Avaliação da associação entre admissão em fim de semana, evento adverso relacionado ao uso de medicamento e morte intra-hospitalar em hospital universitário de Belo Horizonte

Abstract

ABSTRACT

Introduction: Patient safety in the care setting during hospitalizations has been a well-discussed issue at the global level. Objective: The objective of this study was to investigate the association between weekend effects, adverse drug events and in-hospital death among patients hospitalized at a university hospital in Belo Horizonte, MG. Methods: This is a prospective cohort study conducted with the participation of 1,151 patients, 18 years of age or older, hospitalized at the university hospital between October 4 and November 2, 2016 in many wards (Clinic, Surgery, Intensive care, Gynecology). The end “intrahospital death” was obtained in the hospital’s administrative bases. Hospital admissions occurred between 7:00 pm on Friday until 7 am on Monday were considered as weekend admissions. For the definition of EAM, trigger tools proposed by the Institute for Healthcare Improvement (IHI) adapted to the local reality were used. These triggers are tools that can indicate the presence of an EAM, making chart reviews more objectives and directed (altered laboratory examination, medications used to neutralize or treat adverse events and reports from the clinical staff). The search for the adverse drug events was did daily through review of medical records, prescriptions and asks to other involved professionals in care. This search was made by academics from pharmacy, medicine (thirty scientific initiation students), doctors, nurses. In case with positive trigger, a pharmacist and a medical Clinic specialist reviewered to find a real plausibility, to confirm or to delete this case. A multivariate logistic regression model was made to investigate the association between the ends from the study (a model to adverse drugs events and a model to intrahospital death) and the weekend effect adjusted for the variables of the patients and of the care. Results: The median age from these patients was 52 years. The most part were women. Considering 1151 the total sample, were 315 (27,36%) weekend admissions, and 836 (72,4%) admissions on working days. Were 67 (5,82%) deaths and adverse drugs events occurred in 154 (13,37%) patients. The biggest intrahospital death risk was associated with: age (OR 1,028 and CI 1,010 to 1,047); degree of comorbidities (OR 1,357 and CI 1,232 to 1,505); length of stay (OR1,014 to CI 1,007 to 1,021). The biggest chance of adverse drugs events occurs was associated with: length of stay (OR1,008 and CI 1,003 to 1,013); type of stay (OR 3,880 and CI 1,202 to 12,527); degree of comorbidities (OR1,191 and CI 1,098 to 1,291). A significant association between weekend admissions, adverse drugs events and intrahospital deaths didn’t occur. Conclusion: Was not observed weekend effect on intrahospital death or on adverse drug events.

Key words: weekend effects; adverse drug events; intrahospital death.