J Pharm Pharmacogn Res 2(Suppl. 1): S23, 2014
Special supplement with the abstract book of LATINFARMA 2013
CO 043: CLINICAL PHARMACIST PERFORMANCE IN MULTIPROFESSIONAL TEAM IN A TEACHING HOSPITAL
Amaral Pedroso L, Martins Macedo J, Moreira da Costa J, Moreira Reis A, Santos Castro C, Andrade RA.Hospital Risoleta Tolentino Neves, Universidade Federal De Minas Gerais, Brasil. E-mail: firstname.lastname@example.org; email@example.com
Aim: Changes that comes from senescence causes an impact on the metabolism of drugs in elderly patients. This makes them more susceptible to intoxication and adverse drug reactions. Besides, elderly often shows a larger number of comorbidities, associated to a complex pharmacotherapy, which difficult the effectiveness and adherence. Seeking to suit pharmacotherapy and to prevent further complications, it is indispensable to develop practice of clinical pharmacy. Wishing to contribute on elderly’s pharmacotherapy safety in a teaching hospital, pharmacists linked to multiprofessional internship provides clinical pharmacy service.
Method: Patients are selected through active search or clinical suggestion. At first contact, previous clinical historic and subjective data are identified. Afterwards, a pharmacotherapy analysis is made and interventions along with medical staff, if needed. All medicines used are analyzed focusing effectiveness and safety.
Results: From March 2012 to February 2013, 193 patients were accompanied; their average age is 76 years old. During the held of the experiment, 349 pharmaceutics evolution were made (1.80 per patient), 225 considerations (1.16 per patient) and 573 interventions (2.97 per patient). From a total of evolutions, 19% had a catheter enthrall record, 10.31% registered a renal clearance lower than 30mL/min, 32.8% had renal clearance between 30 and 60mL/min and 9.75% reported moderate or intense ache. The most relevant intervention were orientation post-discharged (16.75%) and potential medicinal interaction (16.6%) warnings, as well as decrease of drug dose (9.77%). 49.74% of accompanied patients received pharmaceutics orientation postdischarged, 81.25% out of these were referenced to primary attention, through the pharmacotherapeutic summary, to continuity of care.
Conclusion: During the follow up was noticed that pharmacotherapeutic segment contributed in an effective way to prevent, to detect and to solve related problems to drug, health problems and increase life quality.