Methods: A cross-sectional, quantitative and observational study developed at a pediatric hospital at the tertiary level in Fortaleza, Ceará, Brazil. The sample consisted of 11 Nursing technicians who met the inclusion criteria: being a Nursing professional who acts in the administration of drugs through the intravenous route and being of service in the period of data collection. Already as exclusion criteria, we have: be on vacation, leave or away on days that the observations will be made. For the calculation of the number of observations of the intravenous drug administration process, the sample was calculated based on finite populations, obtaining a total of 135 observations of the intravenous drug administration process. To obtain the information, the data were collected through the application of the interview and the direct and non-participant observations of the actions developed by the members of the Nursing team during the medication process by the intravenous route in pediatrics, using a check list with the actions of the drug process of intravenous route, structured according to the following steps: reading of the medical prescription; hand hygiene; organization of the environment and selection of suitable materials; preparation of medication; guidance on the procedure; and intravenous drug administration, monitoring and recording. The observer had as answer options: yes, no, partial and does not apply. The data collected in the study were stored in a database produced by the researchers in Microsoft Excel of Windows 2010, processed and analyzed in a descriptive way and according to the recommended literature. In order to evaluate the performance of the professionals in the execution of each action of the process, the Positivity Index (IP) for Quality of Care was determined, Desirable (IP = 100%); Suitable (90% <IP <99%); Insurance (80% <IP <89%); Borderline (71% <IP <79%); and Sufficient (IP <70%). Study approved by the Research Ethics Committee of the Federal University of Ceará under opinion no. 2,043,123 and CAAE 65424017.3.0000.5054.
Results: Adequate performance was observed regarding the reading of the medical prescription, and this stage was observed in 97.8% of the observations. The observations in which the nursing professional did not read the prescription were due to the fact that the medication was recorded for more than one time on a tape and placed on the tray when the first dose was prepared. In the hands hygiene stage, it is necessary to remove adornments (jewelry, bracelets and watch) before its execution, and this action was performed in only 13 of the observations (9.6%), fitting into performance suffering. In the hand hygiene stage, all the actions that make up the hand were performed in a poor way, mainly the actions: rub the thumbs with circular movements using the opposite palm (0.7%), use the paper towel to close the (1.5%), washing the back of the fingers, closing them on the palm of the hands (6.7%) and rubbing the palm with palm, with the fingers intertwined (7.4%). As for the time used for hand washing, it was performed in a poor way, because in only 9.7% of the observations, the professionals used time greater than 30 seconds to perform the hands hygiene stage. In the actions related to the organization of the environment and selection of the appropriate materials, the results were obtained: It performs cleaning and organization of the bench (88.1%), Uses personal protective equipment (cap, mask and glove) (28.2%), Properly selects the syringe and needle for aspiration (89.6%). In the actions related to the preparation of the medication, it was: Check the label of the medication with the prescription (85.2%), Observe the expiration date of the medication (8.9%), Disinfection of the ampoule or vial, 7%), Medication reconstituted in distilled water or saline, respecting the principles of hospital infection prevention (97.8%), Identifies the prepared medication (85.9%), Properly discards the materials used during the preparation, 3%). Actions regarding the orientation about the procedure: Explain the procedure for the patient / companion (44.4%). Actions related to intravenous drug administration, monitoring and registration: Provides medication and patient name related to prescription (80%), Installs medication as prescribed by physician (100%), Records/checks immediately on medical records medication (83.7%), Patient / companion guidance (57.8%).
Conclusion: It was concluded that of the 37 actions that make up the drug process by the intravenous route, only two were performed, according to the Index of Positivity for Quality of Care, in a desirable way (100%), five actions were adequate (90-99% ), nine actions were safe (80-89%), one border action (71-79%) and twenty actions considered to be suffering (<70%). Thus, this study allowed the identification of the situational diagnosis of the Nursing team about the performance of the drug process by the intravenous route in pediatrics, corresponding to an unsatisfactory care, representing risks to the safety of the pediatric patient. In view of these findings, it is imperative to improve care by Nursing professionals, through lifelong education.