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DOCUMENTÁRIO: A Origem da Farmácia Clínica no Brasil
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[Music]
and this story begins in 1977
when Brazilian universities as a
whole were experiencing a period of
turbulence and strikes began to occur
in several universities across the country. As a
student leader, I took the
initiative to prepare a questionnaire and
distribute it to my classmates throughout the course. It was
a series of questions that
attempted to show the reality of the
pharmacy course. So I presented all the
points that had been identified
by the class, and if we listened, the merit was that
we not only made criticisms but
always offered some proposed
solution. At the end, the dean set up a
committee that was formed by the director of the
course's coordinating center and myself
to monitor all the measures he had
determined. At
the meeting a few months later, I
sought out the course coordinator when I
was surprised by Professor Maria
de Lourdes Xavier, who told me that the
dean had told me to offer me a
good master's degree and that she suggested it be in the area
of clinical microbiology. I was very
surprised and immediately accepted. At the
end of November, around the same time,
I received an invitation from Professor
Aleixo. He had recently arrived at our
university, invited by
Professor Domingos Gomes de Lima, the dean,
to restructure the
industrial laboratory of the pharmacy school and
create a university foundation. He also
addressed the
specific demands of the dean, for which he
had been invited. He had in mind the
idea of restructuring the pharmacy at the
Hospital das Clínicas. Dean Domingos
Gomes de Lima, "I am not a challenge to the
slaves. My father
made this challenge, and it was recorded here in the
book "Space and Time."
I confess that I
only knew some theory about clinical pharmacy.
Initially, in mid-1985, the
Federal Council of Pharmacy signed, at
my request, the Jaffa, which has a section
on clinical pharmacy in the
Pharmacy Gazette. Articles by Professors Evaldo
de Oliveira from Rio de Janeiro, José
Tobias Neto from Salvador, and Manoel Bastos
Lida from Manaus, dealing with the subject. I did
n't know Professor Tal, so I
was surprised by the invitation for a
conversation. If I wanted to invite him to
study clinical pharmacy, I immediately
said, "I accept. Let me take it." You
know absolutely nothing about clinical pharmacy, I've
never heard of it, but
you accept it. You stated with such
conviction. I said yes, but you have to
study abroad, no problem, you have to
go to Chile. I'll even go
to hell.
Oh, and so we left there straight to
a meeting with the dean. He was
convinced, so Aleixo could move
forward with the process. I did the day, then,
and I went to Chile with an excellent
camera. However, I didn't
take any photos. I visited the service at the
University Hospital of the University
of Chile and learned that clinical pharmacy
only depends on study, a lot of study,
privileged intelligence, and diets. It's
precious to know not to take photos.
In 1978, Professor Aleixo Prates
from the Federal University of Rio Grande do
Norte visited the University of
Chile to learn about the work
developed by the clinical pharmacy group
of the Faculty of
Chemical and Pharmaceutical Sciences of the institution,
of which I was a member.
He planned to implement a
similar practice model at the
UFRN Clinical Hospital in São Paulo. He delegated it
to Professor Tarcísio. He had
invited two other classmates, or
after Professor Julio. Fernandes Maia
Neto and Professor Maria do Socorro
Oliveira da Silva Júnior would be to
restructure the hospital pharmacy and
Socorro to structure
the laboratory of magistral pharmacotechnics because there was practically nothing.
We spoke about the degree in December. When it was in
February, we submitted to the
university exam and were approved. Then
the three of us went to São Paulo. I went to
the Hospital das Clínicas because at the time it
was the reference service in
hospital pharmacy in Brazil with Professor
José Sylvio Cimino, an icon of
Brazilian pharmacy. About two
weeks after being at the Hospital das
Clínicas, I met Dr. George
Washington Bezerra da Cunha, who already
ran the pharmacy. It
's from the heart happy oil. Let's go to
INCOR with me, so I went there to INCOR and
by great coincidence, I started the
internship with the icon of Brazilian pharmacy today, my
colleague Sônia Luciana
Cipriano, Dr. João Pessoa, a visionary.
He introduced a practice that today, or
has been for a while, but at the time, was
absolutely innovative. He had us provide
patient guidance, and in the
room it was written like this:
medication guidance. This environment today would be called a
clinic, right? Pharmacist, then,
in August, I went to
Chile and took a course of almost 500 hours.
