Construção e validação de um bundle para a prevenção de problemas relacionados à farmacoterapia em unidade de terapia intensiva neonatal

Abstract

In Brazil, the implementation of clinical pharmaceutical services has benefited many patients, including newborns in neonatal intensive care units (NICU). However, the harmonization of the work process related to the pharmacist's clinical performance is observed as a current major challenge. In this context, it is understood that the adoption of bundles helps the systematization of actions. This work aims to build a bundle for the systematization of pharmaceutical care in neonatal intensive care units, associated to the prevention of problems related to pharmacotherapy. This is a methodological study with quantitative analysis carried out in two phases involving the following steps: Phase I = Step 1: Integrative literature review using LILACS, MEDLINE / Pubmed, SciELO and SCOPUS as databases to identify studies that report clinical activities developed by pharmacists in neonatal intensive care units; Step 2: Development of the bundle by a Working Group (WG); Phase II = Step 3: Validation of the bundle's content by expert judges and analysis of the Content Validity Index (CVI) and Cronbach's alpha coefficient to assess the instrument's internal consistency; Step 4: Final formatting of the bundle. After applying the inclusion/exclusion criteria, the literature review resulted in 19 studies. Among these, 10 clinical activities carried out by the NICU pharmacist were identified. The WG evaluated and classified four activities as essential and, based on this, the bundle was developed. The instrument created by the WG was made available in electronic format for evaluation by judges who were identified through searching the resumés on the Lattes Plataform. As a result, 22 pharmacists were selected. Of these, thirteen accepted the invitation and agreed to participate in the study. The profile of the judges was characterized by women, with a postgraduate degree and an average experience of five years in Clinical Pharmacy and four years of practice in the field of neonatology. The analysis of the CVI of all components of the bundle presented indices above 0.80, together with the Cronbach's alpha coefficient above 0.7, which showed that there was agreement between the experts' opinions and a low degree of covariance between the items, showing that the bundle was considered a consistent instrument. The findings obtained reinforce the role of the pharmacist in the safety of newborn patients. The clinical activities observed in the selected studies are directly related to pharmacotherapy, its management and monitoring by the pharmacist and the bundle developed was presented as a viable tool for the systematization of pharmaceutical care in neonatology and the execution of activities that contribute to the improvement of the assistance provided to neonates.