016 - On this D Day of flu immunization in Brasil, awareness is needed on confusion between insulin and vaccines as stated by an ISMP Brasil Alert following a serial error that occurred last Thursday 28 April 2016 in the community hospital of Maringa (North Parana) where fifty employees received a dose of insulin by error instead of the influenza vaccine. The nurse in charge of the vaccination of the hospital staff took the wrong box in the refrigerator where insulin and vaccine against influenza were stored.
Although having already alerted healthcare professionals about the risks of errors involving vaccines in a bulletin on insulins and on neuromuscular blockers, ISMP Brasil takes advantage of a National Safety Alert on this confusion between insulin and influenza vaccines occurrence to highlight the need for learning front of the internally identified errors and other health institutions; and to present some recommendations to prevent medication errors involving vaccines. Although without serious consequences for the health professionals who were the subject of this vaccination campaign, the error that occurred in Brasil recalls the urgency to understand and implement the proposals of the IMSN. ULearning provides academic and industry based training courses through lifelong education and network integration. Number of children in Denmark treated with ICS monotherapy alone or in combination with LABA as single products or as a ?xed combination in the period 1997-2005.
Prevalence of patients with pain inadequately controlled by pain medications (white bar) and prevalence of patients with pain but medication not being taken (black bar). For the USA were 666 products on the market, 60 awaiting approval and 1114 in clinical trials). Teaching of undergraduate and graduate level courses on Pharmaceutics, Pharmaceutical Technology and Drug Delivery. I’ve long stated that the conventional health care system is in desperate need of radical change, and the findings published in a new report clearly backs up this assertion.
If the US health care system was a country, it would be the 6th largest economy on the entire planet.
Sure, we may have one of the best systems for treating acute surgical emergencies, but the American medical system is an unmitigated failure at treating chronic illness.
Conventional medicine, which is focused on diagnostic tests, drugs, and surgical interventions for most ills, clearly kills more people than it saves. According to the most recent research1 into the cost of medical mistakes in terms of lives lost, 210,000 Americans are killed by preventable hospital errors each year. When deaths related to diagnostic errors, errors of omission, and failure to follow guidelines are included, the number skyrockets to an estimated 440,000 preventable hospital deaths each year!
This is more than 4.5 times higher than 1999 estimates published by the Institute of Medicine (IOM),2 and makes medical errors the third-leading cause of death in the US, right after heart disease and cancer.
In all, preventable medical mistakes may account for one-sixth of all deaths that occur in the US annually.
According to a report by the Institute of Medicine, an estimated 30 percent of all medical procedures, tests and medications may in fact be unnecessary6 – at a cost of at least $750 billion a year (plus the cost of emotional suffering and related complications and even death, which are impossible to put numbers on). For the past two years, the American Board of Internal Medicine Foundation, one of the largest physician organizations in the US, has released reports on the most overused tests and treatments that provide limited or no benefit to the patient, or worse, causes more harm than good. To learn more, I encourage you to browse through the Choosing Wisely web site,7as they provide informative reports on a wide variety of medical specialties, tests, and procedures that may not be in your best interest.
It’s also important to be aware that many novel medical treatments gain popularity over older standards of care due to clever marketing, more so than solid science… Recent findings by the Mayo Clinic prove this point. The researchers found that reversals are common across all classes of medical practice, and a significant proportion of medical treatments offer no benefit at all.
The most telling data in the Mayo Clinic’s report show just how many common medical treatments are not helping patients at all—or are actually harming them. Once you’re hospitalized, you’re immediately at risk for medical errors, so one of the best safeguards is to have someone there with you. Dr. If someone you know is scheduled for surgery, you can print out the WHO surgical safety checklist and implementation manual,9which is part of the campaign “Safe Surgery Saves Lives.” The checklist can be downloaded free of charge here.
Medical errors are a large reason why the current, fatally flawed medical paradigm is in such desperate need of transformation.
From my perspective there isn’t any easy one, other than to simply minimize your interactions with the conventional system, as it has very little to offer anyway when it comes to prevention or treatment of chronic disease. One of the reasons I am so passionate about sharing the information on this site about healthy eating, exercise, and stress management is because it can help keep you OUT of the hospital. In the unusual case where you are not getting better, it will be wise to seek a health coach or medical professional that can guide you through complicating factors that may be impairing your progress. All in all, leading a common-sense, healthy lifestyle is your best bet to achieve a healthy body and mind. Proper Food Choices: For a comprehensive guide on which foods to eat and which to avoid, see my nutrition plan. I believe the two primary keys for successful weight management are severely restricting carbohydrates (sugars, fructose, and grains) in your diet, and increasing healthy fat consumption. So along with core-strengthening exercises, strength training, and stretching, I highly recommend that twice a week you do Peak Fitness exercises, which raise your heart rate up to your anaerobic threshold for 20 to 30 seconds, followed by a 90-second recovery period. Meditation, prayer, social support and exercise are all viable options that can help you maintain emotional and mental equilibrium. Optimize your vitamin D levels: Research has shown that increasing your vitamin D levels can reduce your risk of death from ALL causes.
