Clinical pharmacists\u2019 interventions across German hospitals: results from a repetitive cross-sectional study

Claudia Langebrake,Susanne Lezius,Gesine Picksak,Carina Hohmann,Wencke Walter,Heike Hilgarth,Sandra Kaden,Angela Ihbe-Heffinger,Michael Lueb,Katja Leichenberg

doi:10.1007/s11096-021-01313-3

Abstract

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.

Highlights

Pharmacists’ interventions (PI) have been shown to positively influence clinical outcome of hospital inpatients [1,2,3,4,5]
We described the scope of clinical pharmacists’ involvement in patient care in daily clinical practice and demonstrated the usefulness and importance of proactive PI in the prevention of hazards and risks for hospital inpatients [14]
DokuPIK users who participated in the DokuPIK intervention week (IW) flagged the datasets that were supposed to be included in the analysis and gave their consent to pseudonymise these datasets in terms of the user, who entered the data

Summary

Introduction

Pharmacists’ interventions (PI) have been shown to positively influence clinical outcome of hospital inpatients [1,2,3,4,5]. DokuPIK is a national anonymous self-reported online documentation system, hosted by the German Association of Hospital Pharmacists (ADKA) for the voluntary documentation of medication errors (ME) and PI. A detailed description has been published elsewhere [11, 12], in brief basic anonymous patient data, classification of drugs using the World Health Organisation Anatomical Therapeutic Chemical classification (ATC) and hierarchical classification of reason, resulting actions, acceptance and severity of the underlying ME according the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) [13] may be entered. 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

Objectives

Methods

Results

Conclusion