Hospital pharmacist interventions in a central hospital

Abstract

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.

Physicians’ acceptance of pharmacists’ interventions in daily hospital practice

“…This acceptance rate is somewhat higher than the acceptance rate of 62% found in the French multi-centre study referred to in the introduction section [3]. Others have reported even lower acceptance rates of around 50% [6,12,13]. The higher acceptance rate found in our study could perhaps be explained by the accurate assessment of the clinical relevance of potential drug-related problems by our pharmacists, illustrated by the small number of clinically irrelevant alerts.…”

“…This indicates that physicians' decisions to accept interventions generally are based on the discussion with the pharmacist, since they hardly viewed the recorded recommendations. Previous studies indeed have shown that verbally communicated interventions are much more likely to be accepted than interventions that are only recorded electronically [6,25]. These findings support the feasibility and safety of pharmacists located in the hospital pharmacy proposing interventions for drug-related problems over the telephone.…”

“…Recommendations to optimize pharmacotherapy may then be proposed to the prescriber. The acceptance rate of these interventions has been shown to vary between 52 and 100% [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. This variation can be explained by differences in, among other things, the prescribing process (computerized or handwritten), the identification of potential drug-related problems (using CDSS or medication review), the medical ward (medical, surgical or intensive care unit) and the way of communicating the intervention (over the telephone, during ward rounds and/or electronically).…”

Impact of clinical pharmacist intervention on antimicrobial use in a small 164-bed hospital

“…In this study, as in other similar studies,19 the most frequently proposed PI was antimicrobial dose adjustment or interval modification due to kidney dysfunction. In view of these results, and because PIs in patients with chronic kidney conditions seem to have a direct positive impact on patient outcomes,20 we suggest that attending physicians should receive pharmacological training about the dosage for patients with impaired kidney function.…”

Medication incidents and pharmacist interventions in relation to directly acting oral anticoagulants in hospital settings: evaluation using Reason’s Accident Causation Theory

“…Overall, dose changes contributed to the highest percentage of recorded interventions. This is consistent with several published studies investigating pharmacist interventions in other therapeutic areas [31][32][33][34]. Hence, this demonstrates lack of prescriber familiarity with dosing regimens and necessitates for further prescriber education.…”