[Drug safety: advances and challenges on the path to excellence at Brazilian hospitals]

The aim was to analyze changes in drug safety practices in Brazil from 2016 to 2023. A retrospective documental study was conducted based on reports from the Brazilian National Assessment of Patient Safety Practices. Data were collected from national Pareto graphs and analyzed in light of Pareto Theory, which states the most vital elements are responsible for 80% of problems. A total of 68% of Brazilian hospitals with ICU beds adhered to the evaluation of patient safety practices by 2023. Among 21 indicators, an average of 12 vital practices were identified as sources of noncompliance. The degree of compliance was greater in the structure domain compared to the process domain. Drug safety was among the most critical sources of noncompliance. A progressive improvement occurred between 2016 and 2019, with a reduction in noncompliance from 9% to 5.82%. Beginning in 2020, however, a tendency toward stagnation was found, with the percentage of noncompliance maintained at around 6% until 2023. The interruption in progress may be attributed to the COVID-19 pandemic, during which efforts and resources were diverted to help deal with the health crisis. The results enable an empirical understanding of advances and limitations with regards to adherence to drug safety practices at Brazilian hospitals, which contributes to strengthening knowledge on the current maturity of the safety culture in Brazil and the development of effective management strategies for the Brazilian Unified National Health System and drug safety.