EVENTOS ADVERSOS COM MEDICAMENTOS NA PEDIATRIA: O PAPEL DA ORGANIZAÇÃO HOSPITALAR

Abstract

Objective: To reflect on the occurrence of adverse events in the context of pediatrics, based on the model of Safety Organizational Analysis. This perspective goes beyond the idea of human error as the only explanatory factor for accidents or adverse events, when proposing that socio-historical determinants are placed as the basis of understanding these phenomena. Method: The methodological approach consisted, initially, of a survey of the occurrence of these events, both nationally and internationally, verifying that 8% of these occur in pediatrics. Based on this finding, a study of an adverse event was performed in the pediatrics sector of a Brazilian hospital, with dramatic outcome. Results: The results point to the need of questioning the superficial understanding that still prevails over the causes of this type of accident, and proposes that a more complex view should be developed about it. Conclusion: We conclude with the idea of going beyond the perspective of mere criminalization or prescription of conduct in order to develop more effective means of prevention.