Clinical Pharmacists and Inpatient Medical Care A Systematic Review (original) (raw)

Clinical Effects of a Pharmacist Intervention in Acute Wards- A Randomised, Controlled Trial

Basic & Clinical Pharmacology & Toxicology, 2017

The purpose of the study was to investigate the clinical effect of a clinical pharmacist (CP) intervention upon admission to hospital on inpatient harm and to assess a potential educational bias. Over 16 months, 593 adult patients taking ≥4 medications daily were included from three Danish acute medicine wards. Patients were randomized to either the CP intervention or the usual care (prospective control). To assess a potential educational bias, a retrospective control group was formed by randomization. The CP intervention comprised medication history, medication reconciliation, medication review and entry of proposed prescriptions into the electronic prescribing system. The primary outcome of inpatient harm was identified using triggers from the Institute of Healthcare Improvement Global Trigger Tool. Harms were validated and rated for severity by two independent and blinded outcome panels. Secondary end-points were harms per patient, length of hospital stay, readmissions and 1-year mortality. Harm affected 11% of the patients in the intervention group compared to 17% in the combined control group, odds ratio (OR) 0.57 (CI 0.32-1.02, p = 0.06). The incidence of harm was similar in the intervention and prospective control groups, OR 0.80 (CI 0.40-1.59, p = 0.52) but occurred less frequently in the intervention than in the retrospective control group OR 0.46 (CI 0.25-0.85, p = 0.01). An educational bias from the intervention to the control group might have contributed to this negative outcome. In conclusion, the CP intervention at admission to hospital had no statistically significant effect on inpatient harm. Materials and Methods Study design and setting. This prospective, randomized, controlled trial was approved by the Danish Data Protection Agency (j.nr.2008-58-0020) and Danish Health and Medicines Authority's Supervision and Patient Safety (j.nr. 3-3013-9). Approval from The Scientific Ethics Committee was not required according to Danish legislation because the study included no biomedical research. The trial was registered at Current Controlled Trials Ltd (ID ISRCTN08043800). The setting was the acute medicine wards of three non-university hospitals in Region Zealand, one in five regions of Denmark. Apart

Multifaceted pharmacist-led interventions in the hospital setting - a systematic review

Clinical pharmacy services often comprise complex interventions. In this MiniReview, we conducted a systematic review aiming to evaluate the impact of multifaceted pharmacist-led interventions in a hospital setting. We searched MEDLINE, Embase, Cochrane Library and CINAHL for peer-reviewed articles published from 2006 to 1 March 2018. Controlled trials con- cerning hospitalized patients in any setting receiving patient-related multifaceted pharmacist-led interventions were considered. All types of outcome were accepted. Inclusion and data extraction were performed. Study characteristics were collected, and risk of bias assessment was conducted utilizing the Cochrane Risk of Bias tools. All stages were conducted by at least two indepen- dent reviewers. The review was registered in PROSPERO (CRD42017075808). A total of 11,896 publications were identified, and 28 publications were included. Of these, 17 were conducted in Europe. Six of the included publications were multi-centre studies, and 16 were randomized trials. Usual care was the comparator. Significant results on quality of medication use were reported as positive in eleven studies (n = 18; 61%) and negative in one (n = 18, 6%). Hospital visits were reduced significantly in seven studies (n = 16; 44%). Four studies (n = 12; 33%) reported a positive significant effect on either length of stay or time to revisit, and one study reported a negative effect (n = 12; 6%). All studies investigating mortality (n = 6), patient-reported out- come (n = 7) and cost-effectiveness (n = 1) showed no significant results. This MiniReview indicates that multifaceted pharma- cist-led interventions in a hospital setting may improve the quality of medication use and reduce hospital visits and length of stay, while no effect was seen on mortality, patient-reported outcome and cost-effectiveness.

