Background Documentation systems that capture the clinical activities of the pharmacist, as well as the pharmacist’s impact on the patient’s drug therapy outcomes and costs, are essential to picture the input of the clinical pharmacist in the multiprofessional healthcare team.

Purpose A rated documentation system was implemented in 8 hospitals within a hospital trust. With this encoding system, the interventions of each clinical pharmacist can be evaluated for benchmarking. The aim was to show the acceptance rate of pharmacist recommendations due to time spent conducting detailed documentation.

Material and methods On 2 neurologic wards, every admission with a polypragmasy of more than 10 prescribed drugs was assessed for drug related problems over a 6 month period from July to December 2014. In cooperation and consultation with the medical staff, the number of medications was reduced to a required minimum.

Each of the wards was visited once a week focusing on general parameters for pharmaceutical care. The documented report for each intervention contained the following:

• type of recommendation;

• varying degree of severity for drug related problems;

• direct costs of medication, an estimated reduction of consequential costs (reduction of continuation);

• drug risk; and

• readmission to hospital.

The physician´s acceptance rate was also recorded, and the total time for the written record.

Results 523 patient files were checked and 198 interventions were set. 13% of these patients had more than 10 medications prescribed and on average 1 to 4 drugs were reduced. Each chart required on average 35 min for documentation. 73% of all therapeutic interventions were accepted by medical staff. 20% of all interventions needed further drug information efforts. 35% of drug therapy problems identified were stopping a medication without indication and 14% were dosage adjustments. Pharmacist estimated cost savings was an estimated decrease of follow-up costs (51%).

Conclusion With a minimal timed input for this comprehensive documentation system, maximum significance was achieved in the hospital trust and can be compared. A numerical cost effective analysis is not essential for planning future clinical directions. Because detailed documentation was provided, a high acceptance rate of the therapeutic recommendations was shown.

References and/or Acknowledgements The author thanks the staff of the pharmacy department and hospital for support.

No conflict of interest.