Pharmaceutical interventions and their clinical outcomes in an inpatient post-transplant unit
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Serviço de Farmácia Clínica, Transplante de rim, Transplante de fígado, Segurança do paciente.Abstract
To contribute to the formation of knowledge in Brazil about the impact of the clinical pharmacist's role in the care of inpatient post-transplant by analyzing the results of the pharmaceutical interventions performed. A descriptive study was conducted from January to July/2014. Data were collected from the records of the Clinical Pharmacy Service (medication reconciliation, prescription analysis and pharmacotherapeutic follow-up), including all patients with drug-related problems and documented pharmaceutical interventions. Epidemiological variables and related to the clinical activities of the pharmacist were described. A total of 131 patients had drug-related problems, especially, during “Pharmacoterapeutic follow-up”. The most frequent categories were: “not prescribed required medicine” (125; 21.7%), “overdosing” (97; 16.8%) and “underdosing” (93; 16.1%). The main drugs involved were “ganciclovir” (81; 13.4%) and “tacrolimus” (33; 5.5%). The pharmaceutical interventions included “dose/adequacy” (193; 33.4%), “inclusion” (122; 21.1%) or “suspension” (122; 21.1%) of medication. The main clinical outcomes were “prevention” (481; 83.4%) or “improvement” (59; 10.2%) of health problems, such as “adverse effects” (170; 29.5%), “infection” (133; 23%) and “rejection” (41; 7.1%), being identified a significant relationship (p<0.05) between the acceptance of interventions and these outcomes, as well as between the non-acceptance and the occurrence of negative outcomes associated with medication. Our findings demonstrated that the pharmaceutical interventions, carried at all stages of care to inpatient post-transplant, integrated with the multidisciplinary team, were able to provide clinical outcomes in the prevention and improvement in health problems related to medication, such as adverse events, infection and rejection.
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