SAFETY PROTOCOL ON MEDICATION PRESCRIPTION, USE AND ADMINISTRATION: MAPPING OF NURSING INTERVENTIONS

Camargos, Raíssa Guimarães Fonseca; Azevedo, Cissa; Moura, Caroline de Castro; Manzo, Bruna Figueiredo; Salgado, Patrícia de Oliveira; Mata, Luciana Regina Ferreira da

doi:10.1590/1980-265X-TCE-2020-0511

Brasil

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Original Article • Texto contexto - enferm. 30 • 2021 • https://doi.org/10.1590/1980-265X-TCE-2020-0511 linkcopy

SAFETY PROTOCOL ON MEDICATION PRESCRIPTION, USE AND ADMINISTRATION: MAPPING OF NURSING INTERVENTIONS

PROTOCOLO DE SEGURIDAD PARA LA PRESCRIPCIÓN, EL USO Y LA ADMINISTRACIÓN DE MEDICAMENTOS: MAPEO DE INTERVENCIONES DE ENFERMERÍA

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: to analyze the correspondence between actions contemplated in the safety protocol on medication prescription, use and administration of the Ministry of Health with interventions of the Nursing Interventions Classification, by means of cross-mapping.

Method: a descriptive study developed in four stages: extraction of the protocol’s Nursing actions; identification of the interventions of the Nursing Interventions Classification; cross-mapping; and cross-mapping validation by experts.

Results: 61 actions of the protocol and 32 interventions of the Nursing Interventions Classification were identified. After two rounds of mapping analysis by the experts, correspondence was identified between 53 actions and seven interventions. The interventions that presented the highest correspondence were the following: Medication Administration, Medication Management and Medication Prescription. Of the 53 mapped actions of the protocol, 56,6% were considered more detailed and specific than the activities of the interventions, 20,8% were classified as similar in meaning, 17,0% as broader and general, and 5,7% were only mapped with the title and definition of the intervention.

Conclusion: the mapped actions of the protocol were considered more detailed and specific in relation to the activities of the interventions of the Nursing Interventions Classification. The unmapped interventions can contribute to elaborating operational protocols that expand the Nursing actions related to the mitigation of medication errors.

DESCRIPTORS: Standardized terminology in Nursing; Patient safety; Medication errors; Drug treatment management; Nursing team; Strategies

Mapping classification	NIC intervention	Protocol's Action
A - Identical terms	Medication Administration Activity: following the five “rights” of medication administration.	Following the five “rights” of medication administration.^*
B - Similar terms	Medication Administration Activity: maintaining the institution's policies and procedures for accurate and safe administration of medications.	Updating standard operating procedures regarding the medication use process.
C - General and broad terms	Medication Administration Activity: monitoring vital signs and laboratory values before medication administration, when possible.	Recording all suitable monitoring parameters (vital signs, blood glucose).
D - Detailed and specific terms	Medication Prescribing Activity: consulting with physician or pharmacist, as appropriate.	Clarifying any questions under Nursing, prescriber or pharmacist supervision prior to administering the medication.

Characterization of the sample	n	%
Professional experience
5-10 years	2	40.0
10-20 years	2	40.0
20-40 years	1	20.0
Scientific activities on the theme of patient safety and Nursing classification systems
Publications in A1/A2/A3/B1 qualis journals	4	80.0
Presentation of papers in national or international scientific events	4	80.0
Theme in master's dissertation or PhD thesis	2	40.0

NIC^* intervention code	Title of the NIC^* intervention	Number of actions mapped n (%)
2300	Medication Administration	37 (69.8)
2380	Medication Management	19 (35.8)
2390	Medication Prescribing	16 (30.2)
2314	Medication Administration: Intravenous (IV)	3 (5.7)
2395	Medication Reconciliation	3 (5.7)
2301	Medication Administration: Enteral	1 (1.9)
5616	Teaching: Prescribed Medication	1 (1.9)

