Pharmaceutical orientation at hospital discharge of transplant patients: strategy for patient safety

Abstract

Objective:To describe and analyze the pharmaceutical orientation given at hospital discharge of transplant patients.Methods:This was a cross-sectional, descriptive and retrospective study that used records of orientation given by the clinical pharmacist in the inpatients unit of the Kidney and Liver Transplant Department, at Hospital Universitário Walter Cantídio, in the city of Fortaleza (CE), Brazil, from January to July, 2014. The following variables recorded at the Clinical Pharmacy Database were analyzed according to their significance and clinical outcomes: pharmaceutical orientation at hospital discharge, drug-related problems and negative outcomes associated with medication, and pharmaceutical interventions performed.Results:The first post-transplant hospital discharge involved the entire multidisciplinary team and the pharmacist was responsible for orienting about drug therapy. The mean hospital discharges/month with pharmaceutical orientation during the study period was 10.6±1.3, totaling 74 orientations. The prescribed drug therapy had a mean of 9.1±2.7 medications per patient. Fifty-nine drug-related problems were identified, in which 67.8% were related to non-prescription of medication needed, resulting in 89.8% of risk of negative outcomes associated with medications due to untreated health problems. The request for inclusion of drugs (66.1%) was the main intervention, and 49.2% of the medications had some action in the digestive tract or metabolism. All interventions were classified as appropriate, and 86.4% of them we able to prevent negative outcomes.Conclusion:Upon discharge of a transplanted patient, the orientation given by the clinical pharmacist together with the multidisciplinary team is important to avoid negative outcomes associated with drug therapy, assuring medication reconciliation and patient safety.

Cultura de segurança no processo de doação de órgãos: revisão de literatura

“…The recommendations identified in this study show that the development of a safety culture during the process of organ donation and transplantation is directly related to transplantation. Most of the studies are related to safety in the transplantation process, involving the use of medication, the participation (12) Brazil. Level IV evidence The clinical pharmacist should be part of the multiprofessional team for education of the transplant patient at the time of hospital discharge, to prevent negative results associated with pharmacotherapy, and to guarantee medication reconciliation and patient safety.…”

“…(16,24) The findings enabled the understanding that when greater patient involvement is obtained in the manipulation of medications, a greater level of treatment adherence is achieved, leading to an improvement in the patient's clinical condition, reducing infection rates, re-admission, and graft rejection. (12,(21)(22)(23) Category 2 -Culture of patient safety in the transplant units The category presents questions related to the safety culture of patients undergoing renal, (18,19) hepatic, (11) abdominal, (24) pancreatic, (20) and bone marrow transplantation, (14) in the pre-and intra-operative periods.…”

Care transition strategies in Latin American countries: an integrative review

“…Five studies were found related to discharge planning (17)(18)(19)(24)(25) . Planning was centered on the health conditions of patients (19) , cognitive capacity (17,19) , social support, and the needs of patients (19) .…”

Cuidados de saúde ao paciente transplantado hepático adulto no pós-operatório tardio

“…Professionals can and should use tools that allow a more effective orientation of care such as the creation of a map with all the medications, their respective schedules and doses described. 8 The patient who is able to understand the transplant can also change their life experience. He needs to learn how to deal with new medications, take them for the rest of his life, and adhere to lifestyle changes including hygiene practices, infection prevention, monitoring of new organ function, changes in body image, adaptation fluctuations in mood and energy level, issues of professional status, among others.…”

“…The team should encourage transplant recipients to carry out the exams on time, as recommended by prevention programs in the country of origin. 8 The main health care for the late postoperative liver transplant patients, described from the experience of the multiprofessional team in a referral hospital, were: prevention of infections; guidance on drug therapy; guidance on returning to outpatient appointments and conducting examinations; and surgical wound care.…”