Clinical pharmacist service in the acute ward

International Journal of Clinical Pharmacy, 2013

Background The majority of hospitalised patients have drug-related problems. Clinical pharmacist services including medication history, medication reconciliation and medication review may reduce the number of drug-related problems. Acute and emergency hospital services have changed considerably during the past decade in Denmark, and the new fast-paced workflows pose new challenges for the provision of clinical pharmacist service. Objective To describe and evaluate a method for a clinical pharmacist service that is relevant and fit the workflow of the medical care in the acute ward. Setting Acute wards at three Danish hospitals. Methods The clinical pharmacist intervention comprised medication history, medication reconciliation, medication review, medical record entries and entry of prescription templates into the electronic medication module. Drug-related problems were categorised using The PCNE Classification V6.2. Inter-rater agreement analysis was used to validate the tool. Acceptance rates were measured as the physicians' approval of prescription templates and according to outcome in the PCNE classification. Main outcome measure Acceptance rate of the clinical pharmacists' interventions through the described method and inter-rater agreement using the PCNE classification for drug-related problems. Results During 17 months, 188 patients were included in this study (average age 72 years and 55 % women). The clinical pharmacists found drug-related problems in 85 % of the patients. In the 1,724 prescriptions, 538 drug-related problems were identified. The overall acceptance rate by the physicians for the proposed interventions was 76 % (95 % CI 74-78 %). There was a substantial inter-rater agreement when using the PCNE classification system. Conclusion The methods for a clinical pharmacist service in the acute ward in this study have been demonstrated to be relevant and timely. The method received a high acceptance rate, regardless of no need for oral communication, and a substantial inter-rater agreement when classifying the drug-related problems. Keywords Acceptance rate Á Acute ward Á Clinical pharmacy Á Denmark Á DRP classification Á Drugrelated problems Á Electronic prescription template Á Medication history Á Medication reconciliation Á Medication review Impacts on practice • Clinical pharmacist services in the acute ward need to fit the high-paced workflow to benefit the health care professional teams and thereby the patients. • The method for a clinical pharmacist service in the acute ward described here fits an intensive workflow, identifies multiple drug-related problems and yields a

An-Evaluation-Of-Interventions-By-Clinical-Pharmacists-In-A-Tertiary-Hospital

Malaysian Journal of Pharmacy, 2021

Introduction: Problems with medication therapy are a major concern in health care because of the associated increase in morbidity, mortality and increased cost of treatment. Clinical pharmacy services are well established in developed countries such as the United States and have been reported to reduce adverse drug events, medication errors, patient's length of stay, mortality rates and costs. Clinical pharmacists proactively ensure rational medication use, avoiding medication errors at point of prescribing. They participate in ward rounds, communicate with the team in the wards, interview patients, perform medication reconciliation, provide counselling, therapeutic drug monitoring, antibiotic stewardship, discharge screening and follow ups. Any discrepancy or problems detected will be conveyed to the relevant team member for correction. Objective: To describe and evaluate the interventions performed by clinical pharmacists in a tertiary teaching hospital in Malaysia. Method: A clinical pharmacy observational retrospective study was conducted between January and December 2019. Fourteen clinical pharmacists were assigned to respective wards in the medical, surgery and intensive care units to provide pharmaceutical care. All interventions performed in the wards were documented systematically. Result: A total of 3345 interventions were recorded. The most frequent interventions were on rational drug therapy (n = 1456, 43.5%), followed by corrections made on prescription (n = 1349, 40.3%) and changes in dosage and frequency (n = 540, 16.2%). The majority of suggestions (n = 3264, 97.6%) have been accepted. Conclusion: To our knowledge, this is the first study reporting clinical pharmacist interventions in a teaching hospital in Malaysia. The involvement of clinical pharmacist in the wards contributed to the optimisation of pharmacotherapy, safety and better patients' outcomes. There was good inter-professional collaboration at the ward level.

Hospital pharmacist interventions in a central hospital

European Journal of Hospital Pharmacy: Science and Practice, 2014

Objective The aim of this study is to describe and categorise pharmacist interventions (PIs) in a central hospital and report acceptance rates by physicians. Methods A retrospective study was carried out in a 350-bed central hospital between January and June 2013. Eleven pharmacists screened the pharmacotherapy charts for drug-related problems leading to PIs. The recommendations resulting from this analysis were entered in the electronic prescribing system. All the PIs registered on the electronic medical record system during the study period were eligible for inclusion. Interventions were quantified and characterised. Computer records were consulted to assess acceptance rate by physicians. Results A total of 1249 PIs were made by 11 pharmacists, and covered 147 drugs, with the most common being antibacterial (25%) and for the central nervous system (24%) and cardiovascular system (18%). Of the 1249 PIs, 18% concerned acetaminophen, 13% enoxaparin and 10% amoxicillin/clavulanic acid. The PIs were classified into three main categories: drug, dosage and administration related. When we analysed the most relevant PI type (n>20), the highest acceptance rate was for dosage adjustment according to therapeutic indication (58.1%) and renal function (57.4%). The global rate of acceptance was 53%. Conclusions Pharmacists' recommendations entered in the electronic prescribing system with a short explanation, as well as the pharmacotherapy recommendation, are immediately available to the doctor; however, the relatively low acceptance rate suggests that a further study also evaluating verbal interventions is needed, since the most urgent recommendations are made verbally, and this would likely increase the acceptance rate.

