Background In our hospital, patient records and all medical prescriptions are computerised in 11 departments. These prescriptions are analysed daily by a pharmacist. Each pharmaceutical intervention (PI) is recorded in the patient record and can be accepted or rejected by physicians. PIs are marked critical, medium or low by the pharmacist. We set up a weekly PI meeting with all pharmacists in June 2012.
Purpose To standardise, analyse and promote our interventions.
Materials and Methods For each PI, the pharmacy student fills in an Excel table with medical ward, drug, problem identified, type of intervention, pharmacist rating and clinical impact of the intervention. During the meeting, all PIs marked critical or that had a physician comment, discrepancy on out of formulary discharge proposal, or any IPs considered relevant by the pharmacist were considered and discussed.
Results Analysis of medical prescriptions generated 1,483 PIs over 3.5 months. The most frequent rating was ‘low’ (70%). There were 18% ‘medium’ and 3% ‘critical’ interventions. The main pharmaceutical problem was out of the formulary discharge proposal which represented 54% of PIs (796/1483). Dosage adaptation was recommended in 12% of cases; 9% of PIs were for stopping the treatment and other interventions were about the choice of route of administration, adding a treatment, therapeutic monitoring and optimization of administration. In total, 58% of PIs were accepted, the physician was not informed of 23% and 19% were not accepted; but 11% of the PIs accepted were not implemented.
135 PIs were discussed in pharmaceutical meetings. Among the subjects that arose, 3 were particularly highlighted: re-evaluation of renal failure and metformin, interaction between beta blockers and flecainide and recommendations on allergies. We have studied out of the formulary discharge proposal discrepancies about cardiology medicines (angiotensin converting enzyme inhibitors and angiotensin receptor antagonists).
Conclusions Feedback on PIs is a key element to improve their relevance. Finally, a weekly pharmaceutical meeting can highlight recurrent prescription problems in order to propose and implement corrective measures. It is moreover a working base for our hospital to improve the quality of medical care.
No conflict of interest.
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