Objetivo: Analisar a influência da complexidade da farmacoterapia (CFT) na adesão ao tratamento imunossupressor. Métodos: Trata-se de um estudo analítico, observacional e transversal, baseado nos registros do atendimento farmacêutico de pacientes transplantados renais de um hospital universitário (Fortaleza/Ceará). A CFT foi avaliada em consulta farmacêutica no período de janeiro a julho/2014, utilizando-se o Índice de Complexidade da Farmacoterapia (ICFT). A análise da adesão foi realizada através do nível sérico dos inibidores da calcineurina e imTor. Resultados: Analisou-se o acompanhamento de 36 pacientes: sendo 52,78% (n=19) homens; 27,80% (n=10) entre 41 e 50 anos; 41,70% (n=15) com ensino fundamental incompleto e 72,22% (n=26) possuíam cuidador. A média de medicamentos foi nove e de pontos no ICFT foi de 50,94. O ICFT máximo foi registrado na faixa de 31-60 dias pós-transplante. Analisando o nível sérico dos imunossupressores, observou-se prevalência de pacientes classificados como “não aderentes” maior no período menor de 60 dias pós-transplante. Conclusão: Concluiu-se que no pós-transplante renal a adesão dos pacientes ao tratamento imunossupressor aumenta com a diminuição da CFT, sendo necessária uma maior e melhor orientação dos pacientes no inicio do pós-transplante.

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Objective:The medication follow-up in infants with extremely low birth-weight in a neonatal intensive care unit is described, identifying drug-related problems (DRP), drug-related negative outcomes, and the relationship between the occurrence of DRP and birth-weight of newborns and their impact on pharmacotherapy and length of hospital stay.Methods:A descriptive and exploratory study was performed in which medication follow-up of a population of infants with extremely low birth-weight admitted to the neonatal intensive care unit of a government-run maternity hospital was carried out by clinical pharmacists. Monitoring comprised assessment of patients’ pharmacotherapy needs through visits to the neonatal unit, evaluation of prescriptions and information on medical records, identification of issues associated with pharmacotherapy and follow-up of the newborns’ clinical evolution to determine whether desired results were achieved.Results:The subjects were 33 infants characterized by extremely low weight at birth. Analysis of patients’ pharmacotherapy showed that 39.4% (n=13) of the neonates presented some type of DRP, totaling 37 DRPs and a mean of 2.8 problems/patient. Fourteen drugs were identified with the occurrence of DRP. Vancomycin and cefepime were the most prevalent, with 18.9% (n=7). Occurrence of DRPs and several clinical characteristics of newborns and their pharmacotherapy were compared. The most prevalent drug-related negative outcomes identified were “untreated health problem” (40%, n=10) and “quantitative ineffectiveness” (32%, n=8). Pharmaceutical interventions were performed for all problems associated with pharmacotherapy, with a prevalence of “treatment day count correction” and “dose correction”, both with 21.6% (n=8), and “correction of dosage” (16.2%, n=6).Conclusion:The research evidenced the role of the clinical pharmacist in the solution and prevention of drug-related problems, contributing with the multidisciplinary team to obtain a safe and effective pharmacotherapy. Further, current study confirmed that there is an association between the characteristics of the newborns under analysis (eg. birth-weight, pharmacotherapy) and the occurrence of drug-related problems.

Background: Investigation based solely on clinical history background is not sufficient to prove drug allergy and may lead to search for more expensive and potentially less effective alternative drugs. There are too few health centers that perform such tests in Brazil. Objectives: The aim of the present work was to structure and to systematize a service for in vivo drug skin testing in a public university hospital. Methods: The project was structured as follows: a) Divulgation about the service among health professionals and also among patients; b) Active search for suspicious cases; d) Referral to the allergist consultation; c) Performance of skin prick, intradermal and/or epicutaneous tests when requested. Results: Disclosure about the service was done through informal talk, workshop, flyers, advertisement. Active search for suspicious cases was done at the Dermatology Outpatient Clinics, Walter Cantídio Hospital School, Brazil. Ninety patients were evaluated by the allergist, and from these, 68 were submitted to drug skin tests. Thirty-five patients out of 68 presented clinical manifestations up to 2 h after drug intake and 33, more than 2h after drug intake. The drugs most implicated were NSAIDS and β-lactam drugs. Seventy-seven tests carried out. For immediate reading, 41 puncture tests and 12 intradermal tests were performed. For delayed reading, 24 epicutaneous tests were done. Two patients presented positive prick test to dipyrone. Conclusion: For implementing an adequate and effective service for drug skin testing, technical and practical training of health professionals about drug safety is necessary, besides interdisciplinary collaboration and an adequate support by the hospital managers.

