Objectives: To explore the national survey of clinical pharmacy practice in Saudi Arabia from 2017-2018 with an emphasis on performances and activities. Methods: This is a 4-month cross-sectional national survey regarding clinical pharmacy practice in Saudi Arabia. The study consisted of two parts:The first part collected demographic information and the second part comprised a questionnaire with 51 questions divided into four domains. The questions were derived from the standards of the American Society of Health-System Pharmacists (ASHP) and Saudi Pharmaceutical Society (SPS) survey, the international standards of the Joint Commission of Hospital Accreditation, in addition to the local standards of Saudi Center of Healthcare Accreditation. The four domains were as follows: clinical pharmacy administration and management, performances and activities, education and training and workload documentation. The responses were obtained using a 5-point Likert response scale system with close-and open-ended questions. The survey questionnaire was distributed in an electronic format to the 31 directors of pharmacies at various hospitals in Saudi Arabia. In this study, we analyzed the national survey of clinical pharmacy practice at hospitals in Saudi Arabia with regard to performances and activities. All data were obtained through the Survey Monkey system. Results: The survey questionnaire was distributed to 31 hospitals. Majority of the specifications of clinical pharmacy services provided were for concurrent and routine monitoring of drug therapy of the patients (17 (54.84%)) and written medication history (16 (51.61%)). Majority of the clinical services recorded was for answering drug information inquiries (74.19%), error and adverse drug event reporting (70.97%) and medication administration (70.97%). Most of the pharmacy units had clinical pharmacy services for control and narcotics system (4.13 (82.60%)), unit dose system (4.07 (81.40%)) and adults emergency medication (3.45 (69%)). Most of the hospital programs had clinical services existed for stewardship antimicrobial (64.52%), medication safety (61.29%) and medication reconciliation/history-taking (54.84%). Most of the methods of clinical pharmacist prescribing privileges in relevant hospital programs was prescribing under physician supervision (66), followed by independent prescribing (49) and refill prescribing (20). Conclusion:The performances of clinical pharmacy services monitoring of drug therapy only; that is including medication misadventures monitoring and prevention through antibiotics, medication safetyrelated services. The clinical pharmacist had inadequate prescribing privilege under physician supervision. Targeting of upgrading the clinical pharmacy performances and privilege is higher recommended with New Saudi vision 2030 to improve patient clinical outcome and avoid any economic burden of the healthcare system in Saudi Arabia.

The general administration of pharmaceutical care released several publications related to the administration of intravenous medications, which mention about the concentration of intravenous medications for adults, pediatrics and neonatal patients. The publications also include several emergency medications with their concentrations. This new initiative was started in order to guide physicians to select the primary emergency medications in intravenous drip administration. The medications were selected based on common evidence-based standardized concentration for adults. This project required to control high-alert medications and prevent drug-related errors. The list of medications may be covered as computerized physician order entry and this project may be implemented as pharmacy project management.

The electrolyte replacement therapy consternation considered one of the high alert drugs. Most of the medication safety organizations have established preventive guidelines for the prescription of electrolyte therapy. The General Administration of Pharmaceutical Care at the Ministry of Health in the Kingdom of Saudi Arabia also has established guidelines for the preparation and administration of electrolyte replacement for adult patients. This new initiative is regarding the standardized concentration of electrolyte preparation and administration for adult patients. The electrolyte therapy may be prescribed via a physician order form, which may be easily converted as computerized physician order entry. This from is designed to prevent all electrolyte-related errors and improve patient outcomes. This project is a new tool implemented for electrolyte safety at the Ministry of Health hospitals in the Kingdom of Saudi Arabia.

The national medications safety program founded in 2013 at the Ministry of Health hospitals and primary care centers in the Kingdom of Saudi Arabia. The program focused on adults, pediatrics and neonatal populations. The program was part of the pharmacy strategic plan. The electrolyte replacement therapy preparation and administration for neonates and pediatrics published and distributed as required of the medication safety program. The new initiatives as complementary project was a standardized concentration of electrolyte replacement therapy for neonates and pediatrics implemented at specific hospitals of the Ministry of health. The new project as regular physician's order form and coveted to computerized physician order entry. The new project prevents neonates and pediatrics medication errors of electrolyte replacement therapy. The project is a new initiative at Ministry of Health hospitals in the Kingdom of Saudi, Gulf and Middle East countries.

The national pediatric pharmacy program was founded in 2014. It is a part of the pharmacy strategic plan. This program has implemented several projects including preparation and administration of intravenous medication to neonates and pediatric patients. The complementary new initiatives program is the neonates and pediatrics standardized concentration of emergency medications with an emphasis on medications used to treat critically ill patients and in emergency department. This new project has physician order form with selected dilutions, concentrations and route of administration. The form may be converted to a computerized order form. The new initiatives of the project may be implemented through project management tools. The project prevents drug-related problem and decrease economic burden on healthcare system for neonates and pediatrics hospitals in the Kingdom of Saudi Arabia.