Clinical Pharmacist Interventions Research Articles

Randomized control trial on impact of clinical pharmacist led interventions on antibiotic stewardship program in children 0 to 18 years age in a tertiary care hospital in southern India

A prospective randomized controlled interventional study was conducted at a quaternary care multispecialty hospital in South India with the primary objective of identifying opportunities to improve antibiotic prescribing patterns in neonates, children, and adolescents. The hospital has a robust clinical pharmacist program wherein antibiotic prescriptions were checked for appropriateness of antibiotic dose, route, formulation, duration of therapy, and IV to oral switch. These characteristics of antibiotic use were therefore similar in the 75 children in the control and 75 in the intervention group. The additional clinical pharmacist interventions analyzed in this study included checking if a provisional diagnosis had been made before initiating antibiotics, ensuring that appropriate cultures were sent before starting antibiotics, time taken to optimize antibiotic therapy in accordance to the culture sensitivity report and whether the indication for antibiotics use was as per Indian Acdemy of Pediatrics (IAP) Drug Formulary recommendations. The main outcomes were that all these parameters except the first (all children had a clinical diagnosis before initiating antibiotic/s) were better in the intervention group and there was a significant reduction in the total antibiotic days, an increase in antibiotic-free days, and an improvement in the appropriateness of duration of antibiotic therapy and frequency of the antibiotic dosing. However, since the incidence of severe sepsis was higher in the intervention group, broad-spectrum and restricted antibiotics were used, and thus treatment costs were higher in this group. The results indicate that despite already existing clinical pharmacist interventions, additional ones could further improve antibiotic prescription accuracy significantly; and re-emphasized the need to employ trained pediatric general and subspecialty clinical pharmacists in sufficient numbers to implement a successful pediatric antibiotic stewardship program in a hospital.

Effectiveness of clinical pharmacist intervention on medication adherence in patients with chronic obstructive pulmonary disease - A randomized controlled study

ObjectivesIn patients with chronic obstructive pulmonary disease (COPD), non-adherence remains challenging to achieve optimal disease control. Our study aimed to determine the impact of pharmacist-led educational interventions on COPD management, focusing mainly on medication adherence. MethodsWe conducted a 1-month open-labeled, randomized, controlled study at Ba Ria Hospital, Vietnam. COPD outpatients were randomly assigned to the intervention group or control group. Pharmacist-delivered education emphasized medication adherence, disease, and medication knowledge. The primary outcome was the between-group difference in medication adherence after the intervention, as assessed by the general medication adherence scale (GMAS). ResultsOf 181 recruited patients, 180 completed the follow-up. After the intervention, the results indicated a significant improvement in medication adherence rate between the two groups (90.1% vs. 66.3%, p < 0.001). Patient behavior was the most common barrier to non-adherence but was effectively reduced at the endpoint. The Modified Medical Research Council (mMRC) scale of dyspnea and inhalation technique also improved significantly in intervention patients. ConclusionsPharmacist intervention can considerably improve medication adherence and knowledge of COPD patients. Practice implicationsThis study promotes the value of clinical pharmacists in patient education to achieve better adherence and enhance population health, especially in resource-limited nations like Vietnam.

Impact of Gram-Negative Rod Bacteremia Rapid Diagnostic Testing and Real-Time Clinical Pharmacist Intervention

Background: The optimal method for implementing rapid diagnostic testing (RDT) into clinical practice has not been determined for gram-negative rod (GNR) bacteremia. At our institution, RDT was implemented in conjunction with real-time notification of results to decentralized clinical pharmacists. Objective: To determine the impact of RDT result notification plus real-time clinical pharmacist review on the management of GNR bacteremia. Methods: This retrospective, matched cohort study included patients with a positive blood culture for a GNR on the BIOFIRE® Blood Culture Identification 2 panel from September 2020 to August 2021 (historical) and October 2021 to September 2022 (interventional). Exclusion criteria were polymicrobial bacteremia, discrepant RDT results from traditional culture, 24-hour mortality, and comfort care or not admitted at the time of RDT result. Patients were matched based on age, pathogen, and resistance. The primary endpoint was time from Gram stain to appropriate antibiotic therapy. Results: This study consisted of 240 patients (n = 120 historical, n = 120 interventional). Escherichia coli was isolated in 71% of patients with extended-spectrum beta-lactamase-producing organisms isolated in 8%. There was no difference in median time to appropriate therapy (0 vs 0 hours, P = 0.28). There was a statistically significant decrease in time to first organism-directed change in therapy (40 vs 11 hours; P < 0.01). Length of stay, days of anti-pseudomonal therapy, and inpatient mortality did not differ between groups. Conclusion: Implementation of RDT plus real-time clinical pharmacist review did not significantly decrease time to appropriate therapy in patients with GNR bacteremia but significantly reduced time to organism-directed antibiotic changes.

