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Clinical Pharmacist, Pôle pharmacie, Centre Hospitalier-Universitaire de Grenoble & Laboratoire ThEMAS TIMC UMR CNRS 5525, Université Joseph Fourier, Grenoble, France
Clinical Pharmacist, Service Pharmacie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, France
Clinical Pharmacist, Service Pharmacie, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, France
Clinical Pharmacist, Service Pharmacie-CRIM, Hôtel-Dieu, Centre Hospitalier-Universitaire de Rennes, France
Clinical Pharmacist, Service Pharmacie, Centre Hospitalier de Mayenne, France
Clinical Pharmacist, Service Pharmacie, Centre Hospitalier Auban-Moët, Epernay, France
Clinical Pharmacist, Service Pharmacie, Centre Hospitalier Lucien Hussel, Vienne, France
Clinical Pharmacist and Assistant Professor in Clinical Pharmacy, Pôle pharmacie, Centre Hospitalier-Universitaire de Grenoble & Laboratoire ThEMAS TIMC UMR CNRS 5525, Université Joseph Fourier
Reprints: Dr. Bedouch, Pôle Pharmacie, Pavillon Vercors, CHU Grenoble, BP 217, 38 043 Grenoble cedex 9, France, fax 33 4 76 76 51 09, PBedouch{at}chu-grenoble.fr
BACKGROUND: The development of clinical pharmacy activities in most European countries is underway; however, data on these activities are still poorly reported. Multicenter studies are necessary to standardize and demonstrate the value of clinical pharmacy activities in these countries.
OBJECTIVE: To document clinical pharmacists' daily routine interventions (PIs) to identify trends of intervention, drugs, and situations most frequently associated with drug-related problems (DRPs) and to estimate physicians' acceptance of PI.
METHODS: A prospective study of PIs was conducted in 6 French hospitals. The sample consisted of 300 randomized PIs per hospital, recorded during the medication order validation process when a DRP was identified. We recorded patients' demographic characteristics, drugs involved, wards, DRP description, pharmacists' recommendations, and whether or not the recommendations were accepted by the physicians.
RESULTS: A total of 38,626 medication orders were analyzed by 28 clinical pharmacists, leading to 1800 PIs (4.66 PIs per 100 medication orders). Of the 1800 PIs, 25.9% targeted psychotropic drugs, 15.9% targeted antithrombotic drugs, 15.5% targeted digestive and metabolic drugs, and 15.0% targeted cardiovascular drugs. The most commonly identified DRPs were nonconformity to guidelines or contraindication (21.3%), followed by improper administration (20.6%), supratherapeutic dose (19.2%), and drug interaction (12.6%). Nearly half (42.2%) of the pharmacists' recommendations were related to drug choice (drug switch 22.2%, drug discontinuation 16.3%, addition of a new drug 3.7%) followed by dose adjustment (23.8%), optimization of administration (21.9%; change of administration route 10.3%, administration modalities 11.6%), and need for drug monitoring (12.2%). The rate of physicians' acceptance was 73.4% (15.3% refusals, 11.3% not assessable).
CONCLUSIONS: In French hospitals, pharmacists contribute to preventing DRPs during medication order validation. This study suggests that a few types of drugs and errors constitute a substantial proportion of PIs. Knowledge of the most frequent DRPs could significantly increase the efficiency of clinical PIs.
Key Words: clinical pharmacy, drug-related problems, France, pharmacoepidemiology
Published Online, June 17, 2008. www.theannals.com, DOI 10.1345/aph.1L045
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