CP-047 Pharmacist’s contribution to the optimisation of drug therapy in oncology inpatients

Abstract

Background Numerous studies have shown that the presence of a pharmacist on hospital rounds as a full member of the patient care team prevents drug errors. Purpose To analyse pharmaceutical interventions made by a fourth-year pharmacy resident to optimise drug treatment in oncology inpatients, as well as the acceptance rate of recommendations. Material and methods 2-month prospective observational study, conducted during the rotation of a fourth-year pharmacy resident in the Oncology ward. In order to perform the patient daily follow-up, the following pharmaceutical care was carried out: 1) participation in medical rounds; 2) review of medical records and analytical data; 3) prescription validation; 4) medicines reconciliation upon admission and discharge; 5) discharge medication information. Pharmaceutical interventions and their acceptance by the medical team were recorded. Results An average of 16 patients were followed up every day. 85 interventions were recorded, classified into: different dose/frequency (29.4%), omission (14.1%), medicines reconciliation (10.6%), prescription clarification (5.9%), antibiotic duration (3.5%), antibiotic/antifungal choice (3.5%), adverse effects information (3.5%), duplicated treatment (2.4%), pharmacological interactions (2.4%), dose adjustment due to renal impairment (2.4%), discharge medication information (2.4%) and other (11.8%). 82.4% of recommendations were accepted by the medical team. Conclusion The presence of a pharmacist on the ward contributed to close monitoring of the drug treatment in oncology inpatients. Thanks to this daily follow-up multiple pharmaceutical interventions were made, mainly related to change in dose or frequency, which had a high acceptance rate by the medical team. This shows the need and importance of the integration of pharmacists in the medical team, to improve the quality and safety of the drug treatment provided to oncology inpatients. References and/or Acknowledgements Bremberg ER, Hising C, Nylen U, et al . An evaluation of pharmacist contribution to an oncology ward in a Swedish hospital. J Oncol Pharm Pract 2006;12(2):75–81 No conflict of interest.