In December, I completed my course. I
returned to Brazil. In early
January 1979, Professor Inês came
to Natal as a guest professor
to listen to me, with the task of monitoring the
implementation of the first
clinical pharmacy service in Brazil. So, in 1979, from
January to March, I
remained in Natal to fulfill the
second part of the agreement. On January
15, 1979,
the first
clinical pharmacy service was formally implemented, and the first
was information about medicines in
Brazil. Still in that same month, around the
25th, if I'm mistaken, we already provided
the first information about medicines
when we took over the pharmacy at the
Onofre Lopes Hospital. The name of the era was the
Hospital das Clínicas. It was a time of
many changes. At the time, the
pharmacy section was composed of the dispensing pharmacy, the
newly created clinical pharmacy, and the
compounding laboratory. This
clinic, which I say was newly created at the
time, was inaugurated under the leadership of
Professor Tarcísio, who was the one
who Later, he invited new
professionals to join the
clinical pharmacy service to
begin the first
practical work within the Onofre Lopes Hospital. Despite
Despite
Professor Inês's extensive experience, we didn't really know
what to do or how to start.
I began to worry
that at the end of March she would leave and I
would be alone. So, I had the idea of
inviting two other classmates:
Lúcia Costa, who later became
known as "You Novo Arco," and my colleague
Ivonete Batista. I was in São Paulo
taking a course. I had recently graduated, right? I
had gone to São Paulo to take a
biological control course.
Not at Unifesp, right? On the anniversary of São
Paulo, which was previously the Paulista School of
Medicine. I didn't know
what clinical pharmacy was, so
I told him that even without knowing what it
was, I would accept this challenge. In
January 1979, I was already at the hospital.
During my stay in Natal, I
had the opportunity to participate,
together with a clinical pharmacy group,
in carrying out several
activities, among which I highlight the
discussions of clinical cases in the fourth
discipline of surgical clinics. The
work we did on
antibiotic therapy involved all
the inpatient units of the Hospital
das Clínicas. What we really
wanted was to get to know the hospital. I wanted to go into
into
the Marias departments and tour the sectors to
understand a little about the reality of the
hospital. We found absurdities.
Practically, each ward was a
pharmacy. The medications were
stored very differently. There were huge discrepancies
between what was written, what was
dispensable, and what was administered. There was
a huge distortion between the
prescribed antibiotics and the
requested cultures. From the notes we made, we
prepared a report and requested a
meeting with the general director at the time,
Professor Luiz Gonzaga Bulhões. He was
very concerned about the data and proposed
that we also present that
work at a meeting with all the
clinic heads. We participated
in the presentation of this work.
At the time of this presentation, we
received an invitation to participate in the sessions
sessions
and in the fourth discipline,
surgical clinic. This meant an
opening of doors for us. I was a
full professor of the fourth discipline of
surgical clinic, the famous Wednesday,
and every Friday we have
group visits to the inpatients.
Then we would go to my office
where they were. After the cases were presented and
a summary of
specialized journals was presented, he
invited me to join the team on
Wednesday, and we began to do
very important work with this
team to reduce the
problems these patients had, whether
related or not to the use of
medications. So, I worked very
hard in these two units,
especially in infection control.
I suffered a serious accident with these patients, which
resulted in the crushing
of the right foot with loss of substance there. I was supposed to have
lost the fetus. It needed to be
put away, but miraculously, while they were
taking me to the private hospital, the
medical team took care of my
foot. At that moment, there
was necrosis. There were
successive hospital infections. It was when Dr.
Kamacho from the Hospital das Clínicas became
interested in my case. She didn't even
come in. Dr. Lúcia Araújo
Costa saw her join the team
and took care of my complaint. The
recovery was slow because the
affected area was large. The work was slow, and with
Dr. Lúcia's dedication, the
treatment progressed and corrective measures were taken
to solve the problem.
That same year, in
July, the university Chile held the
2nd Latin American
clinical course. In this course, I got
first place, right? There was a professor
as a consultant for the
Pan-American Health Organization,
Professor Robail. He was my
advisor, and he committed to
returning to
monitor the development of the
activities that the graduates of this course would carry out.
A few months later, in October,
Professor Ivonete Batista de Araújo, the
newest member of the group, began
her training participating in
clinical pharmacy activities together with
the students of the last semester of the
chemistry and pharmacy course at the University of
Chile. In the first semester of 1979,
Professor Inês, Professor
Lúcia, and Professor Tarcísio, we
decided: "I have to go to the
clinical pharmacy course in Chile with my
own resources." He asked me, "Do
you want to go?" I asked, "Do you have money?"
