Mapping the medication system: Fragilities and risk management

30^th World Congress on Advanced Nursing Practice

September 04-06, 2017 | Edinburgh, Scotland

Cris Renata Grou Volpe, Athos Fhellipe Batista de Souza, Valdiane Dutra Oliveira and Diana Lucia Moura Pinho

University of Brasilia, Brazil

Posters & Accepted Abstracts: Adv Practice Nurs

Abstract :

Safety systems that aim to prevent medication error are essential. The objective was to describe and map the medication system of a large hospital in Brasilia, DF Brazil, proposing risk management strategies for its main fragilities. This is a cross-sectional, exploratory and descriptive study. Data collection was performed with the support of two nurses trained by the researcher. Direct observations and semi-structured interviews were carried out among the professionals involved in the medication system, covering the following processes: prescription, dispensation, preparation and administration of medications. The data collection period was 15 days and occurred in May/June 2013. Eight nursing technicians participated in the study, who are responsible for the preparation and administration of the drugs in this study. This study was approved by the Ethics Committee of the Health Department of the Federal District. 34 activities developed by different professionals were identified which shows its complexity and greater possibility of error. Fragilities such as disruptions, displacements, environmental problems, human resources, lack of patient identification, infrastructure, non-compliance with safety rules and protocols, technical failures during preparation and administration, and deficiencies in compliance with rules and protocols have been identified. It is concluded that the more computerized the process, the less fragilities the same presents. In this sense, it is necessary to implement risk management strategies and the use of technologies for the detection and reduction of risks, in order to guarantee the quality of the processes executed.