Implantação e evolução da farmácia clínica no uso racional de medicamentos em hospital terciário de grande porte / Implementation and progress of clinical pharmacy in the rational medication use in a large tertiary hospital

Objective: To show developments and contributions of a clinical pharmacy service in safety and rational use of medications in a large tertiary hospital. Methods: Clinical pharmacists were responsible for all issues using medications at the hospital. In the beginning this professional was responsible for analyzing medical prescriptions, horizontal visits, and to set up protocols. Afterwards, other activities were designated such as monitoring for drug safety, participating in committees and managed routines. If problems were found, the pharmacist reported them for the physician and, after intervention, registered the management on the prescription or in medical records. The data collected were presented as reports to medical managers. Results: There was an increase of clinical pharmacist employed in 2010, reaching 22 individuals. Interventions types also increased from 1,706 in 2003 to 30,727 in 2010. The adhesion observed in medical team in 2003 was 93.4%, reaching 99.5% of adhesion in 2010. Conclusion: Clinical pharmacy service shows a positive impact when it comes to performed interventions. It also promotes a rational use of medicines and increase patient safety. Pharmacists were included and their importance confirmed within the multidisciplinary team and in the process of patient safety.

Objetivo: Demonstrar o desenvolvimento e a contribuição da farmácia clínica no uso seguro e racional de medicamentos em hospital terciário de grande porte. Métodos: O trabalho envolveu a participação do farmacêutico clínico em todas as questões relacionadas ao uso de medicamentos no hospital. No início, estava relacionado à análise da prescrição médica, visita horizontal e implantação de protocolos. Posteriormente, outras atividades foram incorporadas como: farmacovigilância, participação em comissões e rotinas gerenciadas. Após a identificação do problema relacionado ao medicamento, o farmacêutico contatava o médico e, após a intervenção, registrava a conduta na prescrição e ou no prontuário do paciente. Os dados eram apresentados em forma de relatórios e divulgados para a gerência médica. Resultados: Houve aumento no número de farmacêuticos clínicos, chegando a 22 em 2010. Houve também aumento dos tipos e de número de intervenções realizadas (de 1.706 em 2003 para 30.727 em 2010) e observamos 93,4% de adesão pela equipe médica em 2003, chegando a 99,5% em 2010. Conclusões: A farmácia clínica demonstrou impacto positivo em relação ao número de intervenções realizadas, promovendo uso racional de medicamentos e aumento da segurança do paciente. O farmacêutico foi inserido e garantiu seu espaço junto à equipe multidisciplinar e no processo de segurança do paciente dentro da instituição.

Implementation and progress of clinical pharmacy in the rational medication use in a large tertiary hospital.

OBJECTIVE: To show developments and contributions of a clinical pharmacy service in safety and rational use of medications in a large tertiary hospital. METHODS: Clinical pharmacists were responsible for all issues using medications at the hospital. In the beginning this professional was responsible for analyzing medical prescriptions, horizontal visits, and to set up protocols. Afterwards, other activities were designated such as monitoring for drug safety, participating in committees and managed routines. If problems were found, the pharmacist reported them for the physician and, after intervention, registered the management on the prescription or in medical records. The data collected were presented as reports to medical managers. RESULTS: There was an increase of clinical pharmacist employed in 2010, reaching 22 individuals. Interventions types also increased from 1,706 in 2003 to 30,727 in 2010. The adhesion observed in medical team in 2003 was 93.4%, reaching 99.5% of adhesion in 2010. CONCLUSION: Clinical pharmacy service shows a positive impact when it comes to performed interventions. It also promotes a rational use of medicines and increase patient safety. Pharmacists were included and their importance confirmed within the multidisciplinary team and in the process of patient safety.

Inappropriate medications using the Beers criteria in Brazilian hospitalized elderly patients.

