The treatment of infections caused by gram-negative bacteria has been associated with reports of resistance through different mechanisms of action. Therefore, CAZ/AVI should be reserved for multidrug-resistant infections, and rational use is essential to ensure safe antibiotic therapy and minimize adverse events. In this context, the clinical pharmacist plays a key role in the stewardship of CAZ/AVI, with a strategic role in promoting safety in prescribing and administration.

The aim of this study was to evaluate pharmaceutical interventions related to the use of CAZ/AVI and the impact of implementing a time-out tool on the frequency and acceptability of interventions.

Descriptive, quantitative, retrospective study conducted between January 2022 and December 2024 in a private hospital in Rio de Janeiro. Pharmaceutical interventions related to electronic prescription errors of CAZ/AVI were analyzed. These errors were classified as decision or writing errors, and further subdivided according to the PRAT tool. In August 2023, the SMART-CAZ/AVI algorithm was implemented to standardize prescription analysis, using the time-out as a monitoring tool (CAAE: 77108523.5.0000.5533).

A total of 56 pharmaceutical interventions were performed, with 98.2% classified as decision errors and 1.8% as writing errors. Among decision errors, 74.5% were overdoses according to creatinine clearance (ClCr), 14.5% were underdoses according to ClCr, 9.1% were due to treatment duration requiring suspension, and 1.8% were due to inappropriate scheduling. In writing errors, 100% involved inappropriate units of measurement. Of the interventions performed, 70.2% were accepted by the medical team. After implementation of the SMART-CAZ/AVI tool, there was a 103.03% increase in the number of interventions and a 12.31% increase in the acceptance rate.

The role of the clinical pharmacist was essential for ensuring the safe use of CAZ/AVI, particularly in dose adjustment according to renal function. The SMART-CAZ/AVI tool contributed to increased detection of prescription errors and acceptance of interventions, highlighting the positive impact of standardization and systematization of pharmaceutical care, optimizing the stewardship of rational CAZ/AVI use, and promoting safe antibiotic therapy for patients.