title: Analysis of clinical pharmacist interventions in a tertiary teaching hospital in Brazil.
abstract: OBJECTIVE
  To analyze the clinical pharmacist interventions performed during the review of prescription orders of the Adult Intensive Care, Cardiologic Intensive Care, and Clinical Cardiology Units of a large tertiary teaching hospital in Brazil.
  
  
  METHODS
  The analysis took place daily with the following parameters: dose, rate of administration, presentation and/or dosage form, presence of inappropriate/unnecessary drugs, necessity of additional medication, more proper alternative therapies, presence of relevant drug interactions, inconsistencies in prescription orders, physical-chemical incompatibilities/solution stability. From this evaluation, the drug therapy problems were classified, as well as the resulting clinical interventions.
  
  
  RESULTS
  During the study, a total of 6,438 drug orders were assessed and 933 interventions were performed. The most prevalent drug therapy problems involved ranitidine (28.44%), enoxaparin (13.76%), and meropenem (8.26%). The acceptability of the interventions was 76.32%. The most common problem found was related to dose, representing 46.73% of the total.
  
  
  CONCLUSIONS
  Our study showed that up to 14.6% of the prescriptions reviewed had some drug therapy problem and the pharmacist interventions have promoted positive changes in seven to ten of these prescriptions.
authors.forename: Wálleri Christini Torelli
authors.initials: WC
authors.lastname: Reis
authors.forename: Carolinne Thays
authors.initials: CT
authors.lastname: Scopel
authors.forename: Cassyano Januário
authors.initials: CJ
authors.lastname: Correr
authors.forename: Vânia Mari Salvi
authors.initials: VM
authors.lastname: Andrzejevski
mesh_terms: D001938:Brazil; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008508:Medication Errors / Q000145:classification / Q000706:statistics & numerical data; D008875:Middle Aged; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D011446:Prospective Studies; D062606:Tertiary Care Centers