Priscilla Jordanne Silva Oliveira
1 INITIAL CONSIDERATIONS
The present essay presents a general analysis regarding the dispensation of antibiotics by the pharmacy of the Society Beneficente São Camilo-Hospital São Vicente de Paulo (HSVP), in cases where the prescription of these does not fall within the internal protocol of Antimicrobial agents, but each case should be analyzed individually in the light of the current legislation governing the matter.
It should be Emphasized that the analysis was elaborated from the internal protocol of the HSVP, but it is stated beforehand, to serve as a parameter for similar situations in other health institutions, in the performance of medical professionals and pharmacists.
In This sense, it is questioned about the obligation of the pharmaceutical professional to dispense the medication according to the medical professional’s guidance, in cases where the prescription of these does not fall within the internal protocol of Antimicrobians of the Hospital.
To this end, the objective was to acquire the deontological norms that they have about the performance of the medical professional, opting for the mention of the Code of Medical Ethics; Subsequently, it was intended to relate the deontological content that the Federal Council of Medicine provides, regarding the regulation of the Hospital Infection Control Commission (CCIH), with the current infraconstitutional legislation.
Finally, from the previous considerations, it was intended to seek to answer the proposed question, concluding by the recommendation that the pharmaceutical professional, responsible for the distribution of antimicrobials, when verifying that the dosage of the drug Prescribed by the physician exceeds the pharmacological limits or the prescription presents incompatibilities, before performing the delivery of the medication, have autonomy to request express confirmation to the professional who prescribed it.
2 THE PRESCRIPTION OF ANTIBIOTICS IN DISCONFORMITY WITH THE ANTIMICROBIAL PROTOCOL AND THE PERFORMANCE OF THE MEDICAL PROFESSIONAL AND THE PHARMACIST
It Is ceded that the use of antibiotics accelerates the process of developing mechanisms of resistance by bacteria, and its rational use is important and the awareness that the control of prescription and dispensing of antimicrobials is not a measure that alone resolves the problems of hospitalization due to inappropriate use of these medications. However, it is unequivocally an effective measure, according to the World Health Organization[1].
In the meantime, the consumption of medications improperly or the use of irrational form can cause dependence, antibiotic resistance, adverse reactions, intoxication and even death. In Addition, the wrong combination of medications also offers health risks, since a drug may nullify or potentialize the effect of the other[2].
In Another dimension, medical autonomy, because it is subordinated to scientific protocols, has limits conditioned to previous methods and experimentations and can never be understood as unrestricted professional freedom. In This sense, there is provision expressed in the Code of Medical Ethics, Resolution 2.217/2018 (BRASIL, 2018), according to which, according to Chapter II, section II, it is the right of the physician to indicate the appropriate procedure for the patient, observing the practices scientifically Recognized and respected legislation in force.
In Another dimension, due to the mandatory implementation of the Hospital Infection Control Program defined by Law No. 9.431/1997 (BRASIL, 1997), the Federal Council of Medicine in the use of the attributions conferred by Law No. 3.268/1957 (BRASIL, 1957), Edited Resolution No. 1.552/99 (BRASIL, 1999), to regulate the implementation of the Hospital Infection Control Commission (CCIH). As the art. 1st of the aforementioned Resolution, the prescription of antibiotics in the hospital units will obey the norms emanated from the CCIH.
Currently, it is aimed at the regulation downloaded by Ordinance 2.616/GM/MS, of May 12, 1998 (BRAZIL, 1998), which sends guidelines and norms for the prevention and control of nosocomial infections throughout the national territory, for individuals and corporations, Public or private law.
The breach or failure to comply with this Ordinance, subject the offender to the process and penalties provided for in Law No. 6.437/1977 (BRASIL, 1977), with referral of occurrences to the Public Prosecutor and Consumer Protection agencies for the application of the legislation Applicable (Law 8.078/90).
In This way, hospitals are obliged to constitute the Hospital Infection Control Committee (CCIH), with “status” of advising the institution’s maximum authority and executing the actions of hospital infection control. In the competence of the CCIH, it cites the ordinance, among other items:
3.1 to Elaborate, implement, maintain and evaluate hospital infection control program, appropriate to the characteristics and needs of the institution, contemplating, at a minimum, actions related to:
[…]
3.1.4-Rational use of Antimicrobians, germicides and medical-hospital materials;
[…]
3.7. Define, in cooperation with the Pharmacy and Therapeutics Commission, the policy of the use of Antimicrobians, germicides and medical-hospital materials for the institution; (our emphasis)
The guidelines punctuated by Resolution 1.552/99 (BRASIL, 1999) also have, in its art. 2 º, that the technical-operational routines contained in the norms established by the CCIH for the release and use of antibiotics should be agile and based on scientific protocols.
