5PSQ-042 Clinical interventions in the cardiology service performed by a hospital pharmacy resident

<h3>Background and Importance</h3> Pharmaceutical validation of inpatient treatments in the cardiology department is a fundamental activity in clinical practice of the hospital pharmacist. Thanks to it, many prescription errors are detected, promoting patient safety. In addition, the training of pharmacy residents in the cardiology service contributes to the development of clinical pharmacy. <h3>Aim and Objectives</h3> To describe the interventions performed by a hospital pharmacy resident in the cardiology service, supervised by consultant pharmacists, to promoting patient safety and to evaluate their acceptance degree. <h3>Material and Methods</h3> Prospective interventional study conducted during May 2024. Adult inpatients and Outpatient, whose hospital treatment was reviewed, were included. Demographic (sex and age), clinical (clinical judgement (CJ) and cardiology area) and pharmacotherapeutic (high-risk medication prescribed, according to Institute for the Safe Use of Medicines (1,2)) variables were collected. Interventions were reported to the clinician, nurse or patient in person, by phone, or via electronic prescribing software. They were classified as: Activity (Information/discharge dispensing), Adequacy (detection of prescribing error/therapy reconciliation error), Change (Contraindication/lack of efficacy/substitution), Initiation (usual treatment not prescribed/need for additional treatment), Modification Dosage Form (DF) or Posology, Suspension (duplicity/unnecessary medication). The data were collected through medical records and electronic prescribing software and processed using Excel 2020. <h3>Results</h3> Interventions were performed in 40 patients. 65% male; median age 68±16,6 years. The most frequent CJ were: acute coronary syndrome (n=10, 25%), heart failure (n=10, 25%), arrhythmia (n=8, 20%). Areas with most interventions: hospitalisation plant (n=22, 55%), coronary unit (n=11, 27,5%), outpatient consultations (n=3, 7,5%). 77,5% of patients had prescribed high-risk medicines and the most prescribed medicines were (N=41): oral anticoagulants (n=17, 40,5%), Insulin( n=8, 19,0%), parenteral anticoagulants (n=3, 7,1%), parenteral benzodiazepines (n=3, 7,1%). 55 interventions were performed (26% were ‘not evaluable’). Of the evaluable, 67% were accepted. The percentages were: information (n=16, 29,1%), modification Posology (n=11, 20%), discharge dispensing (n=6, 10,9%), usual treatment not prescribed (n=4, 7,3%), therapy reconciliation error (n=3, 5,5%), lack of efficacy (n=3, 5,5%), need for additional treatment (n=3, 5,5%), substitution (n=2, 3,6%), duplicity (n=2, 3,6%), unnecessary medication (n=2, 3,6%), detection of prescribing error (n=1, 1,8%), contraindication (n=1, 1,8%), modification DF (n=1,1,8%). <h3>Conclusion and Relevance</h3> The data obtained demonstrates that a high percentage of patients used high-risk medicines and clinical interventions performed by the hospital pharmacy resident have a high degree of acceptance, increasing the quality and safety of healthcare and avoiding medication errors. <h3>References and/or Acknowledgements</h3> High-Risk Medicines in Hospitals. ISMP-2012. http://www.ismp-espana.org/ficheros/Medicamentos%20alto%20riesgo%202012.pdf High-risk medicines in chronically ill patients. In: ISMP-2014. http://www.ismp-espana.org/ficheros/Relaci%C3%B3n%20medicamentos%20alto%20riesgo %20en%20cronicos.pdf <h3>Conflict of Interest</h3> No conflict of interest