Erros de prescrição, dose, preparo e desperdício de medicamentos relacionados a distribuição individualizada de antimicrobiano para pacientes de uti-neonatal / Prescription errors, dose, preparation and drug wastage related to individualized antimicrobial distribution for uti-neonatal patients / Errores de prescripción, dosis, preparación y desperdicio de medicamentos relacionados con la distribución individualizada de antimicrobianos a pacientes en unidades de cuidados intensivos neonatales

Introdução: Dentre as diversas áreas de sua competência, a Farmácia Hospitalar é responsável pela promoção e monitoramento do uso seguro de medicamentos. Objetivo: Investigar erros de prescrição, de dose, de preparo e desperdício de antimicrobianos distribuídos de forma individualizada para pacientes de UTI-Neonatal na Fundação Santa Casa de Misericórdia do Pará. Metodologia: Trata-se de uma pesquisa transversal, retrospectiva, fundamentada na pesquisa-ação, tendo como recorte temporal o período de novembro de 2021 a janeiro 2022. As variáveis relacionadas aos medicamentos foram comparadas ao protocolo de prescrição do NEOFAX®. Resultado: O estudo envolveu 76 pacientes e analisou 213 prescrições que envolveram 341 antimicrobianos, dos quais, 280 (82%) dos antimicrobianos prescritos não apresentavam clareza quanto às instruções de preparo e 98 (29%) apresentaram as doses em desacordo com o NEOFAX®. Os itens de maior dúvida foram quanto à estabilidade após o preparo: 341 (100%); quanto ao volume final após preparo 341 (100%) e quanto a técnica de preparo 266 (78%). Do total de pacientes, 32 (42%) eram de muito baixo peso, seguidos de 26 (34%) de extremo baixo peso, e 18 (24%) de baixo peso. Conclusão: Os dados obtidos no estudo subsidiaram a implantação de uma central de misturas intravenosas na instituição estudada.

Introduction: Among the various areas of its competence, the Hospital Pharmacy is responsible for promoting and monitoring the safe use of medicines. Objective: To investigate errors in prescribing, dosage, preparation and waste of antimicrobials distributed individually to neonatal ICU patients at Santa Casa de Misericórdia Foundation of Pará. Methodology: This is a retrospective cross-sectional study, based on action research, with a time frame of November 2021 to January 2022. The variables related to medications were compared to the NEOFAX® prescription protocol. Results: The study involved 76 patients and analyzed 213 prescriptions involving 341 antimicrobials. Of these, 280 (82%) of the prescribed antimicrobials were unclear regarding preparation instructions and 98 (29%) had doses in disagreement with NEOFAX®. The most doubtful items were about stability after preparation: 341 (100%); about the final volume after preparation 341 (100%) and about the preparation technique 266 (78%). Of the total number of patients, 32 (42%) were very low weight, followed by 26 (34%) extreme low weight, and 18 (24%) low weight. Conclusion: The data obtained in this study supported the implementation of an IV mixing center at the studied institution.

Introducción: Entre varias áreas de su competencia, la Farmacia Hospitalaria es responsable de promover y vigilar el uso seguro de los medicamentos. Objetivo: Investigar errores de prescripción, dosificación, preparación y desperdicio de antimicrobianos distribuidos de forma individualizada para pacientes de UCI neonatal en la Fundación Santa Casa de Misericórdia de Pará. Metodologia: Trata-se de uma pesquisa transversal, retrospectiva, fundamentada na pesquisa-ação, tendo como recorte temporal o período de novembro de 2021 a janeiro 2022. Las variables relacionadas con la medicación se compararon con el protocolo de prescripción NEOFAX®. Resultados: El estudio involucró 76 pacientes y analizó 213 prescripciones que involucraron 341 antimicrobianos, de los cuales, 280 (82%) de los antimicrobianos prescritos no eran claros en cuanto a las instrucciones de preparación y 98 (29%) presentaban las dosis en desacuerdo con el NEOFAX®. Los ítems de mayor duda fueron sobre la estabilidad tras la preparación: 341 (100%); sobre el volumen final tras la preparación 341 (100%) y sobre la técnica de preparación 266 (78%). Del total de pacientes, 32 (42%) eran de muy bajo peso, seguidos de 26 (34%) de bajo peso extremo y 18 (24%) de bajo peso. Conclusión: Los datos obtenidos en el estudio subsidian la implementación de un centro de mezclas intravenosas en la institución estudiada.

Análise das solicitações de medicamentos não padronizados de um hospital universitário terciário / Analysis of requests for non-standard medicines from a tertiary university hospital

Introdução: O uso extensivo de medicamentos não padronizados causa aumento de custos em saúde, além de potencial redução de segurança e uso racional de medicamentos. A Comissão de Farmácia e Terapêutica orienta a prescrição de medicamentos, por meio da avaliação e seleção de medicamentos a serem incluídos no formulário de medicamentos padronizados, com base nas melhores evidências científicas disponíveis e no perfil dos pacientes locais, promovendo o uso racional de medicamentos. O objetivo deste trabalho foi analisar as solicitações de fornecimento de medicamentos não padronizados na instituição. Métodos: Trata-se de um estudo observacional e descritivo onde foram analisadas as solicitações de medicamentos não padronizados realizadas entre fevereiro de 2016 e dezembro de 2021, identificando os medicamentos envolvidos e seus respectivos custos. Resultados: Foram realizadas 203 solicitações no período, sendo 174 incluídas no estudo. Os medicamentos que tiveram mais solicitações foram o rituximabe (41), a imunoglobulina humana (31), o sucralfato (23), a nitazoxanida (12) e o eltrombopague (7). As solicitações com maior custo foram as de imunoglobulina humana (US$ 799,702.38), rituximabe (US$ 717,320.26), eltrombopague (US$ 281,062.50), ruxolitinibe (US$ 167,867.46) e bortezomibe (US$ 149,033.52). As principais clínicas que solicitaram medicamentos não padronizado foram a neurologia (47), a hematologia (30), as moléstias infecciosas e parasitárias (17), e a anestesiologia (12). As solicitações de maior custo foram realizadas pela neurologia (US$ 145,519.08), hematologia (US$ 120,980.25), transplante de medula óssea (US$ 51,635.11) e dermatologia (US$ 44,813.40). Conclusão: O estudo demonstrou que há um fluxo estruturado de solicitação de medicamentos não padronizados na instituição, sendo uma importante ferramenta de gerenciamento dessas solicitações, evitando a aquisição desnecessária de itens que não compõem o elenco terapêutico do hospital.

