Preditores de incorreçao na prescrição de antimicrobianos no Hospital Estadual Bauru (Bauru, São Paulo)
Carregando...
Data
2010-09-02
Autores
Kawanami, Gustavo Hideki [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
O uso incorreto de antimicrobianos nos hospitais tem impacto negativo sobre o prognóstico dos pacientes e está associado à emergência e disseminação de microorganismos multidroga-resistentes. Programas de supervisão do uso de antimicrobianos (PSA) têm sido instituídos com o objetivo de promover a qualidade da prescrição desses medicamentos no hospital. Nesse contexto, a identificação de padrões de incorreção na prescrição de antimicrobianos é uma ferramenta valiosa para os PSA, pois permite o direcionamento de ações educativas e restritivas. Com esse objetivo, foi realizado um estudo no Hospital Estadual Bauru, um hospital de ensino de 285 leitos ligado à Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. O hospital possui um PSA ativo desde sua inauguração, em 2002. Foram selecionadas 25% das solicitações de antimicrobianos de uso parenteral do ano de 2005. Excluíram-se as solicitações para uso profilático. Todas as demais foram submetidas a análise, utilizando uma versão modificada de critérios clássicos propostos por Kunin & Jones. Análises uni e multivariadas foram realizadas para identificar preditores para incorreção em geral e para erros específicos. Prescrições consideradas “apropriadas” ou “provavelmente apropriadas” foram selecionadas como controles em todas as etapas do estudo. Em 963 solicitações incluídas no estudo, 34,6% apresentavam alguma incorreção. Os preditores gerais de erro foram: prescrição em fins de semana ou feriados (OR=1,67, IC95%=1,20-2,28, p=0,002), pacientes de Unidades de Terapia Intensiva(OR=1,57, IC95%=1,11-2,23, p=0,01), infecção peritoneal (OR=2,15, IC95%=1,27-3.65, p=0,004) ou de trato urinário (OR=1,89, IC95%=1,25-2,87, p=0,002), terapia com combinação de dois ou mais antimicrobanos (OR=1,72, IC95%=1,15-2,57, p=0,008) e prescrições incluindo penicilinas...
The inappropriate use of antimicrobials in hospitals has negative impact on patients’ outcomes and is associated with the emergence and spread of multidrug-resistant microorganisms. Antimicrobial stewardship programs (ASPs) have been instituted in order to improve the quality of prescriptions in hospitals. In this setting, the identification of patterns of inappropriate antimicrobial prescription is a valuable tool that allows ASPs to identify priorities for directing educative/restrictive polices. With this purpose, a study was conducted in Hospital Estadual Bauru (HEB), a teaching hospital with 285 beds affiliated to Faculdade de Medicina de Botucatu (Botucatu School of Medicine), Universidade Estadual Paulista (São Paulo State University). HEB maintains an active ASP since it was opened, in 2002. We selected 25% of requests of parenteral antimicrobials (RPAs) from year 2005 for analysis. Prescriptions for prophylactic purposes were excluded. All other RPAs were classified according to a modification of classic Kunin & Jones categories. Univariate and multivariable analysis was performed to identify predictors of general inappropriateness and of specific prescription errors. Prescriptions classified as “aproppriate’’ or “probably appropriate” were selected as controls in all stages of the study. Among 963 RPAs included in out study, 34.6% were inappropriate. General predictors of inappropriateness were: prescription on weekends/holidays (OR=1.67, 95%CI=1.20-2.28, p=0.002), patient from Intensive Care Unit (OR=1.57, 95%CI=1.11-2.23, p=0.01), peritoneal (OR=2.15, 95%CI=1.27-3.65, p=0.004) or urinary tract infection (OR=1.89, 95%CI=1.25-2.87, p=0.002), combination therapy with two or more antimicrobials (OR=1.72, 95%CI=1.15-2.57, p=0.008) and prescriptions including penicillins (OR=2.12, 95%CI=1.39-3.25, p=0.001) or first-generation cephalosporins... (Complete abstract click electronic access below)
The inappropriate use of antimicrobials in hospitals has negative impact on patients’ outcomes and is associated with the emergence and spread of multidrug-resistant microorganisms. Antimicrobial stewardship programs (ASPs) have been instituted in order to improve the quality of prescriptions in hospitals. In this setting, the identification of patterns of inappropriate antimicrobial prescription is a valuable tool that allows ASPs to identify priorities for directing educative/restrictive polices. With this purpose, a study was conducted in Hospital Estadual Bauru (HEB), a teaching hospital with 285 beds affiliated to Faculdade de Medicina de Botucatu (Botucatu School of Medicine), Universidade Estadual Paulista (São Paulo State University). HEB maintains an active ASP since it was opened, in 2002. We selected 25% of requests of parenteral antimicrobials (RPAs) from year 2005 for analysis. Prescriptions for prophylactic purposes were excluded. All other RPAs were classified according to a modification of classic Kunin & Jones categories. Univariate and multivariable analysis was performed to identify predictors of general inappropriateness and of specific prescription errors. Prescriptions classified as “aproppriate’’ or “probably appropriate” were selected as controls in all stages of the study. Among 963 RPAs included in out study, 34.6% were inappropriate. General predictors of inappropriateness were: prescription on weekends/holidays (OR=1.67, 95%CI=1.20-2.28, p=0.002), patient from Intensive Care Unit (OR=1.57, 95%CI=1.11-2.23, p=0.01), peritoneal (OR=2.15, 95%CI=1.27-3.65, p=0.004) or urinary tract infection (OR=1.89, 95%CI=1.25-2.87, p=0.002), combination therapy with two or more antimicrobials (OR=1.72, 95%CI=1.15-2.57, p=0.008) and prescriptions including penicillins (OR=2.12, 95%CI=1.39-3.25, p=0.001) or first-generation cephalosporins... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Antimicrobianos - Uso, Infeccão hospitalar - Prevenção e controle, Medical prescriptions, Quality of health care
Como citar
KAWANAMI, Gustavo Hideki. Preditores de incorreçao na prescrição de antimicrobianos no Hospital Estadual Bauru (Bauru, São Paulo). 2010. 90 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2010.