For the first time in a European country, our findings show the scope of clinical pharmacist involvement in patient care in daily clinical practice and demonstrate the usefulness and importance of their proactive interventions in the prevention of hazards and risks for hospital inpatients.

Background Pharmacists’ interventions (PI) are suitable to improve medication safety and optimise patient outcome. However, in Germany, clinical pharmacy services are not yet available nationwide. Aim To gain prospective data on the extent and the composition of routine PI with special focus on intervention rates among German hospital pharmacists during two intervention weeks. Methods Within a repetitive cross-sectional study, clinical pharmacists documented all PIs on five days during a one-month period (intervention week) in 2017 and 2019 using the validated online-database ADKA-DokuPIK. Additionally, data regarding the supply structure/level of medical care, the extent of clinical pharmacy services and their professional experience were collected. All data were anonymised before analysis. Results In total, 2,282 PI from 62 pharmacists (2017) and 2578 PI from 52 pharmacists (2019) were entered. Intervention rate increased from 27.5 PI/100 patient days in 2017 to 38.5 PI/100 patient days in 2019 (p = 0.0097). Frequency of clinical pharmacy services on a daily basis significantly increased from 60% (2017) to 83% (2019). Reasons for PIs from the categories “drugs” (e.g. indication, choice, documentation/transcription) and “dose” were most common in both intervention weeks. The vast majority of underlying medication errors in both intervention weeks were categorised as “error, no harm” (80.3 vs. 78.6%), while the proportion of errors which did not reach the patient, doubled to 39.8% in IW-2019. Conclusion Regular and daily clinical pharmacy services become more established in Germany and clinical pharmacists are increasingly involved in solving drug related problems proactively and early during the medication management process.

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ObjectivesClinical pharmacy services in German hospitals appear to be underdeveloped compared with other European countries. However, recent developments have increased the interest in expanding these services. Detailed data about the current state of clinical pharmacy services in Germany are lacking. This survey establishes the current level of pharmacy services in Germany and the barriers to implementation.MethodsAn online survey conducted in 2017 was distributed to directors of all 389 German hospital pharmacies. The survey contained 26 questions addressing hospital and pharmacy characteristics, clinical pharmacy services provided, the number of clinical pharmacists and the frequency as well as the quality assurance of these services.ResultsThere were 133 responses (34%). Of these, 84 (63%) pharmacies provided some form of clinical pharmacy services. Based on the 389 contacted pharmacies, a clinical pharmacy service is available in at least 22% of hospital pharmacies in Germany. On average there are 2.4 full-time equivalent (FTE) clinical pharmacists per hospital employed, although there is a wide variation in numbers (0.3–22 FTE) and service provision between hospitals. Clinical pharmacy services are generally provided on a daily or weekly basis, with a principal focus on general surgery, critical care and general medicine wards.ConclusionsThis is the first survey providing a detailed picture of clinical pharmacy services in Germany. There is wide variation in clinical service provision among hospitals, with some hospitals having developed a comprehensive range of clinical services. Compared with other countries, particularly the UK where the focus has shifted to provision of 7-day clinical services, the gap in clinical pharmacy services remains large. The focus should be turned to refining clinical pharmacy services in hospital admissions and discharge planning while also improving Health IT, the opportunities for specialisation and aligning education in accordance with the EAHP common training framework.

Background The internet-based categorical, hierarchical documentation system for routine pharmaceutical interventions (PIs) DokuPIK is widely used especially among German ward-based pharmacists. Purpose To conduct a survey-based study on its clinical usability. Materials and methods Out of 498 registered DokuPIK users, 37 volunteered to independently evaluate 24 standardised case reports1 between 01–03 2012. Case evaluation was restricted to the reason for PI and was performed based on 26 given survey items with no limit on the number of items chosen. Ratings were conducted electronically and anonymously. In order to define meaningful reference item selections, majority decisions made by 5 senior clinical pharmacists were considered to be the gold standard. Agreement of raters’ case evaluations with the gold standard was assessed by calculating the proportion of false positive and false negative answers, sensitivity, specificity, positive and negative predictive value (PPV - NPV) and was reported as median and range. Results Independent assessment yielded a median agreement of 90% [79%–94%]. False positive ratings were not assessed as they only constituted 1% [0–2%]. False negative evaluations were revealed to be 10% [4–20%]. Sensitivity and specificity were 37% [21–57%] and 99% [97–100%] respectively. Median PPV and NPV were both 90% [60–100%] [78–95%]. Judging by the percentage variations from the judges’ opinions, fp rate, specificity and NPV seem to be more robust than fn rate, sensitivity and PPV. Conclusions Although comparable data are missing DokuPIKseems to have a favourable PPV and NPV and agree with the majority vote of senior clinical pharmacists. Despite the allowance of multiple choices, predictive values were good and indicate a well-considered decision. The low sensitivity, acceptable for an exclusively informative tool, is explained by a generally conservative attitude to recommending more than one possible intervention option by a single pharmacist whereas the reference definition relied on a majority decision. The variability among case reports should be further explored by subgroup analyses. Reference Ganso 2007 KHP 28:279 No conflict of interest.