Avaliação da terapia medicamentosa de pacientes com imunodeficiências primárias em um hospital público pediátrico

Abstract

The current paper aimed to evaluate the drug therapy as well of the patients with primary immunodeficiencies (PID) who were treated with human immunoglobulin. The study was carried since March to July 2011. Data collection consisted of three steps: interviews with relatives or caregivers using a questionnaire, monitoring the nursing team‟s work and using medical records to collect data on suspected Adverse Drug Reaction (ADR). The data obtained were entered into the database using Epi Info version 3.5.1. The Reports of suspected ADRs‟ analysis were made in the meetings by the staff of the Centro de Farmacovigilância do Ceará. The study included 16 patients, where it was identified that 56,25% (n=9) were male, 50% (n=8) were from the capital and average age was 11,06 years. Analyzing characteristics related to the patients‟ health, it was found that among the types of PID diagnosed, the prevalence was Common Variable Immunodeficiency (62,5%, n=10), 87,5% (n=14) affirmed to present other diseases and all of them have had infections and respiratory tract diseases. 87,5% (n=14) reported the use of other medications at home, totalizing 26 mentioned drugs . The most frequently used were steroids and antimicrobial, as expected, due to clinical conditions that have been cited. The medication administration at home was performed in 93,75% (n=15) of patients by caregivers. In spite of the sum, 43,75% (n=7) presented 29 suspected ADR, and the most commons were headaches and chills. After detecting the occurrence, the infusion of the drug was discontinued and treatment was done according to specific symptoms. Furthermore, the infusion rates were calculated based on the values suggested by literature, and in 93,75% (n=15) of patients, the values were in agreement with the recommendations. However, we must consider that this value is a standard, and does not take into consideration the factors inherent to the patient. Following reconstitution of drugs by nursing staff, process failures were identified, because dilution requires some care, such as temperature and observation of the product during dilution. Therefore, to minimize the adverse events, the team made some pharmaceutical interventions, such as the increase of the infusion's times in all the patients, training the process of reconstituting drugs for nursing staff and requesting the change of immunoglobulin to another brand in liquid form, trying to minimize the symptoms by failures in the reconstitution. As a result, the symptoms ceased. By treating yourself from unforeseen events that resulted in harm to patients, were classified as sentinel events, where the damages caused were the reactions and the factors speed of infusion and reconstitution of drugs increased the risk of that damage to the patients.