Naslov
The analysis of pharmacotherapy at admission and discharge.pdf

Autori
Marinović, I. ; Bačić Vrca, V. ; Marušić, S. ; Mucalo, I. ; Klarić, M. ; Morović-Vergles, J.

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Skup
5. simpozij sekcije kliničkih farmaceuta

Mjesto i datum
Ljutomer, Slovenija, 06.03.2015. - 07.03.2015

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
pharmacotherapy, medication

Sažetak
Introduction: In order to develop a program that includes medication reconciliation at the Clinic of Internal Medicine University Hospital Dubrava , research on the analysis of pharmacotherapy at the hospital admission and discharge has been started and will be conducted for 6 months. Methods: Patients being admitted at the Clinic of Internal Medicine are interviewed and the Best Possible Medication History (BPMH) is created. BPMH is compared to the prescribed therapy at the time of hospital admission and discharge. In communication with physicians all unintentional discrepancies were identified. The potential seriousness of these discrepancies was futher evaluated 1. In order to optimize patients' pharmacotherapy, clinical pharmacy residents carried out interventions during hospital admission. Results: During the 2-month period, 70 patients were enrolled in the research. Thirty-seven unintended discrepancies were identified and classified according to the type of discrepancy. The most common type of discrepancy was omission of drug (59, 5%). Most discrepancies (48, 7%) had the potential to result in severe discomfort or clinical deterioration (class 3). The clinical pharmacy residents carried out 33 interventions for patients receiving 405 prescribed medications. Intervention acceptance rate by physicians was 48, 7%. Conclusion: Our analysis has shown high incidence of unintentional discrepancies with a high potential of resultingin severe discomfort or clinical deterioration (class 3). The clinical pharmacy residents carried out a large number of interventions in order to optimize drug therapy. Patients’ knowledge and understanding of medications use, as well as their adherence rate, was evaluated and the results indicated the need for introducing counseling at the discharge from hospital.

Izvorni jezik
Engleski

Znanstvena područja
Farmacija

POVEZANOST RADA