Introduction: Widespread use of non-formulary drugs (NFD) increases cost and may reduce safety and rational use of medicines. The Pharmacy and Therapeutics Committee provides guidance on drug prescription by evaluating and selecting medications to be included in a hospital's formulary based on best scientific evidence available and local patients' profile, promoting rational use of medicines. The objective of this study was to assess non-formulary drugs prescriptions at a tertiary hospital. Methods: This was a retrospective study. NFD prescribed and its associated costs were assessed through NFD request forms received from February 2016 to December 2021. Results: A total of 203 NFD request forms were received, from which 174 were included in this study. The most frequently prescribed NFD included rituximab (n = 41), immunoglobulin (31), sucralfate (23), nitazoxanide (12), and eltrombopag (7), with the highest costs being with immunoglobulin (US$ 799,702.38), rituximab (US$ 717,320.26), eltrombopag (US$ 281,062.50), ruxolitinib (US$ 167,867.46), and bortezomib (US$ 149,033.52). The most frequent requesting specialties were neurology (n = 47), hematology (30), infectious disease (17) and anesthesiology (12), and highest costs requests were from neurology (US$ 145,519.08), hematology (US$ 120,980.25), bone marrow transplant unit (US$ 51,635.11), and dermatology (US$ 44,813.40). Conclusion: This study showed that a structured request flow for NFD prescription is a critical procedure in order to better manage drug prescription within the hospital, promoting rational use of medicines and preventing unnecessary spending with drugs for which the clinical indication may be covered by a drug already in the hospital's formulary.

Conciliação medicamentosa em hospital universitário: estratégia de segurança em pacientes neurocirúrgicos / Medication reconciliation in a university hospital: safety strategy in neurosurgical patients / Conciliación de medicamentos en un hospital universitario: estrategia de seguridad en pacientes neuroquirúrgicos

Esse trabalho teve como objetivo identificar as discrepâncias medicamentosas, por meio do serviço de conciliação de medicamentosa, em pacientes admitidos na clínica cirúrgica de uma unidade especializada no atendimento de doença relacionadas ao sistema neuromuscular na cidade de Manaus, Amazonas. Trata-se de um estudo descritivo e prospectivo, realizado no período de setembro a dezembro de 2020 em pacientes submetidos a conciliação medicamentosa. Na primeira etapa realizou-se a anamnese farmacêutica em formulário semiestruturado e foi elaborada a melhor história possível de medicamentos (MHPM). Os medicamentos prescritos na admissão foram comparados com a MHPM e as discrepâncias foram identificadas e classificadas quanto a intencionalidade e tipo. Ao total 54 pacientes foram incluídos no estudo, sendo que para 32 foi realizada a conciliação medicamentosa por usarem medicamentos de uso contínuo. Foram identificadas 20 discrepâncias intencionais, 3 discrepâncias intencionais não documentadas e 12 discrepâncias não intencionais. Omissão de medicamentos foi o tipo de discrepância mais comum (86%). Diante do exposto, concluímos que a conciliação medicamentosa mostrou-se um importante recurso para identificação de discrepâncias na transição de cuidado de pacientes com doenças neurológicas, principalmente no que se refere à omissão de medicamentos. As intervenções farmacêuticas a partir das discrepâncias encontradas, conseguiram mitigar erros de medicação e possíveis eventos adversos, aumentando a segurança do paciente.

This work aimed to identify medication discrepancies, through the medi- cation reconciliation service, in patients admitted to the surgical clinic of a unit special- ized in treating diseases related to the neuromuscular system in the city of Manaus, Ama- zonas. This is a descriptive and prospective study, carried out from September to Decem- ber 2020 in patients undergoing medication reconciliation. In the first stage, the pharma- ceutical anamnesis was carried out in a semi-structured form and the best possible medi- cation history (MHPM) was prepared. Medications prescribed on admission were com- pared with the MHPM and discrepancies were identified and classified according to in- tentionality and type. 54 patients were included in the study, and for 32 medication rec- onciliation was performed because they used continuous medication. A total of 20 inten- tional discrepancies, 3 intentional undocumented discrepancies and 12 unintentional dis- crepancies were identified. Medication omission was the most common type of discrep- ancy (86%). We conclude that medication reconciliation proved to be an important re- source for identifying discrepancies in the transition of care for patients with neurological diseases, especially with regard to medication omission. Pharmaceutical interventions, based on the discrepancies found, managed to mitigate medication errors and possible adverse events, increasing patient safety.

