RT Journal Article SR Electronic T1 Comprehensive evaluation of clinical pharmacists' interventions in a large Austrian tertiary care hospital JF European Journal of Hospital Pharmacy: Science and Practice JO Eur J Hosp Pharm FD British Medical Journal Publishing Group SP 529 OP 534 DO 10.1136/ejhpharm-2012-000131 VO 19 IS 6 A1 Gunar Stemer A1 Gerda Laml-Wallner A1 Ingrid Kuegler A1 Petra Poelzleitner A1 Simone Messner A1 Sonja Steininger A1 Elfriede Dolinar A1 Sonja Zehetmayer YR 2012 UL http://ejhp.bmj.com/content/19/6/529.abstract AB Objectives To analyse drug-related problems (DRPs) and describe clinical pharmacists' interventions Method A prospective 22-week observational descriptive clinical pharmacists' intervention study on six different wards of an Austrian tertiary care university hospital. In-depth analysis of DRPs, performed interventions and inter-rater and intra-rater variability analysis of interventions' significance assessment was conducted. Type and frequency of DRPs, clinical pharmacists' interventions and the physicians' acceptance rate were recorded. Further outcome parameters were the clinical significance of the interventions and the proportion of those with a cost-reducing potential. Results A total of 478 DRPs were detected during 138 ward rounds. The most common DRPs related to specific therapy discussions (30.1%), organisational advice (14.2%), medical chart errors (7.7%), untreated indications (7.5%) and drug use without indication (6.9%). Clinical pharmacists provided information (42.9%), suggested the addition of new drugs (13.4%) and the adaptation of drug dosages (12.6%). Antibacterials for systemic use, antithrombotics and drugs for acid-related disorders were commonly implicated. The mean acceptance rate of interventions was 54.7%. Three out of four clinical pharmacists' interventions were rated to be significant. The inter-rater reliability analysis of clinical significance immediately and 2 weeks after study completion showed a fair to moderate agreement (Fleiss's κ 0.35, pairwise Spearman correlation coefficients between 0.5 and 0.74, all p < 0.0001). One out of 20 interventions showed a cost-reducing potential. Conclusions The results highlight a positive impact of clinical pharmacy services in a continually developing environment. Although, on average, every second intervention was immediately accepted, the proportion of significant interventions was high. Clinical pharmacy services are one method of addressing evident DRPs in hospitalised patients in Austria.