Although medication review by hospital pharmacists is an important part of patient care, insufficient resources may preclude a standardised implementation.
This study evaluated the impact, in terms of clinical harm and cost, of a weekly medication review over three months at a teaching hospital in Ireland.
Semi-structured interviews with nurses were also conducted to determine the perspectives of these healthcare professionals about the role and competencies of pharmacists.
The review of prescriptions for 128 patients resulted in 113 issues identified in 59 patients. These issues were communicated to the medical team on the same day; 99% of the recommendations made by pharmacists were accepted, and 88% of these were implemented.
Medication omissions were the most common error, in approximately 28% of the cases, followed by errors in taking medication history and duplications in about 16% of the interventions.
Analgesics were more frequently associated with errors requiring interventions. The total cost of medication review by a senior pharmacist was estimated to be approximately 2500EUR, with a net cost benefit of almost 40,000EUR.
The nurses interviewed thought that pharmacists were underutilised and stated the importance of their integration in the care units to improve patient outcomes and safety.