Clinical Pharmacist Interventions Research Articles

Health Technology Assessment To Improve Patient Care Through Pharmaceutical Care: Clinical Pharmacist’s Perspective

Drug Related Problems could result in the medication errors, adverse events, drug interactions and harm to patients. AIM: The main aim of the study was to assess and evaluate the Clinical Pharmacist’s interventions in health care i.e., HTA and its application to improve and optimize patient care through pharmaceutical care and to achieve accuracy in patient treatment. A prospective, observational and interventional study. Ethical approval was obtained before starting the present study. The inpatient medication charts and orders drug related problems were identified, analysed and rectified by ward and practicing clinical pharmacists within the inpatient pharmacy services, using the parameters: dose, rate of administration, presentation and/or dosage form, presence of inappropriate/unnecessary drugs, necessity of additional medication, more proper alternative therapies, presence of relevant drug interactions, inconsistencies in prescription orders, physical-chemical incompatibilities/solution stability. From this evaluation, the drug therapy problems were classified, resulting clinical interventions made. out of 360 clinical pharmacist interventions followed, male (71.66%) predominance was noted over females (28.33%). Most of the DRP observed were dispensing errors(26.11%),improper drug selection (17.22%),followed by untreated indications (14.4%) Majority of the clinical pharmacist recommendations were on need for proper dispensing(26.11%), and drug change (18.05%). The acceptance rate of intervening clinical pharmacist recommendation and change in drug therapy was found to be high (86.66%). Clinical pharmacists have greater potential in preventing and/or minimizing the DRPs. CONCLUSION: Technology assessment in health care is a multidisciplinary field of policy analysis which studies ethical, social, medical and economic implications of development, diffusion and use of health technology. From the multidisciplinary health technology assessment the methods followed for this study were found to be useful for not only enhancing the appropriate use of drugs in a clinical setting but also sow a seed for the evolvement of HTA in India with clinical pharmacist as its pathfinder.

Effects of multidisciplinary teams and an integrated follow-up electronic system on clinical pharmacist interventions in a cancer hospital.

Background The aim of drug therapy is to attain distinct therapeutic effects that not only improve patient's quality of life but also reduce the inherent risks associated with the therapeutic use of drugs. Pharmacists play a key role in reducing these risks by developing appropriate interventions. Whether to accept or reject the intervention made by the pharmacist is a relevant consultant's decision. Objective To evaluate the impact of electronic prompts and follow-up of rejected pharmacy interventions by clinical pharmacists in an in-patient setting. Setting Shaukat Khanum Cancer Hospital & Research Center, Lahore, Pakistan. Method The study was conducted in two phases. Data for 3months were collected for each phase of the study. Systematic and quantifiable consensus validity was developed for rejected interventions in phase 1, based on patient outcome analyses. Severity rating was assigned to assess the significance of interventions. Electronic prompts for follow-on interventions in phase 2 were then developed and implemented, including daily review via a multidisciplinary team (MDT) approach. Main outcome measure Validity of rejected interventions, acceptance of follow-on interventions before and after re-engineering the pharmacy processes, rejection rate and severity rating of follow-on interventions. Result Of a total of 2649 and 3064 interventions that were implemented during phase 1 and phase 2, 238 (9%) and 307 (10%) were rejected, respectively. Additionally, 133 (56%) were inappropriate rejections during phase 1. The estimated reliability between pharmacists regarding rejected interventions was 0.74 (95% CI of 0.69, 0.79, p 0.000). Prospective data were analysed after implementing electronic alerts and an MDT approach. The acceptance rate of follow-on interventions in phase 2 was 60% (184). Conclusion Electronic prompts for follow-on interventions together with an MDT approach enhance the optimization of pharmacotherapy, increase drug rationality and improve patient care.

The cost-saving effect and prevention of medication errors by clinical pharmacist intervention in a nephrology unit.

