{
  "abstract": "Background and Importance Computerised provider order entry (CPOE) with pharmaceutical validation is widely used for hospitalised treatments. However, a gap may persist between interventions performed by pharmacists and the real modifications recorded in CPOE, which may underestimate the true impact of pharmaceutical validation.Aim and Objectives To compare pharmacist performed interventions with treatment modifications effectively implemented and captured in the CPOE program (FarmaTools ), and to identify the most affected therapeutic groups.Material and Methods Retrospective observational study in a tertiary hospital over two months (01 April 2025–31 May 2025). On the one hand, all pharmacist-driven treatment modifications in prescriptions were retrieved from the CPOE program and reviewed. On the other hand, all pharmacist interventions registered in CPOE were reviewed. Modifications were classified as: addition of a new medication (eg, medication reconciliation), modification of a pre-existing medication (eg, route change, dose adjustment, Antimicrobial Stewardship Programs [ASP]), and suspension/discontinuation. The primary outcome was the Documentation Rate (DR) = (CPOE-recorded interventions/real-life-performed interventions) × 100. Analyses were stratified by ATC and type of modification.Results A total of 1,947 potential treatment modifications were analysed, of which 535 were recorded interventions. The overall Documentation Rate was 27.48%. Documentation rates by categories were similar: additions=29.37%, modifications=26.85% and discontinuations=28.95%. Among registered interventions, 25.1% were ASPs (ATC J01, J02, J03). IV to oral switches (IVOS) were 44.67%, mainly Analgesics (N02, 29.53%) and Drugs for acid-related disorders (A02, 15.14%). Considering all pharmacist performed prescription modifications, 23.73% were ASPs (DR = 27.92%); IVOS were 17.1% (DR = 72%); antithrombotic agent modifications were 7.65% (DR = 16.1%); medications not included in the hospital-formulary were 9.09% (DR = 20.7%); and intravenous fluid therapy–related changes were 6.68% (DR = 1.5%).Conclusion and Relevance Relevant differences exist between reported interventions and real modifications recorded in the system. The largest differences occurred after rapid physician consults (eg, phone-calls), like antithrombotic dose adjustments or fluid-management changes. These findings underscore the importance of improving the documentation of interventions, with special attention to quick consults. Due to the continuous clinical workload, expanding the workforce is essential to ensure ensure proper documentation. The main limitations were the limited study period and a single-centre design which may require confirmation in additional studies.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Hospital Univeritario Del Poniente, Ugci Farmacia Hospitalaria, El Ejido- Almeria, Spain"
      ],
      "name": "A Perea Perez"
    },
    {
      "affiliations": [
        "Hospital Univeritario Del Poniente, Ugci Farmacia Hospitalaria, El Ejido- Almeria, Spain"
      ],
      "name": "M Aznar Garcia"
    },
    {
      "affiliations": [
        "Hospital Univeritario Del Poniente, Ugci Farmacia Hospitalaria, El Ejido- Almeria, Spain"
      ],
      "name": "N Gimenez Carbelo"
    },
    {
      "affiliations": [
        "Hospital Univeritario Del Poniente, Ugci Farmacia Hospitalaria, El Ejido- Almeria, Spain"
      ],
      "name": "AI Faura Salas"
    },
    {
      "affiliations": [
        "Hospital Univeritario Del Poniente, Ugci Farmacia Hospitalaria, El Ejido- Almeria, Spain"
      ],
      "name": "J Castaño Muñoz"
    }
  ],
  "title": "5PSQ-097 Do we report everything we do? A pharmaceutical intervention report",
  "uid": "dca86109-3742-5072-83fb-b6abfb3e6f80"
}