Este estudio tuvo como objetivo identificar las discrepancias de medicación a través del servicio de reconciliación de medicamentos, en pacientes internados en la clínica quirúrgica de una unidad especializada en el tratamiento de enfermedades relacio- nadas con el sistema neuromuscular en la ciudad de Manaus, Amazonas. Este es un estu- dio descriptivo y prospectivo, realizado de septiembre a diciembre de 2020 en pacientes en conciliación de medicación. En la primera etapa se realizó la anamnesis farmacéutica de forma semiestructurada y se elaboró el mejor historial de medicación posible (MHPM). Los medicamentos prescritos al ingreso se compararon con el MHPM y se identificaron las discrepancias y se clasificaron según la intencionalidad y el tipo. Un total de 54 pacientes fueron incluidos en el estudio, y a 32 se les realizó conciliación de medi- cación por utilizar medicación continua. Se identificaron un total de 20 discrepancias in- tencionales, 3 discrepancias intencionales no documentadas y 12 discrepancias no inten- cionales. La omisión de medicamentos fue el tipo más común de discrepancia (86%). Concluimos que la conciliación de medicamentos demostró ser un recurso importante para identificar discrepancias en la transición de la atención a pacientes con enfermedades neurológicas, especialmente en lo que respecta a la omisión de medicamentos. Las inter- venciones farmacéuticas, en base a las discrepancias encontradas, lograron mitigar errores de medicación y posibles eventos adversos, aumentando la seguridad del paciente PALABRAS CLAVE: Conciliación de Medicamentos; Seguridad del Paciente; Servicio de Farmacia Hospitalaria; Neurología.

Redução de custos hospitalares após implementação de ferramentas informatizadas na logística de um serviço de farmácia hospitalar Hospital / Hospital costs reduction after implementation of informatized tools in the logistics of a hospital pharmacy service

A farmácia hospitalar é atualmente uma unidade hospitalar que tem, entre outros objetivos, garantir o uso seguro e racional dos medicamentos e atender às demandas dos pacientes hospitalizados; para tanto, deve possuir um sistema eficiente de informações e dispor de um sistema de controle e acompanhamento de custos. As diversas inovações tecnológicas na informação e controle de dados aplicados aos serviços de saúde trazem agilidade no processo, maior segurança para os pacientes e melhor gerenciamento no processo logístico, reduzindo custos como aqueles associados à expiração da validade de produtos. Nessa perspectiva de análise de custo, o presente trabalho avalia os impactos que um processo de informatização da rastreabilidade e o uso de ferramentas informatizadas proporcionaram a um serviço de farmácia hospitalar, com o objetivo de descrever os impactos financeiros após a implementação dessas ferramentas. Realizamos um estudo observacional, longitudinal e retrospectivo a partir de dados financeiros relacionados a perdas por expiração de validade de medicamentos e produtos para a saúde e de compras emergenciais desses insumos em um período de seis anos. Os dados foram coletados em dezembro de 2021 referentes aos anos de 2015 a 2020 a partir de relatórios extraídos do Smart (Pixeon). Observamos que os custos com perdas por expiração de validade dos produtos para a saúde caíram substancialmente em 2019, com o menor custo em 2020, correspondendo a uma redução média de 47,9% nesses dois últimos anos em relação à média dos quatro anos anteriores. Também houve redução média de 70% nos custos com compras emergenciais ao longo desse período. Assim, quando avaliamos esses resultados, percebe-se que a informatização da rastreabilidade e o uso de ferramentas informatizadas para suporte no processo de trabalho logístico permitem contribuir significativamente para reduzir custos hospitalares.

The hospital pharmacy is currently a hospital unit that has, among other objectives, to guarantee the safe and rational use of drugs and to provide for the demands of inpatients; for such, it must have an efficient information system and have a cost control and monitoring system. The various technological innovations in information and data control applied to health services bring agility to the process, greater security for patients, and better management in the logistics process, reducing costs such as those associated with the expiration of product shelf life. In this perspective of cost analysis, the present study evaluates the impacts that a traceability informatization process and the use of informatized tools provided to a hospital pharmacy service with the objective of describing the financial impacts after the implementation of the process. We conducted an observational, longitudinal and retrospective study from financial data related to expiration losses of medicines and health products and emergency supplies purchases over a six-year period. The data was collected in December 2021 for the years 2015 to 2020 from reports extracted from Smart (Pixeon). We note that health product expiration loss costs fell substantially in 2019, with the lowest cost in 2020, corresponding to an average reduction of 47.9% in these last two years from the previous four-year average. There has also been an almost 70% reduction in emergency purchasing costs over this period. Thus, when we evaluate these results, it can be seen that the informatization of traceability and the use of informatized tools to support the logistical work process can contribute significantly to reducing hospital costs.

Perception of pharmacists regarding human resources, training, and development of a national hospital pharmacy: a preliminary report on Basel Statements

Abstract The hospital pharmacy needs a constant process of evaluation and monitoring of its activities. In Brazil, several agencies establish tasks and duties for pharmacists, but little is known about the compliance and the perception of the professional regarding these policies. The present study aims to characterize the pharmacist's perception of Brazilian hospital pharmacy policies according to the Basel Statements. A search was performed for the contacts of all medium and high complexity hospitals in the country. Subsequently, a questionnaire elaborated following the Basel Statements was sent by e-mail to hospital pharmacists throughout the country. The domain analyzed was "Human Resources, Training, and Development". Statistical analyses were performed using SPSS 19.0. Pharmacists representing a total of 111 hospitals from all Brazilian regions answered the survey questionnaire and showed that more than half of the hospital pharmacists perceive themselves as not complying, whether in the service of local, national, or pharmaceutical education. Besides updating the professionals in relation to national policies, it is necessary that the representative bodies of the pharmaceutical class be more present in the elaboration and evaluation of the policies directed to human resources, seeking uniformity and the possibility of carrying out the activities required.

