Background and importance Intensive clinical pharmacy input from admission to discharge has been shown to improve patient outcomes. The clinical pharmacy service in our institution has historically been under-resourced.

Aim and objectives The study aim was to develop a ward based clinical pharmacy service and to evaluate its impact using a number of clinical, safety and financial metrics.

Material and methods A clinical pharmacist was assigned to provide pharmaceutical care to patients on a medicine for the older person ward. Over an 8 week period, the pharmacist prospectively recorded her interventions/activities. To assess impact on patient care, interventions were graded according to the Eadon criteria. The potential cost avoidance associated with interventions was estimated using two methods identified in the literature. Both define costs related to medication errors and calculate cost avoidance associated with clinical interventions based on prevention of harm. Medication incident reporting was analysed to assess the impact on patient safety.

Results

• Eighty–four patients received a pharmacist review. Across a spectrum of activities, a total of 267 pharmacist interventions were recorded: 87% of patients had at least one pharmacist intervention.

• A total of 90% of interventions requiring follow–up with the medical team were accepted and resulted in a change to patient care.

• Eadon grading of interventions deemed that 81% of interventions improved the standard of patient care.

• Two different methods were used to estimate potential cost avoidance: one estimated annual savings of €154 103–€344 926; the other estimated these at €174 373. Given current pharmacist salary costs, this equates to a cost–benefit ratio of 2.8:1 to 6.3:1. (This does not include the 27% reduction in drug spend observed during the study period. However, more longitudinal data are required to confirm and characterise this phenomenon.)

• In the third quarter of 2018, 21 medication incidents were reported from the study ward compared with an average of 4 incident reports from the first and second quarters of 2018. This represents a fivefold increase in medication incident reporting, suggestive of an enhanced culture of patient safety.

Conclusion and relevance This study assessed and quantified a wide spectrum of pharmacist contributions to medication management and safety. Costing of these contributions estimated the cost–benefit ratio of the clinical pharmacy service, providing compelling support for the extension of this service throughout the hospital.

References and/or acknowledgements No conflict of interest.