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.