Assessment of clinical pharmacist interventions using a web-based application in a Saudi Arabian Tertiary Hospital.

OBJECTIVES: Medication-related problems are a top concern of clinical pharmacists. Medication-related problems can cause patient harm and increase the number of visits, hospital admissions, and length of hospital stay. The objective was to assess clinical pharmacy medication-related problem-related interventions in a tertiary care setting.

METHODS: A retrospective cohort study was conducted at King Fahad Armed Forces Hospital in Jeddah (Saudi Arabia) between June 2021 and June 2022. The data were extracted monthly from a new web-based Microsoft Excel application documenting medication-related problems during any stage of the medication use process.

RESULTS: A total of 5310 medication-related problem-related interventions in 1494 patients were performed. The departments associated with the highest frequency of medication-related problem-related interventions were the critical care unit (26.9%), intensive care unit (23.8%), anticoagulation clinic (17.1%), medical ward (11.3%), and nephrology unit (6.8%). The most common type of medication-related problem-related interventions included inappropriate dosage regimens (25.6%), monitoring drug effect or therapeutic drug monitoring (24.4%), requirement of additional drug therapy (21.9%), and inappropriate drug selection (14.1%). The proposed interventions were accepted by physicians in 97% of the incidents. The most frequent medication classes associated with medication-related problem-related interventions were cardiovascular agents (47.6%), antimicrobial agents (27.2%), and nutrition and blood substitute agents (11.4%). The most frequent medication groups associated with medication-related problem-related interventions were anticoagulants (25.6%) and antibiotics (25.2%).

CONCLUSIONS: The current findings characterize the medication-related problem-related interventions addressed in clinical pharmacy at a tertiary care setting. The high rate of physician acceptance emphasizes the integral patient safety role of clinical pharmacy services.