This study provided an initial empirical basis for selecting 0.80 as a reasonable cut-off point that stratifies adherent and non-adherent patients based on predicting subsequent hospitalization across several highly prevalent chronic diseases. This cut-off point has been widely used in previous research and our findings suggest that it may be valid in these conditions; it is based on a single outcome measure, and additional research using these methods to identify adherence thresholds using other outcome metrics such as laboratory or physiologic measures, which may be more strongly related to adherence, is warranted.

MPR and PDC had the highest predictive validity for hospitalization episodes. These 2 measures should be considered first when selecting among adherence measures when using administrative prescription claims data.

MPR and PDC were among the best predictors of any-cause and mental health-related hospitalization, and are recommended as the preferred adherence measures when a single measure is sought for use with administrative claims data for patients not on polypharmacy.

PURPOSE.To describe clinical pharmacist interventions across a range of critical care units (CCUs) throughout the United Kingdom (UK). To identify CCU medication error rate, prescription optimisation and to identify the type and impact of each intervention in the prevention of harm and improvement of patient therapy. MATERIALS AND METHODS.A prospective observational study was undertaken in 21 UK CCUs from [5][6][7][8][9][10][11][12][13][14][15][16][17][18] th Nov 2012. A data collection web portal was designed where the specialist critical care pharmacist (SCCP) reported all interventions at their site. Each intervention was classified as either: medication error, optimisation or consult. In addition, a clinical impact scale was used to code the interventions. Interventions were scored as low, moderate, high impact and life saving. The final coding was moderated by blinded independent multidisciplinary trialists. RESULTS. 20,517 prescriptions were reviewed with 3,294 interventions recorded during the weekdays. This resulted in an overall intervention rate of 16.1%: 6.8% were classified as medication errors, 8.3 % optimisations and 1.0% consults. The interventions were classified as: low impact (34.0%), moderate impact (46.7%) high impact (19.3%) and one case was life saving. Almost three-quarters of interventions were to optimise the effectiveness of and improve safety of pharmacotherapy. CONCLUSIONS. This observational study demonstrated that both medication error resolution and pharmacist led optimisation rates were substantial. Almost 1 in 6 prescriptions required an intervention from the clinical pharmacist. The error rate was slightly lower than an earlier UK prescribing error study (EQUIP). Two thirds of the interventions were of moderate to high impact. Key wordsCritical care, interventions, specialist critical care pharmacist, medication errors, optimisations, impact coding IntroductionThe critically ill patient is at risk of medicines-related adverse events [1], drug interactions and on some occasions inadequate therapy [2]. This risk can be exacerbated by the presence of organ failure or by supportive therapies such as renal replacement therapy. Consequently, interventions to reduce medication errors and optimise therapy are an essential component of patient care. These include electronic prescribing, smart infusion pumps, medicines reconciliation, clinical guidelines and services normally led by a specialist critical care pharmacist (SCCP) [3]. Improving the safety and efficacy of medication therapy in critical care patients is the cornerstone of SCCP activity. Since the first reports of clinical pharmacist interventions in critical care in the mid-1980s [4], there has been a gradual progression from those focused on financial savings in medicine use, to reducing medication errors and more recently to the optimisation of medication therapy [5]. Clinical pharmacists have been reported to improve medicines-related patient outcomes in the use of sedation [6], antimicrobial therapy [7], therapeutic drug m...

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