Avoid as many chemicals, toxins, and pollutants as possible: This includes tossing out your toxic household cleaners, soaps, personal hygiene products, air fresheners, bug sprays, lawn pesticides, and insecticides, just to name a few, and replacing them with non-toxic alternatives. Get plenty of high-quality sleep: Regularly catching only a few hours of sleep can hinder metabolism and hormone production in a way that is similar to the effects of aging and the early stages of diabetes. There are many instances in which the negligence of surgeons becomes the major cause of the incurable spinal injury. This multi-centre exploratory study aimed to analyze the appropriateness of prescriptions at four Brazilian hospitals and to identify possible errors caused by inadequacies. A informacao sobre a retirada do medicamento pode ser ausente ou nao ser claramente conhecida.
Methods: This is an observational, descriptive, retrospective cohort study, in which a quantitative approach was used. Profile of intravenous therapy in a pediatric university hospital and association with the occurrence of infusion failures: quantitative study. She has been confused with the packaging and administered the wrong substance to her colleagues and to herself. The International Medication Safety Network (IMSN) has made it the starting point of its International Position Statement on Safer Vaccine Packaging and Label Design, calling on 14 December 2015 for greater worldwide attention to the problem of unsafe design of vaccine packaging and labelling. Despite that, the US ranks last in health and mortality when compared with 17 other developed nations. As a general rule, the hospital is a place you want to avoid at all costs, except in cases of accidental trauma or surgical emergencies.
Marty Makary, a surgeon at The Johns Hopkins Hospital and author of the book, Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Healthcare.
Makary, James’ estimate “shows that eliminating medical errors must become a national priority.” He also calls for increasing public awareness of “unintended consequences” associated with medical tests and procedures, and urges doctors to discuss such risks with their patients. And instead of dissuading patients from unnecessary interventions, the system rewards waste and incentivizes disease over health.
To determine the overall effectiveness of our medical care, researchers tracked the frequency of medical reversals over the past decade.


In fact, they found 146 reversals of previously established practices, treatments and procedures over the past 10 years.
Of the studies that tested an existing standard of care, 40 percent reversed the practice, compared to only 38 percent reaffirming it.
Andrew Saul has written an entire book on the issue of safeguarding your health while hospitalized. For every medication given in the hospital, ask questions such as: “What is this medication? If a loved one is in the hospital, print it out and bring it with you, as this can help you protect your family member or friend from preventable errors in care. A majority of healthcare workers observe mistakes made by their peers yet rarely do anything to challenge them.
Clearly, this is yet another piece of the puzzle as to why US medical care is so dangerous.
More often than not, conventional strategies in no way shape or form address the underlying cause of your disease. You can use this site to find well-proven strategies that will address most chronic health problems. Please remember you can always use the search engine at the top of every page on the site to review previous articles we have written. However, the very first step for any chronic health challenge would be to follow my Nutrition Plan as that will likely improve, if not completely eliminate, more than 80 percent of your health challenges.
And while conventional medical science may flip-flop back and forth in its recommendations, there are certain basic tenets of optimal health (and healthy weight) that do not change. Generally speaking, you should be looking to focus your diet on whole, ideally organic, unprocessed foods. All forms of sugar have toxic effects when consumed in excess, and drive multiple disease processes in your body, not the least of which is insulin resistance, a major cause of chronic disease and accelerated aging.
This will optimize insulin and leptin levels, which is key for maintaining a healthy weight and optimal health. High-intensity interval-type training boosts human growth hormone (HGH) production, which is essential for optimal health, strength and vigor. I also strongly believe in using simple tools such as the Emotional Freedom Technique (EFT) to address deeper, oftentimes hidden, emotional problems.
A healthy diet is the ideal way to maintain a healthy gut, and regularly consuming traditionally fermented foods is the easiest, most cost effective way to ensure optimal gut flora.
For practical guidelines on how to use natural sun exposure to optimize your vitamin D benefits, please see my previous article on how to determine if enough UVB is able to penetrate the atmosphere to allow for vitamin D production in your skin. Chronic sleep loss may speed the onset or increase the severity of age-related conditions such as type 2 diabetes, high blood pressure, obesity, and memory loss.
