Background Computerized provider-order-entry (CPOE) system is known to improve quality, increase efficiency, and reduce medication errors.
The pharmacist, through the electronic validation, can provide improvements to the patient pharmacotherapy. However, not all hospitals follow the same method to make such proposals.
Purpose To analyse the type of interventions made in our hospital.
To validate process intervention.
Materials and Methods Pharmacists interventions were studied over a period of one year (June 2011–May 2012). Both prescription and validation are performed in the computer programme Farmatools®. The pharmacist used to write a warning on the patient treatment. Alerts were reviewed the following day and we checked if the recommendation was accepted or not by the physician. Interventions were classified according to the type of recommendation, the drug and whether it was accepted.
Results A total of 788 interventions were analysed (2.2 per day). The most frequent (27%) was dose adjustment for renal failure, followed by switching from intravenous to oral route (16%), change of dose (13%) and indication (12%). Other interventions were medication reconciliation, duplicity, therapeutic equivalent and adverse reaction.
The most frequent drugs were enoxaparin (24%), pantoprazole (12%), paracetamol (5%), insulin (5%), digoxin (4%), amoxicilin-clavulanic (4%) and levofloxacin (4%).
Only 72% of the recommendations were reviewed. From this, 54% were accepted.
Conclusions Although 788 interventions have been studied, there are many who have not been registered in the programme, so it could not be analysed. We observed that the dose adjustment for renal failure, especially enoxaparin, is recorded systematically, but this does not occur with other types of interventions.
Acceptance is lower than those reported in literature, so we can conclude that the method of communication with the clinician is inadequate and should be strengthened with verbal communication.
No conflict of interest.