Pharmacy World and Science

, Volume 25, Issue 2, pp 56–64 | Cite as

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

  • C. Galindo
  • M. Olivé
  • C. Lacasa
  • J. Martínez
  • C. Roure
  • M. Lladó
  • I. Romero
  • A. Vilá


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.

Antibiotic prophylaxis Cost savings Hospital pharmacy Pharmaceutical care Pharmacist interventions Pharmacoeconomics Spain Thromboembolic prophylaxis 


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  1. 1.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990; 47: 533–43.Google Scholar
  2. 2.
    Jiménez Torres NV, Climente Martí M. Atención farmacéutica: premisa para la calidad asistencial. [Pharmaceutical care: premise for quality in caregiving.] Rev Calidad Asistencial 1998; 13: 83–90.Google Scholar
  3. 3.
    ASHP guidelines on a standardized method for pharmaceutical care. Am J Health Syst Pharm 1996; 53: 1713–6.Google Scholar
  4. 4.
    Hepler CD. Pharmaceutical care. Pharm World Sci 1996; 18: 233–36.Google Scholar
  5. 5.
    White SJ. Pharmaceutical care, impossible dream today? Am J Health Syst Pharm 1996; 53: 1817–20.Google Scholar
  6. 6.
    Ivey MF. Re-engineering for dramatic improvement in the medication-use process. Am J Health Syst Pharm 1995; 52: 2681–5.Google Scholar
  7. 7.
    Pérez MT, Crusat D. Impacto de un proceso de "feed-back" informativo sobre la prescripción farmacéutica. [Impact of feedback on pharmaceutical prescriptions.] Aten Primaria 1996; 18: 386–90.Google Scholar
  8. 8.
    Stern CS. Evaluating the performance of a pharmacy benefit management company. Am J Health Syst Pharm 1995; 52: 1865–78.Google Scholar
  9. 9.
    Keys WF, Goetz MC. Computer-guided academic detailing as part of a drug benefit program. Am J Health Syst Pharm 1995; 52: 2199–204.Google Scholar
  10. 10.
    Santó MM, Lacasa C, Fraile MJ et al. Programa de garantía de calidad en el servicio de farmacia del Hospital de Barcelona. [Pharmacy service quality control program at the Hospital de Barcelona.] Farm Hosp 1998; 22: 241–8.Google Scholar
  11. 11.
    Uso racional de antibióticos en los hospitales. Un proyecto para los servicios de farmacia. [Rational use of antibiotics in hospitals. A project for pharmacy services.] Farm Clin 1996; 13: 229.Google Scholar
  12. 12.
    Martínez JA, Baeza JE. Impacto de un programa de uso racional del medicamento sobre la prescripción en un área de salud. [Impact of a rational drug use program on prescriptions in a health-care area.] Aten Primaria 1996; 18: 551–9.Google Scholar
  13. 13.
    Castillo A, Martínez ML, Suárez G et al. Evaluation of pharmaceutical care provided to inpatients of a internal medicine service. Communication at 3rd Congress of the European Association of Hospital Pharmacists, Edinburgh, 1998.Google Scholar
  14. 14.
    Eisenberg JM, Koffer H, Glick HA, et al. What is the cost of nephrotoxicity associated with aminoglycosides? Ann Intern Med 1987; 107: 900–9.Google Scholar
  15. 15.
    Mutnick, A. Cost savings and avoidance from clinical interventions. Am J Health Syst Pharm 1997; 54: 392–6.Google Scholar
  16. 16.
    Weidle P, Bradley L, Gallina J, Mullins CD, Thorn D, Siegel LP. Pharmaceutical care intervention documentation program and related cost savings at a university hospital. Hosp Pharm 1999; 34: 43–52.Google Scholar
  17. 17.
    Schneider PJ, Gift MG. Cost of medication-related problems at a university hospital. Am J Health Syst Pharm 1995; 52: 2415–8.Google Scholar
