title: Implementation and progress of clinical pharmacy in the rational medication use in a large tertiary hospital.
abstract: OBJECTIVE
  To show developments and contributions of a clinical pharmacy service in safety and rational use of medications in a large tertiary hospital.
  
  
  METHODS
  Clinical pharmacists were responsible for all issues using medications at the hospital. In the beginning this professional was responsible for analyzing medical prescriptions, horizontal visits, and to set up protocols. Afterwards, other activities were designated such as monitoring for drug safety, participating in committees and managed routines. If problems were found, the pharmacist reported them for the physician and, after intervention, registered the management on the prescription or in medical records. The data collected were presented as reports to medical managers.
  
  
  RESULTS
  There was an increase of clinical pharmacist employed in 2010, reaching 22 individuals. Interventions types also increased from 1,706 in 2003 to 30,727 in 2010. The adhesion observed in medical team in 2003 was 93.4%, reaching 99.5% of adhesion in 2010.
  
  
  CONCLUSIONS
  Clinical pharmacy service shows a positive impact when it comes to performed interventions. It also promotes a rational use of medicines and increase patient safety. Pharmacists were included and their importance confirmed within the multidisciplinary team and in the process of patient safety.
authors.affiliation: Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR.
authors.forename: Fábio Teixeira
authors.initials: FT
authors.lastname: Ferracini
authors.affiliation: Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR.
authors.forename: Silvana Maria de
authors.initials: SM
authors.lastname: Almeida
authors.affiliation: Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR.
authors.forename: Juliana
authors.initials: J
authors.lastname: Locatelli
authors.affiliation: Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR.
authors.forename: Sandra
authors.initials: S
authors.lastname: Petriccione
authors.affiliation: Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR.
authors.forename: Celina Setsuko
authors.initials: CS
authors.lastname: Haga