Variables
The data collection step was carried out through a form developed and
structured by the research team, that included general patient
information (age, sex, ward, nature of hospitalization, hospitalization
days, and reason for hospitalization) as well as the following
variables. The variables collected from admission clinical notes were:
allergies and/or adverse drug reactions; the use of medications prior to
hospital admission, including dose, frequency and treatment duration;
changes in the use of medications that the patient used before hospital
admission, classified according to the type of change (modification or
suspension), as well as whether this change was justified; and which
time these information were recorded (e.g. admission, hospital stay or
hospital discharge).
In turn, the variables from the hospital stay clinical notes were:
transfers to other wards in the same institution during hospitalization;
changes in the prescribed medications, such as changes of dose,
frequency, route of administration, additions, substitutions and
suspensions of medications and the justification for such alterations;
changes in the prescriptions as a consequence of the intervention of
another professional, and whether this suggestion was accepted;
referrals to other professionals suggesting interventions in
pharmacotherapy; and prescription non-conformities. Non-conformities
were considered as any irregularities reported by the healthcare team
involving the medication use process. For each professional, considering
their specific responsibilities, we assessed different reports in order
to classify them as “non-conformities” as below:
- Nurses - non-administration of medications, report of adverse drug
events, symptoms that suggests need of pharmacotherapy modification,
changes in drug administration time, and route of administration;
- Pharmacists - report of drug interactions, drug-related problems,
adverse drug events, symptoms that suggests pharmacotherapy
modification, and changes in drug administration time;
- Physicians - absence of written report of justification for
pharmacotherapy changes.
Regarding the hospital discharge clinical notes, the following variables
were analyzed: changes between the medications used by the patient prior
to hospital admission and those prescribed at discharge, classified
according to the type of change (modification or suspension), and if
there was justification provided for its change; changes in discharge
prescriptions as a consequence of the intervention of another
professional, and whether this suggestion was accepted; and
counter-referral for the patient after hospital discharge.