Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde

Prevalence of the use of medications requiring renal adjustment in critical care units of a public hospital

Dandara BINDEMANN — 2024-12-11

Objective: To evaluate, among the most prescribed medications in the Intensive Care Units (ICU) of a public teaching hospital, those that require dose adjustment according to renal function, and to present the role of the pharmacist in this care setting. Methods: A cross-sectional observational study was conducted, with data collected from medication prescriptions through reports generated by the institution’s Hospital Information System from 2015 to 2019. Step 1: Based on the list of all medications prescribed during this period in two ICUs of the institution, the prevalence of prescription was calculated. For the 100 most used medications, a search was conducted on the Uptodate platform regarding the need for dose adjustment based on renal function. The data were compiled into a Microsoft Excel spreadsheet. Step 2: The compiled data were presented to five clinical pharmacists from the institution, who assessed the severity and likelihood of occurrence of potential nonadjustment of doses for the 10 most prevalent medications that require it, using the Hazard Score Matrix. Results: Of the 100 most prevalent, a total of 34 medications were identified that require dose adjustment, with the most predominant classes being antimicrobials (41.2%), followed by those related to the cardiovascular system (20.6%) and the central nervous system (17.6%). The medications that scored highest when evaluated by the Hazard Score Matrix were morphine and regular insulin, followed by enoxaparin and potassium chloride. It was noted that dose adjustment is necessary not only to reduce adverse reactions or nephrotoxicity but also to ensure therapeutic effectiveness. Conclusion: This study emphasized the importance of adjusting medication doses in critically ill patients with renal dysfunction. Many frequently prescribed medications require dose modifications to ensure safety and effectiveness, particularly those classified as ‘high-alert’ due to their narrow therapeutic range. Collaboration between physicians and pharmacists is essential for minimizing risks in this context. Additionally, the use of risk analysis tools, such as HFMEA, facilitates the implementation of preventive interventions and dose adjustment protocols.

Analysis and spatial mapping of antimicrobial prescription completeness and legibility in a public community pharmacy

Friedemann BERGER — 2024-12-11

Objective The phenomenon of resistance of antimicrobials is associated with inappropriate use. The analysis of antimicrobial prescriptions, evaluating their legibility and completeness, is interesting because it aims to identify possible errors that may compromise the proper use. This study aims to evaluate the completeness and legibility of antimicrobial prescriptions in a municipality in southeastern Brazil. Methods The antimicrobial prescriptions retained at the Community Pharmacy in the municipality of Alegre, from March 2018 to February 2019, underwent a simple random sampling process to obtain the sample for analysis. In addition, data on the origin of the prescription were georeferenced, generating a map correlating the evaluation of the legibility of the prescriptions with the health units of the municipality. This study was approved by the Research Ethics Committee of the Administrative Coordination of Southern Espírito Santo (CASES) with the CAAE number: 13586319.6.0000.8151. Results The sample comprised 359 prescriptions containing 373 antimicrobials. The majority of prescriptions (97.2%) contained complete data from the prescribing professional, and 70.2% presented the patient’s identification without abbreviations, although 44% showed legibility problems in this parameter. In 35.4% of the prescriptions, there were legibility problems and no data in the joint evaluation of the prescribed antimicrobial, concentration, quantity, pharmaceutical form, dose, frequency, and duration of treatment. In the evaluation of the posology (dose and frequency) and duration of treatment, complete data were found in 82.3% and 71.8%, respectively. Most of the antimicrobials prescribed, 95.4% and 93% respectively, were listed in the National List of Essential Medicines (Rename) and were in the Brazilian Common Denomination (DCB) format. The most prescribed antimicrobial was Cephalexin 500mg. Conclusion The study indicated the presence of antimicrobial prescriptions that do not comply with legislation and may compromise patient safety. These findings highlight the need for targeted interventions to improve prescription legibility and adherence to the regulatory standards in public health settings.

Pharmacies are not supermarkets, and supermarkets should not become pharmacies

Gabriel R. FREITAS — 2024-11-25