Pharmaceutical Care La Farmacoterapia Errores detectados en la dispensación de medicamentos en un hospital público en Costa Rica a!"#$%"#&'(c* a )'"+,"-"!",!)'"."/)'"01,!)!""/232,"!/4" $ )'"+,"-"!",!)'"."/)'"01,!)!""/232,"!/4" " )'"+,"(,!),,12!,5"!/6!'"!/(/"'!,26(7898"!,/81,'!,/,!"!)'"+ ,":)'"2!"/)",//)'"/;!.///2,%" 21!/!"8(!%"#&'2",!"'!"#=""" < RESUMEN >?@7A6>: 7$3,./,/.,'//1!"!/'/"'!,/"!,B,!/ ."/)'"/01,!)!""/0)/2,%"1'//"!,D""!! "!"///1!"! (EA>8> 7,//"1,.,!./!1/"'1!////'/GH/$/ ''I!."/)'"/01,!)!""/0)Se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evista Pharmaceutical Care LA FARMACOTERAPIA Publicación Académica de la Facultad de Farmacia de la Universidad de Costa Rica !"#%"#&'( Introducción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abla 1. Categorías de gravedad de errores de medicación, según NCC MERP. Categoría de Resultado del error error 2"!,!".!,"!"1" ///" ? 7"1!"!1 ciente. C 7"!1"!,1! "/I D 7"!1"!,:! "/I!/'!, "!!,.!"!1"'1$ E 7"!,$:"!/I ,'1:/!,.!"! ) 7"!,$:"!/I ,'1:/#1,"! !"1!4/ J 7"!,$:"!/I 1'!!, 0 7!,.!"!1'! ,!.//1"!, 6 71/"!,$" ',/1"!, )!, (/D"//!,@ Método 7,/!."/)'"/01, / ! )!"" /& """! / ! '"!,!,'!,/"""!//,/ !'/""!6%87(""!,!! /1,"!/",!1/,/1"/ /1!"! / % "// )'"+," / J! ?,I%&J?14!!4+ 7!,'!,"'1'!,/1'"+,"/ 2!,7B,!/."/)'"/01, - !.,4"! ,. 1 $3,. ! ."! !)!""/J"1"D"'!, /,'//1!"!/'/"'!,/"! !.!D!7",!/'!,/ ,B,!/."/)'"/01,!)! !,1/"'1!/////'H/ ""/,.+/"!,D""!!"!" $ / G ! ! # / K ' O 1' / ! / / '/""! '1!/ ! !,'!, / .! """!//,14,!!1!'/ ,"!",!"!,//1!"!/!, 7!,'!,/./!",""!4Q! //,$"!/$/."/)'" /."'"+," $"1"!:/4,"!/","1:,,/ .!D!:1Q,'/'1:!,4 Revista Pharmaceutical Care LA FARMACOTERAPIA Publicación Académica de la Facultad de Farmacia de la Universidad de Costa Rica Pharmaceutical Care La Farmacoterapia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abla 2. '"/'/"'!,,", según su gravedad registrados en la Consulta externa de la Farmacia del HSFA, marzo-abril 2009 7! / .! D! ,'! ! "!, !,""//.D""!!"", Categorías de Número de Porcentaje (%) / ", ! !"! / "1! / '/"'!, error casos 4,/ /!, / $ "! 1/", ,/ 2,4 H 98,6429177 )!'!, ! / '1 : !,4 $/ ./! ! 1/", !,4/ 1"!, ."//D"!"$!,!'/"'!,! /"/!","'!,"'$/1/", 2,4? M 0,33927057 !$/'/"'!, 2/!!"//"'1I/!"/" /'!'"+,"1/'"" /,",4Q!/!,.!D! A'$+! , , !,'!, / """! / 1!! $ ", ,+"!" : ' "+," "!/$! ",/ 1 "!" / "1"!//,:!,/," /"1,.1",. Resultados y discusión 7!1//,/"!,D"!!,,/KG //1!"!/'/"'!,!""!/ 2!,7B,!/."/)'"/01,! )!""/"1!/M1/ &,'/,$3/."/)'"/, #1,:,'///2,%"!1/ !"'1"!/","!."/) '"/01,/,1!1// ! 1!' 4! / 4! ,/ ! "'1 ;!!.,4"!1,!!'"#1, /7,/;!/1/!4!!/ ,",/1/T>,.!1/'4"'! "!!!.'!/!.#1,1!, 2,42 Totales 1,0178117 0 1179 100 )!, 7$"!111,/!,'!,/"" "!//,. - ': "!,// / "1!/!, N "!,D"/ ! /1!"! 4! ! / "1"!:/4,"!/",4D"8,1 "!,3 MGGN "1!/ 1!"1'!, /4, "! / !