  18. 18.
    Pilzer JD, Burke TG, Mutnick AH. Drug allergy assessment at university hospital and clinic. Am J Health Syst Pharm 1996; 53: 2970–5.Google Scholar
  19. 19.
    Classen DC, Pestotnik SL, Evans RS et al. Adverse drug events in hospitalized patients. JAMA 1997; 277: 301–6.Google Scholar
  20. 20.
    Classen DC, Evans RS, Pestotnik SL et al. The timing of prophylactic administration of antibiotics and the risk of surgicalwound infection. N Engl J Med 1992; 326: 281–6.Google Scholar
  21. 21.
    Listados de procedimientos quirÚrgicos del protocolo de Profilaxis Antibiótica QuirÚrgica. Hospital de Barcelona, 1998.Google Scholar
  22. 22.
    DiPiro J, Martindale R, Bakst A et al. Infection in surgical patients: Effects on mortality hospitalization, and postdischarge care. Am J Health Syst Pharm 1998; 55: 777–81.Google Scholar
  23. 23.
    Listados de procedimientos. [Procedures.] Hospital de Barcelona, 1998.Google Scholar
  24. 24.
    Jiménez NV, Casabó VG, Sancho V. Manual de procedimientos para farmacocinética clínica. [Manual of procedures for clinical pharmacokinetics.] 1997; I1, VI6, VI96.Google Scholar
  25. 25.
    Berquist D. Screening and diagnosis of deep vein thrombosis pulmonary embolism. Haemostasis 1993; 23 (Suppl 1): 57–60.Google Scholar
  26. 26.
    Martínez J, Roure C, Lacasa C et al. Garantía de calidad asistencial: indicadores de actuación en la profilaxis de la enfermedad tromboembólica postquirÚrgica. [Health-care quality assurance: indicators of need for postoperative thromboembolic disease prophylaxis.] Farm Clin 1997; 14: 418–29.Google Scholar
  27. 27.
    Delgado O, Hidalgo O, Marruguet M et al. Profilaxis quirÚrgica: adecuación a un estándar de calidad. [Surgical prophylaxis: meeting a quality standard.] Presentation at the XLI Congress of the Sociedad Española de Farmacia Hospitalaria.Google Scholar
  28. 28.
    Quebbeman EJ, Franson TR, Whipple JE et al. Arch Surg 1985; 120: 1069–71.Google Scholar
  29. 29.
    Martínez A, Ribes JL, Castanyer B, Puigventós F, Lozano P, Jordà R, Riera M. Aminoglucósidos: identificación sistemática de candidatos a la monitorización. [Aminoglycosides: systematic identification of candidates for monitoring.] Presentation at the XLI Congress of the Sociedad Española de Farmacia Hospitalaria.Google Scholar
  30. 30.
    Pérez JL, Castillo JR, Torelló J et al. Estudio de la interención sobre la utilización de profilaxis tromboembólica. Comunicación presentada en el XLI Congreso de la Sociedad Española de Farmacia Hospitalaria, 1996.Google Scholar
  31. 31.
    Cuenca ML, Aguilar T, Desongles T et al. Cambios en la terapéutica tras la intervención del farmacéutico. [Therapy changes following pharmacist interventions.] Farm Clin 1998; 15: 76–82.Google Scholar
  32. 32.
    Prieto R, Iglesias A, Ruiz de Velasco E et al. Intervención farmacéutica en la prescripción de medicamentos. [Pharmacist interventions in drug prescribing.] Presentation at the XL Congress of the Sociedad Española de Farmacia Hospitalaria.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • C. Galindo
    • 1
  • M. Olivé
    • 2
  • C. Lacasa
    • 2
  • J. Martínez
    • 2
  • C. Roure
    • 2
  • M. Lladó
    • 2
  • I. Romero
    • 2
  • A. Vilá
    • 2
  1. 1.Pharmacy ServiceHospital de BarcelonaBarcelonaSpain E‐mail
  2. 2.Pharmacy and Dietetics ServiceSCIAS Hospital de BarcelonaBarcelonaSpain

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