Menezes Michelle Santos, Doria Grace Anne Azevedo, Valença-Feitosa Fernanda, Pereira Sylmara Nayara, Silvestre Carina Carvalho, de Oliveira Filho Alfredo Dias, Lobo Iza Maria Fraga, Quintans-Júnior Lucindo José
Federal University of Sergipe (UFS), Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil.
Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil.
Explor Res Clin Soc Pharm. 2024 Apr 8;14:100435. doi: 10.1016/j.rcsop.2024.100435. eCollection 2024 Jun.
High-alert medication (HAM) is more predictable to cause significant harm to the patient, even when used as intended. The damage related to the HAM lead not only suffering to the patient, but also raise the additional costs associated with care.
Evaluate the incidence of drug-related adverse events related to the use of high-alert medications.
It was conducted an active search for information through COCHRANE databases, LILACS, SciELO, SCOPUS, PubMed/MEDLINE and WEB OF SCIENCE. The search strategy included the following terms: "Patient safety", "Medication errors" and "Hospital" and "High Alert Medications" or "Dangerous Drugs" in different combinations. Then two reviewers independently conducted a preliminary evaluation of relevant titles, abstracts and finally full-text. Studies quality was evaluated according to PRISMA declaration.
The systematic review evaluated seven articles, which showed that only 11 HAM identified in the literature could have serious events. The most frequently cited were warfarin (22.2%) which progressed from deep vein thrombosis to gangrene, suggesting lower initial doses, followed by cyclophosphamide (22.2%) and cyclosporine (22.2%) which presented invasive fungal infection and death. In addition to these, morphine was compared with its active metabolite (M6G), with M6G causing fewer serious clinical events related to nausea and vomiting, reducing the need for concomitant use of antiemetics.
The most reported drug classes in the articles included that were related to incidence of drug-related adverse events in use of high-alert medications: morphine, M6G-glucuronide, haloperidol, promethazine, ivabradine, digoxin, warfarin, ximelagatran, cyclophosphamide, cyclosporine, and ATG. The formulate protocols for the use of these medications, with importance placed on evaluating, among the classes, the medication that causes the least harm.
高警示药品（HAM）即使按预期使用，也更有可能对患者造成严重伤害。与HAM相关的损害不仅给患者带来痛苦，还会增加护理的额外成本。
评估与使用高警示药品相关的药物不良事件的发生率。
通过Cochrane数据库、LILACS、SciELO、SCOPUS、PubMed/MEDLINE和科学网进行信息的主动检索。检索策略包括以下术语：“患者安全”、“用药错误”、“医院”以及“高警示药品”或“危险药物”的不同组合。然后由两名评审员独立对相关标题、摘要以及最终全文进行初步评估。根据PRISMA声明对研究质量进行评估。
系统评价评估了7篇文章，这些文章表明，文献中仅确定11种HAM可能引发严重事件。最常被提及的是华法林（22.2%），其可从深静脉血栓形成发展为坏疽，提示初始剂量应降低，其次是环磷酰胺（22.2%）和环孢素（22.2%），它们出现侵袭性真菌感染和死亡。除此之外，将吗啡与其活性代谢物（M6G）进行了比较，M6G引发的与恶心和呕吐相关的严重临床事件较少，从而减少了同时使用止吐药的需求。
文章中报告最多的药物类别与使用高警示药品时药物相关不良事件的发生率有关：吗啡、M6G-葡萄糖醛酸、氟哌啶醇、异丙嗪、伊伐布雷定、地高辛、华法林、希美加群、环磷酰胺、环孢素和抗胸腺细胞球蛋白。制定这些药物的使用方案，重点是在这些类别中评估造成伤害最小的药物。
