Background and importance There has been a change in the performance of hospital pharmacists, aimed at increasing their participation in the pharmacotherapeutic process of patients through inclusion in the multidisciplinary team.

Aim and objectives Quantification and analysis of pharmaceutical interventions carried out by a pharmacist in an internal medicine service.

Material and methods The analysis of pharmaceutical interventions was carried out prospectively over 10 weeks. The pharmacist accompanied the doctors during their visit. The following variables were analysed: characteristics of the patients, number of interventions, type of interventions and acceptance of the interventions. Interventions that generated changes in the prescription were considered ‘accepted’ and those that were rejected ‘not accepted’.

Results 39 patients were visited with a mean age of 81 years (39–95). The reason for admission was mainly respiratory (25.65%), followed by heart failure, kidney problems and low back pain (10%). Patients had a median of seven comorbidities, highlighting arterial hypertension (66.67%), and were polymedicated with a median of nine drugs. During the study period, 108 interventions were performed. The interventions were classified as follows:

• 38 (35.16%) adequacy of treatment

• 18 (16.66%) reconciliation of medication

• 9 (8.33%) sequential therapy

• 9 (8.33%) nutritional advice

• 6 (5.56%) substitutions by therapeutic equivalents

• 5 (4.63%) de–prescription of drugs of low therapeutic utility

• 5 (4.63%) modifications in the duration of treatment

• 4 (3.70%) detection of therapeutics duplications

• 4 (3.70%) management of medications not included in the pharmacotherapeutic guide

• 3 (2.78%) drug detection without justification

• 3 (2.78%) dose adjustments for renal or hepatic failure

• 2 (1.85%) incomplete prescriptions

• 1 (0.93%) detection of drug interactions

• 1 (0.93%) detection of allergies.

95% of the prescriptions were accepted, and of these 95% implied changes in the medical prescription.

Conclusion and relevance The high number of interventions carried out shows that the integration of the pharmacist in the internal medicine service facilitates the detection, prevention and resolution of errors related to medications and more appropriate treatment on admission to hospital or discharge from home. Most of the interventions were accepted; a high number of interventions were related to the adequacy of the treatment.

Conflict of interest No conflict of interest