Background and Importance Implementation of bedside clinical pharmacy services prevents medication errors and associated adverse events but is not possible in many European countries on a hospital-wide and/or on full-time basis due to limited resources. Clinical rules using structural information in the electronic health record can help bedside pharmacists to prioritise their work on the ward by identifying potential high-risk situations. Hence, a risk-based clinical pharmacy service was developed and implemented at the trauma ward, as a proof of concept.

Aim and Objectives To evaluate the impact of a risk-based clinical pharmacy service on potential inappropriate prescriptions (PIPs) at the trauma ward.

Material and Methods The impact on the proportion of residual PIPs per day, i.e. the number of PIPs that persisted up to 24h after pharmacist intervention divided by the number of PIPs at T0, was evaluated using an interrupted time series analysis. The pre-intervention cohort received usual pharmacy services, i.e. 0.3 FTE availability of a junior bedside clinical pharmacist. In the post-intervention period, the pharmacist could rely on 16 clinical rules, targeting antimicrobial, anticoagulant and analgesic therapy. The pre-intervention period was compared to two post-intervention scenarios to investigate possible requirements for the intervention: (scenario A) clinical rule alerts reviewed by a junior clinical pharmacist on a 0.3 FTE basis; and (scenario B) clinical rule alerts reviewed daily for approximately 1h by a clinical pharmacist with one year of clinical pharmacy experience.

Results Pre-intervention, a median proportion of 67% residual PIPs per day was observed. Scenario A showed an immediate relative reduction of 42% (p=0.15) and scenario B a significant immediate relative reduction of 77% (p=0.03) in residual PIPs per day. In scenario A, recommendations were provided by the pharmacist for 19% (44/232) of clinical rule alerts, of which 69% was accepted by the trauma surgeon within 24h. In scenario B, recommendations were given for 56% (167/299) of clinical rule alerts, of which 84% was accepted.

Conclusion and Relevance The use of clinical rules is an effective approach to organise bedside clinical pharmacy services and improves the efficiency of the clinical pharmacist at the trauma ward. Pharmacist’s experience and daily follow-up of the clinical rule alerts are two requirements to be considered.

Conflict of Interest No conflict of interest