Hospital admission
At hospital admission, the pharmacist was the professional who least recorded the medications used prior to admission, with a mean of 2.6 SD 4.5 (0 to 22) days of delay to report such information in the medical record. Table 2 shows the report of medication-related information present in the clinical notes of pharmacists, physicians and nurses.
Regarding the record of medications used by the patient prior to admission, 86 changes were identified. These changes were classified as: suspension of these medications (n=64, 74.4%); and alteration of dose, frequency or route of administration (n=22, 25.6%). Furthermore, the timing of documentation was different among the healthcare professionals. While physicians and nurses reported information on allergies and adverse drug reactions predominantly on admission, pharmacists reported this information in 44.4% (n=12) of their admission clinical notes. Pharmacist records on the patients’ previous pharmacotherapy were also identified mainly during the hospital stay (n=18, 64.3%).
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