Background and importance The roles of hospital pharmacists have been expanded from dispensing to patient care. Establishing interprofessional collaboration between pharmacists and other specialists significantly improves the quality of patient care.

Aim and objectives To analyse pharmaceutical interventions (PIs) carried out in a preliminary phase of a pharmaceutical care programme targeting hospitalised patients.

Material and methods A retrospective descriptive study of PIs was carried out in a tertiary referral hospital (529 beds) over a 1 year period, from January to December 2019. The pharmaceutical care programme was conducted by five pharmacists involving 14 hospitalisation units. Data were obtained from the electronic medical record. Variables included were: number of patients susceptible of monitoring, number of PIs, PIs per patient, type of PI, PIs per hospitalisation unit and acceptance rate. PIs included resolution of issues raised by specialists and proactive recommendations and were performed in the electronic prescription programme (Farmatools). The PIs were registered and classified into eight groups: pharmacokinetic monitoring, dose adjustment in renal failures, clinically relevant interaction, medical reconciliation error, prescribing error, information to prescriber, adverse drug reaction and other.

Results 1102 PIs were performed in 868 patients during the study period (1.3 PI per patient): 19.7% (216) were related to pharmacokinetic monitoring, 19.1% (210) to dose adjustment in renal failure, 14.1% (155) to clinically relevant interactions (categories D and X of Lexicomp), 11.2% (123) to medical reconciliation errors, 10.4% (115) to prescribing errors, 10.3% (114) to information to prescribers, 7.6% (84) to adverse drug reactions and 7.7% (85) other. Regarding PIs per hospitalisation unit: 12.4% were related to pneumology, 11.9% to internal medicine, 9.2% to neurology, 9.1% to general surgery, 8.4% to urology, 8% to traumatology, 7.7% to digestive, 7.3% to vascular surgery, 7% to cardiology, 5.4% to neurosurgery, 5.1% to oncology, 4% to heart surgery, 3% to psychiatry and 1.5% to intensive care unit. The acceptance rate was 78.6% (866).

Conclusion and relevance The acceptance rate was high, which indicated considerable concern by the majority of hospitalisation units. The clinical pharmacist’s integration into hospitalisation units improved the quality of patient care, especially through pharmacokinetic monitoring and dose adjustment in renal failure.

Conflict of interest No conflict of interest