Categories - Protocol's Actions	NIC^* Code Classification
Medication Administration	2300/ 2380 A^†
Performing double-check before medication administration (especially in Pediatrics, Oncology and Intensive Care Unit).	2300/ 2380 A^†
Checking the nine “rights” in medication administration (right patient, right medication, right route, right time, right dose, right record, right action, right way, and right answer).	2300 D^\|\|
Verifying if the patient corresponds to the name identified in the bracelet, to the name identified in the bed and to the name identified in the medical record.	2300 D^\|\|
Knowing the patients and their allergies, checking if they are not allergic to the medication prescribed.	2300/ 2390 B^‡
Washing hands before preparing and administering the medication.	2300 D^\|\|
Verifying if the diluent (type and volume) was prescribed and if the infusion rate was established, by analyzing its compatibility with the administration route and with the medication in case of intravenous administration.	2314/ 2390 A^†
Identifying in the patients what the correct connection is for the administration route prescribed in case of administration through nasogastric tube, nasoenteric tube or parenteral route.	2300/ 2380 D^\|\|
Performing antisepsis of the application site for medication administration to be done parenterally, intravenously or through other routes.	2314 C^§
Clarifying any doubts under Nursing, prescriber or pharmacist supervision prior to administering the medication.	2300/ 2390 D^\|\|
Evaluating the compatibility of medications and medical products used in medication administration (syringes, catheters, tubes, equipment, and others) in manuals, databases for consultation or with a pharmacist.	2300 D^\|\|
Preparing the medication at the right time and in accordance with the manufacturer's recommendations, ensuring its stability.	2300/ 2380 A^†
Instructing the patient about which medication is being administered (name, color, format), reason for the indication, administration frequency, expected effects and those that require follow-up and monitoring.	2300/ 5616/ 2380/ 2390 B^‡
Checking the drip rate, programming and operation of the continuous infusion pumps in case of continuous infusion medications.	2314 B^‡
Instituting the double-check practice by two professionals for calculating the dilution and administration of potentially dangerous or high-surveillance medications.	2380 A^†
Not administering medication in cases of vague prescriptions, such as: “do if necessary”, “according to medical order” or “under medical criteria”.	2300 D^\|\|
Recording the administration time for the medication in the prescription.	2300 C^§
Recording all instances related to the medications, such as delays, cancellations, shortage, patient refusal and adverse events.	2300/ 2380 C^§
Checking whether the pharmaceutical form and administration route prescribed are appropriate for the patient's clinical condition.	2300/ 2380/2395 D^\|\|
Performing medication crushing and suspension for administration through a nasogastric or nasoenteric tube, if necessary.	2301 D^\|\|
Following the institution's protocol regarding the preparation of patients for exams or fasting that may interfere in the administration of the medication.	2300 D^\|\|
Not administering or delaying the administration of doses without discussing such course of action with the prescriber in case of preparing patients for exams or fasting.	2380/ 2390 D^\|\|
Tailoring the medication administration schedules to the routine use already established by the patient before hospitalization, whenever possible.	2300 A^†
	2380 B^‡
Avoiding, as far as possible, drug-drug and drug-food interactions when performing medication scheduling.	2300/ 2380 D^\|\|
	2390 A^†
Following the institutional protocol regarding the care measures, so that there is no administration of medications suspended by the physician.	2300 D^\|\|
Organizing a suitable location for preparing the medications, preferably without distraction sources, and that allows the professional to concentrate on the activity being performed.	2300 B^‡
Taking to the location, at the medication administration time, only what is prescribed to a single patient, not using a tray containing several medications for different patients.	2300 D^\|\|
Preparing the medication immediately before administration, unless there is a special manufacturer's recommendation for a different procedure.	2300 A^†
Medication Prescribing	2390 C^§
Clarifying the prescription legibility doubts directly with the prescriber.	2390 C^§
Paying attention to the doses written with “zero”, “comma” and "point", checking the doubts regarding the desired dose with the prescriber, since they can result in doses being ten or 100 times higher than the desired.	2390 D^\|\|
Consulting the prescriber and asking for the prescription of a metric system unit of measure in case of doubt or inaccurate measurements.	2390 B^‡
Requesting more information to the prescriber in case of vague guidelines, such as “do if necessary”, “according to medical order” or “under medical criteria”.	2390 D^\|\|
Following the institutional protocol regarding verification of the prescriptions during handoff.	2300 D^\|\|
Following the Nursing prescription for the use of infusion pumps for safe medication administration.	2300 D^\|\|
Using typed and electronic prescriptions in order to improve their readability.	2390 B^‡
Prescribing medications without using abbreviations.	2390 B^‡
Recording in the prescription any information considered relevant so that patient care is safe and effective.	2390 C^§
Medication Monitoring and Management	2390/2380 2395 C^§
Identifying, at admission, the medications used by the patient before hospitalization.	2390/2380 2395 C^§
Instructing the patient not to stay with their medications in the hospital unit, in view of the risk of using duplicate doses.	2380 D^\|\|
Observing actions, interactions and side effects of the medications.	2380/2300 2390 C^§
Recording the following in the medical record: adverse reactions, side effects or medication errors described by the patient/caregiver or observed by the team.	2300 D^\|\|
Observing the patient carefully to identify, whenever possible, if the medication had the desired effect.	2300/ 2380 B^‡
Maintaining clear communication with the patient and/or caregiver.	2380/2300 2395 C^§
Recording all suitable monitoring parameters (vital signs, blood glucose).	2300/ 2380 C^§
Proposing a routine for internal and external transfer of patients that contemplates safety in the medication use process during the patient's transfer.	2300 D^\|\|
Medication Distribution and Storage	2300 D^\|\|
Maintaining in the hospitalization units only the potentially dangerous or high-surveillance medications that are strictly necessary for patient care.	2300 D^\|\|
Standardizing the adequate storage and complete and clear identification of all the medications that are under the care of the Nursing team.	2300 D^\|\|
Monitoring the temperature of the medication packaging refrigerator, daily observing the minimum and maximum temperature parameters, verifying doubts with the pharmacist.	2300 D^\|\|
Maintaining an adequate record of the vials of medications prepared that will be stored (with handling date and time, medication concentration, and name of the person in charge of preparation and validation).	2300 D^\|\|
	2380 A^†
Returning non-administered medication leftovers to the pharmacy.	2300/ 2380 D^\|\|
Control of the Medication Error Risk	2300 B‡
Establishing medication administration institutional protocols.	2300 B‡
Updating standard operating procedures regarding the medication use process.	2300 B^‡
Discussing the prevention of drug interactions with the multidisciplinary team (physician, pharmacist and nutritionist).	2380/ 2390 D^\|\|
Updating guides for the prevention of incompatibilities between drugs and medication solutions and dilution guides.	2300 D^\|\|

