Analysis of clinical pharmacist interventions in a tertiary teaching hospital in Brazil

Abstract

Objective:To analyze the clinical pharmacist interventions performed during the review of prescription orders of the Adult Intensive Care, Cardiologic Intensive Care, and Clinical Cardiology Units of a large tertiary teaching hospital in Brazil.Methods:The analysis took place daily with the following parameters: dose, rate of administration, presentation and/or dosage form, presence of inappropriate/unnecessary drugs, necessity of additional medication, more proper alternative therapies, presence of relevant drug interactions, inconsistencies in prescription orders, physical-chemical incompatibilities/solution stability. From this evaluation, the drug therapy problems were classified, as well as the resulting clinical interventions.Results:During the study, a total of 6,438 drug orders were assessed and 933 interventions were performed. The most prevalent drug therapy problems involved ranitidine (28.44%), enoxaparin (13.76%), and meropenem (8.26%). The acceptability of the interventions was 76.32%. The most common problem found was related to dose, representing 46.73% of the total.Conclusion:Our study showed that up to 14.6% of the prescriptions reviewed had some drug therapy problem and the pharmacist interventions have promoted positive changes in seven to ten of these prescriptions.

Clinical Pharmacist Role in Drug Information Services And Medication Errors Management At Tertiary Care Hospital

“…We have analyzed the ward wise intervention and found that the occurrence of errors is more in the General medicine ward 62% (MM 38.7%,FM 22.58%), followed by psychiatry 19.35% and especially Geriatric patients 51.6% were involved similar results were supported by Beveket molla Tigabu et al [15], Professional status of the person involved in the errors, we found that 80.64% of errors were committed by Physicians/Interns, followed by 12.90% by Pharmacists and finally by 6.45% were by nurses. In this study, reasons for the error were estimated based on the professional status involved in the error and we have found that 48.38% of the errors are due to lack of knowledge, followed by 51.61% due to busy schedule/ heavy patients Finally we have observed that prescriptions with Antibiotics & Antihypertensives (51%) are highly involved in the errors supported by A.A.Al-Dhawailie et al [16] and Nrupal Patel et al [17], studies as there are so many drug -drug interactions are possible in these class of drugs and also duration of treatment should be properly prescribed because they may lead to adverse drug reactions, followed by anti-psychotics which shows many ADR's which was supported by Uday venkat Mateti et al study [18].…”

Evaluation of Pharmaceutical Clinical Interventions in the Icu of a Public Hospital of Santa Catarina

“…A result close to that of this study was found with IF performed in a PIC-Recife ICU in 2013, with 98.2% acceptance. 9 They also found a relatively high result of acceptance of the interventions (74.7%) in a study carried out in a Curitiba -PR ICU in 2012, 12 and another with 82.2% in a hospital in Belo Horizonte, MG in 2013. 8 Even with partial acceptance, the interventions served as a warning to monitor the risks to the patient, especially when considering their severity, which assumed the following proportions: higher risk (57%), severe (15%) or moderate (10 %) and contraindicated (12%), recommendation to monitor closely reached 3% and only 3% were of lower severity.…”

“…2 And in another study carried out at an ICU in Curitiba-PR in 2012 the population was most of the male gender, with a mean age of 59 years and an average of 11 prescription drugs. 12 The high quantity of prescription drugs directly implies greater potential for important drug interactions. In this study, 956 drugs were observed requiring pharmaceutical intervention, with the most frequent being: potential drug interactions, followed by potential adverse effects, need for dose adjustment and physicochemical incompatibility.…”

“…Thus, the prior detection of problems related to pharmacotherapy can prevent the occurrence of adverse events and consequent expenses resulting from the management of these. 9,12 Therefore, prescription analysis has been presented as an important part of the pharmacotherapy follow-up process with a focus on patient safety. [14][15] Although it was not possible to measure the impact of pharmaceutical interventions in the present study, it was found that the clinical pharmacy service can contribute to the prevention of drugrelated problems with risk minimization, since the detailed PM analysis and pharmacotherapeutic follow-up by the pharmacist , resulted in the identification of a large number of IFs.…”

“…In one of these, the benefit of the pharmacist's involvement in clinical activities was highlighted, presenting a large number (n=933) of interventions performed in prescriptions of sectors with critical patients, among them ICU. 12 In another study, a total of up to 8.2 daily interventions per ICU patient. 10 The present study had an average of 3 daily interventions per patient, with a minimum of 0 intervention and a maximum of 13 interventions, the largest number of interventions were for prescriptions with more than 25 prescribed drugs.…”