An analysis of pharmaceutical care for critical patients of an adult Intensive Care Unit

Abstract This work analyzed the pharmacotherapeutic problems identified by the clinical pharmacist in an intensive care unit (ICU) and the acceptance of pharmaceutical interventions in solving these problems. This is a descriptive cross-sectional retrospective study, carried out in the adult ICU of a public hospital. All patients hospitalized during the study period had their pharmacotherapy monitored and those whose stay at the ICU lasted less than 24 hours were excluded. The pharmacotherapeutic problems were classified according to type, cause, acceptability/implementation, mode of intervention, outcome and related pharmacotherapeutic group. 302 patients were followed up and 350 pharmacotherapeutic problems were identified. Most of them were classified as unnecessary drug-treatment (n=186; 53.1%). The most frequent causes were excessive drug administration (n=181; 97.3%), and antimicrobials was the main group of drugs associated to that type of problem. 350 pharmaceutical interventions were performed, highlighting "prescriber informed only" (n=178; 50.9%), with an average acceptability of 90.7%, with those carried out on site being more effective (93.4%). The number of pharmacotherapeutic problems that were totally solved was 282 (80.6%). Clinical pharmacy activities in the ICU identified, prevented and corrected pharmacotherapeutic problems, contributing to the optimization of pharmacotherapy in aspects related to the need, efficacy and safety of treatments.

Perfil das Discrepâncias Obtidas por meio da Conciliação Medicamentosa em Pacientes Oncológicos: Revisão Integrativa da Literatura / Profile of the Medication Reconciliation Discrepancies in Oncology Patients: Integrative Literature Review / Perfil de las Discrepancias Obtenidas por la Conciliación de Medicamentos en Pacientes Oncológicos: Revisión Integradora de la Literatura

Introdução: O cuidado ao paciente oncológico demanda ações de uma equipe multiprofissional em virtude da complexidade do seu tratamento. Um dos serviços oferecidos pelo farmacêutico, visando a contribuir para segurança do paciente, é a conciliação medicamentosa capaz de detectar discrepâncias nas prescrições e prevenir erros de medicação. Objetivo: Traçar o perfil das principais discrepâncias encontradas na literatura em pacientes oncológicos durante a prática da conciliação medicamentosa realizada por farmacêuticos. Adicionalmente, visa-se a uma abordagem descritiva sobre as intervenções farmacêuticas realizadas nos estudos. Método: Revisão integrativa da literatura. Foram utilizados os descritores: "Medication Reconciliation", "Neoplasms", "Pharmacists", "Medication Errors" para as estratégias de busca. As bases de dados selecionadas foram: PubMed, Web of Science, Embase e Scopus. Resultados: Inicialmente, identificaram-se 141 artigos. Destes, foram selecionados 11 trabalhos para serem discutidos. A conciliação medicamentosa foi realizada em pacientes na admissão hospitalar (27,3%), alta hospitalar (18,2%), e acompanhamento ambulatorial (54,5%). A maior parte era de estudos observacionais (72,7%) seguidos dos estudos de intervenção (27,3%). A principal discrepância relatada foi a de omissão/necessidade de adição de um medicamento (81,5%). As intervenções farmacêuticas estavam descritas mais detalhadamente em 36,4% das publicações. Conclusão: O estudo demonstrou a necessidade de mais trabalhos que correlacionem a prática da conciliação medicamentosa com a detecção de discrepâncias e intervenções farmacêuticas em Oncologia. Os farmacêuticos, objetivando a segurança do paciente, devem estruturar essa prática na vivência clínica dos pacientes oncológicos

Introduction: Cancer patient care requires actions of a multi-professional team due to the complexity of the treatment. One of the pharmacist's services to contribute for the patient safety is the medication reconciliation, able to detect discrepancies in prescriptions and preventing medication errors. Objective: Draw a profile of the main discrepancies found in the literature in cancer patients during the practice of medication reconciliation performed by pharmacists. Additionally, a descriptive approach of the pharmaceutical interventions found in the studies was also attempted. Method: Integrative review of the literature with descriptors "Medication Reconciliation", "Neoplasms", "Pharmacists", "Medication Errors" utilized to search in the following databases: PubMed, Web of Science, Embase and Scopus. Results: Initially, 141 articles were found and eleven were selected for discussion. Medication reconciliation was performed in patients at admission (27.3%), discharge from hospital (18.2%), and outpatient follow-up (54.5%). Observational Studies were the majority (72.7%) followed by intervention studies (27.3%). The main discrepancy reported was Omission/Need to add a medicine (81.5%). Pharmaceutical interventions were described in more detail in 36.4% of the publications. Conclusion: This study demonstrates the need for more articles that correlates the practice of medication reconciliation with the detection of discrepancies and pharmaceutical interventions in Oncology. Pharmacists should structure the practice of medication reconciliation in the clinical experience with cancer patients to improve their safety

Introducción: La atención a los pacientes con cáncer exige las acciones de un equipo multidisciplinario debido a la complejidad de su tratamiento. Uno de los servicios ofrecidos por el farmacéutico para contribuir a la seguridad del paciente es la conciliación de medicamentos, capaz de detectar discrepancias en las recetas y prevenir errores de medicación. Objetivo: Obtener un perfil de las principales discrepancias encontradas en la literatura en pacientes con cáncer durante la práctica de conciliación de medicamentos realizada por farmacéuticos. Además, también está dirigido a un enfoque descriptivo sobre las intervenciones farmacéuticas llevadas a cabo en los estudios. Método: Estudio de revisión integradora. Se ha utilizado los descriptores: "Medication Reconciliation", "Neoplasms", "Pharmacists", "Medication Errors" para las estrategias de búsqueda. Las bases de datos seleccionadas fueron: PubMed, Web of Science, Embase y Scopus. Resultados: Inicialmente, se encontraron 141 artículos. Se seleccionaron 11 documentos a ser discutidos. La conciliación de medicamentos se realizó en pacientes con ingreso hospitalario (27,3%), alta hospitalaria (18,2%) y seguimiento ambulatorio (54,5%). La mayoría fue de estudios observacionales (72,7%) seguidos de estudios de intervención (27,3%). La principal discrepancia reportada fue la Omisión/Necesidad de añadir un medicamento (81,5%). Las intervenciones farmacéuticas se describieron con más detalle en el 36,4% de las publicaciones. Conclusión: El estudio demostró la necesidad de más trabajos que correlacione la conciliación de la medicación con la detección de discrepancias e intervenciones farmacéuticas en Oncología. Los farmacéuticos que buscan la seguridad del paciente deben estructurar esta práctica clínica en la experiencia clínica de los pacientes con cáncer

Opciones terapéuticas disponibles para infección por covid-19 / Therapeutic options available for covid-19 infection

Resumen de evidencia disponible de tratamiento COVID-19. La información contenida en esta tabla de evidencia está cambiando rápidamente debido a las investigaciones en curso, por lo tanto, está sujeta a actualización a medida se publiquen los resultados de las mismas

Summary of available evidence of COVID-19 treatment. The information contained in this evidence table is changing rapidly due to ongoing investigations, therefore, it is subject to update as the results of these investigations are published.