Antimicrobial stewardship and clinical pharmacist interventions in an Indian tertiary care hospital

AbstractObjectiveComprehensive antimicrobial stewardship programs (ASPs) are needed in Indian healthcare settings due to high rates of communicable diseases and excessive antibiotic use. However, the implementation of both ASPs and clinical pharmacists (CPs) into the system is still in its nascent stages in India. Therefore, our study aims to evaluate the type and acceptance rates of CP interventions in the implementation of ASPs and its impact on antimicrobial utilization.MethodsA single‐center quasi‐experimental study was conducted at Jehangir Hospital, India, wherein prescribed antimicrobials were subjected to evaluation by CPs using the prospective audit and feedback approach. The antimicrobials were reviewed for loading dose, dosages as per creatinine clearance (CrCl), weight, suitability with site of infection, drug interactions, de‐escalations, and therapeutic duplications. Impact on antimicrobial utilization in pre‐intervention (April 2021 to March 2022) and intervention (April 2022 to March 2023) periods were compared using daily defined dose (DDD) per 1000 in‐patient days, following World Health Organization (WHO) guidelines.ResultsDuring the intervention period, 485 out of 609 proposed interventions (79.6%) were implemented. Of these, 417 (85.9%) pertained to intravenous (IV) antimicrobials, while the remaining 68 (14.1%) involved oral formulations. Notably, interventions proposing antibiotic de‐escalations showed higher acceptance rates on Days 3, 5, 7, and 10 compared with other days (p = 0.027). Dosing based on CrCl yielded the highest acceptance rate (50/56, 89.2%). Significant reductions were observed in the DDDs of polymyxins by 58% (3.48–1.29), carbapenems by 7% (57.09–52.85), and glycopeptides by 10% (47.44–42.73). The reduction in these three classes combined was statistically significant (p = 0.04, 95% confidence interval [CI] = 0.3–7.0).ConclusionThis study highlights the vital role of CP interventions within the healthcare team in optimizing antimicrobial pharmacotherapy. The noteworthy reduction in DDDs of restricted antimicrobials provides compelling evidence of the impact CPs can have on antimicrobial consumption and the fight against antimicrobial resistance.

Mobile Health Intervention in Patients With Type 2 Diabetes

Clinical pharmacists and health coaches using mobile health (mHealth) tools, such as telehealth and text messaging, may improve blood glucose levels in African American and Latinx populations with type 2 diabetes. To determine whether clinical pharmacists and health coaches using mHealth tools can improve hemoglobin A1c (HbA1c) levels. This randomized clinical trial included 221 African American or Latinx patients with type 2 diabetes and elevated HbA1c (≥8%) from an academic medical center in Chicago. Adult patients aged 21 to 75 years were enrolled and randomized from March 23, 2017, through January 8, 2020. Patients randomized to the intervention group received mHealth diabetes support for 1 year followed by monitored usual diabetes care during a second year (follow-up duration, 24 months). Those randomized to the waiting list control group received usual diabetes care for 1 year followed by the mHealth diabetes intervention during a second year. The mHealth diabetes intervention included remote support (eg, review of glucose levels and medication intensification) from clinical pharmacists via a video telehealth platform. Health coach activities (eg, addressing barriers to medication use and assisting pharmacists in medication reconciliation and telehealth) occurred in person at participant homes and via phone calls and text messaging. Usual diabetes care comprised routine health care from patients' primary care physicians, including medication reconciliation and adjustment. Outcomes included HbA1c (primary outcome), blood pressure, cholesterol, body mass index, health-related quality of life, diabetes distress, diabetes self-efficacy, depressive symptoms, social support, medication-taking behavior, and diabetes self-care measured every 6 months. Among the 221 participants (mean [SD] age, 55.2 [9.5] years; 154 women [69.7%], 148 African American adults [67.0%], and 73 Latinx adults [33.0%]), the baseline mean (SD) HbA1c level was 9.23% (1.53%). Over the initial 12 months, HbA1c improved by a mean of -0.79 percentage points in the intervention group compared with -0.24 percentage points in the waiting list control group (treatment effect, -0.62; 95% CI, -1.04 to -0.19; P = .005). Over the subsequent 12 months, a significant change in HbA1c was observed in the waiting list control group after they received the same intervention (mean change, -0.57 percentage points; P = .002), while the intervention group maintained benefit (mean change, 0.17 percentage points; P = .35). No between-group differences were found in adjusted models for secondary outcomes. In this randomized clinical trial, HbA1c levels improved among African American and Latinx adults with type 2 diabetes. These findings suggest that a clinical pharmacist and health coach-delivered mobile health intervention can improve blood glucose levels in African American and Latinx populations and may help reduce racial and ethnic disparities. ClinicalTrials.gov Identifier: NCT02990299.

