Background Documentation of interventions is vital to a patient's continuity of care and demonstrates the value of clinical pharmacy.
Purpose The aim of this study was to describe and quantify the pharmaceutical interventions in the surgery area.
Materials and methods Prospective longitudinal study of 2-month (June–July 2011) in the surgery area in a 900-bed university hospital. The pharmacist prepares daily pharmacotherapeutic patient history, perform a conciliation of the treatments and validates them. Interventions were recorded in an Access database. Two pharmacists participated in the study.
Results During the study period, 175 pharmacist interventions were performed (2.8 intervention/day) on 61 patients. The 82% were accepted by the medical staff. 43% (75 interventions) were recommendations for sequential therapy, principally over analgesics (56%) and inhibitors of proton pump (23%). The degree of acceptance was 69%. 20% (35) were adjustments to the nutrients and electrolytes composition in the parenteral nutrition. The degree of acceptance was 100%. 19% (32) of interventions were recommendations about antibiotics: 45% switch to the recommend antibiotic, 25% suspend, 20% sequential therapy and 10% dose adjustment. The degree of acceptance was 78%. Finally 18% were others pharmacist interventions such as interactions, adaptation to the hospital's pharmaceutical guide, reconciliation of home treatment.
Conclusions Most interventions were medical staff assistance for to meet the clinical guidelines. So the integration of the pharmacist in clinical units represents an improvement in clinical outcomes and more effective and safe use of medication. The record of pharmaceutical intervention is a useful tool for documenting and evaluating their contribution to the hospital patient care.
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