Background Patient-centred clinical pharmacy is still in its early stages in _, despite its well evidenced positive impact worldwide. Studies show that clinical pharmacists are valuable members of the healthcare team in improving medicines outcomes in patients with liver disease and liver transplant recipients.

Purpose To assess the results of the introduction of clinical pharmacy services on the hepatology ward of a tertiary care teaching hospital in _.

Material and methods The prospective observational study was conducted on a hepatology ward from March to July 2014, at Gastroenterology and Hepatology Clinic, _. The clinical pharmacist evaluated medicines use during a 4 h visit once per week, and made recommendations to the prescribing physician. The interventions to optimise prescribing were classified according to type and acceptance by the physician.

Results A total of 107 medicines-related interventions were made for 57 patients (investigated or treated for alcohol-related liver disease, non-alcohol-related steatohepatitis, viral hepatitis, autoimmune hepatitis, biliary cirrhosis, sclerosing cholangitis, liver transplant recipients), of which the clinical pharmacist initiated 84 (78.5%) interventions, while 23 (21.5%) interventions were initiated by other health care professionals. The most frequent drug related problems requiring interventions were: incorrect dose (14.7%), inappropriate choice of medicine (11.9%), adverse drug reaction (10.1%) and unavailability of necessary drug (8.9%). The most common type of recommendation was dose adjustment (22.7%), change (15.5%) or discontinuation (11.9%) of a drug, followed by a consultation with a healthcare professional regarding potential adverse drug reactions, interactions and other available treatment options (10.7%). Acceptance rate by physicians was 87.3%.

Conclusion Involving a clinical pharmacist in a hepatology team led to clinically significant and embraced optimisation of medicines use. This approach may serve as a baseline and the support for further development of clinical pharmacy in

References and/or Acknowledgements No conflict of interest.