Objective: To describe failure modes and establish contingency measures related to the clinical medication process using medical prescriptions of patients admitted to an Intensive Respiratory Therapy Unit (UTIR), using the Failure Mode and Effects Analysis (FMEA) tool. Methods: This is a descriptive and cross-sectional study carried out in an Intensive Care Unit of a public hospital in Fortaleza, Brazil, from November/2015 to March/2016. Study population included adults aging ≥ 18 years in intensive care at the UTIR. The study included the medical prescriptions released on Mondays, Wednesdays, and Fridays. The study was divided in five phases: situational diagnosis, formation of a multiprofessional team, assessment of failure modes (FM), monitoring of FM and calculation of the priority coefficient (PC). In the FM assessment, scoring of the three indicators of the FMEA was used within a range of 1-10, whereas a score of 10 characterized the most concerning situation. Therefore, the indicators gravity (G), prevalence (P) and detection (D) were analyzed. The study was carried out with an active interaction between the subjects of the group and several in-person and virtual sessions were performed. Drugs used in the study were categorized for therapeutic class, according to the Anatomical Therapeutic Chemical Classification System. Data analysis was performed using Microsoft Office Excel® 2013 software. Results: 301 prescriptions were analyzed, with the identification of 452 FMs, which related mostly to systemic antibacterials (21.6%, n = 8), psycholeptics (13.5%, n = 5) and antithrombotic agents (10.8%, n = 4). FMs were divided in eleven categories, from which “drug interaction” (36.8%; n = 14), “dose adjustment” (21.1%, n = 8) and “food-drug interaction” (7.9%, n = 3) were the most frequent. The PC of the detected FMs varied between 28 and 294, and 42.1% (n = 16) of them presented PC above 100. Median of the indicators G (6 – min: 3; max: 9), D (7 – min: 3; max 7) and priority coefficient (72 – min: 28; max: 294) indicate that FM had generally moderate gravity, low prevalence and low detection. For the majority of FMs (72.7%, n = 28), the chosen conduct was ‘not to accept’ and the established contingency measure included a sentinel event notification. Conclusion: The use of FMEA enabled the identification, classification, and prioritization of risks of the clinical medication process in the UTIR. This study indicates the need to implement measures that increase safety in the clinical practice of the study Intensive Care Unit.

Objetivos: Avaliar as recomendações farmacêuticas de desprescrição realizadas aos pacientes internados em uma Unidade de Terapia Intensiva (UTI) clínica adulto. Métodos: Trata-se de um estudo transversal, descritivo e quantitativo desenvolvido com as recomendações farmacêuticas de desprescrição de medicamentos, na UTI adulto de um hospital universitário em Fortaleza – CE, de 2017 a 2018. Os dados dos pacientes e das recomendações foram coletados a partir de prontuários de pacientes. A aceitabilidade das recomendações foi mensurada a partir da visualização da alteração sugerida em 24 horas. Os medicamentos envolvidos nas recomendações foram categorizados de acordo com a classificação Anatomical Therapeutic Chemical (ATC) e com a de Medicamentos Potencialmente Perigosos (MPP). Os dados foram compilados e analisados usando o software Microsoft Office Excel® 2013. Resultados: Realizou-se um total de 388 recomendações de desprescrição de medicamentos a 210 pacientes adultos que eram majoritariamente do gênero masculino (58%) e com idade média de 56 anos ± 16,8. A aceitabilidade das recomendações foi de 93,3% (n=362) e a média de medicamentos desprescritos por paciente foi de 1,7 ± 0,7, sendo todos interrompidos de forma abrupta. Os problemas relacionados com as desprescrições foram principalmente, prescrição de medicamentos não necessários (77,6%) medicamentos contraindicados (8,0%) e duplicidade terapêutica (5,1%). As classes terapêuticas mais prevalentes foram os antibacterianos para uso sistêmico (11,3%), oftalmológicos (20,8%) e medicamentos para distúrbios gastrointestinais funcionais (9,5%). Os principais medicamentos desprescritos foram o colírio hipromelose + dextrano (9,6%), bromoprida (6,9%) e cloreto de potássio injetável (5,8%), sendo esse último considerado um MPP. A classe mais associada a não aceitação da desprescrição foi a dos corticosteroides para uso sistêmico (23,1%). Conclusão: Este estudo mostrou um elevado nível de aceitação das recomendações de desprescrição, especialmente entre os antibacterianos para uso sistêmico. O cloreto de potássio injetável, considerado um MPP, ocupou o terceiro lugar geral de desprescrição. Futuros estudos devem avaliar o impacto das recomendações de desprescrição na morbimortalidade na UTI e na redução de custos hospitalares.

