Descrição da implementação de um processo de qualificação do sistema de medicação de uma instituição de longa permanência para idosos.

Abstract

The accelerated aging process has changed the morbidity and mortality profile, leading to an increase in the prevalence of chronic non-communicable diseases, fragilization of aging and an increase in the demand for long-term care facilities for older people (LTCF). In these institutions, it is common for residents to use multiple medications, which increases the complexity of care and the risk of medication errors. Therefore, the qualification of medication systems and practices in LTCF is very important, but studies on the subject in Brazil are still scarce. Thus, the objective of the present study was to describe the implementation of the qualification of the medication system of a large philanthropic LTCF and evaluate its effectiveness. To this end, a hybrid longitudinal effectiveness-implementation study of type 2 was carried out. Initially, an immersion and recognition of the medication system was carried out, which included the diagnosis and mapping of its stages, and the response of LTCF professionals to an electronic questionnaire about the aforementioned system. Afterwards, an individualized distribution system with unit dose was implemented and the medication system´s flow was adjusted to the previously mapped LTCF reality. The effectiveness of the qualification was assessed by comparing the following factors in the pre- and post-qualification periods: 1) time spent on the steps of the medication system; 2) strengths and flaws. The initial mapping demonstrated multiple flaws in the medication system; however, the answers to the questionnaire were contradictory to what was identified, signaling a lack of knowledge about safe medication practices. Qualification allowed improvements in all stages of the medication system: 1) reduction in the number of prescription transcriptions; 2) reduced risk of drug shortages with outsourced acquisition; 3) improvement of organization, dynamics and traceability in distribution, preparation and administration. A reduction of an average of 3 hours and 57 minutes in the time spent distributing, preparing and administering medications was also identified. The qualification of the medication system proved to be effective, improving the safety in the use of medications in ILPI and increasing the availability of time for professionals to focus more on the care and support of older people. However, the search for a process of continuous improvement must be the objective of this type of facility, which includes increasing awareness about patient safety and safe medication practices.