Acute stroke in patients taking an oral anticoagulant: impact of clinical pharmacist’s intervention on pharmacovigilance reporting

ABSTRACT Introduction: Ischemic or hemorrhagic stroke can occur to patients treated with oral anticoagulants (OAC), through lack of effectiveness or overdosing. Objective: To evaluate the impact of clinical pharmacist’s intervention on pharmacovigilance (PV) reporting for OAC-treated patients hospitalized for stroke. Methods: Monocentric prospective study in which a clinical pharmacist’s intervention was performed in a stroke unit, with a focus on patients treated by OAC prior admission. A PV report was made with all data collected for cases of stroke suspected to be related to OAC therapy. Data provided by pharmacist were compared with data initially available in the patient’s electronic medical records. PV reports with pharmacist intervention were compared to those without. Results: During the study period, 48 patients were included in the study: 43 (89.6%) ischemic strokes with an embolic or unknown etiology, four hemorrhage strokes (8.33%), and one medication error (2.08%). A clinical pharmacist intervention was performed for 19 patients (39.6%) and provided significant additional data in all of them (100%). The information was related to adherence to treatment for 17 cases (89.5%), OAC’s initial prescription date for 11 cases (57.9%) and identifying event(s) that could have interfered with the efficacy of the OAC in five cases (26.3%). For patients with pharmacist intervention, PV reports were significantly more informative in terms of date’s introduction of anticoagulant, adherence to treatment, reference to weight change or concomitant event. Conclusions: clinical pharmacist’s intervention with patients taking oral anticoagulants and hospitalized for acute stroke contributes to collect high-quality data for pharmacovigilance reporting.

CLOZAPINE INDUCED EXTRAPYRAMIDAL SYMPTOMS FOLLOWING ALCOHOL CONSUMPTION IN PATIENT WITH SCHIZOPHRENIA AND ALCOHOL DEPENDENCE SYNDROME: A CASE REPORT OF SIALORRHEA, ACUTE AKATHISIA AND DYSTONIA

Clozapine (CLZ), a second-generation or atypical antipsychotic, although not recommended as the first-line drug of choice in the treatment of schizophrenia and schizoaffective disorders; however, it is recommended in the treatment of Treatment-Resistant Schizophrenia and in schizophrenic patients to decrease the recurrent risk of suicidal behavior. For the cytochrome P450 isoenzymes CYP1A2, CYP2D6, and CYP3A4, CLZ serves as a substrate. CLZ also exhibits drug-food interaction with alcohol leading to an increase in the risk of seizures and extrapyramidal symptoms. A case of a 36-year-old male patient with a known history of paranoid schizophrenia and alcohol dependence syndrome came with complaints of dystonia and hypersalivation 1 day following the consumption of alcohol after ingestion of tablet CLZ. After clinical pharmacist intervention, the doses were titrated and the patient improved gradually. With this, it can be postulated that the concomitant use of alcohol with CLZ can be a predisposing factor for drug toxicity in the patients and hence patients should be monitored and counseled to abstain from the use of alcohol while on CLZ therapy.

The Importance of Clinical Pharmacists in Improving Blood Glucose and Lipid Levels in Patients with Diabetes and Myocardial Infarction.