Objective: To evaluate the application of the Antimicrobial (ATM) treatment time reduction strategy in Intensive Care Units (ICU) in an Antimicrobial Stewardship Program (ASP). Method: This is a descriptive and cross-sectional study, carried out in two ICU of a university hospital in Fortaleza, Brazil, from January/2017 to January/2019. Adult patients were included, accompanied by a pharmacist, and using ATM, in which the treatment time reduction strategy was applied. The evaluation of the strategy was made through the difference between the predicted time established at the beginning of the treatment and the effective days of use of each ATM. Results: Of the 100 patients included, 51.0 % were male and 64.0 % were elderly. The respiratory system was the most frequently affected by the infections (37.4 %) and the most prevalent classes of ATM were carbapenems (23.0 %) and glycopeptides (20.1 %). There was a decrease from 831 unnecessary days of antimicrobial therapy and from an average of 13.7 to 8.9 days of treatment. The greatest reductions in days were observed for meropenem, with 202 days reduced. The study also allowed the identification of associations between the reduction > 8 days of treatment and the variables length of stay > 22 days and patients in exclusive palliative care, and associations between hospital discharge and reductions of up to 7 days of therapy. Conclusions: The data obtained suggest that the presence of an ASP influences the practices of ATM use and its treatment time and emphasize the role of pharmaceutical professionals in these programs.

Objetivo: El propósito de este estudio es evaluar las intervenciones farmacéuticas (IF) realizadas sobre PRM y los factores asociados a su aceptación. Método: Se trata de un estudio descriptivo y transversal que analizó las IF realizadas a pacientes adultos de dos UCI de Fortaleza, Brasil, en 2019. Las IF se analizaron en las categorías cantidad de fármaco y estrategia farmacológica, utilizando la clasificación propuesta por Sabater et al. Los fármacos se clasificaron además por el Sistema de Clasificación Anatómica, Terapéutica, Química y por la clasificación de Fármacos de Alta Vigilancia (FAV). Resultados: Se incluyeron 305 pacientes, siendo la mayoría del sexo masculino (55,1 %), ancianos (52,8 %) y atendidos en la UCI quirúrgica (51,4 %). Se analizaron 1.317 IF y se aceptaron el 88,0 %, siendo la sustitución de uno o más fármacos (28,0 %) y la adición de uno o más fármacos (27,7 %) las más frecuentes. La clase terapéutica más prevalente fue antiinfeccioso de uso sistémico (24,1 %) y los FAV estuvieron implicados en el 21,7 % de las IF. Se observó asociación entre las IF aceptadas e ingreso en UCI clínica (p<0,0001), FAV (p=0,0013), sustitución de uno o más fármacos (p=0,0062) y la clase sustitutos sanguíneos y soluciones de perfusión (p= 0,0187). Conclusiones: Se realizaron y aceptaron un elevado número de IF, lo que refuerza la importancia del farmacéutico en la revisión de las prescripciones médicas en UCI.