Risk management and safety in the use of patient-controlled analgesia pumps: a scoping review
Gestão de risco e segurança no uso de bomba de analgesia controlada pelo paciente: revisão de escopo
Thamires Ribeiro da Silva; Erica Brandão de Moraes; Juliana Gomes Poubel; Carolina Rosa Figueiredo; Anderson de Souza Pereira
Abstract
BACKGROUND AND OBJECTIVES: Patient-controlled analgesia (PCA) is effective in controlling pain, but has numerous associated risks, such as: hypotension, respiratory depression, seizures and excessive sedation. The promotion of patient safety aims to reduce the risk of unnecessary health injuries and, therefore, it is important to analyze the failures and risk factors present throughout the process proactively. Therefore, the aim of this study was to map the available evidence on the risks of adverse events associated with the PCA technique and patient safety actions.
CONTENTS: This is a scoping review conducted according to the JBI methodology, whose research question was based on the PCC strategy. The source of information is open and the search occurred in three stages. The databases used were: Medline/Pubmed; LILACS; CINAHL/ EBSCOhost; CENTRAL; Portal Capes; SCOPUS; Web of Science; Google academic; Brazilian Digital Library of Theses and Dissertations; Portal NICE; and Portal ISMP. The search strategy was divided into 3 stages: the first occurred in Medline and Cinahl to identify articles and index terms on the topic; the second used all keywords in all included databases; the third consisted of tracking searches in the reference lists of the included studies. The search resulted in 1,164 studies, of which 83 were selected based on the inclusion criteria: addressing the risks associated with the ACP pump or safety measures, hospital context, without restriction as to the type of study, language, and year. The studies are distributed in categories: previous diseases, profile of indications, types of opioids, types of pump and infusion, adverse effects, incidents without harm, stages of risk, and safety measures.
CONCLUSION: This study made it possible to identify the risks of adverse events associated with the use of ACP in different stages and safety actions, demonstrating that when performed with appropriate patients, trained staff, safe devices, and correct prescription it provides a statistically significant improvement in pain relief, safely with advantages that conventional analgesia does not have.
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: A analgesia controlada pelo paciente (ACP) é eficaz no controle da dor, porém apresenta inúmeros riscos associados, tais como: hipotensão arterial, depressão respiratória, convulsões e sedação excessiva. A promoção da segurança do paciente visa reduzir o risco de lesões desnecessárias à saúde e, para tanto, é importante analisar as falhas e fatores de risco presentes em todo o processo de forma proativa. Portanto, o objetivo deste estudo foi mapear as evidências disponíveis sobre os riscos de eventos adversos associados à técnica de ACP e a ações de segurança do paciente.
CONTEÚDO: Trata-se de uma revisão de escopo realizada segundo a metodologia Joanna Briggs Institute para Scoping Reviews, cuja questão de pesquisa se baseou na estratégia PCC (P: população; C: conceito; C: contexto). As bases de dados utilizadas foram: Medline/Pubmed, LILACS, CINAHL/EBSCOhost, CENTRAL, Portal Capes, SCOPUS, Web of Science, Google acadêmico, Biblioteca Digital Brasileira de Teses e Dissertações, Portal NICE, Portal ISMP. A estratégia de busca foi dividida em 3 etapas: a primeira ocorreu na Medline e Cinahl para identificar artigos e termos de índice sobre o tema; a segunda utilizou todas as palavras-chaves em todas as bases de dados incluídas; a terceira consistiu no rastreamento de pesquisas nas listas de referências dos estudos incluídos. A busca resultou em 1.164 estudos, dos quais 83 foram selecionados com base nos seguintes critérios de inclusão: abordagem dos riscos associados à bomba de ACP ou a medidas de segurança, contexto hospitalar, sem restrição quanto ao tipo de estudo, idioma e ano. Os achados sintetizados estão distribuídos em categorias: doenças prévias, perfil das indicações, tipos de opioides, tipos de bomba e de infusão, efeitos adversos, incidentes sem lesões, estágios de risco e medidas de segurança.
CONCLUSÃO: Este estudo possibilitou identificar os riscos de eventos adversos associados ao uso da ACP em diferentes estágios e ações de segurança, demonstrando que quando realizada com pacientes adequados, com equipe treinada, dispositivos seguros e prescrição correta, fornece uma melhora estatisticamente significativa no alívio da dor, de forma segura e com vantagens que a analgesia convencional não possui.
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Submetido em:
25/10/2022
Aceito em:
20/07/2022
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