The aim of this study was to evaluate whether intervention by clinical pharmacists can improve blood glucose and lipid levels in diabetic patients with complex medical conditions. The retrospective database included 138 patients with diabetes who had presented with acute myocardial infarction (AMI) between January 2019 and October 2021. Blood glucose and lipid levels were measured within 12 weeks and 78 weeks of follow-up. Propensity score matching (PSM) was used to balance the confounding effects of patients' characteristics. A total of 138 eligible patients were assigned to either the intervention group (n = 47) or the usual care group (n = 91). After the intervention, there were significant improvements in blood glucose (glycosylated hemoglobin-HbA1C % from 9.0 to 8.3; fasting blood glucose-FBG mmol/L from 11.3 to 7.1; postprandial blood glucose-PBG mmol/L from 17.0 to 12.1; p < 0.001) and lipid levels (total cholesterol-TC from 4.9 to 3.5, low-density lipoprotein cholesterol-LDL-C from 3.0 to 1.8, p < 0.001, mmol/L) in both follow-up periods. The blood glucose effects were most pronounced in the PBG control rate (76.9% vs 54.0%) before PSM, while HbA1C% and PBG control rate after PSM were significantly higher in the intervention group (HbA1C% rate: 65.6% vs 38.5%; PBG rate: 79.2% vs 45.8%; p < 0.05, intervention vs non-intervention). Subgroup analysis further confirmed the improvement of blood glucose and lipid mainly in patients with higher baseline FBG (≧10mmol/L) and moderate follow-up duration (4-12 weeks). The intervention of clinical pharmacists in multidisciplinary team can significantly improve blood glucose and lipid levels in complex type 2 diabetic patients, especially those with high baseline FBG and moderate follow-up durations.

Building a novel self-iterative clinical pharmacist intervention model in psychiatric hospital: Application and evaluation

Clinical pharmacist intervention (CPI) in psychiatric hospital has not been widely developed in China. This study aimed to establish a real-time dynamic self-iterative CPI model in The Affiliated Mental Health Center of Jiangnan University and evaluated its effect. We focused on the running data in 2021 and 2022. The number of interventions, intervention types and intervention strategies were evaluated. In 2021 and 2022, a total of 443 interventions were reported. Among them, 271 (61.17 %) were identified during ward rounds by physicians, pharmacists and nurses. The proportion of CPI through ward rounds and information system gradually decreased while intervention through other ways increased. Meanwhile, there are various of CPI types including adverse drug reactions (26.86 %), therapeutic drug monitoring recommendations (13.32 %), drug usage and dose adjustment (10.61 %) and among them, adverse reactions are the focus of pharmacists' attention. Besides, the intervention strategies of pharmacists mainly concentrated in medication change (18.74 %), medication discontinuation (15.58 %) and dose reduction (12.19 %). In addition, the self-iterative function can continuously optimize the intervention level of clinical pharmacists. Overall, the CPI model established in this study effectively promote pharmacist intervention and accelerate pharmaceutical transformation.

Impact of clinical pharmacist-led intervention for drug-related problems in neonatal intensive care unit a randomized controlled trial.

Introduction: Drug-related problems (DRPs) incidence is higher in neonatal intensive care units (NICUs), compared to other pediatric wards due to aspects like off-label medications, pharmacokinetic/dynamic variability, or organ dysfunction/immaturity. This study aimed to determine whether and to what extent a clinical pharmacist intervention improves medication safety and prevents DRPs [medication errors (MEs), adverse drug reactions (ADRs), drug-drug interactions (DDIs)]. Methods: A prospective, randomized, double blind, controlled study in NICU-admitted neonates was conducted. NICU patients were randomly assigned to the intervention (clinical pharmacist-led) (IG) or control group (standard care such as clinical diagnosis, pharmacotherapy) (CG). The clinical pharmacist was involved in the IG to identify-prevent-intervene MEs, or identify and monitor ADRs and DDIs. The primary outcome was the number of neonates who developed at least one DRP compared with those seen across IG and CG. Secondary outcomes included length of hospital stay, total number of drugs or DRP type. Results: Neonates were randomly assigned to CG (n = 52) or IG (n = 48). In total, 45%, 42%, and 16% of patients had at least 1MEs, ADRs, and clinically significant DDIs, respectively. The number of patients with at least 1ME was 28 (53%) and 17 (35%) in the CG and IG (p>0.05). The median (range) number of ME was higher in CG [1 (0-7)] than in IG [0 (0-4)] (p = 0.003). Applying regression analysis, the CG had 2.849 times more MEs than the IG (p<0.001). Furthermore, the number of patients (CG to IG) with at least one detected ADR or clinical DDI was 19 (36%) to 23 (47%) (p>0.05) and 4 (7%) to 12 (25%), respectively (p = 0.028). Conclusion: Clinical pharmacist availability to systematically and standardized identify, prevent and resolve DRPs among NICU patients is effective. Daily detailed clinical pharmacist observations and interventions enables prevention and monitoring of DRPs. Clinical Trial Registration ClinicalTrials.gov, identifier NCT04899960.