Medication errors may lead to adverse drug events (ADEs), which endangers patient safety and increases healthcare-related costs. The on-ward deployment of clinical pharmacists has been shown to reduce preventable ADEs, and save costs. The purpose of this study was to evaluate the ADEs prevention and cost-saving effects by clinical pharmacist deployment in a nephrology ward.This was a retrospective study, which compared the number of pharmacist interventions 1 year before and after a clinical pharmacist was deployed in a nephrology ward. The clinical pharmacist attended ward rounds, reviewed and revised all medication orders, and gave active recommendations of medication use. For intervention analysis, the numbers and types of the pharmacist's interventions in medication orders and the active recommendations were compared. For cost analysis, both estimated cost saving and avoidance were calculated and compared.The total numbers of pharmacist interventions in medication orders were 824 in 2012 (preintervention), and 1977 in 2013 (postintervention). The numbers of active recommendation were 40 in 2012, and 253 in 2013. The estimated cost savings in 2012 and 2013 were NT$52,072 and NT$144,138, respectively. The estimated cost avoidances of preventable ADEs in 2012 and 2013 were NT$3,383,700 and NT$7,342,200, respectively. The benefit/cost ratio increased from 4.29 to 9.36, and average admission days decreased by 2 days after the on-ward deployment of a clinical pharmacist.The number of pharmacist's interventions increased dramatically after her on-ward deployment. This service could reduce medication errors, preventable ADEs, and costs of both medications and potential ADEs.

Clinical Effects of a Pharmacist Intervention in Acute Wards - A Randomized Controlled Trial.

The purpose of the study was to investigate the clinical effect of a clinical pharmacist (CP) intervention upon admission to hospital on inpatient harm and to assess a potential educational bias. Over 16months, 593 adult patients taking ≥4 medications daily were included from three Danish acute medicine wards. Patients were randomized to either the CP intervention or the usual care (prospective control). To assess a potential educational bias, a retrospective control group was formed by randomization. The CP intervention comprised medication history, medication reconciliation, medication review and entry of proposed prescriptions into the electronic prescribing system. The primary outcome of inpatient harm was identified using triggers from the Institute of Healthcare Improvement Global Trigger Tool. Harms were validated and rated for severity by two independent and blinded outcome panels. Secondary end-points were harms per patient, length of hospital stay, readmissions and 1-year mortality. Harm affected 11% of the patients in the intervention group compared to 17% in the combined control group, odds ratio (OR) 0.57 (CI 0.32-1.02, p=0.06). The incidence of harm was similar in the intervention and prospective control groups, OR 0.80 (CI 0.40-1.59, p=0.52) but occurred less frequently in the intervention than in the retrospective control group OR 0.46 (CI 0.25-0.85, p=0.01). An educational bias from the intervention to the control group might have contributed to this negative outcome. In conclusion, the CP intervention at admission to hospital had no statistically significant effect on inpatient harm.

Risk factors of adverse health outcomes after hospital discharge modifiable by clinical pharmacist interventions: a review with a systematic approach.

The present review assessed the evidence on risk factors for the occurrence of adverse health outcomes after discharge (i.e. unplanned readmission or adverse drug event after discharge) that are potentially modifiable by clinical pharmacist interventions. The findings were compared with patient characteristics reported in guidelines that supposedly indicate a high risk of drug-related problems. First, guidelines and risk assessment tools were searched for patient characteristics indicating a high risk of drug-related problems. Second, a systematic PubMed search was conducted to identify risk factors significantly associated with adverse health outcomes after discharge that are potentially modifiable by a clinical pharmacist intervention. After the PubMed search, 37 studies were included, reporting 16 risk factors. Only seven of 34 patient characteristics mentioned in pertinent guidelines corresponded to one of these risk factors. Diabetes mellitus (n = 11), chronic obstructive lung disease (n = 9), obesity (n = 7), smoking (n = 5) and polypharmacy (n = 5) were the risk factors reported most frequently in the studies. Additionally, single studies also found associations of adverse health outcomes with different drug classes {e.g. warfarin [hazard ratio 1.50; odds ratio (OR) 3.52], furosemide [OR 2.25] or high beta-blocker starting doses [OR 3.10]}. Although several modifiable risk factors were found, many patient characteristics supposedly indicating a high risk of drug-related problems were not part of the assessed risk factors in the context of an increased risk of adverse health outcomes after discharge. Therefore, an obligatory set of modifiable patient characteristics should be created and implemented in future studies investigating the risk for adverse health outcomes after discharge.

