Clinical pharmacists' interventions in a German University Hospital

Objective To evaluate pharmaceutical interventions by ward-based clinical pharmacists in Germany. Setting Two ward-based clinical pharmacists working at the Departments of Stem Cell Transplantation and Intensive Care Medicine. Methods Pharmaceutical interventions during ward rounds from December 1st 2006 to November 30th 2008 were recorded and classified according to our own system that was adopted from established classification systems. Main outcome measure Classification of (1) cause of intervention, (2) intervention, (3) outcome of intervention and (4) initiator of intervention. Results Altogether 2,312 interventions were documented. Besides 520 cases of information about drugs (rational selection, occurrence of infrequent adverse events or interactions), the main interventions were recommendations for the addition, the withdrawal or the replacement of a drug (n = 907, 50.6%) and advices for the change of dosage, dosing intervals or dose adjustment according to impaired renal or liver function (n = 584, 32.6%). The vast majority of the suggested interventions (92.8%) have been accepted. Conclusion The participation of a clinical pharmacist during ward rounds contributes to the optimisation of pharmacotherapy, in terms of choosing the most appropriate drug and/or the suitable dosage and may improve patient care.