Associate Chief Pharmacist-Clinical Services, Guy' and St Thomas' NHS Foundation Trust, London. Reader in 19 acute hospital trusts in North-west England ondieslinfuncton.ml:/ondieslinfuncton.mldia/pdf/ ondieslinfuncton.ml wellness and disease prevention.8 The practice of clinical pharmacy Wide variations in the extent and nature of hospital clinical pharmacy services 1–4: available online at: ondieslinfuncton.ml pdf. PDF | Objective: To describe how clinical pharmacy is helping to improve medication use at a South Indian teaching hospital by addressing.
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PDF | Clinical Pharmacy is a unique service provided by the leading pharmacy At the King Khalid University Hospital (KKUH) the first Clinical Pharmacy. HOSPITAL AND CLINICAL ondieslinfuncton.ml - Download as PDF File .pdf), Text File .txt) or view presentation slides online. current scenario of pharmacy practices in four hospitals of Bangladesh and to identify the Hospital pharmacy, Clinical pharmacist. .. pdf/ondieslinfuncton.ml
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After that, clinical pharmacists evaluated the orders and the drugs were subsequently dispensed by pharmacy technicians. It is important to note that each clinical pharmacist accompanied a defined inpatient care unit, evaluating medical prescriptions, participating in multiprofessional clinical rounds, and interacting with the healthcare team and with patients, whenever possible.
Thus, in our context, the clinical pharmacist was responsible for monitoring the pharmacotherapeutic needs of patients, seeking to guarantee the rational and safe use of drugs. Prescription order review consisted of an assessment by the pharmacist of parameters related to medication selection, therapeutic regimen, and administration instructions.
Regarding the choice of the classification method of DTP and CPI, several references were consulted, despite the fact that most of them presented limitations in their application to the reality of the hospital. When a DTP was identified during the prescription review, the system adopted by the pharmacist was to contact the physician or other health care professional responsible for the patient to discuss the best approach to take.
The DTP, the CPI and the acceptability were recorded and classified in standardized forms, and then tabulated in spreadsheets and sequentially analyzed.
The acceptability of interventions was classified as follows: accepted; not accepted with justification, when the intervention was not accepted but there was a plausible explanation to justify the medical decision; not accepted without justification; accepted with alterations, in these cases an intervention was proposed, however during the discussion with the healthcare professional some change was made; does not apply to interventions consisting of educational actions.
As a way to establish a cycle for the improvement of existing processes, reports presenting the data obtained from the clinical pharmaceutical activities were periodically sent to the physicians responsible for the hospital units. Then, meetings were scheduled for to assess, discuss, and define continuous improvement actions. All units have integrated multiprofessional teams in their activities, comprising the following professionals: physicians, nurses, pharmacists, nutritionists, psychologists, physiotherapists, and occupational therapists.
Among the study population, The median age was 59 years and the average length of stay in clinical units was 4. About nine out of ten patients had some type of co-morbidity, the most common ones were hypertension Eleven drugs on average were reviewed per prescription, and the average time required for evaluation of each prescription was We found DTPs, involving drugs, in working days, representing 3.
The types of DTP found and frequencies are shown in the table 1. The problems found were: dose for The therapeutic categories involved in DTPs are described in table 2. As shown in the table 3 , the CPIs performed were classified as: Regarding the acceptability of CPIs, During many years, Brazilian pharmacists were restricted to the management of hospital pharmacies; however, every day, the need of this professional in clinical units is becoming clearer and clearer.
Our study showed that the review of prescription orders, integrated to the hospital dispensing routine, is an important way to detect and resolve medication errors and to improve the quality of medication use.
In hospitals, prescription orders play a key role in promoting the communication between the healthcare team and accounts for ensuring the correct use of medication.
Considering this and that the review process of prescription orders is essential to improve pharmacotherapy to patients, particularly in hospitals, this activity was defined as priority. Moreover, studies showed that most of the medication errors occur during medication prescription and administration processes; so pharmacists could have a greater influence in the proper prescription towards quality in medication use 5,6.
