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Pharmacist-led medication review in an acute admissions unit: a systematic procedure description
  1. Trine Graabæk1,2,
  2. Dorthe Krogsgaard Bonnerup3,
  3. Lene Juel Kjeldsen4,
  4. Charlotte Rossing5,
  5. Anton Pottegård2
  1. 1Centre for Clinical Research, Hospital South West Jutland, Esbjerg, Denmark
  2. 2Department of Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense C, Denmark
  3. 3Hospital Pharmacy, Central Denmark Region, Aarhus C, Denmark
  4. 4The Danish Research Unit for Hospital Pharmacy, Amgros I/S, Copenhagen Ø, Denmark
  5. 5Department of Research and Development, Pharmakon, Hillerød, Denmark
  1. Correspondence to Trine Graabæk, Centre for Clinical Research, Hospital South West Jutland, Finsensgade 35, Esbjerg DK-6700, Denmark; trine.graabaek.hansen{at}


Objectives Over the last decades, several papers have evaluated clinical pharmacy interventions in hospital settings with conflicting findings as results. Medication reviews are frequently a central component of these interventions. However, the term ‘medication review’ covers a plethora of principles and methodologies, and the practical procedure is seldom described in detail, which makes reproducing study findings difficult. The objective of this paper is to provide a detailed description of a procedure developed and used for pharmacist-led medication review in acute admissions units.

Methods A procedure was developed based on clinical experience and inspiration from previous studies and literature on medication review models. The procedure was developed to fit the busy workflow in acute admissions units.

Results The procedure consists of five steps: (1) collection of clinical patient data, (2) collection of information about the patient's medical treatment, (3) patient interview, (4) critical examination of the patient's medications and (5) recommendations for the hospital physician.

Conclusions We have provided a detailed description of a procedure for pharmacist-led medication review. We do so, not to provide or advocate a single one-size-fits-all solution, but in an attempt to inspire a debate of the practical approach on how to execute a systematic medication review in order to develop and expand clinical pharmacy and achieve better patient outcomes.

  • Hospitals
  • Acute admissons units
  • clinical pharmacists
  • medication review
  • patient-centered
  • systematic procedure

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