Pharmaceutical care:: pharmacy involvement in prescribing in an acute-care hospital

Background: Pharmaceutical care implies reaching a consensus with physicians on prescriptions in cases that call for the substitution of one active ingredient for another, a modification in dose, frequency, route of administration, etc., through the unit-dose distribution system. The goal of pharmacist interventions in the hospital should be to achieve a rational use of drugs; to ensure this, a daily review of patient prescriptions by a pharmacist is necessary. Most of the incidence of drug-related morbidity and mortality is predictable and can be avoided, thus reducing the overall cost of health care and the duration of hospitalization while improving the quality of care. The optimum quality of physician or pharmacist care to be achieved would be one that which maximizes benefits and minimizes risks and costs. Objective: The goal of this study was to evaluate pharmacist interventions at the Hospital of Barcelona over a six-month period and their clinical and economic repercussions and the degree of compliance. Method: The interventions were recorded on a card and classified by type: antibiotic or thromboembolic prophylaxis; substitution of an active principle not included in the hospital's Pharmacotherapeutic Guide; change in dose or route of administration; therapeutic duplication; dose adjustment of aminoglycosides and vancomycin; and inappropriate treatment duration. The economic evaluation considered the average cost of a hospital stay and of the procedures and diagnostics in 1998 and applied data on published probability rates and drug costs. Results: A total of 3,136 interventions were analyzed prospectively during the study period. The interventions represented savings of 129,058.31 euros. Those that contributed most to these savings were recommendations for antibiotic prophylaxis, thromboembolic prophylaxis and pharmacokinetics studies: 49.4, 47 and 5.7% of interventions, respectively, and 79, 3.6 and 15% of total savings, respectively. Conclusion: In general, the degree of acceptance of the interventions was high (88.8%), as a result of the growing compliance by physicians with the hospital's established protocols. It can be concluded that pharmacist interventions have been useful to improve patient care and have been important to help educate physicians on the quality of drug therapy.