Hospital discharge
Hospital discharge reports showed that, of the 202 patients, 93 (46.0%) had a medication prescribed for discharge. Of these 93 prescriptions, 22 (23.7%) were new medications and 71 (76.3%) of the prescriptions presented changes between the medications used prior to hospital admission and those prescribed at discharge. Of these changes, only 35.1% (n=77) had a justification, similar to the justified changes found in hospital stay, in which addition of medications were the most prevalent (73%), followed by treatment suspension (12%) and adjustments in dose (9%).
The present study also verified that, in 13 (18.3%) discharge prescriptions, changes between the patient’s previous medication and medications that the patient would use after hospitalization were made by the intervention of other medical specialties. Of these changes, only nine made direct reference to the physicians who suggested them, and they were accepted in all cases.
When assessing the nurses’ discharge notes, we found only one (0.4%) discharge medication was documented. The report was related to a continued treatment with an antiretroviral drug. No records were found on the medication use after discharge in the pharmacists’ clinical notes. In addition, record of counter-referrals at hospital discharge was observed in 161 (79.7%) physicians’ clinical notes, followed by one (0.4%) nurse’s clinical note, and no pharmacists’ documentation was found.