A pilot study of pharmacist initiated interventions in drug therapy in a Danish university hospital

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A pilot study of pharmacist initiated interventions in drug therapy in a Danish university hospital

J. Carlsson1, T. Villumsen1, B.R. Olesen

RAP, Clinical pharmaceutical services, Copenhagen OE, Denmark

Background: The aim of this pilot study was to identify possible drug interventions which can be related to the use of the Electronic Patient Medications Module (EPM). The study was based on reviews of prescriptions from the EPM.

Methods: A total of 1003 patient medications were reviewed during 23 consultations with the EPM. The study was executed at 3 different departments with similar medical specialization. Identified interventions were divided into 12 categories, dosage
inappropriate, contraindicated drug, incomplete prescription, inappropriate dose frequency, drug duplication, no administration or dispensing of drug, inappropriate drug formulation, drug-drug interaction, inappropriate route of administration, optimisation of drug therapy, non-approved prescription in the EPM and other.

Results: During this study a number of 1365 interventions were identified. The identified interventions showed the following distribution between the 12 categories. Dosage inappropriate (0.7%), contraindicated drug (0.3%), incomplete prescription (4.9%), inappropriate dose frequency (2.6%), drug duplication (0.3%), no administration or dispensing of drug (47.3%), inappropriate drug formulation (0.5%), drug-drug interaction (24.5%), inappropriate route of administration (0.4%), optimisation of drug therapy (3.3%), non-approved prescription in the EPM (14.9%), other (0.2%). The most commonly identified intervention was ‘no administration or dispensing of drug’ (47.3%). Either the patient did not get the prescribed medication or there was a lack of documentation in relation to the medical administration. The severity of the drug-drug interactions (24.5%) was ranged as major, moderate and minor. 32.2% of the identified drug-drug interactions were recognized as major, 57.9% were recognized as moderate and 9.9% were recognized as minor.

Conclusions: This pilot study showed a potential for pharmacist initiated
interventions to optimise drug therapy in the EPM, especially regarding drug-drug interactions, medical administration and dispensing. This study underlines the benefits of having a clinical pharmacist contributing with scientifically valid
information and advice regarding safe, appropriate and costeffective use of medication.

References: EAHP Congress Barcelona 2009.