Nursing Interventions Classification	Protocol
1. Analgesic Administration (2210)	1. Supervising the preparation and administration of medications carried out by nursing technicians and assistants^†
2. Analgesic Administration: Intraspinal (2214)	2. Notifying the prescription errors or adverse events in the care process to the health institution's Patient Safety Center/Risk Management^†
3. Anesthesia Administration (2840)	3. Preventing two patients with the same name from remaining hospitalized simultaneously in the same room or ward^†
4. Controlling central venous access device (4054)	4. Identifying allergic patients differently, with a bracelet and a warning in the medical record^†
5. Chemical Restraint (6430)	5. Monitoring the occurrence of errors in the activity of medication administration for patient care through indicators^†
6. Chemotherapy Management (2240)	6. Providing ongoing education and training on the safe use of medications to the team members^†
7. Hormone Replacement Therapy (2280)	7. Administering the medication using a verbal order only in case of emergency, employing a double-check method for administration with a written record of the verbal order^\|\|
8. Medication Administration: Ear (2308)	8. Prescribing medications with similar names prominently in the writing of the name section that differentiates them^‡
9. Medication Administration: Eye (2310)
10. Medication Administration: Inhalation (2311)
11. Medication Administration: Interpleural (2302)
12. Medication Administration: Intradermal (2312)
13. Medication Administration: Intramuscular (IM) (2313)
14. Medication Administration: Intraosseous (2303)
15. Medication Administration: Intraspinal (2319)
16. Medication Administration: Nasal (2320)
17. Medication Administration: Oral (2304)
18. Medication Administration: Rectal (2315)
19. Medication Administration: Topical (2316)
20. Medication Administration: Subcutaneous (2317)
21. Medication Administration: Vaginal (2318)
22. Medication Administration: Ventricular Reservoir (2307)
23. Patient-Controlled Analgesia (PCA) Assistance (2400)
24. Sedation Management (2260)
25. Thrombolytic Therapy Management (4270)

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Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
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[TFN1] ^*Hypothetic example: the “identical terms” comparison was not identified in the study.