Prescription errors are a major cause of preventable adverse drug events, therefore interventions aimed at preventing these errors are likely to result in cost reduction.
Possibilities for the reduction of prescription errors are the use of electronic prescribing systems and clinical pharmacy services 18, Our institution has an electronic prescription system and the beginning of a pharmacy residence program enabled the implementation of clinical activities for inpatients and outpatients with significant improvements in the hospital pharmacy unit.
One important breakthrough conquered in our institution during the study period was that the participation of pharmacists in daily clinical activities in inpatient units, which was essential to complement the activities of clinical pharmacists.
This insertion allows the identification of DTPs that were not yet perceived in the pharmacy unit, such as the presence of interactions and incompatibilities between the solutions administered by Y catheter; inadequate protection or medication storage and infusions; problems in the interpretation of medications in the hospital's computerized information system.
The importance of the clinical pharmacist in the prevention, early detection and resolution of DTPs has become clear. Approximately one in every seven prescriptions had some type of DTP, requiring a pharmacist intervention. This result is similar to that found by Franklin et al. Other studies also detected the need of dose adjustment as the most frequent medication error 20, LaPointe 22 , in his review, showed as the most frequent medication errors: wrong medication Moreover, the absolute prevalence of polypharmacy and the number of medications per prescription was high average of 11 medications per order also predisposing to a higher prevalence of inappropriate or unnecessary medications.
The medications predominantly involved in DPT were ranitidine, enoxaparin and meropenem. These medications are commonly prescribed to critically ill patients, for being part of clinical protocols for example: ranitidine for prophylaxis of stress ulcer, enoxaparin for prophylaxis of deep venous thrombosis and enoxaparin for treatment of acute coronary syndrome or for being used to treat pathologies frequent in this population for example: meropenem for infections by Gram-negative bacteria.
The acceptability of the interventions made in the period was It is important to consider that, in our study, pharmacist recommendations to physicians regarding pharmacotherapy monitoring, which correspond to 6. This aspect may have led to a reduction in the acceptability rate of the study. In other hand, in a study performed by Leape et al.
During the classification of DTPs, several questions emerged, and they were discussed in weekly meetings between the team of clinical pharmacists and preceptorship.
Through these discussions, it was possible to identify needs for adjustments in several steps, including: review of the standardization of pharmacist interventions and monitoring registration methods; periodic review of the clinical pharmacy manual; training and capacity building of first-year pharmacist residents, pharmacy technicians, members of the nursing staff, and medical staff; in addition to updating the dispensing routine.
Regarding the disclosure of the data collected, continuous reports of the clinical pharmacy performance were sent to the responsible units, assistance direction, teaching direction, and clinical direction of the hospital. This structure provided a wide dissemination of the activities performed, and permitted the assistance teams to discuss results. It allowed the identification of the most prevalent interventions, and the definition of potential improvement actions with the unit's responsible and the residence team to reduce these numbers.
Our study has some limitations. Otherwise, we could evaluate more than 6, prescriptions in the area of cardiovascular and critical care. In our experience, these units correspond to the most important areas regarding the occurrence of medication errors.
Another limitation corresponds to the fact that the assessment of prescriptions was performed in the hospital pharmacy unit, often hampering the communication with the healthcare team and the perception of errors associated with the preparation and medication administration routine.
Despite the fact that pharmacist participation in clinical rounds could minimize this limitation, we cannot rule out the possibility that DTP prevalence may have been underestimated. Like any new process, the effective action of the clinical pharmacist in Brazil still has a long way to go. However, everyday the need for the inclusion of clinical pharmacists in healthcare teams becomes more evident, since the incidence of medication errors is still alarming, and pharmacist interventions can generate direct benefits for patient safety, as well as provide improvement in the quality of care.