Analysis of the situation ，influential factors and their relationship of hospital pharmacy managers ’servant leadership behavior and hospital pharmacists ’job satisfaction / 中国药房

OBJECTIVE To investigate the situation ，influential factors and their re lationship of hospital pharmacy managers ’ servant leadership behavior and hospital pharmacists ’job satisfaction. METHODS The questionnaire survey method was adopted to stratified cluster sampling from primary ，secondary and tertiary hospitals ，five for each in Henan province. The personal basic data scale of pharmacists ，the hospital pharmaceutical service leadership behavior scale and the job satisfaction scale of pharmacists were used to conduct a questionnaire survey among hospital pharmacists. Excel 2019 and SPSS 23.0 software were used for statistical analysis. RESULTS A total of 956 questionnaires were distributed and 882 questionnaires were recovered ，including 841 valid questionnaires，with an effective recovery rate of 95.35％. The reliability coefficients Cronbach’s α of hospital pharmacy managers ’ servant leadership behavior scale and hospital pharmacists ’job satisfaction scale were 0.986 and 0.978，and the validity coefficients KMO were 0.908 and 0.977（P＜0.01）. The total score of hospital pharmacy managers ’servant leadership behavior was （110.73± 18.63）. The total score of hospital pharmacists ’job satisfaction was （126.33±17.79）. Hospital grade ，gender，age，professional title and highest education level all affected pharmacists ’recognition for managers ’servant leadership behavior （P＜0.05）. Hospital grade，age，professional title ，marital status ，highest education level and position all affected job satisfaction （P＜0.05）. The servant leadership behavior of hospital pharmacy managers was positively correlated with the job satisfaction of hospital pharmacists （correlation coefficient r was 0.521-0.698，all P＜0.01）. CONCLUSIONS The promotion and optimization the servant leadership behavior of hospital pharmacy managers can improve the job satisfaction of pharmacists ，stabilize the team of pharmacists ，and provide high-quality pharmaceutical care for patients ，so as to improve the core competitiveness of the hospital.

Avaliação da farmacoterapia no âmbito hospitalar veterinário como ferramenta de promoção na segurança do paciente / Evaluation of pharmacotherapy in the veterinary hospital as a tool to promote patient safety / Avaliação da farmacoterapia fora do ambiente de hospital veterinário como meio de promover a segurança do paciente

RESUMO Introdução: Os serviços farmacêuticos contribuem na prevenção e resolução de erros relacionados ao uso de medicamentos. No âmbito veterinário os protocolos relacionados à segurança do paciente, especificamente quanto ao uso seguro e racional de medicamentos não são bem definidos. Objetivo: Avaliar a farmacoterapia em um hospital veterinário universitário de uma instituição de ensino superior. Resultados: Verificou-se que no ambiente hospitalar veterinário, existe prescrições de medicamentos inadequados e desnecessários para uso. Bem como a detecção de problemas relacionados a medicamentos do tipo: erros na prescrição, medicamentos não padronizados, doses erradas, duplicidade de terapêuticas e potenciais interações medicamentosas.

SUMMARY Introduction: Pharmaceutical services contribute to the prevention and resolution of errors related to the use of medicines. In the veterinary field, protocols related to patient safety, specifically regarding the safe and rational use of medications, are not well defined. Aim: To evaluate pharmacotherapy in a university veterinary hospital of a higher education institution. Results: It was found that in the veterinary hospital environment, there are prescriptions for inappropriate and unnecessary medications for use. As well as the detection of problems related to medications of the type: errors in prescription, non-standard medications, wrong doses, duplication of therapies and potential drug interactions.

RESUMEN Introducción: Los servicios farmacéuticos contribuyen a la prevención y resolución de errores relacionados con el uso de medicamentos. En el campo veterinario, los protocolos relacionados con la seguridad del paciente, específicamente, el uso seguro y racional de los medicamentos no están bien definidos. Objetivo: Evaluar la farmacoterapia en un hospital veterinario universitario de una institución de educación superior. Resultados: Se encontró que en el ámbito hospitalario veterinario existen prescripciones de medicamentos inadecuadas e innecesarias para su uso. Así como la detección de problemas relacionados con medicamentos como: errores de prescripción, medicamentos no estándar, dosis incorrectas, duplicación de terapias y posibles interacciones medicamentosas.

Evaluation of ibuprofen prescriptions into a Psychiatric Hospital: regarding safety, indication, and dose / Avaliação das prescrições de ibuprofeno em um hospital psiquiátrico: aspectos de segurança, indicação e dose

Introduction: non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are widely used throughout the world. In the psychiatric hospital, where this study was conducted, drugs such as selective serotonin reuptake inhibitors (SSRI) and lithium are widely used and may interact with ibuprofen (IBU). The literature also shows that ibuprofen may lead to changes in the central nervous system, which may trigger the imbalance of psychiatric disorders. Objective: to evaluate whether both the frequency of use and the prescriptions of ibuprofen are in agreement with the information contained in the literature regarding safety, indication, and dose. Methodology: retrospective observational cross-sectional study to evaluate the use of ibuprofen on patients from a psychiatric hospital. The prescriptions were evaluated for a 10-month period. Results: of the total number of prescriptions, 43 contained ibuprofen 600 mg. Note that in most cases, the drug was being prescribed according to the literature. However, in some cases there were divergences in the literature regarding: i) safety ­ information about the absence or presence of ulcers (1; 2.3%), gastrointestinal events (0; 0%) and absence of dyspepsia, abdominal pain and discomfort gastrointestinal (11; 25.5%) ­ ii) and the dose, in which in 19 cases (44%) it was higher than recommended by the literature. In addition, in 2 prescriptions (4.7%), the concomitant use of IBU and SSRI was observed and in 5 (11.6%) of IBU and lithium. Conclusion: the use of this drug often escaped safety and dosage criteria concerning scientific literature.