I said, "No, I don't, but I have the
money for the return ticket. We
made a loan to me 30 million. When I
arrived there, fifteen days later, I will
become a Cruzeiro appreciation fund, and
then the money I took was no longer enough
to finish. Professor Inês, she
said, "No, I heard the news. I already
knew what happened with your book, and I
talked to my parents, and they
agreed. We'll host it. It was in
1979 that I was invited to teach
a pharmacokinetics course. The course was
aimed at pharmacists, doctors, and nurses.
nurses.
In general, during the course, I remember the
need for teamwork was
strongly emphasized. At the end of 1979, we had
three pharmacists already
trained in clinical pharmacy,
and this was very important for running the
service. Professor Ivonete became
interested and joined the
gastroenterology department. She began monitoring
gastroenterology patients with Dr.
Carlos dos Santos Fonseca, and I started
in pulmonology with Dr. Francisco
Marques de Carvalho. I stayed with her
in residency. So, every week
we visited the patients. They
returned to the
gastroenterology room, and we discussed
clinical cases and any
new articles about medications, therapeutic advances,
drug interactions, and adverse drug reactions.
These forms were used to
document the medications
that were used. In the daily lives of
patients here, we have an example of
a patient who could not read or
write. We used
this resource of colors. We took
pieces of cardboard, cut them, and
put them inside the
plastic bag with the medications.
Red, yellow, and blue cardboard, and sold it. It was with the
perspective that the
patient could make the link between the
color and the time that we
recommend the use of those medications.
When Professor Lúcia na Braga is going to
do a master's degree in England, I take over
and the mother of patients using
oral anticoagulants. These were the
cards that we used. Among the
most important facts, I highlight a
patient who was affected by
rheumatic fever, had a mitral valve transplant
in Recife, and he had to wear
his steering wheel for the rest of his life. Record
Farina to avoid
thromboembolic diseases that no one knew how to
monitor. The patient bled on
Fridays. He had people pushing him.
He did something on the
weekend that no one knew what it was.
Every Friday, the same amiodarone,
and it inhibits the metabolism of warfarin.
He did not take it on Saturday and Sunday. What
is it? What was happening was the effect of
warfarin, the inhibition of the appeared, it returned
to normal when it was on Monday,
we have to increase the dose. I
asked why you were
without medication on Saturday and Sunday. He explained that it
was because he worked on the
computer, he was a systems analyst, and
he was very focused on the screen and had
a lot of burning in his eyes, and it is still a
consequence of this. The doctor had given him
this weekend space, and then he
was used on alternate days, and the
resolution of his problem occurred. Isn't it
very interesting that after the
work began to resonate with some
people, and then I want a
clinical pharmacist with me too, and I want a clinical pharmacist in my
ward at SETRA. So, that
initial concern, people wanting to know
know
the price of people working here,
clinical pharmacist, which is so sour
cream, what does it do for you, the clinician,
to write medication. So, those
were some concerns that as
people learned about what
we do in the wards, in the teams, it
is not together with the doctor or nurse,
and as the patients and students
learned about our work,
these concerns were being eased, they were being
smoothed out, and They were
dissipated over time. No one was
important to the hospital. They knew that the
pharmacy part and
hospital infection control, the control of 200
biotics were quite
confusing. At that time, I
remember Dr. Aleixo. Professor Aleixo
brought this group to us because of a
blessing. It was Dr. Tarcísio, here
too, Dr. Livonesi, I give,
and it's also nothing more today. And
being able to post this video was a
pioneer here in Brazil. It's
his willpower, scientific rigor, the
ability to study. The group discussed,
discussed with the doctor, discussed with the
resident. So, because I saw
that environment greatly improved the
scientific level of our hospital. It's easy that
the creation of the pharmacy, which I always have a
lot of knowledge about the many variables
involved in prescribing medication,
brought up for discussion. Topics that are
often neglected, such as
drug interactions and incompatibilities, which even today arouse
commotion in some circles. Many
resident students, professors, and doctors
began to resort to the collection and
knowledge. The pharmacy, at that time,
became the center of information
about medications. From that
initial contact,
a partnership takes place, where the
clinical pharmacist, in this case, Tarcísio and his team,
advising the military doctors,
go to the wards of the hospital
clinics, advising them and providing
information on
drug interactions and side effects
of most medications,
making medical practice much
more effective than when there was no
resistance from the clinical pharmacy and the
hospital pharmacy. This was actually
the embryo of what would become in the future
this great institution that is the
clinical pharmacy. Among the cases of the many
patients followed over the
years, I would like to highlight the case of a
patient who was admitted to the
pulmonology service in status asthmaticus.
