Escolar Documentos
Profissional Documentos
Cultura Documentos
Introduo
Estudos apontam que um dos pontos mais crticos sade pblica mundial
est relacionado aos erros na prescrio, dispensao e administrao de
medicamentos
(14)
(1)
(3)
. Outro
estudo revela que 2,4 a 3,6% das admisses hospitalares so decorrentes de EAMs
e que 69% destes eventos poderiam ter sido evitados. J para pacientes internados,
a taxa de incidncia de EAMs varia de 0,7 a 6,5% e destes, de 17 a 56% tambm
poderiam ser evitados
(5)
(1)
(1)
(1,2,68)
. Atravs de um
(2,5,9)
(1,2)
(1,2,6)
. Os alertas computadorizados
nos SADC tem o potencial de reduzir erros na prescrio pela antecipao ao risco
da medicao causar algum EAM
(8)
(10)
(1,6)
(16)
(1,2,11)
Mtodo
OR
D050316
Electronic
Prescribing
Decision Support
OR Systems, Clinical OR
Medication
Errors
D055695
D020000
D008508
2014
AND
Alert Fatigue
Resultados e Discusses
(19)
ignorados,
especialmente
na
checagem
de
interao
Cancelamento de alerta
Tipo do Alerta
16,8
15,8
33,1
% alertas
cancelados
77,4
60,2
28,6
92
12
82
%
Inapropriado
8
88
18
12,4
24,4
88
12
2,7
69,7
69
31
6,7
2,5
10,1
79,0
78,0
85,0
39
12
57
60
85
43
% Alertas
Alergia do Paciente
Interao Medicamentosa
Duplicidade de Medicamentos
Interao entre Medicamentos e
Classes de Medicamentos
Interao entre Classes de
medicamentos
Sugesto baseada na idade *
Sugesto renal **
Substituio teraputica
Idoneidade do cancelamento
% Apropriado
Ttulo do Artigo
Nome do
Peridico
Ano de
publicao
Escopo
Physicians' Perceptions
on the usefulness of
contextual information for
prioritizing and presenting
alerts in computerized
physician order entry
systems
BMC Medical
Informatics
and Decision
Making
2012
Health affairs
(Project Hope)
2011
Preventability of adverse
drug events involving
multiple drugs using
publicly available clinical
decision support tools
American
journal of
health-system
pharmacy :
AJHP
2012
BMC medical
informatics
and decision
making
2013
Journal of the
American
Medical
Informatics
Association :
JAMIA
2013
Journal of the
American
Medical
Informatics
Association :
JAMIA
2012
International
journal of
medical
informatics
2013
Journal of the
American
Medical
Informatics
Association :
JAMIA
2010
BMC medical
informatics
and decision
making
2013
American
journal of
health-system
pharmacy :
AJHP
2013
Towards meaningful
medication-related clinical
decision support:
recommendations for an
initial implementation
Applied clinical
informatics
2011
Development of a context
model to prioritize drug
safety alerts in CPOE
systems
BMC medical
informatics
and decision
making
2011
High-priority drug-drug
interactions for use in
electronic health records
Journal of the
American
Medical
Informatics
Association :
JAMIA
2012
Drug-drug interactions
that should be noninterruptive in order to
reduce alert fatigue in
electronic health records
Journal of the
American
Medical
Informatics
Association :
JAMIA
2012
Tecnologia da Informao
e Comunicao e a
Segurana do Paciente
TIC Sade
2013
2013
Alerts
OHSU Clinical
Informatics
Wiki
2014
Alert fatigue
American
Journal of
Health-System
Pharmacy
2009
Development and
preliminary evidence for
the validity of an
instrument assessing
implementation of humanfactors principles in
medication-related
decision-support systems-I-MeDeSA.
Journal of the
American
Medical
Informatics
Association :
JAMIA
2011
Proposta
Filtro/supresso de alertas no
relevantes e no urgentes
(1,6,9,16,18)
clinicamente
Particularizao/Customizao
de alertas ao contexto/quadro
(1,2,6,16)
clnico do paciente
Desligamento de alertas
(6)
frequentemente cancelados
Detalhamento da proposta
A partir de uma anlise crtica dos alertas, identificar os que no
tm relevncia clnica, no urgente ou fora de contexto e
suprimir o acionamento destes alertas, limitando-se a interagir
com o usurio nos casos mais importantes.
Consiste em cruzar os dados da base de conhecimento dos
SADC com os dados clnicos dos pacientes, a fim de acionar
alertas apenas quando sejam relevantes ao quadro clnico de
cada paciente, reduzindo assim os falsos-positivo
A alta taxa de cancelamento dos alertas pode indicar a
irrelevncia da informao ali expressa. Aps anlise destes
alertas, se concludo que so irrelevantes a sade do paciente,
estes devem ser suprimidos.
Alertas com alta relevncia sade do paciente como
interaes medicamentosas graves e interaes do
medicamento com o quadro clnico do paciente que sejam
crticas, precisam de destaque e no podem ser suprimidos.
importante que haja a classificao e categorizao da base
de conhecimento dos SADC para apresentarem-se alertas em
consonncia com o que de fato o alerta representa. Alertas de
alta relevncia devem impedir o prosseguimento do usurio at
que se satisfaam as condies previstas. Alertas de relevncia
mdia devem interromper o fluxo, porm mediante a
confirmao do usurio, a prescrio deve ser prosseguida. J
alertas de baixa relevncia, no se recomenda que interrompa o
processo
Sensibilidade e Especificidade
(6,21)
dos SADC
Auditoria/Monitoramento/Medi
o da qualidade dos alertas
(6,8,13,20,22)
(6)
(15)
Concluses
Referncias
1.
Jung M, Riedmann D, Hackl WO, Hoerbst A, Jaspers MW, Ferret L, et al. Physicians
Perceptions on the usefulness of contextual information for prioritizing and presenting alerts in
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2.
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14.
Phansalkar S, Edworthy J, Hellier E, Seger DL, Schedlbauer A, Avery AJ, et al. A review of
human factors principles for the design and implementation of medication safety alerts in
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[Citado
2014
Out
7];21(3):48791.
Disponvel
em:
http://www.ncbi.nlm.nih.gov/pubmed/24166725