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 cardiosurgery ward (28 beds) in a large academic teaching hospital (2000 beds). On weekdays, three 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 starting 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 1561 patients, with 1335 MRPs detected in 1317 patients (84.4%; 37.4% female; average age 66.7 years; average medicines/day: 10.5). Common MRPs were choosing a suboptimal administration route (16.8%), untreated indications (6.1%) and non-adherence to treatment guidelines (5.4%). The most common clinical pharmacists’ interventions were the provision of information (12.8%), recommendations to discontinue medicines (9.0%) or alter dosages (7.6%). The most frequently involved medicines were cardiovascular drugs, NSAIDs and proton pump inhibitors. The overall physicians’ acceptance rate was 92%. 21.3% of interventions were assessed as directly reducing medicines’ expenses on the ward, while only 6% led to an increase. A total of 155 patients were counselled and 37 MRPs (2.8%) were resolved at discharge. The average (±SD) time/day spent on CPS was 82 (±31) min.

Conclusion Continuous CPS have considerably contributed to the resolution of MRPs in cardiosurgery patients, as illustrated by the high number of interventions performed and the high acceptance rate. Counselling at discharge was well received by patients and helped to further resolve MRPs. 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.