Carine Raquel Blatt

Objectives: To examine how patient experience (PX) has been defined, assessed, and reported in pharmacist-led services delivered in ambulatory care, and to identify experiential themes across service models. Methods: A systematic review was conducted and registered in PROSPERO (CRD42025635268), and the results were reported according to PRISMA 2020. MEDLINE (Ovid), Embase, and LILACS were searched from 1 January 2000 to 31 December 2024. Interventional and observational studies examining service users’ experiences with pharmacist-led ambulatory services beyond satisfaction measures were included. Inpatient and non–pharmacist-led services were excluded. Titles, abstracts, and full texts were independently screened by two reviewers, and data were extracted independently. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research, and confidence in findings was evaluated using GRADE-CERQual. Given the heterogeneity, a narrative synthesis was conducted, guided by a multidimensional experiential framework. Key findings: Twenty-three studies were included, predominantly qualitative (n = 18) and conducted in high-income countries (n = 22). Only two studies explicitly defined PX, and two used validated Patient-Reported Experience Measures. Three recurring themes were identified: trust (n = 18), accessibility (n = 14), and holistic and longitudinal care (n = 12). In-person services emphasized relational continuity, remote services prioritized convenience but raised concerns about impersonality, and hybrid models combined flexibility with continuity. Confidence in the review findings was high for trust, moderate for accessibility, and low to moderate for holistic and longitudinal care. Conclusions: PX in pharmacist-led ambulatory services is multidimensional yet inconsistently conceptualized and measured. Clearer operationalization and routine assessment may strengthen service evaluation and support sustainable implementation.

O objetivo do estudo é descrever a validação e implementação de um checklist de transporte intra-hospitalar do paciente crítico adulto. Realizou-se a validação do conteúdo do checklist por um painel de especialistas, através da Técnica Delphi, seguida de análise de consistência interna, utilizando o Alpha de Cronbach. Além disso, foram elaborados indicadores para o monitoramento do transporte intra-hospitalar do paciente crítico adulto. A versão final do checklist possui dez domínios: identificação do paciente, dispositivos invasivos, nível de consciência, hemodinâmica, equipamentos, monitorização pré-transporte, monitorização pós-transporte, intercorrências, medicamentos e contraste. Foram realizadas quatro rodadas para a validação de conteúdo e um índice de 0,845 de consistência interna foi obtido. Foram elaborados seis indicadores, sendo um de estrutura, quatro de processo e um de resultado. O instrumento elaborado foi validado e teve boa consistência interna. Os resultados da implantação do checklist indicaram boa aceitação pela equipe de enfermagem e apoio da coordenação do serviço, com destaque para a melhora na organização dos processos de transporte intra-hospitalar. Espera-se que com sua aplicação, possibilite a prevenção de eventos adversos no transporte intra-hospitalar.

O comportamento suicida representa um dos maiores desafios para a saúde pública global. Longe de constituir um evento isolado, configura-se como um processo complexo que abrange desde a ideação e o planejamento até a tentativa propriamente dita. Diante de sua natureza silenciosa e multifatorial, as instituições hospitalares devem oferecer uma resposta ágil, segura e isenta de julgamentos em consonância com as diretrizes da Organização Mundial da Saúde. No âmbito nosocomial, a prevenção efetiva depende de uma gestão de risco sistematizada, respaldada por ferramentas prospectivas como a Failure Mode and Effect Analysis (FMEA/HFMEA), decisivas para mapear falhas precocemente e evitar eventos sentinela. Paralelamente, faz-se indispensável a adequação da infraestrutura física pela restringir o acesso a meios letais e materiais perfurocortantes. Por fim, a centralidade do fator humano se manifesta na capacitação continuada da equipe multiprofissional, na simulação clínica e no exercício da escuta qualificada, pilares vitais para substituir abordagens reativas por um acolhimento protetivo, humanizado e reconstrutor. Desse modo, o objetivo do presente capítulo é descrever as estratégias de gestão de risco e as práticas de segurança do paciente aplicadas à prevenção do comportamento suicida no ambiente hospitalar/ambulatorial.