He already presented the characteristics of the syndrome. Upon taking the
syndrome. Upon taking the
anamnesis, it was not difficult to
determine that he was a patient with
asthma. 4 independent powers. So, he had
had a crisis many years ago and
was given attack treatment.
After maintenance treatment, which
ended with a
0.5 mg dexamethasone tablet for three days, he began to
feel so well that he decided to
self-medicate. His own precision is to
use this tablet daily. At
this point in his hospitalization,
he had been using this tablet
every day for eight years. What I wanted to leave
with this case first is The importance
of pharmaceutical anamnesis is that
Cushing's syndrome could have other
origins. Second, I want to draw
attention to the importance of patient counseling. In other
words, two aspects of the
pharmacist's activity are highly relevant
to the rest of a treatment.
Henrique was so happy with the
treatment he received, the attention he received. From
then on, every time he
went to the doctor of any specialty,
upon leaving, he would return to our service
for advice on the medications
that had just been prescribed for him. I
worked at the
Onofre Lopes University Hospital with the clinical pharmacy, and at the
Presidente Dutra Hospital without the presence
of the clinical pharmacy on the team. So,
we clearly perceive the difference and
the importance of this professional. The
knowledge and guidance that this
professional brings and adds to the team is
very significant. We certainly, by
having knowledge of our
care perspective, our attitude, our
care practice, tends to change.
There was a change in this routine
because he learned
a new perspective within
integrated care and with greater knowledge in
drug therapy, he brought
a lot of contribution to clinical pharmacy.
It came precisely to create in the doctor
that trust with other
professionals. So, there was a
very good interaction with the clinical pharmacy. In the
hospital pharmacy, with the
compounding part, we
really worked as a team. Today, it's
already very clear, but at that time, it
wasn't commercial. So, the first
steps were to bring
people together to see or look at
this connection in the pharmacy or the clinic
services. This wasn't done
routinely. Aliagen wasn't done in
any way. The store just acted separately.
separately.
There's no connection. And a structure that
was recommended to us, which we knew
there in Chile and which we tried to create here,
was the drug information center.
The teachers didn't say so,
and the information center is a
very strong base. It's an indispensable base for the
practice of clinical pharmacy, not only
for personal training, not for the
pharmacist himself, but also as a
workplace that helps the
pharmacist. A seminar
on drug information. When we started
in 1979, we were offered
this room, and it was here that
we worked most of the time until the
pharmacy was renovated. Here was
my desk, which was more or less here. The
teacher's desk and doll desk were
here, and here behind there were a lot of
steel shelves with
material. Yes, because in the beginning Since
we have very little bibliography, it was possible to
do both in the same space,
both clinical pharmacy and
drug information.
It operated alongside the
clinical pharmacy, but as the
service grew, we began to feel
the need for a larger space for the
drug information center.
It came to this room.
Shortly after, we received a donation
from Professor Rua Robayo of the University
of Oklahoma, who donated an
entire library. Not for the
Federal University of Rio Grande do Norte, but
specifically for the
university hospital. This donation came
to this space, where not only this
pharmacist, who was part of this
information center, provided information,
but also all of us, the three of us, as
clinical pharmacists, also helped with the
demands received by the
drug information center.
Despite the clarity we have about the
importance of the drug information center
for the practice of
clinical pharmacy, it was not
easy to establish an information center
because there was a sectoral library in the
health center, and some people said they
already thought it was the same thing, that there was no
need because there was already a library. And
then we, still under the guidance of
Professor Aleixo, and despite the
guidance on his initiative,
several attempts were made to... yes, that was
it. There were nine in total, no,
most of them were led by
Professor Aleixo and then by myself.
All the new ones were frustrated. We
were already in the second year of our
activities and we came to the conclusion that
the time had come to open the doors
of the clinical pharmacy and the
drug information center so that
Brazilian pharmacists could evaluate. It was
with this purpose that we idealized and
then we held the 1st
Brazilian seminar on clinical pharmacy in 1981.
