Construção e validação de checklist de preparo e administração de medicamentos endovenosos em unidade de terapia intensiva adulto

Abstract

Background: Drug therapy is a resource frequently used in the Intensive Care Unit (ICU) during the care of critically ill patients, who receive at least twice as many medications as those hospitalized in general sectors, increasing their exposure to errors. It is essential for this activity to be based on recommendations for safe practices in order to reduce adverse events related to drugs that have a high prevalence in ICUs. One of the strategies to control these events is the use of checklists as they systematize and assist in the safe execution of procedures. However, no validated instruments were found to assess the process of preparing and administering drugs in patients admitted to an adult ICU, making evident the need to develop and validate the content of a checklist capable of evaluating these processes. Objective: Develop and validate the content of a checklist to assess the processes of preparation and administration of intravenous drugs in patients admitted to an adult intensive care unit. Methodology: This is a methodological study of content validation. The population was composed of researchers with theoretical and practical knowledge in the areas of interest and publications on the subject in the last five years and by nurses with experience in adult intensive care, postgraduate in the area or in Patient Safety, totaling 77 guests. Two phases of individual evaluation of the instrument and one phase of group evaluation were carried out using the focus group technique. The analysis occurred by calculating the Agreement Rate and the Content Validity Index (CVI), and items with CVI ≥ 0.90 were considered apt to compose the instrument. Results: The construction of the checklist was based on technical documents from the Ministry of Health, generating 25 items divided into 3 domains, namely: I- Drugs Prescription with 2 items, II- Preparation of Intravenous Medicines with 7 items and III- Administration of Intravenous Medicines with 16 items. From the 77 invited experts, 34 (44.2%) participated in the first phase. Of these, half (50.0%) had specialization in intensive care and 32.0% were masters. The median length of experience in an adult ICU was 7 years. More than half (56.0%) worked in the assistance area, 47.0% with teaching and research and 21.0% in management. The second stage had half of the experts from the initial stage (17) and of these, seven participated in the focus group. From 33 elements evaluated, including titles, layouts, instructions for completion, the items themselves, as the domains and the instrument as a whole, 24 reached CVI ≥ 0.90 with the assessments of clarity, relevance and comprehensiveness by the Likert scale. The nine items that presented CVI < 0.9, one related to the title of the manual and eight other items, were evaluated in a focus group and included in the final version of the checklist. Conclusion: At the end of the study, a checklist with content validity was built and is ready for clinical validation, with a future possibility to guide the process of preparation and administration of intravenous drugs in the ICU, providing a quality and safe care to critical patients.