Objective: To describe the development of an educational technology aimed at nursing staff on safety in the preparation and administration of sedative, analgesic and vasoactive medications in critically ill patients. Methods: The ADDIE model of instructional design was followed. In the conception, three stages were carried out: analysis, design and development. During execution, the implementation stage took place. Results: The educational technology developed was a series of three videos called: nursing care in the preparation and administration of sedative, analgesic and vasoactive medications in critically ill patients. The first video addresses patient safety and medication errors, lasting five minutes and three seconds. The second presents the main safety precautions with sedative and analgesic medications, lasting seven minutes and 49 seconds. The third highlights safety precautions when using vasoactive drugs, lasting seven minutes and 55 seconds. All videos were made available on the YouTube® website. Conclusion: Educational videos based on scientific evidence can be used in the permanent and continuing education of the team, in supporting students, nursing technicians and nurses focused on the safety of critical patient care, allowing theory and practice to be linked.

Background: Drug-induced liver injury (DILI) is an important but underdiagnosed adverse drug reaction in hospitalized patients. The complexity of diagnosis, under-reporting, and a lack of standardized assessment tools contribute to underestimation of its prevalence. Objectives: To estimate the prevalence of DILI in a tertiary care hospital and to discuss the role of clinical pharmacists in using the Roussel Uclaf Causality Assessment Method (RUCAM) to detect, assess, and manage DILI. Methods: This cross-sectional study included patients who were admitted between January and June 2022 to a tertiary care hospital in Porto Alegre, Brazil. All hospitalized patients with alanine aminotransferase (ALT) levels at least 3 times the upper limit of normal at any point during the hospital stay were screened. Suspected cases of DILI were evaluated by trained pharmacists using the RUCAM. Data were collected retrospectively from electronic medical records and analyzed using descriptive and inferential statistics. Results: Of 56 014 patients admitted to the hospital during the study period, 1274 had elevated ALT, of whom 38 were classified by the RUCAM as having DILI. Among these, 33 (87%) experienced development of DILI during the hospital stay. Most of the patients (n = 29, 76%) were in general hospital wards, and this factor showed a significant association with occurrence of DILI. Anti-infectives were the most commonly implicated drugs (69%), specifically the combination of rifampicin, isoniazid, pyrazinamide, and ethambutol and various β-lactams. Simvastatin was also commonly implicated. None of the DILI cases were reported to the institutional pharmacovigilance system. Conclusions: DILI remains under-recognized and under-reported in hospital settings. This study reinforces the potential role of clinical pharmacists in active surveillance using RUCAM and highlights the need for institutional strategies prioritizing the monitoring of liver function in high-risk patients, particularly on general wards. Keywords: drug-induced liver injury, hospital pharmacy, patient safety, pharmacovigilance RÉSUMÉ Contexte : La lésion hépatique d’origine médicamenteuse (LHOM) est une réaction indésirable importante, mais souvent sous-diagnostiquée chez les patients hospitalisés. La complexité du diagnostic, la sous déclaration des cas et le manque d’outils d’évaluation standardisés contribuent à la sous-estimation de sa prévalence. Objectifs : Estimer la prévalence de la LHOM dans un hôpital de soins tertiaires et discuter du rôle des pharmaciens cliniciens dans la détection, l’évaluation et la prise en charge de la LHOM à l’aide de la méthode d’évaluation de la causalité Roussel Uclaf (échelle RUCAM). Méthodologie : Cette étude transversale comprenait des patients admis de janvier à juin 2022 dans un établissement de soins tertiaires à Porto Alegre, au Brésil. Tous les patients hospitalisés dont le taux d’alanine aminotransférase (ALT) était supérieur ou égal à trois fois la limite supérieure de la normale à un moment quelconque de l’hospitalisation ont été sélectionnés. Les cas suspects de LHOM ont été évalués à l’aide de l’échelle RUCAM par des pharmaciens formés. Les données ont été recueillies rétrospectivement à partir des dossiers médicaux électroniques et analysées à l’aide de statistiques descriptives et inférentielles. Résultats : Sur les 56 014 patients admis à l’hôpital pendant la période de l’étude, les taux d’ALT de 1274 patients étaient élevés, dont 38 qui ont été classés comme ayant une LHOM selon l’échelle RUCAM. Parmi ceux-ci, 33 patients (87 %) ont développé une LHOM au cours de leur séjour. La majorité des patients (n = 29, 76 %) se trouvaient dans des unités d’hospitalisation générale. Ce facteur a démontré une association significative avec la survenue de la LHOM. Les médicaments anti-infectieux étaient les plus fréquemment associés à cette dernière (69 %), en particulier la combinaison rifampicine, isoniazide, pyrazinamide et éthambutol, ainsi que divers β-lactamines. La simvastatine y était, elle aussi, fréquemment associée. Aucun des cas de LHOM n’a été signalé au système institutionnel de pharmacovigilance. Conclusions : La LHOM demeure sous-reconnue et sous-déclarée en milieu hospitalier. Cette étude renforce le rôle potentiel des pharmaciens cliniciens dans la surveillance active à l’aide de l’échelle RUCAM et souligne la nécessité de stratégies institutionnelles visant à prioriser le suivi de la fonction hépatique chez les patients à haut risque, en particulier dans les unités d’hospitalisation générales. Mots-clés : lésion hépatique d’origine médicamenteuse, pharmacie d’hôpital, sécurité du patient, pharmacovigilance

