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%).
[INSERT TABLE 2]