Pharmacist participation in the reduction of preventable adverse drug reactions in Thai hospitalised patients

Abstract

A non-randomised prospective study was carried out on two general medical wards during a 10 month control period followed by a 10 month intervention after period to assess whether a clinical pharmacist's intervention could reduce or prevent adverse drug reactions (ADRs) from occurring in a large teaching hospital. The rate of preventable ADRs occurring in hospitalised patients in both control and intervention periods was used as the primary outcome measure. The acceptance by physicians of a clinical pharmacist's interventions for preventing an ADR was a secondary measure. A total of 1,548 patients (765 male, 783 female) were monitored for ADRs during the control period with 985 (514 male, 471 female) patients being studied in the intervention period. It was found that the rate of preventable ADRs was 5.20 per 1,000 patient-days (95% confidence interval, 5.60-4.80) during the control period compared with 1.72 patient-days (95% confidence interval, 2.24-1.20) during the intervention period. Thus, the pharmacist's interventions resulted in a reduction in the number of preventable ADRs by 66.9% (p<0.001). In total, the clinical pharmacist made 143 recommendations to the medical care team resulting in avoidance of an ADR. These recommendations included dosage modification (48.3%), prevention of a possible drug-drug interaction (18.9%), inappropriate medication for the disease under treatment (13.9%), requests for therapeutic drug monitoring (13.3%) and the identification of a history-related drug-induced allergy (5.6%). Eighty percent of all the pharmacist's recommendations were accepted by the physician and implemented by the medical care team. In conclusion, the data from the present study demonstrate the value of providing a clinical pharmacy service in reducing the number of drug-induced ADRs in hospitalised patient resulting in improved patient safety to the benefit of both patients and the health service.