Background To increase the pharmacist presence in the computerised medical record (CMR) emerged as one of the improvement actions (IA) when internal customer feedback (satisfaction surveys to medical staff) was examined during the implementation of a Quality Management System (QMS) based on ISO 9001:2008 standard in a Pharmacy Service.

Purpose To analyse the degree of acceptance (DA) of the pharmacotherapeutic recommendations (PRs) after pharmacist participation in the CMR.

Material and methods 4-week ambispective quasi-experimental study (pre-intervention (A) 15 August–30 August’14; post-intervention (B) 1 September–15 September’14) performed in the Unit-Dose Drug Dispensing System (UDDDS) with manual prescription, nurse transcription and subsequent validation by a pharmacist, in a level-II hospital (411 beds, 52.8% of them with UDDDS). During period B the pharmacist wrote an advisory note in the CMR (MambrinoXXIv5.4^®) called “Pharmaceutical Care”, in addition to submitting the printed PR form (PPRF) with the prescription; while during period A, only the PPRF was sent. End points: ward [medical, surgical, medical-surgical (MS)], drug, type of PR, degree of acceptance. Data collection and processing: Farmatools-Dominion, Excel.

Results 93 PRs were recorded [period A (38 PRs, 32 patients, 74.9 ± 13.4 years old; 63.2% male); period B (55 PRs, 47 patients, 72.8 ± 17.6 years old, 74.5% male)]. Type of ward: medical (39.5% A vs. 36.4% B), surgical (57.9% A vs. 52.7% B) and MS (2.7% A vs. 10.9% B). Main drugs involved: proton pump inhibitors (15.8% A vs. 9.1% B), potassium-fluid replacement treatment (15.8% A vs. 5.5% B), not included in guide (NIG) (42.1% A vs. 36.4%B). Major types of PR: substitution of medicines NIG for available therapeutic alternatives (36.8% A vs. 34.5% B), dose/dosage regimen modification (10.5% A vs. 16.4% B), drug interactions (10.4% A vs. 8.9% B), monitoring hypo/hyperkalaemia (21.1% A vs. 5.5% B). The degree of acceptance was 63.3% A vs. 79.5% B.

Conclusion The QMS identified weak points in order to establish IA. Moreover, sharing the CMR and making it accessible to health personnel was found to improve coordination and communication of care, creating an opportunity for pharmacists to develop a comprehensive patient-centred plan and to promote their integration in the interdisciplinary healthcare team.

References and/or acknowledgements No conflict of interest.