Introdução: os anti-inflamatórios não esteróides (AINEs), como o ibuprofeno, são amplamente utilizados no mundo todo. No hospital psiquiátrico em que este estudo foi realizado, medicamentos como inibidores seletivos da recaptação de serotonina e lítio são amplamente utilizados e sabe-se que podem interagir com o ibuprofeno. A literatura também mostra que o ibuprofeno pode levar a alterações no sistema nervoso central, o que pode desencadear o desequilíbrio dos distúrbios psiquiátricos. Objetivo: avaliar a frequência da utilização do ibuprofeno e se suas prescrições estão de acordo com as informações contidas na literatura com relação à segurança, indicação e dose. Metodologia: realizou-se um estudo transversal observacional retrospectivo para avaliar o uso de ibuprofeno em pacientes de um hospital psiquiátrico. As prescrições foram avaliadas por um período de 10 meses. Resultados: entre as 43 prescrições avaliadas, recomendou-se a dose de 600 mg. Foi observado que, na maioria dos casos, o medicamento estava sendo usado conforme prescrito na literatura. No entanto, em alguns casos houve divergências da literatura em relação a i) segurança ­ informações sobre a ausência ou presença de úlceras (1; 2,3%), de eventos gastrointestinais (0; 0%) e ausência de dispepsia, dor abdominal e desconforto gastrointestinal (11; 25,5%) ­ ii) dose, em que em 19 casos (44%) foi maior do que o preconizado pela literatura. Além disso, em duas (4,7%) prescrições, foi observado o uso concomitante de IBU e ISRS) e em cinco (11,6%) de IBU e lítio. Conclusão: o uso desse medicamento frequentemente de modo geral não obedeceu aos critérios de segurança e dosagem referentes à literatura científica.

Avaliação da economia gerada por meio das intervenções farmacêuticas realizadas em um hospital universitário terciário de grande porte / Evaluation of cost savings generated through pharmaceutical inverventions performed in a large tertiary university hospital

Introdução: A farmácia clínica tem como objetivo garantir uma farmacoterapia adequada ao paciente. A avaliação de prescrição é uma das principais atividades do farmacêutico clínico, o que pode resultar em intervenções e economia para a instituição, além de promover o uso racional e seguro de medicamentos. O objetivo deste estudo foi avaliar a economia gerada por meio das intervenções realizadas pelos farmacêuticos clínicos durante o processo de avaliação farmacêutica de prescrição. Métodos: Estudo transversal, observacional e analítico, onde foi analisada a economia gerada através das intervenções realizadas pelos farmacêuticos no período entre janeiro e julho de 2017. Resultados: Foram realizadas 3.033 intervenções no período do estudo e 943 foram incluídas. O valor da economia gerada foi de R$ 72.648,39 (US$ 23.134,95), sendo as intervenções mais frequentes relacionadas à adequação de apresentação (847) e forma farmacêutica (44). Dentre os medicamentos cujas intervenções farmacêuticas resultaram em maior economia, estão a anfotericina B lipossomal (R$ 18.919,75), a daptomicina (R$ 8.575,00), o valganciclovir (R$ 7.452,00) e a anidulafungina (R$ 7.422,35). Algumas intervenções não resultaram em economia direta do tratamento medicamentoso, como ocorreu com a risperidona comprimido (− R$ 264,04) e o sulfametoxazol+trimetoprima comprimido (− R$ 208,62), que foram substituídos por solução oral para administração por sondas. Conclusão: O estudo demonstrou que a atuação do farmacêutico clínico resultou na efetivação de intervenções relacionadas à adequação de dose, correção de diluição, alteração de apresentação, substituição de forma farmacêutica, adequação de tempo de tratamento e a adesão aos protocolos institucionais. Essas intervenções refletiram diretamente na redução de custo dos tratamentos, otimizando recursos e gerando economia ao serviço de saúde. (AU)

Introduction: Clinical pharmacy aims to ensure appropriate pharmacotherapy for patients. Prescription evaluation is one of the main activities of the clinical pharmacist and can result in interventions and cost savings for the institution, in addition to promoting the rational and safe use of medications. The objective of this study was to evaluate cost savings generated through interventions performed by clinical pharmacists during the process of prescription evaluation. Methods: This cross-sectional, observational, analytical study analyzed cost savings generated through interventions performed by pharmacists from January to July 2017. Results: A total of 3,033 interventions were performed during the study period, of which 943 were included. Cost savings amounted to R$ 72,648.39 (US$ 23,134.95), and the most frequent interventions were related to the adequacy of presentation (847) and dosage form (44). The medications whose pharmaceutical interventions resulted in the greatest cost savings are liposomal amphotericin B (R$ 18,919.75), daptomycin (R$ 8,575.00), valganciclovir (R$ 7,452.00), and anidulafungin (R$ 7,422.35). Some interventions did not result in direct cost savings, such as treatment with risperidone tablet (− R$ 264.04) and trimethoprim-sulfamethoxazole tablet (− R$ 208.62), which were replaced by oral solution for tube administration. Conclusion: The study demonstrated that the performance of clinical pharmacists resulted in the implementation of interventions related to dose adjustment, dilution correction, change of presentation, replacement of dosage form, adjustment of treatment duration, and adherence to institutional protocols. These interventions directly resulted in the reduction of treatment costs, optimizing resources and generating cost savings for the health system. (AU)

Preparation of extemporaneous oral liquid in the hospital pharmacy

At the hospital, the pharmacist is constantly challenged to prepare extemporaneous solutions from tablets, capsules or drug powder for patients unable to swallow, such as pediatric, elderly and patients that use nasoenteric and nasogastric tubes. The preparation of extemporaneous solutions from capsules, tablets and drug powder requires stability studies analysis. This article is a bibliographic review of preparation of extemporaneous oral liquid from solid oral dosage forms used in clinical practice. The selected articles contain all the information regarding manipulation techniques, pharmaceutical excipients, packaging, storage conditions and results of stability studies above 90% performed by HPLC analysis. In addition, a situational analysis of the strategies for the preparation of the extemporaneous solution was described to help the manipulator in the decision. The preparation of extemporaneous solution from solid oral dosage forms is based on information from official compendium or scientific literature, to ensure safe and effective manipulated medicine.

