Intervenções farmacêuticas na farmacoterapia de idosos em unidade de terapia intensiva

Abstract

Introduction: The increase in the number of elderly people and the change in the demographic profile, lead to an increase in hospitalizations and demands for hospitalizations in the Intensive Care Units (ICU). Patients hospitalized in the ICU are considered to be at high risk for medication errors and Adverse Drug Reactions (ADR). Polypharmacy is common in the elderly, which is the consumption of five or more different types of medicines. Studies point to the need for pharmacotherapeutic follow-up for the elderly, in order to minimize drug-related problems and provide a better quality of life for this population. Objectives: To evaluate the use of drugs by the elderly in ICUs, to describe the drugs and pharmacological groups most prescribed to the elderly, to analyze whether protocols are used for the safe use of drugs for the elderly, to describe the pharmacist's interventions, to analyze the acceptability of the interventions performed by the pharmacist, and to propose instruments for safe pharmacotherapy of the elderly. Methods: Observational, descriptive and prospective research was performed. The population was composed of the elderly hospitalized in the ICU, during the period between September 2017 and July 2018, for more than 24 hours, after obtaining the Free and Informed Consent Term (TCLE), by means of a census of the patients. The data were collected from electronic prescriptions and, possibly, manual and electronic medical records. They were released in Excel® 2013 worksheet. Data analysis was performed by the Statistical Package for the Social Sciences (SPSS), version 20.0 and Microsoft Excel. The level of significance of the research adopted was 5%. Statistical analyzes were performed uni- / bivariate. The Shapiro-Wilk test was used to evaluate the Normality of the sample in relation to the variables age and weight. For the relation between age and number of interventions, the Spearman's Correlation and the Fisher's Exact test were used for sex and intervention variables. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) method was used to elaborate the original article. Results: A total of 67 patients were studied, most of them female (53.7%), the majority of the elderly being between 60 and 79 years old and the mean age was 71.7 years + - 6.6 years SD, mean weight was 63 , 8% kg + - 6.2 DP. Weighted average length of hospital stay of 21 days. Main causes of hospitalization: post-surgical cancer (43.0%), digestive diseases (13.0%) and septic shock (12.0%). The majority of the elderly 43.3% (n = 29) received diet by nasoenteral tube. Regarding the outcome, 52.2% (n = 35) of the patients evolved to death. Polypharmacy was registered in all patients, and 112 drugs were prescribed, ranging from 6 to 24 medications per patient. The most prescribed pharmacological group was the alimentary tract and metabolism, followed by the group of blood and blood forming organs and third, the drugs of the nervous system group. 22 antimicrobials were prescribed. 37.0% of the patients (n = 25) received meropenem, 32.8% (n = 22) used vancomycin and 17.9% (n = 12) polymyxin B. For systemic antifungal drugs, anidulafungin 17.9% (n = 12) and fluconazole with 6.0% (n = 4). Classified by pharmacological group, carbapenems were more frequently indicated (n = 30) 21.9%, followed by glycopeptides (n = 22) and polymyxins (n = 12) 8.76%, the antimycotics together accounted for 11.6%. Eleven patients (16.4%) did not use any anti-infective and only 1 patient made use of anti-infective topical for ocular use. There were 25 drugs inappropriate to the elderly (MPI), with the most prevalent being: regular insulin, Pantoprazole, Metoclopramide, Enoxaparin, Fentanyl, Furosemide, Midazolam, Tramadol, Hydrocortisone, Amiodarone. A total of 4.5% of patients with drug allergy were registered. The interventions involved 152 pharmaceutical interventions of 15 different types. All patients received some type of intervention, and the mean intervention was 2.3 interventions per patient. All pharmaceutical interventions involved the medical staff and more than half involved the nursing team. Interventions related to monitoring laboratory tests, drug stock, drug reconciliation, drug administration, medication allergy registration and stability management were fully accepted. There was no statistical association between interventions and gender or age of the patients. As for the interventions were performed 152 pharmaceutical interventions of 15 different types. All patients received some type of intervention, and the mean intervention was 2.3 interventions per patient. All pharmaceutical interventions involved the medical staff and more than half involved the nursing team. Interventions related to monitoring laboratory tests, drug stock, drug reconciliation, medication administration, drug allergy registration and stability management were fully accepted. There was no statistical association between interventions and gender or age of the patients. Conclusion: he study showed that the characteristics of the elderly, such as age, gender, weight, reason for hospitalization, type of diet and outcomes were similar to those of the national reference studies. The polypharmacy was confirmed in the elderly. There is follow-up of the elderly by the clinical pharmacist with Pharmaceutical Interventions in pharmacoprapies. Most of the elderly used antimicrobials, the most consumed being indicated for the treatment of infections caused by multiresistant bacteria. Research has shown that all patients used at least one MPI. There is no protocol in the service that uses MPI in the elderly. All the pharmaceutical interventions involved the medical team and more than half involved the nursing team, which was a differential in the assistance to the elderly promoting greater integration of patient care with a positive impact on the pharmacotherapy. The study also showed that the types of interventions and high acceptance rate of the clinical pharmacist in the ICU is an essential professional in the care of the elderly, which is a polymodedic one, increasing patient safety and promoting greater cohesion of the health team in the pharmacotherapy of hospitalized elderly. It was evident that the medication conciliation intervention is fundamental for the continuity of the safe treatment of the elderly patient. It is important that there are very clear protocols for antimicrobial use in the elderly and in the ICU, as well as clear protocols for the use of IPM for critically ill seniors as a public health strategy. As products of this dissertation, an Original Article with the title "Pharmaceutical Interventions in the Pharmacotherapy of the Elderly in an Intensive Care Unit" was submitted to the Brazilian Nursing Journal - REBEn, under number 2019-0169. Summary with Title "Potentially Inappropriate Prescribed Medications for the Elderly in an Intensive Care Unit of a Public Hospital of the Federal District" ID 4098, approved for presentation in the form of a poster at the Brazilian Congress of Hospital Pharmacy of SBRAFH 2019. Summary entitled "Prescribed Anti-Infectious to the Elderly in Intensive Care Unit of a Public Hospital of the Federal District "approved for presentation in the form of poster at the I Congress of Pharmaceutical Sciences of the Center-West, which received a certificate of HONOR TO MERIT on the date of April 28, 2019. A model developmental form called "Model of Pharmaceutical Evolution with Intervention" was developed at HRAN and in the registration phase of the National Library under the protocol EDA / DLLLB / BSB nº 156/2019.