Background Within the framework of the Austrian healthcare reform, a publicly funded project with the aim of resolving medication related problems (MRPs) by means of inhospital clinical pharmacy services (CPS) was conducted.

Purpose The aim of the study was to detect and resolve MRPs and to analyse the clinical pharmacists’ interventions.

Material and methods CPS were implemented on one trauma surgery ward (28 beds) in a large academic teaching hospital (2000 beds). On weekdays, two pharmacists alternately provided continuous CPS, comprising medication reviews (MRs) of newly admitted patients and patient counselling at discharge. Ward round participation took place once weekly. All MRPs, proposed interventions and the physicians’ acceptance rate were assessed and recorded during the study period (October 2014 to September 2015; patient counselling started in April 2015) according to an adapted classification system¹. Further project relevant data (eg, demographics, involved medications, time spent on CPS, etc) were also recorded.

Results MRs were performed in 1462 patients, with 1029 MRPs detected in 1027 patients (70.2%; 58% female; average age 68.5 years; average medicines/day 8,4). Patients with MRPs were older and took more medicines. Common MRPs were overdosing (13.8%), medicines prescribed without an indication (9.0%) and untreated indications (5%). Frequent clinical pharmacists’ interventions were the provision of information (14.6%) and the recommendations to alter dosing (15.6%) or discontinue medicines (9.5%). The most frequently involved medicines were proton pump inhibitors, NSAIDs and cardiovascular medicines. The overall physicians’ acceptance rate of interventions was 71.1%. 39.7% of interventions were assessed as directly reducing medicines’ expenses on the ward, while only 7.9% led to an increase. A total of 176 patients were counselled at discharge. The average (±SD) time/day spent on CPS was 71 (±38) min.

Conclusion Continuous CPS have considerably contributed to the resolution of MRPs in trauma surgery patients, as illustrated by the high number of interventions performed and the high acceptance rate. Counselling at discharge was well received by patients. Based on the project results, the political decision to extend funding has been taken.

References and/or Acknowledgements

1. Allenet B, et al. Pharm World Sci 2006;28:181-8

References and/or AcknowledgementsConflict of interest.