Indication-driven order entry decreases stewardship and pharmacist interventions.

Indication-driven order entry (IDOE) was implemented at our pediatric institution for cefazolin, piperacillin-tazobactam, and meropenem; the 3 most intervened upon antibiotics during prospective audit and feedback (PAF) by the antimicrobial stewardship program (ASP). IDOE was associated with a significant reduction in both ASP PAF recommendations and clinical pharmacist interventions.

Adherence to epilepsy quality indicators in a tertiary referral center

BackgroundQuality indicators play an important role in healthcare quality and patient safety. The aim of this study is to identify specific clinical pharmacy interventions to improve adherence to quality indicators and minimize risks among patients with epilepsy. Material and methodsA prospective, two-phase, observational study was conducted in a neurology outpatient clinic of a tertiary university hospital. In the first phase of the study, the rate of adherence to the quality indicators was evaluated with a checklist containing the quality indicators. In the second phase of the study, an expert panel meeting was convened to identify clinical pharmacist interventions to reduce the risks associated with non-adherence. The Fine–Kinney method was used to prioritize risks, and adherence rates with each quality improvement indicator (QI) were calculated. ResultsThe study found that adherence rates were highest for QIs involving estimating the number and type of seizures, providing medical treatment or referring patients with evidence of mood disorders to mental healthcare, and co-managing prenatal care for women with epilepsy. The most non-adherence rates were found in QIs involving quality-of-life assessment, daily folate supplementation, and addressing the decreased effectiveness of oral contraception. The annual review of information about educational issues was also poorly provided. An expert panel decided to integrate a clinical pharmacist into the outpatient clinic to improve medication adherence, side-effect assessment, drug interaction assessment, patient education, lifestyle-modification education, depression/suicide-related behavior screening, quality-of-life assessment, and effectiveness evaluation of oral contraceptives for female patients using enzyme-inducing ASM. ConclusionThe study shows that medication adherence, assessment of side effects, drug interactions, and patient education are inadequately provided by neurologists in patients with epilepsy. Clinical pharmacists have a crucial role in reducing potential risks of non-adherence with quality indicators. By integrating clinical pharmacy services into routine epilepsy care processes, the quality of care can be improved. Future studies should focus on implementing these interventions and evaluating their impact on patient outcomes.

Impact of a clinical pharmacist’s intervention on pneumococcal vaccination in a population of at- risk hospitalized patients: The IP-VAC study

ObjectivesThe aim of this study was to evaluate the impact of clinical pharmacist intervention on compliance with pneumococcal vaccination (PV) recommendations in hospitalized patients. MethodsThis was a prospective, single-center, before-and-after study conducted in 2019–2020. Patients had to be over 18 years of age, at risk of pneumococcal infection, and with no PV. No changes were made in the observational phase. During the interventional phase, the clinical pharmacist discussed a prescription for preventive PV and a mention in the discharge letter. A pharmaceutical consultation sensitized the patient to the interest of PV. The clinical pharmacist ensured that a complete vaccination protocol would be carried out by the retail pharmacist within 3 months of hospitalization. ResultsOne hundred and sixty-seven (167) patients were included. In the observational phase, 2.3% of patients received a complete vaccination protocol after discharge from primary care. The rate increased to 63.8% after the clinical pharmacist’s intervention (p < 0.001). Vaccines were prescribed by hospital physicians in 97.5% of cases, while 40% of discharge letters included the indication for PV. ConclusionThe clinical pharmacist’s intervention led to delivery of a complete PV protocol after discharge for over half the patients. This study demonstrated the feasibility of a pharmaceutical intervention to promote PV in hospital activities.

Characteristics of the clinical pharmacist interventions at the National Center for Cancer Care and Research Hospital in Qatar.