In This tuning fork, it was elaborated by the Society Beneficente São Camilo-Hospital São Vicente de Paulo An internal protocol for the release of Antimicrobians to be observed by all health professionals who work there. Similar Situation should occur in all health institutions in the country.
It is also Important to emphasize that according to art. 18 of the Code of Medical Ethics, the physician is prohibited from disobeying the judgments and resolutions of the Federal and Regional Medical Councils or disregarding them.
Finally, on the basis of Law No. 5.991/1973 (BRASIL, 1973), which has on the sanitary control of the drug trade, medicines, pharmaceutical inputs and related, it is recommended to the pharmacist that when verified that the dosage of the prescribed medicine exceeds the pharmacologic limits or the prescription presents incompatibilities, which request express confirmation to the professional who prescribed it[3].
3 FINAL CONSIDERATIONS
In View of the above, we emphasize the need for non-interference in the scientific autonomy of the medical professional in the indication of the appropriate procedure for the patient, according to the Resolution 2.217/2018 of the Federal Council of Medicine.
In Another dimension, we emphasize the validity of the Ordinance 2.616/GM/MS and the existence of an internal protocol in force in the HSVP about the exemption of Antimicrobians, as well as the duty of care shared among health professionals, and, in this sense, it is recommended To promote the widespread dissemination of the internal protocol in the Hospital about the exemption of Antimicrobians, for knowledge and immediate adoption by medical professionals.
Finally, it is concluded by the recommendation that the pharmaceutical professional, responsible for the distribution of Antimicrobians, who, when verifying that the dosage of the prescribed drug exceeds the pharmacological limits or the prescription presents Incompatibilities, in the use of their professional autonomy, request express confirmation to the professional who prescribed it.
References
| BRAZIL, Law 9,431, of January 06, 1997. it has the obligation to maintain a program to control hospital infections by hospitals in The country. Available at: <http://www.planalto.gov.br/ccivil_03/leis/l9431.htm>. Access on: 27 Jan. 2019. |
Brazil. Law 9,431, of January 06, 1997. it has the obligation to maintain a program to control hospital infections by hospitals in The country. Available at: <http://www.planalto.gov.br/ccivil_03/leis/l9431.htm>. Access on: 27 Jan. 2019.
Brazil. Law N. 8,078 of September 11, 1990. it provides for the protection of the consumer and makes other arrangements. Available at: <http://www.planalto.gov.br/ccivil_03/Leis/l8078.htm>. Access on 27 Jan. 2019.
Brazil. Law 3,268, of September 30, 1957. It has on The Medical councils, and makes other arrangements. Available at: <http://www.planalto.gov.br/ccivil_03/LEIS/L3268.htm>. Access on 27 Jan. 2019.
Brazil. Ordinance No. 2616, of May 12, 1998. Available in: <Http://bvsms.saude.gov.br/bvs/saudelegis/gm/1998/prt2616_12_05_1998.html>. Access on 27 Jan. 2019.
Brazil. Law 6,437, August 20, 1977. It configures violations of federal sanitary legislation, establishes the respective sanctions, and makes other arrangements. Available at: <http://www.planalto.gov.br/ccivil_03/LEIS/L6437.htm>. Access on 27 Jan. 2019.
Brazil. Law 5,991, of December 17, 1973. It has on The Sanitary control of The trade Of drugs, medicines, Pharmaceutical inputs And related, and gives other S Providence. Available at: <http://www.planalto.gov.br/ccivil_03/LEIS/L5991.htm>. Access on 27 Jan. 2019.
FEDERAL COUNCIL OF MEDICINE. CFM Resolution No. 2,217 of November 01, 2018. approves The code Of Medical ethics. Available at: <https://sistemas.cfm.org.br/normas/visualizar/resolucoes/BR/2018/2217>. Access on 27 Jan. 2019.
[1] Available at: <https://bit.ly/2xkxzmC>. Access on 27 Jan. 2019.
[2] Available at: <https://bit.ly/2xkxzmC>. Access on 27 Jan. 2019.
[3] Art. 41. When the dosage of the prescribed drug exceeds the pharmacological limits or the prescription presents incompatibilities, the technician responsible for the establishment will request confirmation to the professional who prescribed it.