BackgroundWithin the framework of the Austrian healthcare reform, a publicly funded project with the aim of resolving medication related problems (MRPs) by means of inhospital clinical pharmacy services (CPS) was conducted.PurposeThe aim of the study was to detect and resolve MRPs and to analyse the clinical pharmacists’ interventions.Material and methodsCPS were implemented on one trauma surgery ward (28 beds) in a large academic teaching hospital (2000 beds). On weekdays, two pharmacists alternately provided continuous CPS, comprising medication reviews (MRs) of newly admitted patients and patient counselling at discharge. Ward round participation took place once weekly. All MRPs, proposed interventions and the physicians’ acceptance rate were assessed and recorded during the study period (October 2014 to September 2015; patient counselling started in April 2015) according to an adapted classification system1. Further project relevant data (eg, demographics, involved medications, time spent on CPS, etc) were also recorded.ResultsMRs were performed in 1462 patients, with 1029 MRPs detected in 1027 patients (70.2%; 58% female; average age 68.5 years; average medicines/day 8,4). Patients with MRPs were older and took more medicines. Common MRPs were overdosing (13.8%), medicines prescribed without an indication (9.0%) and untreated indications (5%). Frequent clinical pharmacists’ interventions were the provision of information (14.6%) and the recommendations to alter dosing (15.6%) or discontinue medicines (9.5%). The most frequently involved medicines were proton pump inhibitors, NSAIDs and cardiovascular medicines. The overall physicians’ acceptance rate of interventions was 71.1%. 39.7% of interventions were assessed as directly reducing medicines’ expenses on the ward, while only 7.9% led to an increase. A total of 176 patients were counselled at discharge. The average (±SD) time/day spent on CPS was 71 (±38) min.ConclusionContinuous CPS have considerably contributed to the resolution of MRPs in trauma surgery patients, as illustrated by the high number of interventions performed and the high acceptance rate. Counselling at discharge was well received by patients. Based on the project results, the political decision to extend funding has been taken.References and/or AcknowledgementsAllenet B, et al. Pharm World Sci 2006;28:181-8Conflict of interest.

BackgroundWithin the framework of the Austrian healthcare reform, a publicly funded project with the aim of resolving medication related problems (MRPs) by means of inhospital clinical pharmacy services (CPS) was conducted.PurposeThe aim of the study was to detect and resolve MRPs and to analyse the clinical pharmacists’ interventions.Material and methodsCPS were implemented on one oral surgery ward (40 beds) in a large academic teaching hospital (2000 beds). On weekdays, three pharmacists alternately provided continuous CPS, comprising medication reviews (MRs) of newly admitted patients and patient counselling at discharge. Ward round participation took place twice weekly. All MRPs, proposed interventions and the physicians’ acceptance rate were assessed and recorded during the study period (October 2014 to September 2015; patient counselling starting in April 2015) according to an adapted classification system1. Further project relevant data (eg, demographics, involved medications, time spent on CPS, etc) were also recorded.ResultsMRs were performed in 2171 patients, with 1477 MRPs detected in 1361 patients (62.7%; 46% female; average age 56 years; average medicines/day: 8.3). Patients with MRPs were older and took more medicines. Common MRPs were medicines prescribed without an indication (10.9%), overdosing (9.8%) and choosing a suboptimal administration route (8.2%). The most common clinical pharmacists’ interventions were the provision of information (20.6%) and the recommendations to discontinue medicines (16.6%) or alter dosages (9.8%). The most frequently involved medicines were proton pump inhibitors, NSAIDs and antibiotics. The overall physicians’ acceptance rate was 93.7%. 37% of interventions were assessed as directly reducing medicines’ expenses on the ward, while only 11.5% led to an increase. A total of 459 patients were counselled, and 187 MRPs (12.7%) were resolved at discharge. The average (±SD) time/day spent on CPS was 125 (±62) min.ConclusionContinuous CPS have considerably contributed to the resolution of MRPs in oral surgery patients, as illustrated by the high number of interventions performed and the high acceptance rate. Counselling at discharge helped to further resolve MRPs. Based on the project results, the political decision to extend funding has been taken.References and/or AcknowledgementsAllenet B, et al. Pharm World Sci 2006;28:181­8.Conflict of interest.

seven-item questionnaire: prescription, monitoring, pump use, clarity of prescription, nurse skills and presence of a painreferent (specialised nurse). The information was collected in the care unit using PCA between June and September 2021. Results Seven department health executives were interviewed. Concerning the prescription: five departments use a computerised prescription, none include dilution information, and programming details are added by the prescriber because there is no prepared protocol. Two services use a paper prescription that is also the follow-up paper: they contain dilution information but not the background dose. Five services carry out the follow-up with a paper follow-up sheet, which differs according to the service, and two services use written computer transmissions. Concerning the other items: there is a lack of training sessions about the PCA pump use, only one service had a recent course by the company. Conclusion and relevanceThe assessment showed a disparity in the method of prescription and monitoring. It appears that essential data are missing, data which are necessary to have a complete prescription. It would be interesting to work on a computer protocol making it possible to simplify the prescription (basic dose, bolus, inter-dose, etc.), as well as to propose a single paper prescription for non-computerised services. A working group comprising representatives of the pharmacy department, prescribers from the care units concerned, health executives and pain-adviser nurses has been set up to work on this issue with the objective of improving patient care.

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