Objetivo: Describir el desarrollo de una tecnología educativa para el personal de enfermería sobre seguridad en la preparación y administración de medicamentos sedantes, analgésicos y vasoactivos en pacientes críticos. Métodos: Se siguió el modelo de diseño instruccional ADDIE. En la concepción se llevaron a cabo tres etapas: análisis, diseño y desarrollo. Durante la ejecución se llevó a cabo la etapa de implementación. Resultados: La tecnología educativa desarrollada fue una serie de tres videos denominada: cuidados de enfermería en la preparación y administración de medicamentos sedantes, analgésicos y vasoactivos en pacientes críticos. El primero aborda la seguridad del paciente y los errores de medicación, con una duración de cinco minutos y tres segundos. El segundo presenta precauciones de seguridad con medicamentos sedantes y analgésicos, con una duración de siete minutos y 49 segundos. El tercero destaca las precauciones de seguridad al utilizar fármacos vasoactivos y tiene una duración de siete minutos y 55 segundos. Los videos estuvieron disponibles en YouTube®. Conclusión: Los videos educativos basados en evidencia científica pueden ser utilizados en la educación permanente y continua, apoyando a estudiantes, técnicos de enfermería y enfermeros enfocados en la seguridad del cuidado del paciente crítico, permitiendo vincular teoría y práctica.

RESUMO Objetivo Descrever o desenvolvimento de uma tecnologia educacional destinada a equipe de enfermagem sobre a segurança nos cuidados no preparo e administração de medicamentos sedativos, analgésicos e vasoativos em pacientes críticos. Métodos Seguiu-se o modelo ADDIE de design instrucional. Na concepção realizou-se as três etapas: análise, desenho e desenvolvimento. Na execução ocorreu a etapa da implementação. Resultados A tecnologia educacional desenvolvida foi uma série de três vídeos denominada: cuidados de enfermagem no preparo e administração de medicamentos sedativos, analgésicos [...] RESUMO Objetivo Descrever o desenvolvimento de uma tecnologia educacional destinada a equipe de enfermagem sobre a segurança nos cuidados no preparo e administração de medicamentos sedativos, analgésicos e vasoativos em pacientes críticos. Métodos Seguiu-se o modelo ADDIE de design instrucional. Na concepção realizou-se as três etapas: análise, desenho e desenvolvimento. Na execução ocorreu a etapa da implementação. Resultados A tecnologia educacional desenvolvida foi uma série de três vídeos denominada: cuidados de enfermagem no preparo e administração de medicamentos sedativos, analgésicos

Objective: To analyze the records of pharmaceutical interventions of a public hospital and classify them using the Pharmaceutical Care Network Europe (PCNE) Association Classification for Drug-Related Problems. Methods: Descriptive and retrospective study, based on a database of records of pharmaceutical interventions performed in 2022 by the Clinical Pharmacy service of a public emergency care hospital. The interventions were quantified and classified according to the service standards and then reclassified according to the standards of the classification for drug-related problems of the PCNE version 9.1. Results: During 2022, 414 pharmaceutical interventions related to 337 patients were recorded. Regarding the location, the interventions were performed on patients admitted to the clinical inpatient unit (35%), intensive care unit (33%), emergency room (27%), and surgical recovery room (5%). According to the service’s own classification, reconciliation of health information (36%) and dose or frequency adjustment (33%) were the most frequent pharmaceutical interventions. Using the PCNE system to classify pharmaceutical interventions, the main problems identified were: effectiveness (86%) and safety of treatment (7%); the main causes were: dose selection (36%) and patient transfer (37%); and the main type of intervention: related to the prescriber (91%). Conclusions: The PCNE classification can be used in a hospital environment to generate quality indicators that allow the evaluation of processes and results related to pharmaceutical interventions. Research is needed that uses standardized methods to evaluate outcomes and events, allowing comparison between results.