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Clinical pharmacy and clinical trials (including case series)
Pharmacist's contribution on the wards†
  1. M. Muros Ortega,
  2. M.J. Blazquez Alvarez,
  3. L. Menéndez Naranjo,
  4. M.S. Díaz-Carrasco,
  5. C. Bonillo García,
  6. M.A. De La Rubia Nieto
  1. 1University Hospital Arrixaca, Farmacia, Murcia, Spain

Abstract

Background During the fourth year of training, pharmacy residents perform a rotation with the team doctor on various wards.

Purpose To describe and to classify the interventions made during the rotation through the wards and to assess the level of acceptance of the interventions by the doctor.

Materials and methods Prospective study of the interventions made during 8 months of rotation. Data were collected from each patient: name, age, sex, allergies, weight, date of admission and discharge, harmful habits, medical history, primary diagnosis, drug treatment, income and home diagnostic tests performed. Any contribution made to drug treatment was considered an intervention. These were classified as: change in dose / frequency, start / stop treatment, drug substitution, modified via and other (request for information, diagnostic tests and pharmacokinetics). Databases such as Micromedex 2.0, Antimicrobial Clinical Practice Guideline 2010, BOT Plus and the hospital's drug substitution program were used to record the interventions.

Results The wards were: Cardiology, Children's Oncology, Intensive Care, Gastroenterology, Internal Medicine HIV and Internal Medicine Infections. The average stay per unit was 1.3 months. The resident participated in the daily ward round and start and change of treatment. 98 interventions were performed in 85 patients treated (1.15 interventions / patient). Classification of interventions: change in dose (25.5%), request for information (23.5%), starting treatment (17.3%), discontinue treatment (9.2%), frequency change (8.2%), pharmacokinetic studies (6.1%), change in treatment (5.1%), modified via (3.1%), request additional tests (2%) and drug substitution (0%). 89% of the interventions were accepted. 11% of the interventions were not accepted, the initial stance was justified by the doctor.

Conclusions The integration of the pharmacy residents onto the wards has been widely accepted because it has helped adjust the treatment at the time of prescribing, improving safety in the care process.

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