To our pleasant surprise,
representatives of organizations and entities participated in this seminar:
government agencies, the Ministry of Education, the
Ministry of Health, the Federal Council of
Pharmacy, regional councils, and
professors from several
Brazilian universities and also pharmacists
linked to various institutions and even the
private sector. There were 111
participants from 14 Brazilian states.
I was invited in 1981 to participate
in the 1st clinical pharmacy seminar, and I
came with the international consultation, right? And
I was known at the time of Hulk that I
was here, so was that it, or they
invited me, and I also have
Pharmacy experience, respect there in the first
scenario. I also came to evaluate the
service at the free hospital.
Who was called at that time? I
found one here. I asked people already
working in the clinical pharmacy, already
connected with the doctor, a patient with a
nurse, to do our
clinical pharmacy things that should be done. I also
evaluated the medication distribution system,
and I offered the
possibility of implementing
unit dose, which helps a lot in this
clinical pharmacy system. I set up,
with the help of pharmacy staff, to fix
a system. It was very simple. At the
time, we used a plastic bag, placed
each 12, sealed with a machine to
cut later, and the system shows which
patient, at what time.
Good morning, which medicine, who should deliver it.
And this here, let me, the pharmacy,
but with medication control in
nursing, it was very good. It was excellent
because it removed an overload. Because it was
an overload having to administer
all the medication, order everything, and
then now it is not the pharmacy that is
responsible for delivering the medication every day to be
made and
administered to patients.
Currently, here at UOL, the process of
individualizing the dose occurs from
the moment the pharmacist evaluates the
medical prescription, right? It comes here, and
then the pharmacy technicians
use the medications to place them in the
Individualized doses and
unitized medications come here to
compose the individualized dose for 24
hours that will be provided to patients
in the wards. In 1983, as a result of the
positive evaluations of the seminar, we
designed and held the first
Brazilian clinical pharmacy course. This
course was attended by 18 pharmacists from
seven Brazilian states. We had
extremely diverse and
broad content, and we had 62 pros.
As teachers of this course, our
expectation was that the participants of
this course, upon returning to their
units of origin, would implement, create, and establish
establish
new clinical pharmacy services. This is
how clinical pharmacy is
spreading throughout Brazil through
our work in the hospital. We began
to take on other commitments with other
courses because people saw the
work and began to appreciate it. Those
works were also important for
their students. So, we have
weekly seminars with
medical students in the supervised internship in clinical medicine.
The medical students
studied certain drugs, and
seminars were held together with the pharmacists.
pharmacists.
This was to disseminate
certain topics, for example,
anticonvulsants. This was taught
by Professor Djacyr together with With Dr.
Tarcísio, it was a series of 12 seminars
that were given to the Sertanista students.
They participated with questions,
bringing up questions about those drugs.
drugs.
And later, when they were
writing the medications, Dr. Tarcísio
reviewed his prescription to find out
where the flaws were.
This was later discussed with
the students about their flaws.
So, it was a kind of pharmacology
with therapeutics. We have
wonderful excellent evaluations of this activity. Of all the
activities of the supervised internship in
clinical medicine, which were
approximately 8/9. The seminars
were never evaluated below the third
best evaluation. In addition to the activity with
medicines, we taught classes for
nursing students in the discipline
Introduction to Nursing. The focus was on
adverse reactions and interactions
incompatibilities. We teach classes for
dentistry students in the discipline
Surgery One, and the focus was on
antimicrobials, anesthetics, and
anti-inflammatories. We
also teach classes in the course.
My focus was on drug-
food interactions. The greatest importance was to
foster the practice of teamwork.
In the early 1980s, we began
to evaluate the prescriptions, so we
evaluated them, and when he detected
We tried to resolve the errors before
a medication was dispensed, of course.
This generated some discomfort in the
hospital because word started to spread
everywhere that the pharmacy was
interfering in the position of the
hospital director. He called me to talk
about it. He said he wouldn't show me
the confidential document, but it was 60
meters long and his residency had signed the list
protesting the pharmacy's interference
in medical prescriptions. He said he was going to hold
a meeting with all of us to resolve
this issue. So I
went to the pharmacy, selected three
very absurd prescriptions, and took them because
we wrote prescriptions in two copies,
stamped in the afternoon, and the second copy also
had a stamp. Then I showed them if I think
I can dispense this. He said no. I
would like to say that I will
support you, but the meeting has to
happen. The room was crowded and there were no
seats for us to sit. Then they
started to protest, right?
