Elaboração de manual para medicamentos orais administrados via sonda em Unidade de Terapia Intensiva (UTI) neonatal

Abstract

Neonatal Intensive Care Units (NICU) accommodate several health professionals, working together to ensure comprehensive care for patients. Since the 1990s, the pharmaceutical professional has been proposed as one of the fundamental members of the multidisciplinary team caring for critically ill patients. The challenge of safe and appropriate drug use in the neonatal period is daunting and is made more complicated by the notorious lack of evidence based data to guide decision-making. The present work aimed to develop a manual for the use of oral medications prescribed for administration via tube to hospitalized patients, to support the development of a guidance instrument for the multidisciplinary team. This is a documentary study of a descriptive, analytical and retrospective nature with a quantitative approach, where data were analyzed from medical prescriptions from the NICU in the period from January 1, 2020 to December 31, 2021, excluding newborns with length of stay of less than 24 hours and/or who did not have a prescription for medication to be administered via a tube and nursing report forms. During the study, 633 newborns were admitted to the NICU, of which 23.5% were excluded due to a length of stay of less than 24 hours, 18.4% due to lack of information in the medical record and 34.1% because they did not have a medication prescription via tube. In this sense, the study population consisted of 151 newborns, of which 53.6% were male and 46.4% were female, the majority of which were born through surgical delivery (59.6%). This population weighed between 750g and 4,515g, with the statistically significant majority being underweight (59.6%), followed by those with very low weight (23.8%). The average stay in the ICU was 12.6 days, with a minimum of 2 days and a maximum of 40 days. Furthermore, the most prevalent diagnosis was prematurity, which reached 72.2%, with 47.7% of isolated prematurity and 24.5% of prematurity plus Respiratory Distress Syndrome (RDS), with the proportion of prematurity being statistically significant in in relation to other diagnoses. Almost 50% of newborns were prescribed three or more medications, where it was found that the most prescribed medications were antiphysetics and antiemetics (Simethicone/Domperidone: 42.2 and Bromopride: 24.6%), the most frequent pharmaceutical form was liquid (90.7%), and can be administered through a tube (98.0%), without interacting with medication (98.0%) or with diet (parenteral nutrition) (89.4%). In nursing reports, 79.2% stated that they had prepared/administered a medication prescribed for administration via tube and 73% of professionals stated that they had doubts regarding the preparation and administration of medications. The most frequent question was about administration (10 out of 14-71.4%). There were also doubts regarding dilution and incompatibility of the medicine (35.7% both), as well as preparation, crushing and closing time (21.4% each). Therefore, the need to develop a Manual that will contribute as a tool for good practices in the administration of medications via tube stands out, as a tool aimed mainly at the nursing professional, an active participant in this process.