Self reported clinical pharmacist interventions under-estimate their input to patient care

Pharmacy world & science : PWS, 2001

Pharmacists' impact on individual patient care is difficult to measure especially the contribution made by clinical pharmacy ward visits. This study set out to determine what activities pharmacists actually undertook on a clinical pharmacy ward visit and compare this with the usual method of measuring clinical pharmacist performance, self-reported pharmacist interventions. Observational analysis was carried out on 16 pharmacists providing a ward clinical pharmacy service in four acute hospitals. Percentage of pharmacist interventions recorded. A total of 34 wards were visited during the study which included both medical and surgical specialties. Average time spent per patient was less than two minutes for most pharmacists and three-quarters of the pharmacists checked over 80% of patient drug charts. Interventions represented 68% of pharmacist activities on the wards but on questioning the pharmacists reported that they would record only 31% of those interventions. Comparison of ...

Interventions by pharmacists in out-patient pharmaceutical care

Saudi Pharmaceutical Journal, 2014

Interventions by the pharmacists have always been considered as a valuable input by the health care community in the patient care process by reducing the medication errors, rationalizing the therapy and reducing the cost of therapy. The primary objective of this study was to determine the number and types of medication errors intervened by the dispensing pharmacists at OPD pharmacy in the Khoula Hospital during 2009 retrospectively. The interventions filed by the pharmacists and assistant pharmacists in OPD pharmacy were collected. Then they were categorized and analyzed after a detailed review. The results show that 72.3% of the interventions were minor of which 40.5% were about change medication order. Comparatively more numbers of prescriptions were intervened in female patients than male patients. 98.2% of the interventions were accepted by the prescribers reflecting the awareness of the doctors about the importance of the pharmacy practice. In this study only 688 interventions were due to prescribing errors of which 40.5% interventions were done in changing the medication order of clarifying the medicine. 14.9% of the interventions were related to administrative issues, 8.7% of the interventions were related to selection of medications as well as errors due to ignorance of history of patients. 8.2% of the interventions were to address the overdose of medications. Moderately significant interventions were observed in 19.4% and 7.5% of them were having the impact on major medication errors. Pharmacists have intervened 20.8% of the prescriptions to prevent complications, 25.1% were to rationalize the treatment, 7.9% of them were to improve compliance. Based on the results we conclude that the role of pharmacist in improving the health care system is vital. We recommend more number of such research based studies to bring awareness among health care professionals, provide solution

Pharmaceutical care: pharmacy involvement in prescribing in an acute‐care hospital

Pharmacy World & Science, 2003

Background: Pharmaceutical care implies reaching a consensus with physicians on prescriptions in cases that call for the substitution of one active ingredient for another, a modification in dose, frequency, route of administration, etc., through the unit‐dose distribution system. The goal of pharmacist interventions in the hospital should be to achieve a rational use of drugs; to ensure this, a daily review of patient prescriptions by a pharmacist is necessary. Most of the incidence of drug‐related morbidity and mortality is predictable and can be avoided, thus reducing the overall cost of health care and the duration of hospitalization while improving the quality of care. The optimum quality of physician or pharmacist care to be achieved would be one that which maximizes benefits and minimizes risks and costs.Objective: The goal of this study was to evaluate pharmacist interventions at the Hospital of Barcelona over a six‐month period and their clinical and economic repercussions and the degree of compliance. Method: The interventions were recorded on a card and classified by type: antibiotic or thromboembolic prophylaxis; substitution of an active principle not included in the hospital's Pharmacotherapeutic Guide; change in dose or route of administration; therapeutic duplication; dose adjustment of aminoglycosides and vancomycin; and inappropriate treatment duration. The economic evaluation considered the average cost of a hospital stay and of the procedures and diagnostics in 1998 and applied data on published probability rates and drug costs.Results: A total of 3,136 interventions were analyzed prospectively during the study period. The interventions represented savings of 129,058.31 euros. Those that contributed most to these savings were recommendations for antibiotic prophylaxis, thromboembolic prophylaxis and pharmacokinetics studies: 49.4, 47 and 5.7% of interventions, respectively, and 79, 3.6 and 15% of total savings, respectively. Conclusion: In general, the degree of acceptance of the interventions was high (88.8%), as a result of the growing compliance by physicians with the hospital's established protocols. It can be concluded that pharmacist interventions have been useful to improve patient care and have been important to help educate physicians on the quality of drug therapy.