Hi, and one of the methods said, "If I
prescribe poison, I have to send a baby."
We had a confrontation. It's not part of the
medical, pharmacy, and nursing code of ethics,
where it says the doctor can't
write incorrectly. The pharmacist can't. If
the nurse dispenses incorrectly, they
cannot administer incorrectly. So, if the
prescription is wrong, I dispense incorrectly. I
am complicit, right? I am harming the
patient, or I cannot dispense a
prescription. In 1983, the
Brazilian Society of Surgeons made a
broad complaint about the situation of
hospital infections in the country, which was
very serious. One hospital was
concerned about this. People died
from hospital infections, and there was no
program to prevent
or control this problem.
Well, initially, a meeting was held
in Brasília, including
foreign advisors and several
people from different parts of the country. It was
decided that there was no point in starting, for
example, health surveillance, requiring
hospital infection prevention and control measures in hospitals because
no one was used to knowing if
no one knew what to do, much less
how to do it. So, the decision was to
create a broad national course, a
national mass training program
for health and
hospital professionals. The presence of a
pharmacist on this team was essential because it was
impossible to control
hospital infections without antimicrobial control. The
rational use of
antimicrobials in the hospital has
adequate quality control and
materials. Hospital doctors without
germicides, disinfectants,
and so on will want a set of
questions that are
within the pharmacist's area of expertise.
Hi, and we are a pharmacist who
has a clinical perspective and not
merely medication management. In
Manaus, the first course was held with
representatives of
university hospitals, which they selected
according to criteria from the
hospital infection control program. Today, the
the
Federal University of Rio Grande do
Norte Hospital, Dr. Lúcia Lo Blah, was also selected. The commitment
was that, upon returning to their hospitals,
they would start a training center
in hospital infection control for
health professionals. It wasn't just
pharmacists, but pharmacists, doctors,
nurses, and other
professionals. Basically, these three, who
are the three most involved with
hospital infection control processes. I was nominated by the
hospital management to represent
Onofre Lopes in this course, as an example of
our work on the infection control committee.
I also
showed the work we
developed in selecting
antimicrobials to the
pharmacy and therapeutics committee. The use of germicides,
antiseptics, and disinfectants that
nursing has. assumed as a
role of the nurse, and when in
fact the handling of these products
should be centralized in the
pharmacy service. The person who had gone as
coordinator of this course to Manaus from the
Ministry of Health, who was part of the
infection control program, was
very concerned, and I was
systematically during the course
calling attention to the
responsibility that the Ministry of
Health had, right, in disseminating
erroneous information, right, and that
I was that they had to correct
that there, right, Keila. Those problems
are for whoever up front and the ministry
was not answering, right, for these
inconsistencies or for errors, including
attributions of a professional nature,
exactly on the day of
Tancredo Neves' hospitalization. At that time, there was still no such thing.
This helped the program, helped the
problem because the topic was in the media,
people started to worry about it,
visibility, and this even got
political, institutional, and
financial support. At ten-thirty in the evening, the
press secretary, Antônio Brito,
the last bulletin of these 38 days of
training by the president was bulletin
number 42. I regret to inform that His
Excellency, President of the
Republic Tancredo de Almeida Neves,
passed away. That night,
at 10:23, I returned to Natal from the Heart Institute,
and a week later, I received a
call from the Ministry of Health,
Dr. Romero, inviting me to spend
a month at the Ministry of Health to
work on updating this
material and, of course, making
corrections related to these
identified problems. He then invited me
to set up a
specialization course in
hospital infection control. We arrived at the Natal hospital
because it was one of the few hospitals that
had a pharmacy service with
sufficient dynamism and this
perspective, and with clinical pharmacists
on staff. We had a pharmacy
whose pharmacists were
truly integrated into the
hospital patient care team.
For this reason, Rio Grande do Norte was
not the hospital with the best
structure, but it was the state that could bring
together, at that time, the best
conditions to offer
this course. It was a specialization course for several classes.
Fernando, pharmacists from all over the country,
this training bore great fruit
because we trained people to teach
hospital pharmacy disciplines and
served as a stimulus for the offering of
hospital pharmacy and
clinical pharmacy disciplines in several
pharmacy schools in the country. This participation of
professionals from other states who
sought specialization courses
came to learn about the experience of
clinical pharmacy implemented at the
Onofre Lopes University Hospital. This has
spread throughout the country,
bringing important benefits to the
training of generations of professionals from
different courses. This work, I
also understand, has
placed the Federal University of Rio
Grande do Norte, the
Onofre Lopes University Hospital, as having assumed a
vanguard position in
clinical pharmacy here in
our country.
