Conciliação medicamentosa na admissão de pacientes transplantados renais em um hospital universitário / Medication reconciliation in the admission of kidney transplant patients to a university hospital

Introdução:O presente estudo considerou conciliações medicamentosas realizadas na admissão hospitalar de pacientes transplantados renais e intervenções farmacêuticas decorrentes desse processo.Métodos:Trata-se de um estudo transversal realizado no período de julho de 2018 a julho de 2019 no Hospital de Clínicas de Porto Alegre. Foram coletadas as características dos pacientes, as conciliações medicamentosas realizadas pelo farmacêutico clínico, as discrepâncias identificadas pelo mesmo (intencionais e não intencionais) e o resultado das intervenções. Os medicamentos foram classificados de acordo com a Anatomic Therapeutic Chemical (ATC).Resultados:Dos 719 pacientes acompanhados pelo farmacêutico clínico, 175 tiveram a conciliação medicamentosa de admissão realizada, desses, 56 apresentaram discrepâncias não intencionais. Encontramos a média de 2,2 medicamentos omissos por prescrição com desvio padrão de 1,3 medicamentos. No total, foram realizadas 122 intervenções farmacêuticas, sendo que em 61,5% houve adesão por parte da equipe médica. A classe terapêutica com maior ocorrência (43,4%) de discrepâncias não intencionais foi a que atuava sobre o aparelho cardiovascular. As variáveis observadas foram sexo, número de medicamentos nas intervenções (ambas com associação significativa com a adesão médica), idade, tempo de internação, número de medicamentos na internação e número de medicamentos de uso prévio (estas últimas sem associação significativa com a adesão médica). Conclusões:A conciliação medicamentosa previne possíveis erros de medicação, uma vez que a identificação das discrepâncias não intencionais na prescrição médica gera sinalizações que são levadas pelo farmacêutico clínico à equipe assistente, a fim garantir o uso seguro e correto dos medicamentos durante a internação hospitalar.

Introduction:This study considered medication reconciliations performed on hospital admission of kidney transplant patients and pharmaceutical interventions resulting from this process.Methods:This is a cross-sectional study carried out from July 2018 to July 2019 at Hospital de Clínicas de Porto Alegre. The characteristics of the patients, the medication reconciliations performed by the clinical pharmacist, the discrepancies identified by the same (intentional and unintentional) and the result of the interventions were collected. The drugs were classified according to the Anatomic Therapeutic Chemical (ATC). Results:Of the 719 patients monitored by the clinical pharmacist, 175 had medication reconciliation on admission performed, of which 56 had unintentional discrepancies. We found an average of 2.2 missing medications per prescription with a standard deviation of 1.3 medications. In total, 122 pharmaceutical interventions were performed, and in 61.5% there was adherence by the medical team. The therapeutic class with the highest occurrence (43.4%) of unintentional discrepancies was that which acted on the cardiovascular system. The variables observed were gender, number of medications in interventions (both with a significant association with medical adherence), age, length of stay, number of medications in hospitalization and number of medications previously used (the latter without a significant association with medical adherence).Conclusions:Medication reconciliation prevents possible medication errors, since the identification of unintentional discrepancies in the medical prescription generates signals that are taken by the clinical pharmacist to the assistant team, in order to guarantee the safe and correct use of medications during hospitalization.

Processo de educação em saúde a pacientes e familiares na perspectiva do cuidado seguro / Health education process for patients and family members safe care setting

Introdução: Este artigo resulta de uma pesquisa de avaliação sobre o processo educativo de pacientes e familiares realizado por equipe multiprofissional de saúde do Hospital de Clínicas de Porto Alegre.Métodos: Pesquisa de avaliação desenvolvida em unidades de internação clínicas, cirúrgicas e pediátricas, tendo como amostra 149 sujeitos de pesquisa entre pacientes, ou familiares ou acompanhantes.A coleta de dados utilizou um questionário impresso semiestruturado, contendo nove questões sobre o processo educativo, a atuação multiprofissional e a compreensão da educação recebida.Resultados: Dentre os 149 participantes, 75 (50,3%) composto por pacientes e 74 (49,7%) por familiares/acompanhantes. Entre os respondentes, 94,6% recebeu orientações realizadas por médicos e enfermeiros; 91,2% referiu que compreendeu a orientação educativa. Um percentual de 90,6% dos participantes conhecia o seu problema de saúde ou o do seu familiar e 81,9% sentiam-se seguros para assumir o cuidado.Conclusão: A educação ocorre em diferentes cenários do hospital. Entretanto, há necessidade de incrementar a participação de diferentes profissionais na educação, potencializando o planejamento terapêutico multiprofissional na perspectiva da segurança no cuidado.

Introduction: This study resulted from an evaluation survey on the educational process of patients and their family members/caregivers conducted by a multidisciplinary health team at Hospital de Clínicas de Porto Alegre, Brazil.Methods: This was an evaluation study conducted at clinical, surgical, and pediatric inpatient units. The sample included 149 participants, consisting of patients and family members/caregivers. Data was collected using a semi-structured printed questionnaire with 9 questions about the educational process, multidisciplinary work, and whether participants understood the educational guidance.Results: Of 149 participants, 75 (50.3%) were patients and 74 (49.7%) were family members/caregivers. Among the respondents, 94.6% received guidance by a doctor or nurse and 91.2% reported that they understood the educational guidance. Most participants (90.6%) were aware of their health problem or that of their family member, and 81.9% felt confident to assume care. Conclusion: Education takes place in different hospital settings. However, the inclusion of different professionals in the educational process should be increased to promote multidisciplinary therapeutic planning in a safe care setting.

The pharmaceutical care bundle: development and evaluation of an instrument for inpatient monitoring

Introduction: Care bundles help healthcare professionals provide the best care possible in a structured and reliable way. The purpose of this study was to develop and apply an instrument for inpatient follow-up by clinical pharmacists, and evaluate its results. Methods: The care bundle was based on previously validated instruments. Population consisted of patients monitored by clinical pharmacists at a general hospital. The study was conducted in two phases: the first involved the development and implementation of the bundle, and the evaluation of pharmaceutical interventions; the second involved analyzing data from patients treated with the bundle over one year. Results: The bundle included fourteen pharmaceutical follow-up criteria used in different patterns by each area of care. In the first phase of the study, 3263 patients were monitored and 536 pharmaceutical interventions were performed, with an 85.3% compliance rate. In the second phase of the study, follow-up data was collected from 21,214 patients. The bundle criteria were used in a similar way in clinical, surgical and cancer patients. Pharmacotherapy review was the most prevalent intervention in all cases (60.1%). Hospital discharge planning and medication reconciliation were performed with a similar frequency in clinical, surgical, pediatric and general patients. Conclusions: The development and validation of a bundle aimed at guiding the clinical activities of pharmacists helped standardize procedures and interventions. Pharmacotherapy review was the bundle criterion with the highest rate of application and interventions due to the hospital's complexity and the need to consider individual patient needs and follow institutional policies. (AU)