Drug-related problems (DRPs) affect the health outcomes of patients during hospitalization. We sought to analyze the clinical pharmacist-documented interventions among hospitalized patients in the cancer hospital in Qatar. A retrospective analysis of electronically reported clinical pharmacist interventions of patients admitted to cancer units at Hamad Medical Corporation, Qatar was conducted. Extracted data was based on an overall 3-month follow-up period; March 1-31, 2018, July 15-August 15, 2018 and January 1-31, 2019. Categorical variables were expressed as frequencies and percentages, while continuous variables were expressed as mean ± standard deviation (SD). A total of 281 cancer patients with 1354 interventions were included. The average age of the study participants was 47 years (SD ± 17.36). The majority of the study population was females (n = 154, 54.80%). The prevailing pharmacist intervention was the addition of a drug therapy (n = 305, 22.53%), followed by medication discontinuation (n = 288, 21.27%) and the addition of a prophylactic agent (n = 174, 12.85%). This pattern was similar across all subgroups (i.e., gender, age, ward), except for the urgent care unit, where an increase in medication dose was the third highest frequently identified intervention (n = 3, 0.22%). The two medication groups associated with the majority of interventions were the anti-infective and fluid/electrolyte agents. Most of the interventions documented were in the oncology ward (73.19%), while the urgent care unit had the least documented interventions (1.62%). Our analysis showed that clinical pharmacists can effectively identify and prevent DRPs among hospitalized cancer patients.

A Clinical Pharmacist-led Approach on Reducing Drug Related Problems Among Patients with Neurological Disorders: An Interventional Study

BackgroundNeurological disorders are common in the general population and the majority of patients have other chronic diseases, necessitating the use of multiple medications, which increases the incidence of drug-related problems (DRPs). Studies from different countries discovered an average of 0.29–1.45 DRPs per patient admitted into the neurology unit. ObjectivesTo identify common DRPs and to evaluate the impact of clinical pharmacist's interventions in resolving the identified DRPs in patients with neurological disorders. MethodsA prospective interventional study was conducted in the Department of Neurology in a tertiary care teaching hospital in Southern India, for a period of six months. Patients aged ≥18 years and had been hospitalized for >24 h, were intensively monitored until discharge for the occurrence of any DRPs and pharmacist interventions were provided. The identified DRPs were classified according to Hepler and Strand's Classification. ResultsA total of 310 prescriptions were reviewed, of which 174 patients (mean age 45.93 ± 2.49 years) experienced at least one DRP during their hospital stay. The average DRP per patient was found to be 1.75, with drug-drug interactions [254 (83%)] being the predominant DRPs, followed by adverse drug reactions [13 (4%)], and drug duplications [9 (3%)]. Most of the drug-drug interactions were pharmacokinetic [144 (56.69%)]. Hyponatremia [2 (15%)]; and nausea and vomiting [2 (15%)] were most commonly reported ADRs. All 306 DRPs involved active clinical pharmacist intervention, of which [275 (89.87%)] of pharmacists' interventions were accepted, which led to modification of the therapy. ConclusionMonitoring the use of drugs allowed the clinical pharmacist to detect DRPs and to suggest interventions that promote rational drug prescribing, therapy optimization and enhanced patient safety.

Clinical pharmacist intervention to improve medication safety for hip fracture patients through secondary and primary care settings: a nonrandomised controlled trial

