Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde

Analysis of the notifications of adverse drug events in a Brazilian public hospital

Larissa Duarte SANTOS — 2024-12-30

Objective: to describe the adverse drug events (ADE) reported to the Brazilian Health Regulatory Agency (Anvisa) by a public hospital of the Sentinel Network in Belo Horizonte. Method: descriptive observational study, with analysis of the complete ADE notifications registered at VigiMed by the Permanent Committee for Hospital Sanitary Risk Management from January 2021 to May 2022. The notified ADEs were described according to their distribution by month, by sector and according to their classification as adverse drug reaction (ADR) or medication error. The drugs involved in the notifications were classified according to the first level of the Anatomical Therapeutic Chemical (ATC) code from World Health Organization. Results: 74 notifications were analyzed, with a median of five notifications each month. Of those, 14 (18.9%) were ADR; seven (9.4%) were prescription errors; 11 (14.9%) were dispensing errors and 42 (56.8%) were administration errors. The sectors with the highest number of notifications were adult ward - inpatient, oncology - outpatient and pharmacy units. The class of drugs most involved in ADE was “Blood and Blood-forming Organs” (20.3%), followed by “Anti-infectives for systemic use” (18.9%). Conclusion: In this study, the ADEs notified to Anvisa at a public hospital of the Sentinel Network of Belo Horizonte were described qualitatively and quantitatively. Most of the ADEs were drug administration errors and there was a reduced number of ADR notifications. The analysis of these notifications can help the institution with the implementation of preventive and corrective measures to improve the safety in the prescription, use and administration of medicines. It is important to encourage the notification culture to better understand the profile of errors related to the drug chain and act effectively to reduce them.

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.

Analysis of medication returns to the pharmacy in a high-complexity hospital in Rio de Janeiro

João Victor PASSOS — 2024-12-31

Objective: Analysis the profile and costs related to return of medication to a large hospital pharmacy. Methods: This retrospective observational study collected monthly data on medication returns from June 2023 to May 2024. Data were recorded in spreadsheets upon receipt of returns. Medications that were not reintegrated into pharmacy stock for various reasons were categorized using Microsoft Excel® and categorized by pharmaceutical form, pharmacological class, quantity, and unit value. Financial impact analyses were conducted to assess these losses for the hospital. Results: Of the average monthly total of US$7170,88 in medications returned to the hospital pharmacy, US$507,73 represented losses — medications that could not be reintroduced into the pharmacy stock. The substantial value of reused items emphasizes the importance of monitoring the return process. Additionally, it was observed that a majority of medications reintegrated into pharmacy stock were antimicrobials. Although this practice has provided financial benefits to the institution due to the high cost of these medications, it raises an important concern regarding potential treatment failures. The return of antimicrobials may be related to prescription errors, changes in the patient’s clinical condition, or misdiagnoses. As a result, these factors significantly contribute to the non-administration of the medications and, consequently, their return to pharmacy stock. Conclusion: The results demonstrate the critical need for improving the hospital’s medication return process to reduce losses and ensure greater medication safety for patients.

Efficacy and safety of ketamine for unipolar refractory depression: an overview of systematic reviews

Gabriela Ribeiro PENA — 2024-12-26

Purpose: To analyze the evidence of efficacy and safety of the use of intravenous ketamine for adults with refractory unipolar major depression. Methods: This is an overview of systematic reviews performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) check-list and Cochrane Collaboration recommendations, in which the literature searches were executed in Medline (via Pubmed) and Embase databases. Systematic reviews of randomized clinical trials of adults with refractory unipolar major depression were included, using other drugs as comparators. The methodological quality was evaluated according to the AMSTAR-2 tool (A measurement tool to assess systematic reviews - 2). Results: A total of 445 records, in which 73 studies were selected for full-text reading and 21 fully met the eligibility criteria. The most prevalent dosage was 0.5mg/kg in single dose and in multiple doses. Compared to control, ketamine promoted beneficial effect by reducing the depressive symptoms and suicidal ideation, and improving the depression tools scores. The effects were observed for 3-7 days after the ketamine infusion; in a single dose, these effects restricted the first hours (between 30-40 minutes). Additionally, the studies revealed that the adverse effects were predominantly mild, and only two studies showed serious events, such as bradycardia and hypotension, but did not result in discontinuation of the studies. The methodological quality was considered “critically low” in most cases (62%). Conclusion: The intravenous ketamine showed a significant improvement or non-inferiority in comparison to other treatments, and a reduction of depressive symptoms, including suicidal ideation, with an appropriate safety profile. Therefore, besides the low quality of the included systematic reviews, intravenous ketamine can represent an effective and safe option for refractory unipolar major depression. Higher quality studies about this topic are needed to guarantee more robust evidence, especially related to the ideal dosage of intravenous ketamine.