The companion must be samples were
taken care of, agreement when there is argaria face
participants. The dream, teachers,
my life is reborn. At the time, Stephanie
Five appeared because I don't remember 1990,
I taught a class except the 6th
specialization course in hospital pharmacy
for hospital infection control,
also in Natal. I wasn't going to practice within the
hospital. I started to have a series of
problems that were linked to
hospital infection. I also had the opportunity at the
Federal University of Rio Grande do
Sul to attend a course in which
professors from the Federal University of
Rio Grande do Norte spoke about the issue
of clinical pharmacy. If then, it was
preponderant on what I was
experiencing and also seeing the knowledge.
What these professors had
was a unique opportunity for
pharmacists to see another side of
pharmacy for those who had no training in
hospital pharmacy. I had a
class in the pharmacotechnics discipline,
along with a number of other colleagues who
wanted to get a better idea of what to
do as a professional and learn more.
I 988. From this course, we
received a lot of teachings, both
theoretically and practically.
We are very well trained in
clinical pharmacy,
hospital pharmacy, and also in the prevention of
hospital infections. When we
returned to the
hospital, we had to do a
project to implement
intervention measures. This project
was presented
and approved. For example, I managed to get
several of these interventions,
practically all of them, to be
done in the pharmacy,
improving the quality of care. At the
time of the creation of the clinical pharmacy in the
hospital, it also coincided with the
installation of the
hospital infection control committee. This was
practically a joint effort
where there was a
multidisciplinary team. We were
pharmacists, doctors, and
nursing staff, so it was a team that
worked in unison, and it really was
something that bore fantastic fruit. For
example, you just have to have an idea in the hospital at the
time. established the control of the use
of antimicrobials. We
clearly notice the difference, especially
in the policy of control and
rationalization of antibiotic use.
We notice that prescriptions are
sometimes not very appropriate.
And when
rationalization is implemented, this clash between
pharmacy and medical professionals
occurs in the area of knowledge. When you
have a clinical pharmacist, of these 191
pharmacists who participated in these
courses, many from then on became
even more motivated in their activities, and many
even entered the
clinical area. We have here today
people who are icons of the
pharmaceutical profession in Brazil. It is also a record
that in 1995 the
Brazilian Society of
Hospital Pharmacy was created, and since 1995, the society
has had 11 presidents, of which 11, four are
graduates of our courses. So, I
have no doubt in stating that
these courses were
watershed in the history of
hospital pharmacy in Brazil. This plaque has a
very large representation for us
because on April 20, 2000,
2010, that is, 31 years since the
implementation of clinical pharmacy and
this information Regarding medications, we
were fortunate to be able to gather
the professors here, and they were the most
important in this context, starting
with Professor Aleixo, who was the
great creator of all this, and
Professor Inês Luiz from the
University of Chile, who was
responsible for our information and
also for having been here in the
first three months of the implementation of the service.
Professor Onofre Lopes da
Silva Júnior, the doctor who opened
the doors of the clinic for our
initial activities. It is also
in honor of me, as I was
responsible for the implementation of the first
service. The Ouro Clinical Pharmacy service
currently operates with eight
clinical pharmacists, right? We
seek to serve the main clinics:
ICU, not pediatrics, cardiology, neurology,
mental health, kidney transplant,
rheumatology, oncology. Our
main service will be the
clinical monitoring of these patients
regarding their
medication therapy. The clinical pharmacy is
extremely present, the availability
of the team to discuss all cases and
to follow up on the cases. This
monitoring is done both with the
inpatient and later
when the patient is discharged. They have
outpatient follow-up.
Inpatients, we do
medication reconciliation, as these patients
normally also bring medication
to the hospital. We will
try this with what
he will use of the medicine
he brought from home and what will it be,
but from the hospital in parallel, we
also participate in medical visits and
provide information about the
safety of using that medicine.
Their arrival enabled
greater engagement between health professionals. The
positive point is to truly see the
patient as a whole, to be able to meet
their needs, right? Each one in their
specificity of their profession,
contributing to the well-being for the good
recovery and the prompt recovery of the
patient. Seeing the importance of the
clinical pharmacist both in teaching
and in improving
patient care, as well as from an economic point of view.
