Evaluation of the Contribution of Clinical Pharmacists: Inpatient Care and Cost Reduction

Abstract

Clinical pharmacists in this study hospital reported 1027 interventions in patient drug therapy over two time periods of three and two weeks, respectively. These interventions were subjected to self and peer reviews and to cost-avoidance evaluation. The most frequent type of intervention was recommendations related to drug selection (29.6 percent). Recommendations were not implemented by physicians in only 10.2 percent of the cases. The perceived impact of these interventions on the quality, cost, or both was found by the peer reviewers to occur in 58.5, 16.1, and 25.6 percent of the cases, respectively. Also, when peer reviewed for clinical significance, 983 of these interventions were judged to improve drug therapy to an acceptable level based on the professional literature, and 36 were deemed very significant in terms of saving patients' lives or preserving major organ functions. Of the 983 interventions rendering drug therapy to an appropriate level, 398 were deemed to have cost-avoidance impact; of this number a 25 percent random sample was subjected to cost-avoidance evaluation. Realized cost-avoidance averaged $242 for each intervention implemented. When extrapolated annually, $364 900 was the net realized cost-avoidance after discounting for the cost of providing clinical pharmacy services. An average cost-avoidance of $860.50 was calculated for each intervention made by pharmacists, but not followed by physicians, for an annual potential cost-avoidance of $532 650. In all, clinical pharmacists had the potential to save $897 550 annually in hospital resources if all their interventions had been accepted and implemented.

Drug-Therapy Problems, Inconsistencies and Omissions Identified During a Medication Reconciliation and Seamless Care Service

“…Wernick and colleagues (1996) conducted a six-week study which evaluated the frequency and types of variances that occurred in patients' discharge prescriptions. Their study reported that 11.9% of the participating patients' discharge prescriptions contained a variance that required an intervention, and, using the same Intervention Ranking system (Hatoum et al 1988), 48.6% of pharmacist interventions were categorized as significant (Wernick et al 1996). As discussed by others (Schumock et al 1994;Wernick et al 1996), comparing rates of prescription discrepancies between studies can be difficult when each study does not use the same definition of discrepancy and the same identification methods.…”

“…All of the DTPsm were scored for their potential clinical impact according to the Intervention Ranking system (Hatoum et al 1988). Other researchers have used this scale to evaluate the clinical impact of pharmacists' interventions (Wernick et al 1996).…”

Healthy People 2010: Challenges, Opportunities, and a Call to Action for America's Pharmacists

“…Drugrelated problems associated with inappropriate dosing occur in individuals with renal insufficiency or failure, and pharmacists have documented positive outcomes through drug management and other innovative programs for this population. [83][84][85][86][87][88][89][90][91][92][93][94][95][96] Documented Impact…”

Redesign of the Clinical Pharmacy Practice Model in a Tertiary Academic Hospital in Medellín, Colombia

“…1 Currently, direct patient care by clinical pharmacists within multidisciplinary teams is recognized as one of the best pharmacy practice models because it minimizes risks, care costs, morbidity and mortality rates, as well as time spent in hospital; it also improves pharmacotherapy results. [2][3][4][5][6][7][8][9] Several initiatives and standards of practice for clinical pharmacy have been proposed around the world. These proposals promote the transformation of clinical pharmacy services through participation of pharmacists as providers of direct patient care, counselling, and support to medical and nursing staff in their decision-making.…”