The Impacts of Clinical Pharmacists’ Interventions on Clinical Significance and Cost Avoidance in a Tertiary Care University Hospital in Oman: A Retrospective Analysis

Abstract

Objectives: Pharmaceutical interventions are implicit components of the enhanced role that clinical pharmacists provide in clinical settings. We aimed to study the clinical significance and analyze the presumed cost avoidance achieved by clinical pharmacists’ interventions. Methods: A retrospective study of documented clinical pharmacists’ interventions at a tertiary care hospital in Oman was conducted between January and March 2022. The interventions were electronically recorded in the patients’ medical records as routine practice by clinical pharmacists. Data on clinical outcomes were extracted and analyzed. Cost implications were cross checked by another clinical pharmacist, and then, cost avoidance was calculated using the Rx Medi-Trend system values. Results: A total of 2032 interventions were analyzed, and 97% of them were accepted by the treating physicians. Around 30% of the accepted interventions were for antimicrobials, and the most common type was dosage adjustment (30%). Treatment efficacy was enhanced in 60% and toxicity was avoided in 22% of the interventions. The presumed cost avoided during the study period was USD 110,000 with a projected annual cost avoidance of approximately USD 440,000. Conclusion: There was an overall positive clinical and financial impact of clinical pharmacists’ interventions. Most interventions have prevented moderate or major harm with a high physician acceptance rate. Optimal documentation of the interventions is crucial for emphasizing clinical pharmacists’ value in multi-specialty hospitals.

Documentation and classification of hospital pharmacist interventions: A scoping review

“…All studies were descriptive, with three prospective 21,22,27 and six retrospective, 6,17,18,28,34,39,45 while one also included a survey 17 . Most of the studies were from the Middle East (Saudi Arabia, 6,17,22 Iran, 21 Lebanon 28 and Oman 18 ), two were from the United States, 27,34 one from Germany 39 and the other one from Australia 45 . For their own use, the hospitals or private health systems developed the internal documentation and/or classification systems mentioned in these studies.…”

“…The lack of consistency in PI categorization has previously been referred to in the literature, particularly by Cousins et al 54 The development of national systems has already been suggested to aid access to data collection for all hospitals, provided issues of categorizing and grading can be resolved. 5 PI documentation has been mainly accomplished through distinctive electronic approaches, either by direct EHR entries 17,18,22 or by electronic forms. 18,39 In some cases, a paper-based method (in diaries or pre-printed forms) is still used.…”

“…5 PI documentation has been mainly accomplished through distinctive electronic approaches, either by direct EHR entries 17,18,22 or by electronic forms. 18,39 In some cases, a paper-based method (in diaries or pre-printed forms) is still used. Vi-Med ® , a validated paper-based tool used in Vietnamese hospitals, was considered by the experts very suitable, functional and fitting for everyday use.…”

“…Some of them are entirely designed internally to meet that hospital's requirements, 6,17,21,27,34,45 while others are the result of individualized adaptation from previous systems. 18,22,28,39 Pharmacist documentation integrated into patient electronic medical records (EMRs) elevates and empowers the importance and utility of pragmatic pharmacist intervention documentation compared to web-based and silo electronic tool-based systems. 17,18,22 Also, PIs integrated into the EMR fulfil another purpose of documenting key events available to the interprofessional team (ie, medical and nursing team) rather than in a siloed documentation system that only the pharmacist can see.…”

“…6,17,21,27,34,45 Others (40%) were a result of in-house modifications and adaptations of previous published studies. 18,22,28,39 The amount of information documented and the number of categories used for classifying PIs was highly variable and is detailed in Table 2.…”