Background The Swiss Society of Public Health Administration and Hospital Pharmacists (GSASA) published in 2011 a codification tool to standardise the documentation of clinical pharmacists’ interventions during clinical rounds (www.gsasa.ch/pages/activites/activites-cliniques). It includes the five following items: problem, type of problem (potential or actual), reason for intervention, intervention, and outcome. The clinical pharmacists at the ICHV document their interventions by a short description which is stored in a locally developed database. A random sample of those described interventions (DI) is codified with the GSASA tool once a year.
Purpose The aim of the work was to compare the retrospective codification of the same DI by two pharmacists in order to evaluate the inter-user agreement and to estimate the time needed for the codification. Material and method One hundred DI performed in 2012 in an internal medicine unit were randomly chosen. Two pharmacists codified those DI separately and the time used to codify was measured. Global agreement was defined as five concordant items (problem, type of problem, reason for intervention, intervention, and outcome) and the disagreement, by a discrepancy of at least one item.
Results Twenty of the 100 interventions could not be codified because of an incomplete or vague description by the clinical pharmacist or because the DI was not covered by the items of the tool. The global agreement for the 80 codified DI was only 15%. Among the causes of disagreement, the category with the highest inter-user variability was the “type of problem” (64% of disagreement), where the codifying pharmacist needed to choose between “actual” or “potential”. The disagreement rate was 21% for the “reason for intervention”, 19% for the “problem”, 15% for the “intervention” and 4% for the “outcome”.
Discussion and conclusion We welcome the GSASA codification tool which can be used to codify the DI retrospectively; however a high inter-user variability was identified. The item “type of problem” was the major cause of disagreement (64%). The choice between “actual” or “potential” is unclear. Does this item refer to a drug related problem or to its effect on the patient? The “reason for intervention” showed 21% of disagreement because of one major reason: if two medications have an additive side effect (e.g additive effect of QT prolonging drugs), should it be classified as “interaction” (pharmacodynamic interaction) or as “adverse reaction”? GSASA is planning to develop a user’s manual which should help clarifying each category and improve inter-user agreement. This hypothesis should be further tested.
No conflict of interest.
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