Authors (including presenting author) :
Yau WY(1), Chow LC(1), Tsang CS(1), Ding Q(2), Yau HT(2), Ip CY(2), Kwan KP(1), Lee SC(1), Ho WS(2)
Affiliation :
Department of Pharmacy(1), Department of Medicine & Therapeutics(2), Prince of Wales Hospital
Introduction :
Clinical Pharmacy Service was launched in a medical ward in Prince of Wales Hospital in 2014. Clinical pharmacists perform proactive pharmaceutical care activities, not only medication reconciliation and discharge counseling, but also detailed medication review and provision of drug information to doctors and nurses.
Objectives :
This project aims to evaluate the acceptance of clinical pharmacist interventions since service establishment. Secondary outcomes include the types and details of pharmacist interventions.
Methodology :
All interventions made between June 2014 and May 2020, which were documented on the structured case summary form by clinical pharmacists, were reviewed. The data was entered and analyzed by Microsoft Excel.
Result & Outcome :
Clinical pharmacists have made 896 interventions over the review period, and the average acceptance rate was 86.7%. With the extended service hours implemented, more proactive feedbacks and direct discussions on individual patient’s pharmaceutical care plan could be conducted between doctors and pharmacists. A significant increase in the acceptance rate (63.3% in 2014 vs. 91.9% in 2020, p-value < 0.05, Chi-square test) was observed.
The most common type of interventions was the detection of un-intentional omission of chronic medications in admission orders (42.5%). Other recommendations included drug dose recommendations (19.2%) according to patient’s clinical condition and/or organ functions, followed by de-prescribing of unnecessary medications (7%), optimization of drug therapy for prevention of potential adverse drug reaction (5.8%), and rectification of inappropriate therapeutic duplication (5.8%). Potential drug-drug interactions have been prevented (3%), and drug administration problems such as inappropriate crushing of modified-release formulations were identified (2%).
Increasing acceptance of clinical pharmacist interventions has been observed, suggesting an increasing recognition of roles of clinical pharmacists in improving the quality of drug treatment processes with a timely resolution of drug-related problems in a medical ward setting.
