Objectives: This study aims to analyze the compliance with the ISEP-Brazil patient safety good practice indicators related to medication management. It also aims to evaluate the applicability and limitations of these indicators in these hospitals. Methods: This is a cross-sectional study conducted in two large hospitals (H1 e H2) of the Minas Gerais public hospital network. The Group 5 indicators (medication management) and additional information on the safety profile were collected in both hospitals in February 2018, through an on-site visit. The difference between the proportions of the items met at H1 and H2 was evaluated using the Pearson chi-square test at a level of statistical significance of 5%. Results: Both hospitals satisfactorily meet more than 65% of the items evaluated (H1=71.2%, H2=66.7%), with H1 meeting three more items (n=42) than H2 (n=39). There was no statistically significant difference between the proportions of items in compliance at H1 and H2 (p = 0.69). However, through additional collection, activities that were not evaluated by the ISEP-Brazil indicators which may contribute to patient safety were detected, especially in H1. Examples are clinical activities, computerization of the dispensing and emergency carts, daily check of dispensing errors. Conclusion: A considerable proportion of sub-items followed the ISEP-Brazil indicators in hospitals. Although there was no statistically significant difference between these proportions, the additional on-site diagnosis allowed identification of a safer medication system in H1.
Objective: To describe the identification of drugs with similar primary packaging available in a large teaching hospital. Methods: This is a descriptive study carried out using a multi-step approach. First, the small volume parenteral drugs and oral solutions available at the institution (Step I) were listed. Then, from the list developed in Step I, groups of drugs with similar packaging (double, trio or foursome) were identified according to their characteristics (Step II). These groups were then visually evaluated by the pharmacy team (Step III), and later by the internal community of the institution (Step IV). Results: A total of 233 drugs in the pharmaceutical forms of interest were available at the institution (Stage I). In step II, 62 groups with similar primary packaging were identified. After evaluation by the pharmacy team, 19 groups remained (Stage III), which were then evaluated by the internal community, generating a final list of 15 groups of drugs with similar primary packaging. Among these, the pharmaceutical form of parenteral use (80%) and the amber ampoule as primary packaging (46.7%) were frequent. Conclusion: The results of the study point to the applicability and adequacy of the multistep approach to identify the presence of groups of drugs with similar primary packaging in a real-world scenario. The identification of these groups of drugs in health care institutions is the first important step to plan strategies to minimize errors involving similar packaging, thus increasing the safety of medication use in the hospital environment.
Objective: To assess the results of the health condition management service provided for children with sickle cell disease (SCD). Methods: a cross-sectional study of the health condition management service offered to newly diagnosed children with SCD treated between January 2016 and December 2019 at the Blood Center in Belo Horizonte, Brazil. The service was provided by a clinical pharmacist and an academic from the pharmacy course, with data from the initial consultation (start of drug use) performed in a pharmacist’s office and telephone contact carried out eight days later. All children seen at the service were evaluated, and their demographic characteristics, compliance with the beginning of the use of prophylactic drugs for sickle cell disease (phenoxymethylpenicillin and folic acid) according to the protocol of the Ministry of Health (within 90 days after birth), and documented reason in case of non-compliance. The doubts regarding the medications and the standardized interventions of the service to the children´s guardians were also described. The difference in the distribution of variables in the adequacy and non-adequacy group to the MS protocol was assessed using Pearson’s chi-square test (categorical) and Mann-Whitney (numerical). Results: In the SCD condition management service, all children together with their guardians (N = 298) had their first consultation with the pharmacist (initial dispensation day), however, only 185 (62.1%) participated in the pharmaceutical service by telephone (eight days after the initial dispensing). Approximately 88.3% of children started using drugs for sickle cell disease according to the protocol of the Ministry of Health; the most frequent reason for non-compliance was the late diagnosis in the complementary health system (22.9%). The guardians pointed out 63 doubts about the medications, highlighting their non-acceptance by the child (28.6%), and for all doubts standard pharmaceutical guidelines were provided in the service. Conclusion: It was identified that the health condition management service provided is relevant, since most of those responsible for the children with SCD had doubts about their medication after the administration of medications began. The pharmacist contributes positively to the pharmacotherapeutic management of SCD, promoting empowerment about the correct use of medicines.
Objective: A drug interaction (DI) is the clinical event in which the effect or action of one drug is modified by the presence of another. Because of potential harms and low consistency of available information, it is critical to assess the clinical relevance of DI. This study aimed to identify and evaluate the clinical consequences of DI in the pharmacotherapy of patients followed in a primary care Comprehensive Medication Management (CMM) services. Methods: This observational cross-sectional study was based on the analysis of the CMM records all the patients that used at least two medications and attended to at least three CMM consultations from August 2015 to March 2016 (n=88). Potential DI were identified among the medications used in the initial consultation of CMM using Micromedex® Drug-Reax® software. The DI were classified as “monitorable” (when its clinical consequences could be monitored by effectiveness or safety paremeters) or non-monitorable, and their clinical consequences were evaluated by analysis of CMM records. Results: Among the studied population 95.5% of the patients had at least one potential DI in their pharmacotherapy, totaling 493 potential DI. Of all the potential DIs identified, 90.9% were monitorable, and the majority of these monitorable DI presented no clinical consequences (62.7%). For 63.9% of the DI with clinical impact, the pharmacist adopted direct or indirect measures that would favor the resolution or reduction of the clinical impact of DIs. Conclusion: The CMM service facilitates the management of DIs since its decision-making method calls for monitoring of the effectiveness and safety parameters, individualizing the management of DIs according to the patient’s needs and their clinical consequences.
Objective: To describe the results of a Comprehensive Medication Management (CMM) service offered to patients of an adult intensive care unit. Methods: A descriptive cross-sectional study of the results of the CMM service (April 2017 to November 2018). All the patients followed up in the CMM service were included in the sample of this study. The service was integrally based on the Pharmaceutical Care Practice and, therefore, used the Pharmacotherapy Workup (PW) method. the drug therapy Problems (DTP) were quantified and classified according to the PW method. The main medications involved in the DTP were also described, as well as the acceptance of the interventions by the multidisciplinary care team members and patients. Results: 146 patients were followed up during the study period, and 512 DTP were identified. Of these DTP, most were related to medication safety (37.7%) and to indication (37.5%). The main causes were high dose (23.0%, with emphasis on dose adjustments in cases of kidney injury), need for additional medication (18.9%, inclusion of medication for electrolytic, glycemic, and prophylactic control), and unnecessary medication (18.6%, emphasis on de-prescription of antibiotics that were not indicated). Most of the problems (23.6%) were related to the therapeutic class of systemic anti-infective agent. Of the total DTP detected, 81.6% were resolved. A total of 451 interventions were implemented, of which 92.9% (n=419) were with physicians. The majority of the interventions with physicians were accepted (n=344, 82.1%). Conclusion: A high number of drug therapy problems have been detected and resolved by the CMM pharmacist, with emphasis on safety problems. The high acceptability of the interventions reinforces the need for the service applied to the critical patient.
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