Important Aspects of Pharmacist‐led Medication Reviews in an Acute Medical Ward

Abstract

In some hospitals, clinical pharmacists review the medication to find drug-related problems (DRPs) in acutely admitted patients. We aimed to identify the nature of identified DRPs and investigate factors of potential importance for the clinical implementation of pharmacist suggestions. In 100 randomly selected medication review (MR) notes, we retrospectively evaluated the clinical implementation and classified (1) timing and communication of the review; (2) DRPs and related suggestions for the physician; and (3) DRPs' potential clinical relevance to patients as 'beneficial', 'somewhat beneficial', 'no relevance' or 'other relevance'. Of 327 DRPs (0-13 DRPs per patient), 42% were implemented. The clinical implementation was higher if the MR note was made prior to (instead of after) the physician's admission, and even higher if the suggestions were communicated verbally (instead of only in writing) to the physicians (44% versus 79%, p < 0.05). The clinical relevance of the DRPs was either 'beneficial' (16%), 'somewhat beneficial' (43%), 'no relevance' (22%) or 'other relevance' (19%). The 'beneficial' DRPs had a higher clinical implementation (53%) than 'no relevance' (34%) (p < 0.05). The most frequently implemented suggestions were based on DRPs concerning 'indication for drug treatment not noticed', 'inappropriate drug form' and 'drug dose too low', with implementation rates of 83%, 67% and 63%, respectively. In our sample, the pharmacist's MR suggestions were only implemented by physicians in 42% of the cases, but review prior to physician contact and verbal communication of the suggestions, higher clinical relevance and specific types of DRPs were associated with a higher implementation rate.

A Collaborative Medication Review Including Deprescribing for Older Patients in an Emergency Department: A Longitudinal Feasibility Study

“…These results are consistent with existing literature [46,47] and emphasize the necessity of medication reconciliation as a part of a medication review intervention. The geriatrician agreed with 81% and implemented 61% of changes recommended by the clinical pharmacist, which is within the implementation range of 40%-90% reported by other studies [48][49][50]. Considering the acute condition of patients and rapid patient turnover in the ED, our reported implementation rate of 61% indicates successful cross-functional collaboration between pharmacists and geriatricians.…”

Evaluation of drug‐related problems and subsequent clinical pharmacists’ interventions at a Swiss university hospital

“…Only a few previous studies assessed the potential clinical impact of PIs, and the use of different classification tools limits comparability. Nevertheless, the clinical relevance of PIs in the hospital setting has also been demonstrated in other countries . This is in line with the findings of several intervention studies suggesting that clinical pharmacy services can reduce the length of hospital stay, the number of adverse drug events and drug‐related readmissions …”

Causes of discrepancies between medications listed in the national electronic prescribing system and patients' actual use of medications

“…For each patient, the pharmacist evaluated “actual medication use” by systematically gathering the best possible medication history 13–15 including information on medication adherence from multiple sources in addition to the SMR. Information sources included conversation with the patients, and examination of their medication list and pill organisers.…”