Establishment of Hospital Pharmacy Prevention and Control Strategies for Novel Coronavirus Infection Based on 5M1E Analysis Method / 中国药房

OBJECTIVE：To provide re ference f or hospital pharmacy prevention and control management during novel coronavirus（SARS-CoV-2）infection epidemic period. METHODS ：Based on 5M1E analysis method ，according to the needs of epidemic prevention and control ，it is necessary to analyze the risks of 5 aspects as personnel ，equipment and materials ，methods， environment，monitoring of the pharmacy work in hospital ，and establish the prevention and control strategy of hospital pharmacy infection in response to the epidemic situation of novel coronavirus pneumonia （COVID-19）according to the corresponding risks. RESULTS & CONCLUSIONS ：Personnel management strategies include carrying out pharmacist prevention and control training ， focusing on physical and mental health of pharmacists during infection prevention and control ；equipment and materials management strategies include strengthening equipment disinfection management and strengthening the management of materials for infection prevention and control ；method management strategies include developing emergency plans for infection prevention and control，standardizing individual infection prevention and control method ；environment management strategies include environment cleaning and disinfection management ，infection exposure management of related medical material ，medical waste management ； monitoring management strategies include strengthening pharmacists infection monitoring and evaluating pharmacists ’prevention and control effect. By establishing the strategy for COVID- 19 epidemic prevention and control ，it can effectively guiding pharmacists to carry out epidemic prevention and control.

Construction of Integrated Emergency Management Model for Novel Coronavirus Pneumonia Epidemic Prevention and Control in Hospital Pharmacy Department / 中国药房

OBJECTIVE： To provide reference for improving emergency capacity of the hospital pharmacy department in response to the novel coronavirus pneumonia （COVID-19） epidemic. METHODS ：According to the related regulations and requirements of Law of the People ’s Republic of China on the Prevention and Control of Infectious Diseases ，combined with the situation of COVID- 19 epidemic prevention and control ，and management experience of relevant hospitals ，on the basis of in-depth analysis of drug supply and quality assurance ，drug dispensing management ，provision of clinical pharmaceutical services and other related material support of hospital pharmacy department，integrated emergency management model was constructed for COVID- 19 epidemic prevention and control ，and the precautions and response measures of each link were sorted out. RESULTS ：Integruted emergency management mode for COVID-19 epidemic prevention and control in hospital pharmacy department included but was not limited to human resource management，drug and disinfection products supply management （mainly including key treatment drugs and disinfection product list formulation，control，inventory increase ，etc.）；drug dispensing management （mainly including prescription ，pharmacy window ， planning quantitative reserve ， drug return ， etc.）；clinical pharmaceutical care management （mainly including providing pharmaceutical information support ，online pharmaceutical service ，monitoring drug safety ，etc.）；personnel protection and disinfection （mainly including personnel protection ，environment and window ，equipment and container ，paper prescription disinfection，etc.）；special management of donated drugs ；prevention and control knowledge training ；pharmaceutical education and scientific research management ，etc. CONCLUSIONS ：The integrated emergency management model for epidemic prevention and control is helpful for hospital pharmacy to manage public health emergencies. During the outbreak of COVID- 19，hospital pharmacy department should start integrated emergency management mode for epidemic prevention and control ，strengthen the risk control of each link ，and play a good role in the key functional departments in the special period.

Interpretation of Novel Coronavirus Infection ：Expert Consensus on Guidance and Prevention Strategies for Hospi tal Pharmacists and the Pharmacy Workforce / 中国药房

OBJECTIVE：To provid e reference for pharmaceutical workers to better understand Novel Coronavirus Infection ： Expert Consensus on Guidance and Prevention Strategies for Hospital Pharmacists and the Pharmacy Workforce （hereinafter referred to as “expert consensus ”），and to apply and practice in specific work ，so as to give full play to the role of pharmacists to help fight the epidemic.METHODS ：The background of the formulation and revision of the expert consensus were introduced ，and its main contents and viewpoints were interpreted. RESULTS & CONCLUSIONS ：The text of expert consensus is divided into 8 parts，mainly including disease diagnosis and treatment [SARS-CoV- 2 infection related background ，clinical manifestations and diagnosis， treatment]，hospital pharmacy （prevention and control strategy ，work guidance ），drug and facility support management（key drug/facility/equipment support ，management and use of the drug in special circumstances ），information sources and related resources ，etc.，which comprehensively and detailedly provide information ，guidance and strategies for coronavirus SARS-CoV-2 infection prevention and control to play the role of pharmacists in hospital pharmacy well ，do well in the protection of staff in different pharmaceutical posts ，drug security work in response to epidemic situation ，and develop pharmaceutical care. So far，the understanding of SARS-CoV- 2 in the pharmaceutical industry is relatively limited. Based on the accumulated experience and progress in epidemic prevention and control ，the expert consensus will be updated and improved continuously ，so as to provide guidance and help for hospital pharmaceutical personnel.

