RESUMO
BACKGROUND: Analysis and validation of hospital prescriptions by the pharmacy department, although mandatory since 1991, appears relatively uncommon. Little is known of the nature and frequency of the actions taken by clinical pharmacists during this process. OBJECTIVE: To describe the nature and frequency of pharmaceutical interventions in a large university hospital. METHODS: We reviewed interventions during the pharmaceutical analysis of prescriptions in a surgical ward, a general medical ward and a short-stay hospital unit over a 5-year period. RESULTS: Pharmacists took some type of action in 1438 of the 13,760 prescriptions analyzed (10.4%). Drug interactions accounted for 30.9% of the interventions; 20.2% concerned dose adaptation in cases of renal insufficiency; 13.8% proposed a change from injectable to oral drugs; and 4.1% concerned the physicochemical incompatibility of the simultaneous administration of two drugs through the same infusion line. Drug interactions most frequently involved oral fluoroquinolones and anticoagulants. Dose adaptation was suggested most often for amoxicillin, buflomedil, ofloxacin and allopurinol, while the pharmacists most often proposed changing mixtures of multivitamins, omeprazole, imidazole derivatives and fluoroquinolones from parenteral to oral administration. Physicochemical incompatibility was most frequently associated with furosemide or nicardipine and with antibiotics. CONCLUSION: The analysis of prescriptions by a pharmacist is useful for medical teams: it helps to modify common attitudes towards prescribing drugs and contributes to their appropriate use and to the prevention of adverse events.
