Science and Technology

Presence of pharmacist wards avoids problems with drugs

During the study pharmacist seeks not only to identify problems with the recipes, but also intervene when necessary

Study reveals that the participation of pharmacists in the decision process concerning the prescription of elderly patients may benefit medical teams, contributing to the treatment and to reduce the occurrence of drug related problems (DRPs) in hospital wards. Prescriptions not appropriate for the elderly have been observed and constitute a serious public health problem, says pharmacist Mário Henrique Tomassi, Pharmacist Pharmacy Service of the University Hospital (UH), USP.

In research at the Institute of Biomedical Sciences (ICB), USP, Tomassi monitored a team of health HU responsible for elderly patients of the clinic's medical institution. I joined one of the groups, accompanying medical visits and activities for the clinical outcome of patients account. During the study, he sought not only to identify any problems with the recipes, but also intervene when necessary to prevent its occurrence.

Were followed 28 patients in the ward of HU, with a mean age of 70 years, hospitalized due to complications from chronic diseases or suffering from some infection. In general, the patient remained hospitalized for about ten days, making extensive use of multiple drugs (concomitant drugs over 5) and, in some cases, extreme polypharmacy (10 or more drugs) reports the researcher. The research included the evaluation of charts and 100 prescriptions random.

In prescriptions, were found, in all, 924 problems, and 920 medication errors (MEs) and 4 possible adverse drug reactions (ADRs), one confirmed clinically. However, says the pharmacist, it is essential to differentiate the various occurrences. These problems may be related to ADRs, considered as unavoidable and always produce harm to the patient or EMs considered preventable and that may or may not cause damage, explains.

The most frequent errors were therapeutic (46.5%) and administrative and procedural (42.7%). In the first case stood out potential drug interactions (28.7% of total) and the second, errors of a general nature (28.0%), as failure to follow the rules of safe prescription American Society of Health-System Pharmacists [ASHP] and of the institution, the researcher specifies.

Among the errors were of a general lack of space between dose and unit revenues outside of the international measures, deleted items, prescription medications by their brand names and not generic, as determined by the Unified Health System (SUS), among others . In addition, potentially inappropriate medications for older were administered to 21.4% of the sick. Although most of the errors have been classified as without harm to the patient, Tomassi highlights that information is not well underway can be interpreted in the wrong way and have more serious effects.

Activities by the medical team, Tomassi conducted 143 interventions in 73 prescriptions. The pharmaceutical intervention clinic is linked to something called active pharmacovigilance, which is given by the demand in real time, drug related problems, which can change the outcome of the case. He explains the activity: Pharmaceutical hospital may have a role in improving the management through a collaborative medication review, a process in which the practitioner evaluates medicines for patients and suggests changes subject to the agreement of the responsible physician.

Besides the integration of the pharmacist to medical teams, the research points out other changes to mitigate problems with prescriptions, such as improved communication between staff, better use of electronic tools for managing and controlling revenues and dispensing and administration of drugs, incorporating protocols clinicians to the hospital routine and continuing education for health professionals.

<i> Agency information USP </ i>