BackgroundHip fracture patients face a patient safety threat due to medication discrepancies and adverse drug reactions when they have a combination of high age, polypharmacy and several care transitions. Consequently, optimised pharmacotherapy through medication reviews and seamless communication of medication information between care settings is necessary. The primary aim of this study was to investigate the impact on medication management and pharmacotherapy. The secondary aim was to evaluate implementation of the novel Patient Pathway Pharmacist intervention for hip fracture patients.MethodsHip fracture patients were included in this nonrandomised controlled trial, comparing a prospective intervention group (n = 58) with pre-intervention controls who received standard care (n = 50). The Patient Pathway Pharmacist intervention consisted of the steps: (A) medication reconciliation at admission to hospital, (B) medication review during hospitalisation, (C) recommendation for the medication information in the hospital discharge summary, (D) medication reconciliation at admission to rehabilitation, and (E) medication reconciliation and (F) review after hospital discharge. The primary outcome measure was quality score of the medication information in the discharge summary (range 0–14). Secondary outcomes were potentially inappropriate medications (PIMs) at discharge, proportion receiving pharmacotherapy according to guidelines (e.g. prophylactic laxatives and osteoporosis pharmacotherapy), and all-cause readmission and mortality.ResultsThe quality score of the discharge summaries was significantly higher for the intervention patients (12.3 vs. 7.2, p < 0.001). The intervention group had significantly less PIMs at discharge (− 0.44 (95% confidence interval − 0.72, − 0.15), p = 0.003), and a higher proportion received prophylactic laxative (72 vs. 35%, p < 0.001) and osteoporosis pharmacotherapy (96 vs. 16%, p < 0.001). There were no differences in readmission or mortality 30 and 90 days post-discharge. The intervention steps were delivered to all patients (step A, B, E, F = 100% of patients), except step (C) medication information at discharge (86% of patients) and step (D) medication reconciliation at admission to rehabilitation (98% of patients).ConclusionThe intervention steps were successfully implemented for hip fracture patients and contributed to patient safety through a higher quality medication information in the discharge summary, fewer PIMs and optimised pharmacotherapy.Trial registration: NCT03695081.

Economic impact of clinical pharmacist interventions in a general tertiary hospital in Qatar.

With an increasingly strained health system budgets, healthcare services need to continually demonstrate evidence of economic benefits. This study sought to evaluate the economic impact of interventions initiated by clinical pharmacists in an adult general tertiary hospital. A retrospective review of clinical pharmacist interventions was carried out throughout follow-up durations in March 2018, July/August 2018, and January 2019 in Hamad General Hospital (HGH) at Hamad Medical Corporation (HMC) in Qatar. The study included clinical pharmacy interventions data of patients admitted to the internal medicine, critical care, and emergency wards. Included interventions were documented by clinical pharmacists or clinical pharmacy specialists, and approved by physicians. Interventions by non-clinical pharmacists or with missing data were excluded. Adopting the perspective of HMC, we calculated the total economic benefit, which is the sum of the cost savings and the cost avoidance associated with the interventions. Cost savings was defined as the reduced cost of therapy associated with therapy changes minus the cost of intervention and cost avoidance was the cost avoided by eliminating the occurrence of adverse drug events (ADEs). Sensitivity analyses were performed to assess the robustness of results against uncertainties. A total of 852 interventions, based on 340 patients, were included. The analysis projected an annual total benefit of QAR 2,267,036 (USD 621,106) based on a negative cost-savings of QAR-175,139 (USD-47,983) and a positive cost avoidance of QAR741,898 (USD203,260) over the 3-month follow-up period. The uncertainty analysis demonstrated the robustness of outcomes, including a 100% probability of positive economic benefit. The clinical pharmacist intervention was associated with an increased cost of resource use, which was overtaken by the cost avoidance generated. The pharmacy intervention, therefore, is an overall economically beneficial practice in HGH, reducing ADEs with considerable consequential positive economic savings.

EE105 Impact of Clinical Pharmacist Interventions on Economic Outcomes in Women's Wellness and Research Center in Qatar

Due to the constrained financial burden that the healthcare systems are currently facing, healthcare services need to demonstrate that they remain cost saving through proving continually the economic benefit of such services. We sought to evaluate the economic impact of interventions initiated by a clinical pharmacist in Women's Wellness and Research Center (WWRC) in Qatar.

EE518 Characteristics of the Clinical Pharmacist Interventions at a Tertiary Cancer Care Hospital in Qatar

Drug-related problems (DRPs) affect the health outcomes of patients during the hospital stay. Clinical pharmacist-led interventions have a profound impact on medication safety and improving patient outcomes since their role is evolving. In Qatar, there is an opportunity for pharmacists to expand their role as patient safety leaders to prevent medication errors. This study aims to describe and classifythepharmacist-documented interventions among hospitalized patients in a cancer hospital in Qatar.

EE400 Economic Impact of Clinical Pharmacist Interventions in the Neonatal Intensive Care Unit in Qatar

The economic benefit of the clinical pharmacist’s role in ensuring the optimum use of medicines is potentially considerable, particularly when it comes to critical care management. This study sought to evaluate the overall economic impact of clinical pharmacist interventions in the main Neonatal Intensive Care Unit (NICU) in Qatar.