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.

Knowledge and use of the digital platform of institutional documents by pharmacy professionals: a diagnosis

Elice Maria SILVA — 2024-12-27

Objective: This study analyzed the knowledge and use of the digital platform for accessing institutional documents by pharmacy professionals at a philanthropic hospital in São Paulo. Method: This is an exploratory study with a quantitative approach. The results were obtained by applying a semi-structured questionnaire to pharmacy professionals at the hospital under study, with different job titles and work shifts. Results: A total of 152 professionals were interviewed, and the majority were male (51.3%). Regarding age, they were adults with an average of 32.3 years. Knowledge of the digital platform used by the hospital was reported by 75% of the survey participants, while daily access at work was described by only 2.6%. Most interviewees described the lack of keyword recognition by the system as the main difficulty in accessing institutional documents. It was observed that 78.9% of the professionals interviewed stated that they had knowledge of the procedures in their area, while 21.1% did not. The most frequently mentioned opportunity for improvement for these documents was the text being written in a clear and direct manner (39.5%). Conclusion: Although most professionals are familiar with the platform and its function, there is low usage, which can be explained by the difficulty of accessing it, searching for documents using keywords, and the extensive format and few visual illustrations in which the documents are presented. Thus, this study can be used as information support for improvement actions in the areas of pharmacy and hospital quality management, and it is also possible to replicate this study for other sectors, seeking to obtain a broader view of this topic.

Evaluation of the physico-chemical stability of the adapted oral pharmaceutical form of mycophenolate mofetil

Livian Nathaly GRESELE — 2024-12-30

Objective: To evaluate the physicochemical stability of the adapted oral suspension of mycophenolate mofetil tablets developed by a university hospital in Paraná, in order to determine the concentration of the active ingredient present in the oral suspension over time, assess the homogeneity of the drug concentration during the administration of the doses and establish a shelf life consistent with the stability of the adapted pharmaceutical form. Method: Mycophenolate mofetil tablets were used to make suspensions in two different concentrations - 50 mg/mL and 100 mg/mL - using sorbitol and water as vehicles (1:1) and adding a flavoring agent. The chromatographic analysis of the samples was carried out at times (T): T0h, T24h, T48h, T120h and T168h. The chromatographic conditions used for high-performance liquid chromatography were adapted from the United States Pharmacopeia. Results: The average relative standard deviation of the three batches analyzed at each time and concentration ranged from 6 to 18%, establishing an acceptable variability in the data obtained, but signaling the inhomogeneity of the active in the suspension. In the chromatographic analysis, the drug concentration values obtained in the formulations were satisfactory for all the times analyzed, with the values for T0h, T24h, T48h, T120h and T168h being 100%, 99.3%, 97.2%, 106.6% and 96.8% respectively. No physical changes were observed during the análisis period. The formulation showed physicochemical stability in an amber glass bottle, protected from light and at room temperature for 7 days. Conclusion: It was possible to validate the stability of the proposed formulations for seven days at room emperature and in an amber glass bottle. It is important to develop further studies on oral liquid formulations adapted from mycophenolate mofetil tablets.

Evaluation of palliative care costs for neurological patients in a hospital of the Unified Health System

Carina Soares MACIEL — 2024-12-31

Objective: To quantify daily direct costs through absorption costing and the demographic profile of neurological patients receiving palliative care (PCs) at a hospital in the Unified Health System. Methods: Convenience sample composed of 132 individuals admitted to Hospital Mestre Vitalino (HMV), in Caruaru-Pernambuco, with a diagnosis of neurological diseases, over 18 years of age and a favorable opinion for PCs, admitted to the Intensive Care Unit (ICU) and/or wards of HMV, and who had a favorable opinion from the PCs committee to start this type of care at HMV between 01/01/2019 and 12/31/2019, evolving to death in the unit in the same period. Average daily costs were adjusted by purchasing power parity1 and the American Consumer Price Index2, later converted to US dollars according to the exchange rate in effect on September 13, 2024. Results: The time interval between the start of PC and death had an average of 18.3 days. After the institution of this assistance, there was a 27% reduction (p<0.0001) in daily costs in the wards for the group evaluated. The reduction in costs for PC patients admitted to the Intensive Care Unit was not statistically significant for the sample evaluated, just as the demographic variables did not statistically influence the costs. The total cost was US$ 211,981.49 to US$ 164,562.37 in daily rates after the institution of PCs for the entire sample during 2019. Conclusion: The present study found a significant reduction in direct hospitalization costs for patients after insertion into PCs, mainly for those who were inserted into PCs from the beginning of the hospitalization period and who were allocated to wards.

Pharmacies are not supermarkets, and supermarkets should not become pharmacies

Gabriel R. FREITAS — 2024-11-25