Doctors\u2019 and nurses\u2019 perceptions of a ward-based pharmacist in rural northern Sweden

Background This project is part of the prospective quasi experimental proof-of-concept investigation of clinical pharmacist intervention study to reduce drug-related problems among people admitted to a ward in a rural hospital in northern Sweden. Objective To explore doctors’ and nurses’ perceptions and expectations of having a ward-based pharmacist providing clinical pharmacy services. Setting Medical ward in a rural hospital in northern Sweden. Method Eighteen face-to-face semi-structured interviews were conducted with a purposive sample of doctors and nurses working on the ward where the clinical pharmacy service was due to be implemented. Semi-structured interviews were digitally recorded, transcribed and analysed using thematic analysis. Main outcome measure Perceptions and expectations of nurses and doctors. Results Doctors and nurses had limited experience of working with pharmacists. Most had a vague idea of what pharmacists can contribute within a ward setting. Participants, mainly nurses, suggested inventory and drug distribution roles, but few were aware of the pharmacists’ skills and clinical competence. Different views were expressed on whether the new clinical pharmacy service would have an impact on workload. However, most participants took a positive view of having a ward-based pharmacist. Conclusion This study provided an opportunity to explore doctors’ and nurses’ expectations of the role of clinical pharmacists before a clinical pharmacy service was implemented. To successfully implement a clinical pharmacy service, roles, clinical competence and responsibilities should be clearly described. Furthermore, it is important to focus on collaborative working relationships between doctors, nurses and pharmacists.

Validation of the assessment of risk tool: patient prioritisation technology for clinical pharmacist interventions

BackgroundAdverse drug events (ADEs) pose a heavy burden on health systems worldwide. The assessment of risk tool (ART) was developed to help prioritise hospitalised patients for interventions such as medication...

Impact of clinical pharmacist intervention in anticoagulation clinic in Sudan.

Background Many trials have compared anticoagulation management provided by a pharmacist led anticoagulation clinic versus usual physician care showing the role for clinical pharmacist in the management of anticoagulant therapy, and demonstrating excellent outcomes. In Sudan, there is no published research evaluating the role of pharmacist in providing pharmaceutical care for patients taking warfarin. Objective The objective of the study is to assess the role of clinical pharmacist intervention in warfarin patients compared to usual medical care. Setting This study was conducted in Ahmed Gasim cardiac surgery and renal transplant center warfarin clinic. Methods One hundred thirty-five patients were randomly selected from adult patients on warfarin therapy The history of INR records, and adverse effects for the past year, were recorded. Then patients' warfarin dose adjustments according to INR, was done by the clinical pharmacist for one year. Patients received continuous verbal education and written information about warfarin. Main outcome measure The primary outcome for this study was the INR control, while the secondary outcomes were the bleeding events and hospitalization due to warfarin. Results After the clinical pharmacist intervention there was significant (P<0.01) improvement in INR control and a significant (P<0.05) reduction in incidence of bleeding after clinical pharmacist intervention. Hospitalization due to warfarin related complications (bleeding, high INR, low INR) was also significantly (P<0.001) reduced. Conclusion Clinical pharmacists intervention in warfarin therapy improve INR control, reduce bleeding and hospitalization due to warfarin complications.

