Documenting clinical pharmacist intervention before and after the introduction of a web-based tool

Nurgat, Zubeir; Al-Jazairi, Abdulrazaq S; Abu-Shraie, Nada; Al‐Jedai, Ahmed

doi:10.1007/s11096-010-9466-x

Cited by 15 publications

(25 citation statements)

References 23 publications

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“…O acesso ao prontuário de qualquer computador da instituição que possua o sistema de gestão instalado permite que vários profissionais, simultaneamente, tenham acesso as informações sobre o paciente, possibilitando o registro. A implantação e utilização de sistemas informatizados para a guarda de dados de paciente e registros de atividades clínicas é vista como um fator facilitador da assistência à saúde (23)(24) . Embora a atuação clínica destes farmacêuticos na instituição seja modesta, suas contribuições, mesmo que pontuais, são indispensáveis para o cuidado do paciente pela equipe multiprofissional.…”

Section: Discussionunclassified

Farmácia Clínica Em Ambiente Hospitalar: Enfoque No Registro Das Atividades

Lima¹,

Silva²,

Ricieri³

et al. 2017

Rev. Bras. Farm. Hosp. Serv. Saúde

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Introdução: A análise da terapia farmacológica, a atuação interprofissional e o uso de ferramentas de pesquisa são contribuições do farmacêutico no suporte ao paciente e à equipe assistencial. Documentar as atividades profissionais relacionadas à assistência é fundamental para a continuidade do cuidado. Objetivo: Verificar a percepção e a prática do farmacêutico sobre o registro das atividades clínicas. Métodos: Estudo transversal com farmacêuticos de um hospital de Porto Alegre a partir da aplicação de um questionário em formato eletrônico com questões relacionadas ao perfil do farmacêutico (sexo, idade, formação), atuação em farmácia clinica (experiência) e registro de informações no prontuário (conhecimento, prática e importância), entre setembro e outubro de 2016. Foi realizada análise descritiva dos dados quantitativos, os dados qualitativos foram analisados por categorização de ideias centrais e frequência de acordo com o discurso do sujeito coletivo. Resultados: Dentre os 27 profissionais que compunham a amostra, foi possível contatar 26.73% dos farmacêuticos convidados participaram do estudo. Observou-se um perfil de farmacêuticos jovens (24 a 35 anos), em sua maior parte do sexo feminino (94,74%), com formação recente (01 mês a 12 anos) e em instituição privada (83,16%). Grande parte destes farmacêuticos (57,89% dos farmacêuticos) atua em mais de um setor (farmácias internas, satélites e central). Conclusões: Os farmacêuticos desta instituição reconhecem a importância e a necessidade de registrar suas atividades clínicas, no entanto, este registro não ocorre devido à inexperiência prática, sobrecarga de atividades, necessidade de elaboração de políticas institucionais e capacitação desses profissionais.Descritores: Farmacêutico, Serviço de Farmácia Hospitalar, Prontuário do Paciente, Farmácia Clínica. ABSTRACTBackground: The analysis of the pharmacological therapy, the inter-professional performance and the use of research tools are contributions of the pharmacist in the support of patient and the care team. Documenting care-related professional activities is critical to the continuity of care process. Objective: To check the pharmacist's perception and practice regarding the documentation of clinical activities. Methods: Cross-sectional study with pharmacists of a hospital in Porto Alegre based on the application of a questionnaire in electronic format with questions related pharmacist's profile (gender, age, formation), acting in clinical pharmacy (practice) and recording information in the medical record (knowing, practice and importance), between September and October 2016. Descriptive analysis of quantitative data was performed. Qualitative data were analyzed by categorization of central idea and frequency according the discourse of the collective subject. Results: Out of the 27 professionals, who made up a sample, were possible contacts 26.73% of the invited pharmacists participated in the study. A profile of young pharmacists (24 to 35 years old), mostly female (94.74%), with recent college concl...

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Section: Discussionunclassified

Farmácia Clínica Em Ambiente Hospitalar: Enfoque No Registro Das Atividades

Lima¹,

Silva²,

Ricieri³

et al. 2017

Rev. Bras. Farm. Hosp. Serv. Saúde

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“…Drug information centers are moving toward increased use of electronic documentation systems, which have helped to increase the depth and quantity of documentation, as well as provide increased efficiency and cost savings. [17][18][19][20][21] In addition, an electronic system can promote a standardized and systematic approach and provides a readily retrievable archive that can be used to rapidly search previously answered questions. 22 Documenting Pharmaceutical Care in Patient Medical Records states that "the professional actions of pharmacists that are intended to ensure safe and effective use of drugs and that may affect patient outcomes should be documented in the patient medical record."…”

Section: Documentation and Quality Assessmentmentioning

confidence: 99%

ASHP Guidelines on the Pharmacist’s Role in Providing Drug Information

Ghaibi

Ipema

Gabay

2015

American Journal of Health-System Pharmacy

112

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“…15 There are, however, discrepancies between consensus recommendations of intervention recording and documentation of such interventions. 18 For this reason, various guidelines [7][8][9] and suggestions have been published on the subject as outlined above. The controversy of whether near miss or other interventions that prevent significant harm to patients by hospital pharmacist should be documented in patients' hospital health records when making recommendations will not be discussed in this chapter.…”

Section: Benefits and Outcomes Of Pharmacists' Interventionsmentioning

confidence: 99%

“…5 However, there seems to be significant differences in the number of documented interventions between clinical pharmacists with respect to the level of managerial responsibilities. 5,7 Clinical pharmacists with managerial responsibilities have variable workloads, while those without have more time allocated to spend on rounds with the medical team, enabling them to document all of their interventions. In addition, the significant effect of education level of clinical pharmacists and the number of interventions documented has been previously published.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the significant effect of education level of clinical pharmacists and the number of interventions documented has been previously published. 7 Clinical pharmacists with postgraduate qualifications seem to document significantly more interventions than those without. 7 This is not surprising that post doctorate pharmacists contribute more interventions due to their higher level of training, experience and confidence than those without a post graduate degree.…”

Section: Introductionmentioning

confidence: 99%

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