The hospital also wins; the
patient wins; the teaching wins. In addition to this
experience, we today have a
significantly expanded staff of pharmacists.
We have a
multiprofessional residency, so we are
managing to train
and this professional can go to college
through multiprofessional residency.
We are currently satisfied
because all our students leaving the
residency are being well
integrated into the job market. We
currently have a return of at least
four former residents already inserted within
the UFRN, so this is very graphic of
our work. I am very happy to have been
able to do it, and all the days in brazil the
practice of clinical pharmacy in natal at the
hospital das c The clinics of the
Federal University of Rio Grande do Norte must
emphasize emphatically that
absolutely nothing in terms of pharmacy
is more important than clinical pharmacy.
Our clients need to be convinced
of this. If I'm concerned about the existence of
pharmacies empty of pharmacists,
I'm even more concerned about pharmacies in
a filter of voids and knowledge.
My first visit to Natal was the
privilege and honor of knowing and
observing up close the
significant advances made by the
clinical pharmacy team in Natal under the direction
of Professor Tarcísio Pallano. This
clinical pharmacy that we have was a
pioneer in Brazil. We didn't know
about that, nor did we know that we were
experiencing a historic process.
Only young people who
wanted to do our work in the
best possible way entered. After that, it was
good to do pharmacy, which was a shame. It
paraded a kind of model in the country.
Several other hospitals and
other universities adopted this same
system, which was really very important. I thought it
was extremely productive at that
time for us to do this work from
the beginning. I made it my mission to
promote clinical pharmacy and I have sought to
do so throughout my
professional life. How gratifying it is to be able to
see that this ideal has been achieved. It was propagated
and assimilated, including by institutions
and entities that in one way or another
contributed and continue to contribute to the
dissemination and consolidation of
clinical pharmacy. This pioneering mark of the
university in the history of pharmacy in
Brazil is a great marker of this
history. So, in these 60 years of UFRN's existence, it
is a very important point and
we need to celebrate and tell this
story to our students and to
our professors and to the society of Rio
Grande do Norte, also to Brazil. Since
2012, when we assumed the management of the
Federal Council of Pharmacy, we have
worked hard to disseminate
pharmaceutical practice based on
patient care. One question is that this model
of professional practice that began in
Brazil with services founded at the Hospital das
Clínicas of the Federal University of Rio
Grande do Norte has been largely responsible for
responsible for
rescuing the image of the
Brazilian pharmacist as a
true health professional. We have
fought hard for this rescue in all
areas of pharmaceutical education, including
practice in community pharmacies.
Therefore, the
participation of the council in the reconstruction of
the history of the first
clinical pharmacy service in Brazil, together with
UFRN, is of great importance. Of
clinical pharmacy, this story has
not yet been fragmented in the memory
of its protagonists. Therefore, by
recounting the trajectory of
pioneering service, we take another step towards the
broad dissemination of this
essential model of patient care.
Finally, I would like to take this opportunity
to congratulate the Federal University
of Rio Grande do Norte for this
pioneering work in
clinical pharmacy and also for its 60 years, which is being
celebrated at this moment. The one
who should care is one,
and in the hospital today, I am certain I
can already leave the scene. I have been in the hospital for 38 years. I
am the only one remaining. There are
20 professors at the college
who were my students in the discipline. I
share the theoretical discipline with five former students, so
I have guides,
right? In other words, I will no longer fall into the trap
of those who did not leave the substitute, did not
know how to do school. I managed to
reproduce
everything I learned here at the Federal University of Bahia's University Hospital, at the Federal University of Bahia. It is a
feeling of knowing that I did
something that will continue to be, let's
say, encouraged and implemented in
other places, but that the seed, right, was
planted here, and I am
part of this, let's say, of this
implementation of this moment that It's a
historic moment and one that leaves me feeling
very fulfilled professionally.
Many students, many
pharmacists, decided to pursue
clinical pharmacy based on the
knowledge gained from our
experience here in Natal.
Migrate is very important. Returning to this
step, obviously reconstructed for this
recording, is very exciting for all of
us. Returning is reliving the past and
also nurturing the hope that what
we did here will truly
continue, that the
seed we planted back in 1979
and that germinated will continue to be
irrigated by this new generation of
clinical pharmacists, so that here
too, in a few years, some will be able to
tell these two stories with the same
emotion, the same feeling, and the
same sense of duty accomplished that
we are doing now. And then,
then,
and then, and then, and
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