OBJECTIVE: To study the prevalence and to identify risk factors of using potentially inappropriate medication (PIM) in hospitalized elderly patients. DESIGN: A cross-sectional study was conducted. For identification of PIM, modified 2003 Beers criteria were used. SETTING: The private Hospital Israelita Albert Einstein admission wards. PATIENTS, PARTICIPANTS: 250 elderly patients (>or = 60 years of age) with a length of stay > or = 48 hours up to 30 days. INTERVENTIONS: None. MAIN OUTCOME MEASURE: The main outcome measure was to study the prevalence and to identify risk factors of using PIM in hospitalized elderly patients. RESULTS: 156 (62%) patients used at least one PIM independent of diagnosis or condition, and 28% currently used the PIMs at home. The most frequent PIM, independent of diagnosis or condition, was scopolamine (27.2%), followed by clonazepam (17.9%) and amiodarone (16.4%). The prescription of PIM was related to number of drugs (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.05-1.23, P = 0.001), female gender (OR 2.36, 95% CI 1.34-4.14, P = 0.003), nongeriatrician prescribers (OR 5.54, 95% CI 1.62-18.89, P = 0.006), heart disease (OR 2.17, 95% CI 1.22-3.85, P = 0.008), and depression (OR 3.34, 95% CI 1.33-8.31, P = 0.010). CONCLUSION: The present study has shown that the use of PIM is usual in hospitalized patients, and the Beers list must be used as a guide of good practices rather than being used prohibitively. This study will serve as a base for selection and intervention programs on medical prescription in order to warrant a safe and effective drug therapy for hospitalized elderly patients.

Interações medicamentosas em idosos hospitalizados / Drug interactions in hospitalized elderly patients

Objetivo: Estudar a prevalência de interações medicamentosas empacientes idosos hospitalizados e descrever as interações maisprevalentes. Métodos: Foi realizado um estudo retrospectivo em 155pacientes idosos hospitalizados incluídos no programa de FarmáciaClínica, na unidade de geriatria do Hospital Israelita Albert Einstein,no período de janeiro de 2006 a janeiro de 2007. As interações foramclassificadas conforme Micromedex®. Resultados: Foram identificadas705 potenciais interações medicamentosas, sendo aproximadamente4 interações por paciente. Segundo classificação de severidade, 201(28%) eram de severidade maior e 504 (72%) moderada. Entre as705 interações, foram selecionadas, conforme efeito resultante, 444interações, sendo: 161 (36%) por aumento do risco de sangramento, 78 (18%) por hipoglicemia ou hiperglicemia, 50 (11%) por cardiotoxicidade,46 (10%) por toxicidade digitálica, 40 (9%) por toxicidade fenitoína, 31(7%) por depressão respiratória aditiva, 20 (5%) por hipercalemia e 18(4%) por diminuição da absorção da levotiroxina. Conclusão: O altoíndice de interações medicamentosas encontradas neste estudo indicaa relevância deste tema em idosos hospitalizados e a necessidade deavaliar e monitorar a terapêutica medicamentosa no idoso no sentidode prevenir e diminuir as conseqüências dos efeitos decorrentes depotenciais interações medicamentosas.

Antibacterial activity of plant extracts and phytochemicals on antibiotic-resistant bacteria

The antimicrobial activity of plant extracts and phytochemicals was evaluated with antibiotic susceptible and resistant microorganisms. In addition, the possible synergistic effects when associated with antibiotics were studied. Extracts from the following plants were utilized: Achillea millifolium (yarrow), Caryophyllus aromaticus (clove), Melissa offficinalis (lemon-balm), Ocimun basilucum (basil), Psidium guajava (guava), Punica granatum (pomegranate), Rosmarinus officinalis (rosemary), Salvia officinalis (sage), Syzygyum joabolanum (jambolan) and Thymus vulgaris (thyme). The phytochemicals benzoic acid, cinnamic acid, eugenol and farnesol were also utilized. The highest antimicrobial potentials were observed for the extracts of Caryophyllus aromaticus and Syzygyum joabolanum, which inhibited 64.2 and 57.1 ( per cent) of the tested microorganisms, respectively, with higher activity against antibiotic-resistant bacteria 83.3 ( per cent). Sage and yarrow extracts did not present any antimicrobial activity. Association of antibiotics and plant extracts showed synergistic antibacterial activity against antibiotic-resistant bacteria. The results obtained with Pseudomonas aeruginosa was particularly interesting, since it was inhibited by clove, jambolan, pomegranate and thyme extracts. This inhibition was observed with the individual extracts and when they were used in lower concentrations with ineffective antibiotics.