Risk management of extravasation of cytostatic drugs at the Adult Chemotherapy Outpatient Clinic of a university hospital.
OBJECTIVE
To verify the incidence of extravasation of cytostatic drugs in patients treated on an outpatient basis at a university hospital in the city of São Paulo, Brazil, during the period from 1998 to 2002, and to assess the quality of care provided by the nursing team using a protocol adopted for the treatment of this adverse event as a parameter.


BACKGROUND
The movement for quality in healthcare services has been a recent event in Brazil, mainly as the result of the Brazilian Program of Hospital Accreditation instituted in 1998. Considering the emphasis on risk management, it is important to mention the monitoring of the occurrence of extravasations of cytostatic drugs in order to improve the quality of nursing care provided to cancer patients.


METHODS
An evaluative study with a descriptive, prospective and longitudinal design was conducted, based on the documentary analysis of the notification of 216 extravasations of vesicant and irritant drugs that occurred between 1998 and 2002 and the corresponding prescriptions of cold or hot compresses.


RESULTS
The mean incidence of extravasations ranged from 0.2 to 1.4% over the five years of the study. Incorrect prescription of the type of compress was observed for three patients. Undesired effects were ulcers caused by the extravasation of vinblastine and dacarbazine in two cases.


CONCLUSIONS
The low incidence of both extravasation and tissue damage demonstrates the adequate quality of nursing care provided to cancer patients at the outpatient clinic studied. However, the identification of the lack of 12 records of thermal treatment and of three erroneous prescriptions requires the implementation of educational measures to prevent these types of incident.


CONCLUSIONS
The relevance of this study to clinical practice is to increase the awareness and involvement of the nursing team in the maintenance of a continuous surveillance system of the process and results of chemotherapy administration in order to increase the quality of care and the safety of the patient.
Department of Nursing, Federal University of São Paulo, São Paulo, Brazil. npiva@denf.epm.br
Nilce Piva
NP
Adami
Maria Gaby Rivero
MG
de Gutiérrez
Selma Montosa
SM
da Fonseca
Elizabeth Pinto Magalhães
EP
de Almeida
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001938:Brazil; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000453:epidemiology*; D006785:Hospitals, University / Q000592:standards; D006801:Humans; D015994:Incidence; D008510:Medication Systems, Hospital; D009369:Neoplasms / Q000188:drug therapy* / Q000451:nursing; D009859:Oncology Nursing / Q000592:standards*; D010044:Outpatient Clinics, Hospital / Q000592:standards; D011787:Quality of Health Care; D012308:Risk Management
D000970:Antineoplastic Agents