It is very unfortunate when the doctors and surgeons are held responsible for causing harm to their patients and they have to pay the spinal injury claims to the victims. The sample consisted of 864 prescriptions obtained at hospital medical clinics in January 2003.
O evento deve ser farmacologicamente ou fenomenologicamente definido, utilizando um procedimento de reintroducao satisfatoria, se necessario. This study will be operationalized through documentary research with regard to medical records.
Frequently, you’re going to be relatively debilitated, especially post-op when you’re under the influence of anesthesia, and you won’t have the opportunity to see the types of processes that are going on.
For the best nutrition and health benefits, you will want to eat a good portion of your food raw. We will use medical records of the period between May 2010 and April 2011 and from June 2011 to May 2012. Given the error, staff members who have been "vaccinated" with insulin received a glucose injection.
This means that anywhere between 40 and 78 percent of the medical testing, treatments, and procedures you receive are of NO benefit to you—or are actually harmful—as determined by clinical studies.
What’s the dose?” Most people, doctors and nurses included, are more apt to go through that extra step of due diligence to make sure they’re getting it right if they know they’ll be questioned about it. You can typically find many good referrals from people in independently-owned health food stores.
I have a presentation that I am presently working on, and I have been on the look out for such information. But be sure to get a clear consensus and ask as many people as you can, as choosing a doctor is a very important step, and you want to make sure you get it right. The research scenario will be the neonatal intensive care unit of a university hospital in the public health network of the state of Rio de Janeiro.
This study identified a range of vulnerable points in the prescription phase of the medication system at the hospitals. Physicians, pharmacists and nurses should therefore jointly propose strategies to avoid these prescription errors. Their effects can range from small injuries to the patient's death and these errors can occur at any stage of the medication system. For these reasons, various studies have aimed to analyze medication systems, detect the most frequent problems, remove the focus from human caused errors and, above all, improve patient safety 1,2. According to the National Coordinating Council for Errors in Medication Reporting and Prevention (NCCMERP) 3, a medication error is defined as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the health care professional, patient or consumer. In the United Kingdom, medication error is one of the most common causes of unintentional harm which results in an estimated 85,000 hospital admissions every year 6. These errors were responsible for approximately 5% of hospitalizations in Spain, with an average cost of 3,000 Euros per patient 7. An observational study carried out in Colombia between 1993 and 2006 demonstrated that the main types of medication errors caused death (45%) or harm (47.3%) to patients 9. In Argentina, two studies in public hospitals estimated that there are errors in two out of every ten medication indications 10. One study in Uruguay showed that the majority of resident doctors do not have sufficient knowledge about doses, adverse reactions and contraindications of drugs 11.
Medication errors accounted for 50% of adverse events detected in a study carried out in a private hospital in the city of Campinas (São Paulo State) 14. In anoother study performed in a public hospital in the city of Belo Horizonte (Minas Gerais State), 82% of 422 prescription order forms presented at least one dispensing error 15. In 2001, the National Sanitary Surveillance Agency (ANVISA) created a project, called the Sentinel Hospitals, to reduce these problems and try to build a reference network for hospitals that will provide data on adverse events 2.
Although various health care providers are involved in this system, these processes should be harmonized to ensure patient safety. Any flaw at this stage can directly or indirectly lead to problems in subsequent stages, increase medication error statistics and affect patient safety.
17, the incidence of prescribing errors in the United States has been reported to range from three to 99 errors per 1,000 inpatient medication orders. In Brazil, every year, millions of prescriptions do not follow the legal requirements that are necessary to guarantee correct dispensing and administration of medication 18.


Moreover, different studies have shown that the inadequacies of prescriptions and the difficulties in understanding them risk patient safety 1,15,19. Therefore, the aims of this study were to analyze the quality of prescriptions at four Brazilian hospitals and to identify possible errors caused by inadequacies. Furthermore, a Sentinel Hospital Network was created as a national net pilot test, which has more than 100 hospitals involved. These hospitals were chosen for having a larger number of medical residence programs per state. Notification of adverse drug events is encouraged in order to gather as much information as possible, so the government is able to regulate medicines and medical commerce 16.
From this total, 110 were from hospital A, 108 from B, 294 from C and 248 from hospital D.
Data was collected in close proximity to the nursing staff and always at the end of the afternoon, during seven consecutive days 17,20,21 through a structured instrument developed by the group of researchers, based on the literature 22, with items about the type of medication prescription (electronic or handwritten), legibility (legible, illegible or partially printing), completeness of prescriptions (complete or not complete), abbreviations (present or not present) and existence of changes and erasures. It is important to highlight that illegible prescriptions or unmarked items were not included in the other analysis. The researchers built a protocol based on the literature and Brazilian regulations to judge these prescriptions 18,23. During the data collection, the researchers tried to read the prescriptions and discussed its legibility.