Role of the Clinical Pharmacist in Reducing Preventable Adverse Drug Events

According to so many previous studies, lack of sufficient information during prescribing steps may lead to medication errors. Thus, the presence of the clinical pharmacist during routine rounding process in the ward with intervention of patient care plan may reduce the probability of adverse drug events (ADEs).This study evaluate role of the clinical pharmacists, as a member of medical team with the physician, on ADEs and report their interventions in the internal medicine unit. This study was designed to compare between two groups of patients, those receiving care from a rounding team (physician, nurse, and clinical pharmacist) (study or intervention group with 51 patient); and those receiving care from a rounding team (physician and nurse, but without any pharmacist) (control group with 49 patient). The primary outcome measure was preventable ADEs and secondary one involves the time of staying in the hospital and onset of response to therapy. Patients were randomly selected, followed a single-blind design, and evaluated by a senior physicians and clinical pharmacists who document their medical interventions.Specialist physicians accepted (60) of (77) recommendations (i.e. do modifications in drug therapy depending on clinical pharmacist interventions). The most common intervention was recommending dosage or frequency of medication (32.4%), followed by addition of medication (19.5%).The rate of preventable ordering ADEs in the study unit was 77% lower than in the control unit (P&lt;0.05). There was no significant difference (p&gt;0.05) in the cost of drug therapy between patient groups. Patients with ADEs in the control group had an average of 1.5 day longer staying period at the hospital; which was not differ significantly (p&gt;0.05) from the study group.In summary, presence of clinical pharmacist during tour as a full member of the patient care team in internal medicine ward was associated with a substantially lowered rate of ADEs which caused by prescribing errors. Types of errors indicate the need for activation of the clinical pharmacist's interventions.&#x0D; Key words: adverse drug events (ADEs), clinical pharmacist.

Handling of drug–drug interactions in clinical pharmacy practice

Introduction Potential drug-drug interactions (DDI) are an important risk factor for adverse drug events (ADE). Automatic interaction check systems have been implemented in many hospitals but they are often not used by physicians due to “alert fatigue”. We tried to find out how often clinical pharmacists intervene because of DDI, and what are the reasons for this decision. Methods 1. All interventions of clinical pharmacists in our hospital in 2015, routinely documented with the GSASA-tool, were analysed for DDI. 2. A sample of medication profiles was checked for DDI (classes 1–4) using the ABDA database provided by emediat (integrated in our electronic prescribing tool) and compared to documented interventions of DDI. 3. Using a structured form, clinical pharmacists were asked after ward rounds, whether and why they did an interaction check, whether and why they intervened and whether the intervention was accepted by the physician. Results 1. One hundred and forty-six of 1170 (12%) interventions concerned DDI. Acceptance rate of DDI interventions was 93% compared to 87% of all interventions. 2. Twenty-seven out of 524 detected DDI (5%) were discussed during ward rounds. Most detected DDI (398) belonged to class 3. Intervention rate was 6.7% for class 1 DDI, 15.6% for class 2 DDI, 4.8% for class 3 DDI and 2.5% for class 4 DDI (lowest risk of DDI). 3. The evaluation and handling of DDI were observed in 83 patient charts involving 3 clinical pharmacists. In this sample (with potential observation bias), the intervention rate was 7% (21 of 313 DDI). In 24 cases, an interaction check was not performed, mainly because the interaction was known (15). Reasons for no intervention were: medication on demand (122), low DDI class or low risk of ADE (25), medication necessary/no alternative (9), other intervention more important (3), other such as discharge planned or no clinical relevance (131). Most frequent reasons for intervention were risk of toxic reaction (10) or of reduced effect (7). Seventeen (of 21) interventions were accepted by the physician in charge. Conclusions Interventions regarding possible DDI are low, because clinical pharmacists often judge DDI as not clinically relevant. Acceptance rate was high, possibly due to high clinical relevance. Physicians may have neither time nor enough pharmacologic knowledge to find out relevant DDI. Therefore, an automatic interaction check integrated in prescribing tools does not necessarily improve DDI detection. Clinical pharmacists can help to fill this gap, but should not forget others, equally important drug related problems.

Effect of pharmaceutical intervention on rational use of alanyl-glutamine

Objective To explore the effect of clinical pharmacist intervention on the rational use of alanyl-glutamine injection. Methods Refer to the second quarter of 2015 and the second quarter of 2016 in the General Hospital of Shanxi Datong Coal Group using alanyl-glutamine injection discharge instructions for special comment, compared and analyzed the changes in the use of the drug before and after the intervention. Results Before intervention, the usage rate and the irrational rate of alanyl-glutamine injection were 4.6% and 52.9%, those were 2.9% and 10.9% after intervention.The differences were statistically significant(χ2=49.209, 169.200, all P<0.05). There were significant differences before and after intervention compared in the choice of drug suitability, the high concentration of the medicine liquid, the excessive supply of amino acid and the incompatibility of the compatibility (χ2=38.882, 31.348, 26.242, 4.286, all P<0.05). Conclusion The pharmacy intervention is feasible and effective for the rational use of alanyl-glutamine injection, and it can reduce irrational using rate. Key words: Pharmaceutical intervention; Alanyl-glutamine; Analysis

