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| Authors | R Theuma M Cordina A G Fenech MR Schiavone Pavia J Sciberras |
| Abstract | Background: Clinical pharmacists can improve patient care by identifying drug-related problems (DRPs) and initiating interventions to optimise medication use which results in better outcomes for the patients health. Aim: To describe and characterise the types of pharmacist intervention in medical wards at the main general hospital in Malta. Methods: Clinical pharmacist interventions were made during ward rounds by reviewing patient files and treatment charts of all patients under the care of three medical consultant physicians over a period of five months. The principal investigator identified and documented the drug-related problems using a standard intervention form. The form also recorded the type of pharmacist intervention and the outcome of the intervention together with the patients demographic details. DRPs, interventions and outcomes were coded and for each DRP the drug class involved was also recorded. The data was processed and analysed using the BMDP statistical package. Results: A total of 707 interventions were made in 330 patients. Out of these 41.7% n =295 involved treatment chart rewriting and patient discharge counselling n = 106. The majority of interventions, 58.3% n = 412=; were classified as DRPs, with the most common DRP being untreated indication (11.9%, n = 84). The problem, most frequently identified was with cardiovascular drugs (6.9%, n = 49) and central nervous system drugs (2.0%, n = 14). Problems of unnecessary drug treatment were also common (7.9%, n = 56), mostly with antiinfective agents (3.5%, n = 25) and cardiovascular drugs (1.6%, n = 11). Subtherapeutic dosing was identified in 5.3%, n = 38 of cases with cardiovascular drugs being most commonly implicated (4.2%, n = 30). Conclusions: The most commonly encountered DRPs were inappropriate drug choice of cardiovascular drugs. This mostly included under-use of angiotensin converting enzyme inhibitors and betablockers as first line drugs in congestive heart failure and ischaemic heart disease respectively. Subtherapeutic dosing of cardiovascular drugs was also noted especially with angiotensin converting enzyme inhibitor in congestive heart failure. Another frequently identified DRP was unnecessary drug treatment, which occurred commonly with prolonged use of antibiotics. This study highlights the importance of clinical pharmacist interventions in identifying and rectifying drug related problems leading to improved patient care. |
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| Journal | Pharmacy Education |
| Volume | Vol. 4 (3/4) |
| Pages | 245 - 246 |
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| Key words | Clinical Pharmacist, Intervention, Medical Wards, pharmacy |