/""! '+/" 1 '/"'!, : ! GON "!,// / '/"'!, /1!/ "!"/ "! ,/ / ! ,/ 1. / ! , #1, 1+" ","! " 1, ! MN / /,",/ /!, 1/ / !.,4"! "1!/! ! /4,"!/!/""!/,,4Q!1"1 "! '+/" M 1',!/ ,! ! / / ,1 ! 1" / /1!"! !", ,!"! Revista Pharmaceutical Care LA FARMACOTERAPIA Publicación Académica de la Facultad de Farmacia de la Universidad de Costa Rica 13 !"#%"#&'( Gráfico 1. Porcentaje de errores cuantificados según el área del proceso de dispensación de medicamentos de la Consulta Externa de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evista Pharmaceutical Care LA FARMACOTERAPIA Publicación Académica de la Facultad de Farmacia de la Universidad de Costa Rica Pharmaceutical Care La Farmacoterapia !TGO",!!' %1",,1!,3,/."'1'!, !/'3,"'"'1/"!/ 7! , !,/ 4Q! ,/ / !, : "$ "!/ /""! / / / "' / 1/", / !"'!, ! "4 / ,$3 "',,"!1"/'$/) 4!/",'"!,1"!"/ '":!'3/D!"!//,$31 /'/""!1"//1/,""!H7! "D" ,' 1Q$" / / ","! "'Q! '"/$!/1!,.Q'!/",1 Limitaciones !/B,I!"'1,!, 7!,',"!/,/,!/'!,"! ///1!"! ",!!#!",!O1'K'!! 7!#1,!'+"J!?,I:2!/, /$/:/'!41!1$, ///1!"!/'/"'!,! $"'4!,/!","!/"!/ '$!,/,$3"!$"4,!./ /1!"!!# !,1"!/,""!:/':HHN!"' 1"!"!!,!"!!.'$3/, Conclusiones 1", HN H >,,/ 11"!! 1 $/#$!'//$:// -1!"1!,//'/""!/,",/! !/!,D!"!"!"!,"!:1/!/'! 2!, 7B,! / ." / )'" / 01, "1"//1/'1I!"!"4!,. !)!""/$"!1"/"$: ,!"1"!/1"1"!'+/"7!':! 7 1! / )'" I , / ! !4!",1"!,:"!/! ,+ ',."! /"1! 1/! 4! 1.!$7!,!,/#"!"!"1 /!, 1" / /1!"! / ' "!/'//"",.'3!.! /"'!, 4! ,/ I! 1, / 1$'"!/"!4!"!1"/'! 1$' / ',."! , // 1 # B". , / ,$3 '/ ,+"!" "!/"! $ : '!,4,/,'11/"!'$!, #'! "! D! / /" "!" / //1!"! 4$!,/,$3KT - '1/ / ." / )'" / , #1, #"!!"/D"!"!1!,""' , ", ",/ / 1"! / / '/ ""!2$444!,/I! '!"!/D"!,,$3!4//!/ "' ", ."! "!" / / /1!"!H Grafico 2. Razones asociadas a la ocurrencia de errores en el Servicio de Farmacia del HSFA, según el personal de Farmacia. - ,/ $,!/ ! ,/ 1/! Q, "'1'11//!,',! ///1,//'/""!1' , ,$" , / / /1!"! 4Q! .$,//"!.!!,,!.,4"! "!,'1 .$ "' ,1 '/""! // / 1"!, .// / D! / "'1'!, //'"!'"",.:/'!, '!'"!/''!,41$///! //1!"! Referencias L! 2 ?" & 0!!/ (% "! @--1(@@,(@,7,/// /1!"! ! D"! / '" / !" &#'271M OHOT [# % ?, 8 \ -!/4! 2 ("]!! [ @,(/",!!//./4.!, !1/,"!1,!,@(TO M )!, 7$"!111,/!,'!,/ """!//,. H -!/'$4,7//1"#/'/ "'!, ! ! 01, 1Q$" 1/," %. -,!'7!'4'TO TTK Revista Pharmaceutical Care LA FARMACOTERAPIA Publicación Académica de la Facultad de Farmacia de la Universidad de Costa Rica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`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gradecimientos ?,8&.!,!4'/",! '':' ,/1!/!,'"$! @0,#:,KM11G G !//!.,4"! 16 H !, @ 0"] % ("]]!@2! 8 (/ ",! 7B1!" ,# ;!,/ &#" 1 ;& '/'B %1,!4 &4' @ 2! 5"!,"!D!!"'!,/4Q!,1 &#'"MMH K M @'! -J 7 ! 1" / /1! "!/'/"'!,8"1"!/!" - , / 1!, /"'!, /"! ! ,! 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