Effect of clinical pharmacist intervention on clinical rational use of antineoplastic drugs

Objective To explore the effect of clinical pharmacist on clinical rational use of antineoplastic drugs after participating in treatment group. Methods Retrospective research was used.According to whether there was a clinical pharmacist directly or indirectly involved in, all medical teams of the oncology department were divided into intervention group, advisory group and control group in our hospital.Intervention group was the medical team that had a specialist clinical pharmacist who could intervene irrational use of antineoplastic drug in the treatment on the spot.Advisory group was in the same area with the intervention group, and didn't have a specialist clinical pharmacist, but used to communicate with clinical pharmacist and take his medication advice, where clinical pharmacist indirectly involved in treatment.The control group was the medical group in the other area without clinical pharmacists of oncology department.The control group one and two were with the most beds among the control group.Randomly selected lung cancer, breast cancer, esophageal cancer, gastric cancer, colorectal cancer, gynecological cancer, liver/gallbladder/pancreatic cancer and other tumors patients from intervention group, advisory group, control group one and control group two, from January 2015 to December 2015, 10 copies of each case, 80 copies of each group.And antineoplastic drugs were commented specially.The information such as sex, age, clinical diagnosis, irrational antineoplastic drug use, adverse reaction and unexpected events and hospitalization time were recorded. Results The rate of irrational antineoplastic drug use of the intervention group (41.25%) was lower than the advisory group(80%), and was significantly lower than two control groups(147.50%, 161.25%), advisory group was also lower than two control groups, but no significant differences between the two control groups(χ2=0.193, P>0.05). Irrational chemotherapy, inappropriate usage and dosage and inappropriate indications were prominent problems in intervention group and advisory group.In addition, there were more improper solvent and contraindicated or adverse interaction problems in two control groups.Adverse events and incidence of unexpected events in intervention group (46.25%, 12.50%) were significantly lower than those in two control groups[(73.75%, 22.50%), (23.75%, 18.75%)]. Furthermore, the length of stay of intervention group patients was shortest in four groups (F=8.766, P<0.05). Conclusion By participating in the treatment group, clinical pharmacists can discover the irrational drug use and security risks in treatment, can provide medication guidance, consultation, publicity and other pharmaceutical service for specialist medical staff and patients.They will be more and more prominent in the treatment of cancer. Key words: Clinical pharmacist; Intervention; Antineoplastic drugs; Rational drug use

Developing an Economic Case of Clinical Pharmacists' Interventions on Venous Thromboembolism Prophylaxis Through Service Evaluation.

Objective:Venous thromboembolism (VTE) has become a huge health problem as well as a financial burden for the National Health Service. The objective of this study was to characterize current practice of VTE prophylaxis (VTEP) and evaluate the economic impact of clinical pharmacists’ interventions (CPIs) on VTEP.Methods:A prospective service evaluation was conducted in a medical and surgical ward at a tertiary teaching hospital in London from 23 May to 08 June 2016. Appropriateness of risk assessment (RA) and VTEP and CPIs were categorized and assessed. Based on the results of the service evaluation, a pharmacoeconomic analysis was undertaken to estimate the cost savings by CPIs for inappropriate pharmacological VTEP.Findings:A total of 203 cases were analyzed. The rates of appropriateness for RA on admission, RA at 24 h and pharmacological VTEP were 58.6%, 39.7%, and 75.4%, respectively. In the medical ward, there was a significant difference of appropriate RAs between on admission and at 24 h (70.3% vs. 23.8%, respectively). Whereas, the rate of appropriate pharmacological VTEP accounted for 75.4% and the rate of appropriate prophylaxis was significantly higher in the medical ward than surgical ward (80.5% vs. 68.2%, P = 0.045). Of 50 cases of inappropriate pharmacological prophylaxis, 39 cases (78.0%) were corrected by clinical pharmacists. These CPIs resulted in £1,286.23 cost savings during the study and it was estimated to be £517,522/annum.Conclusion:CPIs had significant positive clinical and economic impacts on VTEP. There is more scope for the improvement of RA at 24 h through CPIs.