Precarização do trabalho e sofrimento psíquico: ação em psicodinâmica do trabalho em um serviço de farmácia hospitalar universitário / Precariousness of work and psychic suffering: psychodynamics of work action in a university hospital pharmacy service

Introdução: desde 2014, a divisão de farmácia (DF) de um hospital universitário vivencia um processo de precarização do trabalho derivado de uma crise político-financeira. Visando superar conflitos decorrentes dessa precarização, os farmacêuticos demandaram uma ação em psicodinâmica do trabalho (PDT) a uma equipe de pesquisadores da universidade. Objetivos: criar espaços de reflexão e discussão com os farmacêuticos; elaborar um diagnóstico organizacional e relacional da DF; e promover ações que transformassem o contexto então vigente. Métodos: a partir da formação de grupos de reflexão sobre o trabalho, a ação em PDT foi organizada segundo princípios teórico-metodológicos clássicos: análise da demanda; observação clínica; análise do material das sessões; interpretação; elaboração de relatório e validação. Resultados: a precarização impactou o trabalho dos farmacêuticos e da DF, gerando insegurança quanto ao futuro profissional, dificuldade de cooperação, sentimentos de não reconhecimento do trabalho realizado e necessidade de readequação das atividades. Conclusão: a ação em PDT possibilitou maior diálogo entre os farmacêuticos e reapropriação do trabalho realizado pela DF, favorecendo a busca de estratégias para superar os conflitos relacionais e as dificuldades encontradas no cotidiano, de modo a enfrentar o momento vivenciado.

Introduction: since 2014, the pharmacy division (PD) of a university hospital has faced the ongoing precariousness of their work process due to a political-financial crisis. Seeking to overcome conflicts arising from such precariousness, pharmacists requested an action in psychodynamics of work from a team of researchers of the university. Objectives: to create opportunities for reflection and discussion meetings with the pharmacists; to make a diagnosis on the organizational and relational working conditions in the PD; and to promote actions to transform the context. Methods: from the reflection groups, the psychodynamics of work action was organized according to classic theoretical-methodological principles: demand analysis; clinical observation; analysis of the material produced during the sessions; interpretation; report writing, and its validation. Results: precariousness impacted the pharmacists' and PD´s work, generating insecurity about their professional future, difficulty in cooperation, feelings of non-recognition of their work and the need to re-adapt the activities. Conclusion: the action in psychodynamics of work allowed greater dialogue among pharmacists and the re-appropriation of the work held by the PD, favoring the search for strategies to overcome the relational conflicts and difficulties encountered in their daily life in order to face the experienced moment.

Pharmacy students' experiences on smoking cessation campaigns at a tertiary government hospital

@#<p style="text-align: justify;"><strong>BACKGROUND AND OBJECTIVES:</strong> Smoking cessation campaigns aim to raise awareness on the dangers of tobacco use and provide help for successful abstinence. Fourth year students of the UP College of Pharmacy implemented activities to promote smoking cessation among patients and clients at a tertiary government hospital. This paper aimed to describe the students' experiences on their project at the hospital during their Hospital Pharmacy course. Key learnings, challenges, and recommendations for the project's improvement, as well as their perceptions on current smoking cessation programs of the government were, likewise, determined.</p><p style="text-align: justify;"><strong>METHODS:</strong> The students' activities were documented and described. A descriptive quantitative design using a self-administered online questionnaire was used to determine challenges, key learnings, and recommendations while content analysis was applied on open-ended questions to determine the frequency of responses in common themes identified. Perceptions on current smoking cessation campaigns were also summarized using frequency statistics.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The five approved projects implemented by the students were (1) setting up of smoking cessation booths, (2) display of posters within the hospital premises, (3) distribution of leaflets and reading materials, (4) playing of smoking cessation campaign videos, and (5) the creation of a social media page. Most of the students were challenged in scheduling and delegation of tasks (81.4%) and delays in project implementation (57.6%). They also realized the difficulty of stopping smoking (74.6%) and that it has various root causes (72.9%) that need to be addressed. To improve the project, students recommended collaborations with the hospital (79.7%) and the Department of Health (84.7%) to further smoking cessation programs. Lastly, they perceived that the current smoking cessation program is inadequate or underutilized.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Smoking cessation programs require a multi-sectoral approach to be effective and sustainable, and students can be active partners in their implementation. Pharmacy student smoking cessation-led activities can complement government programs on smoking cessation. Moreover, students can apply what they have learned about smoking cessation while preparing them for their future role as pharmacist-counsellors.</p>

Acreditação no âmbito da assistência farmacêutica hospitalar: uma abordagem qualitativa de seus impactos / Accreditation in the field of hospital pharmacy services: a qualitative approach of its effects

Resumo Este estudo analisa o impacto do processo de acreditação na assistência farmacêutica hospitalar, visando identificar evidências de mudanças e melhorias do serviço prestado pela farmácia hospitalar. Grupos focais foram conduzidos com farmacêuticos e clientes internos do serviço de farmácia de cinco hospitais privados do Estado do Rio de Janeiro intencionalmente selecionados. Foram realizadas gravações, posteriormente transcritas, para análise do conteúdo dos diálogos e categorização temática. Segundo as narrativas revelaram, a acreditação resultou em investimentos de infraestrutura e recursos humanos, implantação de novos processos e discreta mudança de atuação do farmacêutico, alavancada pela farmácia clínica. Observou-se que tais modificações contribuíram para uma transformação contínua da assistência farmacêutica hospitalar, com modesta melhora da eficiência, qualidade e segurança do serviço prestado. Quando considerados os resultados finalísticos, a satisfação foi parcial, já que o ciclo da assistência farmacêutica ainda não se completa, fragilizando os processos recém-implantados em prol da qualidade do atendimento oferecido ao paciente. Apesar disso, o impacto no desempenho global da farmácia hospitalar foi considerado positivo, permitindo concluir que as diretrizes da acreditação apontaram o caminho para o desenvolvimento dos serviços avaliados, na medida em que exigiram o cumprimento de padrões necessários a uma assistência farmacêutica de qualidade.