The purpose of the present work was neither to find out nor to identify the professional that committed the flaw, but to analyze and detect the prescription errors, making the medication system safer for its users.
Therefore, the collected data was used exclusively by the researchers, guaranteeing the privacy of the information obtained.
This was possible because the computer system does not permit changes after the electronic prescription printout. At hospital C, for example, 7% of the 294 prescriptions examined were illegible and 28.5% partially illegible (Table 1).
Other and less frequent alterations referred to substituted drugs, handwritten changes in posology, time and routes of administration, as well as modifications in other items (Table 2). Moreover, 100% of the electronic prescriptions in hospital A were frequently dated in comparison with about 96% of handwritten patient prescriptions, at B and C.
27, the electronic prescription is one way of modernizing, simplifying and making the medication system safer, partially because it eliminates the problem of legibility, reduces errors and provides greater safety for medication distribution and administration.
These prescriptions, credited with lowering medication errors by up to 81% eliminate mistakes due to illegible handwriting, and reduce the likelihood of errors that stem from drugs with similar names 17. However, some studies have demonstrated that an electronic prescription system can minimize but does not fully eliminate the possibility of errors 19,20.
It is also expensive to establish such a system, even by international standards, which is an impediment for a number of institutions. At hospitals C and D a copy of the physician's handwritten prescription was sent to the pharmacy, while the original was kept inside the patient's records.
Although this system can avoid transcription errors, the copy handled by the pharmacy is not always legible. In almost all cases, errors caused by illegible handwritten prescriptions could be preventable, thus, efforts from universities and ANVISA are necessary to qualify prescribers and eliminate this problem from the Sentinel Hospitals Network.
This is a relevant fact, as high drug costs have been indicated as the cause of omission errors and as a limiting factor for medication treatment adherence, mainly in middle-income countries such as Brazil 19,20.
The literature mentions the use of both generic and brand names as the most advisable and safe approach to avoiding system errors 29.
In this study, few prescriptions analyzed contained the correct and complete specifications, which are paramount for treatment success. The literature affirms that most hospitals do not have a computerized physician order entry system yet, and for this reason the incorporation of the pharmacist into the health care team is a more feasible alternative to checking prescription completeness to avoid these errors 14,30,31. Although it saves time and space, using abbreviations may sometimes turn out to be very expensive, as they may be misinterpreted, have double meanings, be confusing and give rise to errors 32,33,34.
Some studies mentioned difficulties in making the following distinctions on handwritten prescriptions: comp (tablets) vs.
In 2007, ANVISA discussed the establishment of standards for abbreviations in prescriptions 36. Hence, prescribers should avoid frequent abbreviations and, if necessary, only use standardized versions 37,38. It may cause confusion, which goes against the Brazilian medical ethics code which establishes that the doctor is responsible for prescribing clearly and legibly and, therefore, without erasures 40. Despite this, previous studies showed that erasures are common in Brazilian prescriptions 13,20,35.
However, this alternative has to be evaluated by the pharmacist or nurse for both logistical and safety reasons 26. The omission of this information may cause the interruption of drug administration before the foreseen treatment duration. In the case of antibiotics, for instance, the interruption before the foreseen treatment duration may cause bacterial resistance and the inability to use subsequently the same antimicrobial agent 30. Based on this, nurses and pharmacists, although they are not directly responsible for prescribing drugs, should know all aspects and phases involved in the process, collaborating with physicians to prevent errors that negatively affect the patients 26. These results may not be generalizable to other hospital settings where there are no medical residency programs. There is a chance that during this week prescribing errors occurred more frequently than they occur on average. The gravity of this situation is worsened by the fact that the four hospitals are referral institutions in the SUS and, mainly, responsible for training future health care providers.
Therefore, physicians, pharmacists and nurses should work together, discuss and propose strategies to avoid the most common prescription errors, contributing to the structure of a safer medication system for Brazilian patients. Nuevas iniciativas para mejorar la seguridad de la utilización de los medicamentos en los hospitales. The epidemiology of prescribing errors: the potential impact of computerized prescriber order entry.
Medication errors: a prospective cohort study of hand-written and computerised physician order entry in the intensive care unit. Medication errors in hospitals: computerized unit dose drug dispensing system versus ward stock distribution system.
Implementation of a computerized physician medication order entry system at the Academic Medical Centre in Amsterdam. ASHP National Survey of Pharmacy Practice in Hospital Settings: prescribing and transcribing - 2004. How can information technology improve patient safety and reduce medication errors in children's health care?



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Comments

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    14.07.2015