Impact of drug-related problems and clinical pharmacist interventions on therapeutic outcomes of the patients admitted to a tertiary care hospital

Background: A drug-related problems (DRPs) are defined as an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes. The DRPs can occur at any level of its usage. Objective: The aim of the study was to find out the DRPs and pharmacist intervention on therapeutic outcome of the patients. Materials and Methods: A prospective and observational study was conducted over a period of 6-month. The data collected from each patient were documented in a patient data collection form. DRPs and interactions were analyzed using the Micromedex online database and StockleyÂ’s Drug-Drug Interactions text book. Results: Out of 120 patients, 32 males and 19 females were identified with DRPs. The maximum subjects 24 were found between the age group 26-35 and minimum subjects 13 were found in the age group >65 years. Most of the comorbidities were observed in hypertensive patients 15 and diabetes 12. 42 risk factors were observed like smoking 19, tobacco chewing 05, and alcohol 18.137 DRPs were have been identified in which most of them accounted for drug interactions 119, adverse drug reactions (ADRs) 11, untreated indication 05, drug use without indication 02. DRPs were more observed in subjects with anemia 17 and gastrointestinal 15.119 drug interactions have been identified in which major 26, moderate 71, and minor 22. Most of the ADRs are caused due to antiviral drugs such as zidovudine and tenofovir followed by fluoroquinolones, ofloxacin, and levofloxacin. Clinical pharmacistÂ’s interventions were recommended which include drug replacement 03, drug discontinuation 03, and frequency changes 01. Conclusion: The study concludes that involvement of clinical pharmacist services in patient care can significantly help to identify, resolve, and prevent the DRPs in the hospital thereby enhance the patient compliance.

Analysis of clinical effect of involvement of clinical pharmacists in perioperative total parenteral nutrition prescription for cancer patients

Objective To evaluate the effect of the intervention of involving clinical pharmacists in perioperative total parenteral nutrition (TPN) prescription, including rationality of prescriptions, the length of hospital stay and economic evaluation. Methods We respectively selected TPN prescriptions in September to November 2015 (pre-intervention) and December 2015 to February 2016 (post-intervention) from a surgery department of Harbin Medical University Cancer Hospital. The data regarding rationality of prescription, length of hospital stay, and economic benefit were analyzed in order to evaluate the effect of involvement of clinical pharmacists in TPN prescriptions. Results A total of 81 patients with 115 TPN prescriptions before the intervention and 92 patients with 124 TPN prescriptions after the intervention were recruited. Through comparative analysis, the rationality of TPN prescriptions increased significantly after the participation of clinical pharmacists in terms of the rational glucose: fat ratio, energy: nitrogen ratio, electrolyte concentration, and the choice of vitamin preparations; and the utilization of controversial treatments such as invert sugar and other drugs into ready-to-use TPN solution was decreased significantly; average daily cost of TPN was decreased from (1 021±218) yuan to (860±176) yuan (P 0.05). Compared with the data before the intervention, serum albumin levels after the intervention showed no statistically significant difference but pre-albumin levels were significantly higher after the participation of clinical pharmacists[(175.0±77.9)g/L vs.(153.2±64.8)g/L, P 0.05). Conclusion Engaging clinical pharmacists in TPN prescription can improve prescription rationality, ensure clinical drug safety, reduce the daily cost of nutrition treatment and thus reduce the economic burden of patients. Key words: Pharmacists; Parenteral nutrition; Inappropriate prescription; Intervention

Patients with diabetes are at high risk of serious medication errors at hospital: Interest of clinical pharmacist intervention to improve healthcare