Abstract This study analyzes the impact of the accreditation process on hospital pharmacy services, aiming to identify evidence of changes and improvements in the service provided by the hospital pharmacy. Focus groups were conducted with pharmacists and internal clients of the pharmacy service of five private hospitals in the state of Rio de Janeiro intentionally selected. Recordings were made, later transcribed, to analyze the content of the dialogues and thematic categorization. According to the narratives, the accreditation resulted in investments both in infrastructure and human resources, implementation of new processes and discreet change in the performance of the pharmacist, leveraged by the clinical pharmacy. It was observed that such modifications contributed to a continuous transformation of hospital pharmacy services, with a modest improvement in the efficiency, quality and safety of the service provided. When considering the final results, the satisfaction was partial, since the pharmaceutical assistance cycle is not yet complete, weakening the processes recently implemented in favor of the quality of care offered to the patient. Despite of this aspect, the impact on the overall performance of the hospital pharmacy was considered positive, allowing to conclude that the accreditation guidelines pointed the way for the development of the evaluated services, as they required the fulfillment of the standards necessary for qualifiedpharmacy services.

The Establishment and Evaluation of Foreign Pharmacist-managed Clinic / 中国药学杂志

OBJECTIVE: To introduce the formation background, development course and common service items of foreign pharmacist-managed clinic, deepen our understanding of its development satus, and provide us a reference of hospital pharmacy development and pharmacist-managed clinic build. METHODS: We search key words"pharmacist-managed clinic"and "medication therapy management" in database PubMed, CNKI and WANFANG DATA, then find out and read relevant research literatures published in recent 20 years. Browse the medical forum and website for related reports of pharmacist-managed clinic. Sum up the relevant clinical research cases, analyze and evaluate the effect of pharmacist-managed clinic. RESULTS AND CONCLUSION: We can conclude that the development of pharmacist-managed clinic can improve the compliance of patients with medication, reduce the incidence of drug-related diseases and hospitalization rates due to drug interactions and adverse reactions under the premise of ensuring the efficacy of drugs, while reducing medical expenses and promoting the rational allocation of medical resources, which is of great significance to the development of hospital medicine and the improvement of national health.

Analysis on Pregnancy Contraindication in Package Inserts of Chinese Patent Medicine in Our Hospital / 中国中医药信息杂志

Objective To provide references for rational use of Chinese patent medicine (CPM). Methods The package inserts of 143 CPM which were prescribed in our hospital were set as subjects, and the contents were analyzed according to pregnancy contraindication stated in Chinese Pharmacopoeia (2015 edition). Results Among the 143 CPM, there were 74 CPM which had the contraindication labels. Only 17 CPM contained prohibited compositions and 33 CPM contained caution compositions. There were 21 CPM which had no prohibited compositions and 3 CPM had prescription confidentiality. But the contraindication labels of only 25 CPM matched with their compositions. The rest did not match with their compositions. Conclusion Some package inserts of CPM about pregnancy contraindication exist content missing and description irregularities. The drug regulatory departments should further strength the supervision and management, and improve the quality of package inserts.

Analysis on Outpatient Prescriptions of TCM Decoction Pieces in 2016 in Chongqing Hospital of Traditional Chinese Medicine / 中国中医药信息杂志

Objective To understand the present situation and regularity of the application of TCM prescriptions in Chongqing Hospital of Traditional Chinese Medicine (hereinafter referred to as "our hospital"); To provide references for TCM pharmacy management and rational medication in clinic. Methods 8756 TCM prescriptions in our hospital from January to December in 2016 were randomly selected and the method of subtotals was used to collect statistics. The basic rules and existing problems of the TCM prescriptions were analyzed. Results The TCM prescriptions issued more in the famous doctor's center (27.67%), preventive treatment of disease center (13.67%) and oncology department (13.35%); elderly patients took the lead (45–75 years old accounted for 65.90%); prescriptions with 16–20 Chinese herbs added up to 4326 (49.41%); prescriptions within 3–7 dosages were 4921 in total (56.20%);single prescription cost within 100–300 yuan were 2777 in all (31.71%); prescriptions of single dosage cost 21–80 yuan were 5500 altogether (62.81%). Conclusion The application of TCM prescriptions in our hospital is basically rational, but problems such as too many herbs in one prescription, overdose use of some prescriptions and higher amount still exist.

Analysis on Usage of TCM Decoction Pieces in First Hospital of Zhangjiakou City During 2014-2016 / 中国中医药信息杂志

Objective To analyze usage and development trend of TCM decoction pieces in First Hospital of Zhangjiakou City (hereinafter referred to as "our hospital") from 2014 to 2016; To provide the basis for making reasonable purchase plan, reserving TCM decoction pieces and guaranteeing clinical medication.Methods Computer medicine management system was used to conduct statistical analysis on the prescription or order number, dosage, sales, and top 10 TCM decoction pieces among annual consumption and sales of TCM decoction pieces from 2014 to 2016.Results The results showed that the prescription and the order, dosage and sales of TCM decoction pieces decreased year by year. The top 10 TCM decoction pieces in the three years were the same with nine kinds, namely Astragali Radix, Poria, Angelicae Sinensis Radix, Salviae Miltiorrhizae Radix et Rhizoma, Atractylodis Macrocephalae Rhizoma, Ophiopogonis Radix, Coicis Semen, Citri Reticulatae Pericarpium, and Lycii Fructus. Conclusion The usage of TCM decoction pieces in our hospital is reasonable and the structure of medication is stable.