Napake medicinskih sester pri uporabi zdravil v enotah intenzivne terapije : diplomsko delo

Škrjanec, Žan (author), Mlinar, Suzana (mentor), Ovijač, Darja (reviewer)

Uvod: Napake pri uporabi zdravil so resen in zapleten problem v klinični praksi, zlasti v enotah intenzivne terapije, kjer imajo lahko pacienti zaradi kritične narave bolezni in farmakoterapevtskih programov, ki se pri njih izvajajo, zelo resne posledice. Namen: Namen diplomskega dela je s pomočjo relevantne literature ugotoviti, katere napake pri uporabi zdravil se v največji meri pojavljajo med medicinskimi sestrami in zdravstveniki, ki so zaposleni v enotah intenzivne terapije, in katere intervencije v zdravstveni negi bi lahko te napake preprečile oziroma zmanjšale. Metode dela: V diplomskem delu smo uporabili opisno metodo dela pregleda literature, ki je v večini temeljila na tuji strokovni literaturi. Iskanje literature je potekalo s pomočjo ključnih besed: »medicinske sestre« IN »napake pri uporabi zdravil v enoti intenzivne terapije« / »nurses« AND »ICU medication errors«, »medicinske sestre« IN »intervencije za zmanjševanje napak pri uporabi zdravil« / »nurses« AND »interventions to reduce medication errors« ter »medicinske sestre« IN »prijavljanje napak pri uporabi zdravil« / »nurses« AND »reporting medication errors«. Rezultati: Podrobno smo pregledali 11 enot literature. Najpogostejše napake pri uporabi zdravil so bile napačen odmerek zdravila, napačen časovni interval aplikacije in napačna hitrost pretoka infuzije. Vzroki za napake pri uporabi zdravil so bili utrujenost in preobremenjenost medicinskih sester, pomanjkanje farmakološkega znanja, napake pri prepisovanju zdravnikovih naročil, moteči dejavniki pri delu. Za izboljšanje prijavljanja napak pri uporabi zdravil bodo morale glavne medicinske sestre in ostalo osebje razviti varno okolje za medicinske sestre, ki ne bo obtoževalo in kaznovalo medicinskih sester, ki bodo napako prijavile. Razprava in zaključek: Medicinske sestre imajo ključno vlogo pri preprečevanju napak pri uporabi zdravil, saj so tiste, ki zdravila pripravljajo in aplicirajo. Z rednimi izobraževanji medicinskih sester, uvedbo kliničnega farmacevta v proces dela in z uvedbo elektronskih zdravnikovih naročil za zdravila, namesto, da medicinske sestre prepisujejo naročila, bi lahko že v veliki meri zmanjšali napake pri uporabi zdravil. Na področju preprečevanja in zmanjševanja napak pri uporabi zdravil je še veliko prostora za napredek, predvsem v ustvarjanju varnega okolja za sporočanje o napakah pri uporabi zdravil.

• Language: Slovenian
• Keywords: diplomska dela, zdravstvena nega, EIT, medicinske sestre, napake, zdravila, poročanje
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [Ž. Škrjanec]
• Year: 2024
• Number of pages: 34 str.
• PID: 20.500.12556/RUL-158899
• UDC: 616-083
• COBISS.SI-ID: 199738627
• Publication date in RUL: 22.06.2024

ŠKRJANEC, Žan, 2024, Napake medicinskih sester pri uporabi zdravil v enotah intenzivne terapije : diplomsko delo [online]. Bachelor’s thesis. Ljubljana : Ž. Škrjanec. [Accessed 30 March 2025]. Retrieved from: https://repozitorij.uni-lj.si/IzpisGradiva.php?lang=eng&id=158899

Secondary language

• Language: English
• Title: Medication errors between nurses in intensive care units : diploma work

Abstract

Introduction: Errors in medicine administration are a serious and complicated problem in clinical practice, especially in intensive therapy units, where patients may suffer highly serious consequences due to the critical nature of their disease and pharmacotherapeutic programs performed there. Purpose: The aim of this paper was to determine, based on relevant literature, what errors in medicine administration are the most common among nurses working in intensive therapy units and what healthcare interventions could prevent or reduce these errors. Methods: In this paper, we used the descriptive method of literature overview, which was mostly based on foreign professional literature. Literature was searched using the following keywords: »medicinske sestre« IN »napake pri uporabi zdravil v enoti intenzivne terapije« / »nurses« AND » ICU medication errors«, »medicinske sestre« IN »intervencije za zmanjševanje napak pri uporabi zdravil« / »nurses« AND »interventions to reduce medication errors«, ter »medicinske sestre« IN »prijavljanje napak pri uporabi zdravil« / »nurses« AND »reporting medication errors«. In total, 11 articles were analysed. Results: The most common errors in medicine administration were inaccurate medicine dose, inaccurate application interval and inaccurate infusion flow rate. The reasons for these errors in medicine administration were tiredness and overwhelmingness of nurses, the lack of pharmacological knowledge, errors in transcribing doctor's orders, disturbing factors in intensive therapy units, etc. In order to improve the reporting of errors in medicine administration, head nurses and other personnel will have to develop a safe environment for nurses in which nurses will not be accused of and punished for reporting an error. Discussion and conclusion: Nurses play a key role in preventing errors in medicine administration, as they are the ones who prepare and also administer these medicines. Errors in medicine administration could be reduced to a great extent by providing regular training of nurses, introducing a clinical pharmacist in the work process in intensive therapy units and implementing electronic doctor's orders for medicines instead of having nurses transcribe the orders manually. When it comes to preventing and reducing errors in medicine administration, there is still a lot of room for improvement, especially in regard to creating a safe environment to report errors in medicine administration.

• Keywords: diploma theses, nursing care, intensive therapy units, nurses, errors, medicines, reporting