BackgroundMedication errors (ME) are major public health issues in hospitals because of their consequences on patients' morbi-mortality. This study aims to evaluate the prevalence of ME at admission and discharge of hospitalization in diabetic and non-diabetic patients, and determine their potential clinical impact. MethodThis prospective observational study was conducted at the Endocrinology-Diabetology-Nutrition Department. All adult patients admitted were eligible. A total of 904 patients were included, of which 671 (74.2%) with diabetes mellitus. Clinical pharmacists conducted medication reconciliation: they collected the Best Possible Medication History and then compared it with admission and discharge prescriptions to identify medication discrepancies. ME were defined as unintended medication discrepancies if corrected by the physician. ResultsClinical pharmacists allowed correcting ME in 176/904 (19.5%) patients at admission and in 86/865 (9.9%) patients at discharge. More than half of ME were omissions. Diabetic patients were more affected by ME than non-diabetic patients, both at admission (22.1% vs 12.0%, p<0.001) and at discharge (11.4% vs 5.7%, p=0.01). The diabetic group also had more potentially severe and very severe ME. Diabetic patients had on average twice more medications than non-diabetic patients (8.7±4.5 vs 4.4±3.4, p<0.001). The polypharmacy associated with diabetes, but not diabetes mellitus itself, was identified as a risk factor of ME. ConclusionsThe intervention of clinical pharmacists allowed correcting 378 ME in 25.8% of the cohort before they caused harm. Clinicians, pharmacists and other health care providers should therefore work together to improve patients' safety, in particular in high-risk patients such as diabetic patients.

PRS2 - Effectiveness of Clinical Pharmacist Intervention on Direct Medical Cost in Chronic Obstructive Pulmonary Disorder Patients - A Randomized Controlled Study

PRS2 - Effectiveness of Clinical Pharmacist Intervention on Direct Medical Cost in Chronic Obstructive Pulmonary Disorder Patients - A Randomized Controlled Study

Do Clinical Pharmacist Interventions With Procalcitonin (PCT) Levels Change Antibiotic Therapy in an Academic and Level 1 Trauma Center: Pilot Study

Do Clinical Pharmacist Interventions With Procalcitonin (PCT) Levels Change Antibiotic Therapy in an Academic and Level 1 Trauma Center: Pilot Study

Impact of Clinical Pharmacist Intervention on the Effectiveness of a Rapid Diagnostic Test for Gram-Positive Bacteremia

Impact of Clinical Pharmacist Intervention on the Effectiveness of a Rapid Diagnostic Test for Gram-Positive Bacteremia

PROTECTED-UK - Clinical pharmacist interventions in the UK critical care unit: exploration of relationship between intervention, service characteristics and experience level.

Clinical pharmacist (CP) interventions from the PROTECTED-UK cohort, a multi-site critical care interventions study, were further analysed to assess effects of: time on critical care, number of interventions, CP expertise and days of week, on impact of intervention and ultimately contribution to patient care. Intervention data were collected from 21 adult critical care units over 14 days. Interventions could be error, optimisation or consults, and were blind-coded to ensure consistency, prior to bivariate analysis. Pharmacy service demographics were further collated by investigator survey. Of the 20 758 prescriptions reviewed, 3375 interventions were made (intervention rate 16.1%). CPs spent 3.5 h per day (mean, ±SD 1.7) on direct patient care, reviewed 10.3 patients per day (±SD 4.2) and required 22.5 min (±SD 9.5) per review. Intervention rate had a moderate inverse correlation with the time the pharmacist spent on critical care (P = 0.05; r = 0.4). Optimisation rate had a strong inverse association with total number of prescriptions reviewed per day (P = 0.001; r = 0.7). A consultant CP had a moderate inverse correlation with number of errors identified (P = 0.008; r = 0.6). No correlation existed between the presence of electronic prescribing in critical care and any intervention rate. Few centres provided weekend services, although the intervention rate was significantly higher on weekends than weekdays. A CP is essential for safe and optimised patient medication therapy; an extended and developed pharmacy service is expected to reduce errors. CP services should be adequately staffed to enable adequate time for prescription review and maximal therapy optimisation.