MATERIAIS E MEDICAMENTOS COM VALIDADE EXPIRADA, GERENCIAMENTO E DESAFIOS

DESAFIOS Karla Rona da Silva1 , Elci de Souza Santos2 , Shirlei Moreira da Costa Faria3 , Marina Lanari Fernandes4 , Mery Natali Silva Abreu5 RESUMO Objetivo: conhecer o gerenciamento de resíduos de serviços de saúde oriundos de materiais hospitalares e medicamentos descartados devido à data de validade expirada, em um hospital universitário. Método: trata-se de um estudo quantitativo, descritivo, transversal, a ser realizado em um hospital universitário. Coletar-se-ão os dados por meio de consulta ao banco de dados e formulários restritos do cenário de estudo. Investigar-se-ão as seguintes variáveis: descrição do resíduo; período de destinação final; custo do produto e da destinação final; quantidade e local de geração. Organizar-se-ão os dados em planilhas de Excel, analisando-os pelo software Statistical Package for the Social Sciences, versão 19. Realizar-se-á o estudo após a aprovação dos Comitês de Ética responsáveis. Resultados esperados: pretendem-se obter informações que subsidiem a intervenção por meio de planejamento, monitoramento e avaliação logística de todos os processos da gestão de resíduos de serviços de saúde. Descritores: Resíduos de Serviços de Saúde; Resíduos; Serviços de Saúde; Almoxarifado Central Hospitalar; Estabilidade de Medicamentos; Equipamentos e Provisões Hospitalares. Descriptors: Medical Waste; Waste Products; Health Services; Central Supply, Hospital; Drug Stability; Equipment and Supplies, Hospital. Descriptores: Residuos Sanitarios; Resíduos; Servicios de Salud; Central de Suministros em Hospital; Estabilidad de Medicamentos; Equipos y Suministros de Hospitalares. 1Universidade Federal de Minas Gerais/UFMG. Belo Horizonte (MG), Brasil. 1 https://orcid.org/0000-0003-0495-789X 2 https://orcid.org/0000-0001-8815-2778 3 https://orcid.org/0000-0002-7901-4098 4 https://orcid.org/0000-0002-9942-6903 5 https://orcid.org/0000-0002-6691-3537

Descriptors: Health Services Waste; Health Services; Central Hospital Warehouse; Drug Stability; Hospital Equipment and Supplies.

RESUMEN
Objetivo: conocer la gestión de los residuos del servicio de salud a partir de materiales hospitalarios y medicamentos descartados por caducidad, en un hospital universitario. Método: se trata de un estudio cuantitativo, descriptivo, transversal, para ser realizado en un hospital universitario. Los datos se recogerán consultando la base de datos y formularios restringidos del escenario de estudio. Se investigarán las siguientes variables: descripción del residuo; período de destino final; costo del producto y destino final; cantidad y lugar de generación. Los datos se organizarán en hojas de cálculo Excel, analizados mediante el software Statistical Package for the Social Sciences, versión 19. El estudio se llevará a cabo tras la aprobación de los Comités de Ética responsables. Resultados esperados: pretendemos obtener informaciones que sustenten la intervención mediante la planificación, monitoreo y evaluación logística de todos los procesos de gestión de residuos de los servicios de salud. destination of these MAT/DRU with expired validity has an impact on the allocation and use of financial resources, due to the high cost of their final destination, once they become Health Services Waste (HSW). [3][4][5] The management of HSW is constituted in a set of management procedures planned and implemented from scientific and technical, normative and legal bases. The objective is to minimize the production, the quantity of waste, as well as to provide its safe forwarding and, consequently, contribute to the protection of workers, the preservation of public health, natural resources and the environment. 5-6

Descriptores
The MAT/DRU consist of products for use in health treatment which, according to the purpose and use of the material, may be non-invasive, invasive, active and special, according to criteria recommended by the National Health Surveillance Agency (ANVISA), being the manager's responsibility the Good Storage Practice (GSP), good distribution practices, besides the control, training, codification, safekeeping and registering of these in physical or electronic format. [7][8] The drugs are produced in order to avoid the expansion of the pathology, to cure, to be a palliative during the suffering in terminology and for the improvement of medical diagnoses. It is added, however, that they can also be configured as pharmaceutical input or related product. The standardization of the availability of these materials in the institution should be taken into account, having as one of the criteria the expiration date and the complexity of intersectoral actions. 9 It is important to consider, if there are hospital MAT/DRU losses due to the expiration date, that at some point in the process the structures of acquisition, stock, availability and use by professionals of these resources are not well established. It is understood that it is up to the manager to define new procedures, routines and methods. The standardization of Business Process Management (BPM) has the potential to allow the manager to evaluate, analyze and study the various methods available, identifying, explaining and justifying the limitations, especially the implications and possible results of their uses. 8 This study is relevant, based on these reflections, because there is no consolidated information on quantification, classification, generating unit and intervention strategies on the target theme. It is noteworthy that products, when managed in a non-compliant manner, become waste, burdening the institution not only with the demand for new purchases, but also with the cost of final destination.
It is expected, from the organizational point of view, that the data collected will provide inputs for the planning of necessary actions in order to develop an intersectoral communication that will contribute to the strengthening of warehouse management and organization of purchasing processes in order to optimize the distribution of drugs and medical hospital materials, preventing such products from becoming HSW.
This study aims to answer the following guiding question: "How has the management of HSW from MAT/DRU discarded due to the expiration date in a university hospital from 2015 to 2019 occurred?".
To learn about the management of health care waste from hospital materials and drugs discarded due to the expiration date, at a university hospital. This is a quantitative, descriptive, cross-sectional study that will be carried out at a university hospital in the State of Minas Gerais.
Research will be carried out in a health service integrated to the Unified Health System (UHS), which is under the administration of a public company, whose management is federal, with 24-hour care. It is informed that it is a reference in transplants, oncologic treatments and chemotherapy, maternity and high risk nursery, high cost pacemakers, cardiac surgery, among others. The average monthly production is presented as follows: 4500 emergency consultations; 1500 hospitalizations; 36 thousand outpatient consultations; 160 thousand laboratorial exams; 1600 surgeries and 200 births.
It is explained that it is a reference hospital teaching unit in high cardiovascular complexity, high complexity in neurology and neurosurgery, which offers to SUS users outpatient care in the levels of basic, medium and high complexity and medium and high complexity hospital care. 10 For data collection, spreadsheets will be built in Microsoft Office Excel 2010 in order to register the HSW: MAT/DRU generated in the last five years (2015-2019), through consultation in a restricted database of the institution, and documentary analysis of the available forms. This period was chosen due to the fact that the institutional records have been reliably executed in the last five years as a result of internal process improvements. The following variables will be investigated: description of the residue; period of final destination; cost of the product and final destination; discarded quantity and place of generation. In order to calculate the cost with the acquisition and final destination environmentally adequate of these MAT/DRU, only the year 2019 will be considered, which presents updated data on this variable, because, in that year, the registration became mandatory.

METHOD
The descriptive analysis of the data will be performed through the Statistical Package for the Social Sciences (SPSS), version 19, with calculation of absolute and relative frequencies, measures of central tendency and variability and construction of graphs.