Background Pharmaceutical care is the pharmacist’s contribution to the care of individuals in order to optimise medicines use and improve health outcomes. Pharmacist interventions involve the identification of actual or potential drug-related problems and the provision of recommendations to resolve or prevent them.

Purpose The aim of this study was to characterise interventions performed during the review of prescription orders from the pharmacist responsible for supporting the Cardiology Department and evaluate prescribers’ acceptance rates.

Material and methods A descriptive, observational and retrospective study was performed between January 2015 and August 2017. The pharmacist screened the pharmacotherapy charts for drug-related problems leading to pharmacist interventions. All the pharmacist interventions registered on the electronic medical record system during the study period were eligible for inclusion. Interventions were quantified and characterised. Computer records were consulted to assess acceptance rates by prescribers. A descriptive analysis methodology was performed.

Results A total of 15 707 prescriptions were reviewed and 1152 pharmacist interventions were made. The pharmacist interventions were categorised into three main sets: drug-, dosage- and administration-related. The majority of interventions made were classified as alternative/new therapy recommended (19.0%), more appropriate dose/dosage regimen (12.9%) and optimisation of drug administration (11.9%). Of the total of the pharmacist interventions made, 544 were accepted, 330 were not accepted and 278 were unresolved. Analysing the most relevant types of pharmacist interventions, the highest acceptance rates were for interventions advising the wrong length of therapy/discontinue therapy (87.0%), wrong dose prescribed (79.0%), alternative route of administration (79.0%) and duplicate therapy (75.3%). The global rate of acceptance was 62.2%.

Conclusion The results from this study revealed that prescribers’ acceptance rates for pharmacist interventions were higher for medication-prescribing errors compared with recommendations for pharmacological therapy optimisation or safety concerns. The acceptance rate could be more accurate if in a further study verbal interventions would be included, since the most urgent recommendations are made verbally, which would likely increase the acceptance rate. The integration of clinical pharmacists on the multidisciplinary team seems to be essential in promoting a more safety and efficacy culture in hospital settings.

No conflict of interest