Written communication about the use of medications in medical records in a Brazilian hospital.

BACKGROUND: Effective communication regarding the use of medications in hospital environments is a process that contributes to patient safety. Despite its importance, written communication about the medication use process in medical records remains insufficiently investigated. AIM: To describe the documentation in medical records regarding the medication use process by pharmacists, physicians and nurses on admission, during the hospital stay, and at hospital discharge. METHOD: A retrospective cross-sectional chart review study was carried out in medical records of patients admitted to a teaching hospital in Northeast Brazil. The study considered all patients admitted between December 2016 and February 2017, aged 18 or older and hospitalised for at least 48 hours. Clinical notes made by pharmacists, physicians and nurses were examined at three transition points of care. Data were collected using a questionnaire relating to the use of medications prior to hospital admission, changes in the prescribed medications during the hospital stay and discharge, as well as prescription non-conformities. Communication failures between the three healthcare professional groups were analysed and classified. The study was authorised by the Hospital's Board of Directors and approved by the Research Ethics Committee of the Federal University of Sergipe. RESULTS: This study included 202 medical records of patients with a mean age of 51.48 (SD 6.42, range: 19-97) years. There was no record of a patient or relative interview on allergies and adverse drug reactions in 54 (26.8%) physician notes, 44 (21.9%) nursing notes, and 9 (25.0%) pharmacist notes. Moreover, 1,588 changes in prescriptions were identified during data collection, and 1,198 (75.4%) of these were unjustified. CONCLUSION: Medication-related information in medical records was incomplete and inconsistent in the clinical notes of the three studied professions, especially in pharmacists' documentation. Future studies should focus on investigating the consequences of interprofessional communication in patient care.

Prevalence of clinically manifested drug interactions in hospitalized patients: A systematic review and meta-analysis.

AIMS: This review aims to determine the prevalence of clinically manifested drug-drug interactions (DDIs) in hospitalized patients. METHODS: PubMed, Scopus, Embase, Web of Science, and Lilacs databases were used to identify articles published before June 2019 that met specific inclusion criteria. The search strategy was developed using both controlled and uncontrolled vocabulary related to the following domains: "drug interactions," "clinically relevant," and "hospital." In this review, we discuss original observational studies that detected DDIs in the hospital setting, studies that provided enough data to allow us to calculate the prevalence of clinically manifested DDIs, and studies that described the drugs prescribed or provided DDI adverse reaction reports, published in either English, Portuguese, or Spanish. RESULTS: From the initial 5,999 articles identified, 10 met the inclusion criteria. The pooled prevalence of clinically manifested DDIs was 9.2% (CI 95% 4.0-19.7). The mean number of medications per patient reported in six studies ranged from 4.0 to 9.0, with an overall average of 5.47 ± 1.77 drugs per patient. The quality of the included studies was moderate. The main methods used to identify clinically manifested DDIs were evaluating medical records and ward visits (n = 7). Micromedex® (27.7%) and Lexi-Comp® (27.7%) online reference databases were commonly used to detect DDIs and none of the studies evaluated used more than one database for this purpose. CONCLUSIONS: This systematic review showed that, despite the significant prevalence of potential DDIs reported in the literature, less than one in ten patients were exposed to a clinically manifested drug interaction. The use of causality tools to identify clinically manifested DDIs as well as clinical adoption of DDI lists based on actual adverse outcomes that can be identified through the implementation of real DDI notification systems is recommended to reduce the incidence of alert fatigue, enhance decision-making for DDI prevention or resolution, and, consequently, contribute to patient safety.

Factors influencing the implementation of clinical pharmacy services for hospitalized patients: A mixed-methods systematic review.

BACKGROUND: Despite the evidence of benefits, clinical pharmacy services (CPS) are not uniformly implemented across healthcare institutions. Understanding the influencing factors and identifying the domains in which they act is the first step to a successful implementation. OBJECTIVE: To identify the factors that affect the implementation of CPS for inpatients and to categorize them. METHODS: Cochrane Library, Embase, CINAHL, IPA, Medline/PubMed, and Lilacs databases were researched up until January 2018. The search strategy was developed using text words or MESH terms related to the following four domains: "clinical pharmacy," "influencing factors," "implementation," and "hospital." Two reviewers selected original research articles that reported the factors influencing the implementation of CPS in hospitals, extracted data, and assessed the quality of the studies. After framework synthesis and categorization of the factors, a diagrammatic approach was used to present the results. RESULTS: Fifty-three factors were identified in the 21 studies that were included in this review. The most cited influencing factors were uniformly distributed across the following four domains: Attitudinal, POlitical, TEChnical and Administrative (APOTECA domains). However, in terms of level (pharmacist, healthcare team, patient, institution, and national organization), the "pharmacist" group had the highest concentration of factors. "Clinical skills and knowledge" was the most frequently cited implementation factor, followed by "time to implement CPS." CONCLUSION: Our findings showed the multifactorial nature of CPS implementation process. We suggest that factors from all four APOTECA domains need to be fully considered and strategies need to be addressed for all five groups of interest to successfully implement CPS in hospitals. Future studies on the influence of implementation stages, interrelationships of implementing factors, and strategies to overcome barriers could accelerate the successful adoption of these services. REGISTRATION: PROSPERO register CRD42016050140.

Sign Language in Brazilian Pharmacy Education.

Objective. To evaluate undergraduate pharmacy curricula at Federal Institutions of Higher Education in Brazil in order to identify sign language courses and other content related to the provision of care to deaf patients. Methods. A cross-sectional, descriptive study was conducted between March and June 2017. Data were collected from the websites of undergraduate pharmacy education programs in Brazil. Sign language courses were classified according to type (mandatory or elective), nature (theoretical or theoretical-practical), course period and workload. The course contents were extracted and analyzed by content analysis. Results. Of the 35 schools of pharmacy included in the study, 18 (51.4%) included a sign language course in their curriculum. Eighteen (100%) of the sign language courses were elective, one (5.6%) was theorical-practical, 16 (89.0%) did not have a predetermined point in the curriculum for students to complete the course, and 11 (61.1%) had a workload equal to or greater than 60 hours. The main pedagogical content identified related to the teaching and learning of sign language. Conclusion. Learning sign language in undergraduate pharmacy is important for these professionals could provide humanistic and integral care to deaf patients. Therefore, there is considerable room for improvement in teaching sign language to undergraduate pharmacy students in Brazil.