Evaluation of pharmacist clinical recommendations in a geriatric hospital

Abstract

Objectives: This study was undertaken to record the number and type of recommendations made by pharmacists reviewing the drug treatment of older patients, to note acceptance of these recommendations by physicians and to assess clinical significance of pharmacist recommendations. Method: Three pharmacists providing inpatient services at Zammit Clapp Hospital were asked to record specific details of all recommendations given using a designed documentation form. The clinical impact of the pharmacists’ recommendations was assessed by the pharmacists making the recommendations together with a panel of two independent pharmacists and a medical doctor who had to rate the contribution of each recommendation as major, moderate, minor or of no clinical significance. Key findings: A total of 263 valid pharmacist recommendations were documented. The most frequent recommendations, accounting for 20.5% (n=54) of the total number of recommendations were adjustment to dosage, frequency and time of administration followed by discontinuation of a medication. The majority of recommendations were accepted by physicians (80%) and were rated by the panel to be of moderate (60.5%) clinical significance. Conclusion: Clinical pharmacists make a number of recommendations of significant clinical benefit to the care of hospitalised elderly patients, the majority of which are accepted by physicians.