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Auditoria aos Procedimentos de Oxigenoterapia num Serviço de Medicina Interna
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Advisor(s)
Abstract(s)
Introdução: A prescrição de oxigénio (O2) é frequente nos serviços de Medicina Interna. Recomendações como as da British Thoracic Society estabelecem o uso apropriado de O2 em cuidados de saúde. O objectivo deste estudo foi avaliar os procedimentos de oxigenoterapia num serviço de Medicina Interna à luz das recomendações British Thoracic Society 2017. Métodos: Realizou-se um estudo observacional que decorreu
num período de tempo de 48 horas e que incluiu doentes no serviço de Medicina Interna do Hospital Central
do Funchal, com prescrições activas de oxigenoterapia ou a realização de oxigenoterapia sem prescrição. Avaliaram-se 4 parâmetros 1) a indicação para a prescrição, 2) o tipo de prescrição (dose fixa ou objectivo de intervalo de saturação periférica (SpO2)), 3) a conformidade entre a prescrição e administração e, 4) a monitorização da SpO2 (prescrição e registo da mesma).
Resultados: Dos 116 doentes admitidos no estudo, 114 (98%) tinham prescrição de oxigenoterapia. Destes, seis (5,3%) não apresentavam hipoxemia e 57 (50%) não tinham registo da avaliação da hipoxemia. Dos 114 doentes com prescrição, apenas 38 (33%) tinham objectivos de intervalo de SpO2. Destes, 61% não tinha prescrito o obje ctivo de SpO2 máxima e apenas 8% tinha os dois limites de intervalo definidos. Dos 76 (67%) com prescrição fixa, nenhum apresentava a totalidade dos quatro parâmetros recomendados. Oito, (11%) não faziam oxigenoterapia e 39 (51%) estavam a realizar um débito de O2 diferente do prescrito. Quanto à monitorização, foi realizada, em média, 2,16 vezes em 24 horas. Cinco doentes (4%) não tinham qualquer
registo de monitorização.
Conclusão: A maioria das prescrições de oxigenoterapia não cumpria as recomendações mais recentes. Verificou-se haver espaço para a optimização da prescrição, administração e monitorização
da oxigenoterapia. É necessária sensibilização dos profissionais de saúde e posterior aferição dos resultados atingidos.
Introduction: Oxygen (O2) prescription is frequent in an Internal Medicine ward. Recommendations such as the British Thoracic establish the appropriate use of O2 in health care. Our objective was to evaluate O2 therapy procedures in na Internal Medicine ward, in light of 2017 British Thoracic Society recommendations. Methods: We conducted an observational study, during a period of 48 hours, which included patients admitted to the Internal Medicine ward of Hospital Central do Funchal, under oxygen therapy, with or without prescription. We analysed: 1) the reason for the prescription, 2) the type of prescription (fixed dose versus peripheral O2 interval saturation oriented dose), 3) accordance between prescription and administration, and 4) monitoring (prescription and registration). Results: From a total of 116 hospitalized patients, 114 (98%) had O2 prescription. Six patients (5.3%) had no hypoxemia, and 57 (50%) had no hypoxemia assessment registration. From the 114 patients with a prescription, only 38 (33%) had targeted saturation range objectives. Of these, 61% did not have prescribed the maximum saturation target and only 8% had the two interval limits defined. From 76 patients (67%) with fixed dose prescription, none had the registrations of the four recommended parameters. Eight (11%) did not receive O2 therapy and 39 (51%) were receiving an O2 dose different from the one prescribed. Monitoring was performed, on average, 2.16 times in a 24 hours period. Five patients (4%) had no monitoring record. Conclusion: The majority of O2 therapy prescriptions did not meet the current recommendations. Therefore, practice optimization is needed in the prescription, administration and monitoring of O2 therapy steps. It is necessary to raise awareness among health professionals and reprise outcome audition.
Introduction: Oxygen (O2) prescription is frequent in an Internal Medicine ward. Recommendations such as the British Thoracic establish the appropriate use of O2 in health care. Our objective was to evaluate O2 therapy procedures in na Internal Medicine ward, in light of 2017 British Thoracic Society recommendations. Methods: We conducted an observational study, during a period of 48 hours, which included patients admitted to the Internal Medicine ward of Hospital Central do Funchal, under oxygen therapy, with or without prescription. We analysed: 1) the reason for the prescription, 2) the type of prescription (fixed dose versus peripheral O2 interval saturation oriented dose), 3) accordance between prescription and administration, and 4) monitoring (prescription and registration). Results: From a total of 116 hospitalized patients, 114 (98%) had O2 prescription. Six patients (5.3%) had no hypoxemia, and 57 (50%) had no hypoxemia assessment registration. From the 114 patients with a prescription, only 38 (33%) had targeted saturation range objectives. Of these, 61% did not have prescribed the maximum saturation target and only 8% had the two interval limits defined. From 76 patients (67%) with fixed dose prescription, none had the registrations of the four recommended parameters. Eight (11%) did not receive O2 therapy and 39 (51%) were receiving an O2 dose different from the one prescribed. Monitoring was performed, on average, 2.16 times in a 24 hours period. Five patients (4%) had no monitoring record. Conclusion: The majority of O2 therapy prescriptions did not meet the current recommendations. Therefore, practice optimization is needed in the prescription, administration and monitoring of O2 therapy steps. It is necessary to raise awareness among health professionals and reprise outcome audition.
Description
Keywords
auditoria clínica departamentos hospitalares Medician Interna oxigenoterapia Madeira Island Região Autónoma da Madeira
Citation
Medicina Interna
Publisher
SPMI- Sociedade Portuigueda de Medicina Interna