[Diffusion of pharmacist interventions within the framework of clinical pharmacy activity in the clinical ward].
BACKGROUND
Computerised physician order entry (CPOE) and the integration of a pharmacist in clinical wards have been shown to prevent medication errors.


OBJECTIVE
The objectives were to describe interventions performed by a clinical pharmacist integrated into clinical wards with CPOE, to assess the acceptance of interventions by prescribers, and to describe factors associated with acceptance.


METHODS
A 3-week prospective study was conducted in five wards of a 2000-bed French teaching hospital.


RESULTS
During pharmacist review of medication orders and participation on physician rounds, six resident pharmacists provided interventions either conveyed orally to prescribers, using the computer system, or combining both methods. There were 221 pharmacist interventions concerning drug-drug interactions (27%), drug monitoring (17%) and computer-related problems (16%). Pharmacist interventions consisted of change of drug choice or dose adjustment (49%), drug monitoring (17%) and administration modality optimisation (14%). Interventions were provided solely via computer systems in 67% of cases. The rate of intervention acceptance was 47.1%. In multivariate analysis, acceptance was significantly associated with oral transmission (odds ratio [OR] = 6.46; 95% confidence interval [95% CI] [1.65-25.24]; p < 0.01), change of drug choice or dose adjustment recommendations (OR = 3.81; 95% CI [1.63-8.86]; p < 0.01) and administration modality optimisation recommendations (OR = 9.51; 95% CI [3.02-29.93]; p < 0.01).


CONCLUSIONS
Communication method and nature of recommendation are factors associated with pharmacist intervention acceptance. CPOE is necessary to develop clinical pharmacy practice. However, only the integration of the pharmacist on the ward can guarantee a high level of acceptance of pharmacist interventions by prescribers.
Bedouch
Pierrick
P
Département de Pharmacie, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France. PBedouch@chu-grenoble.fr
Allenet
Benoît
B
Labarere
José
J
Brudieu
Etienne
E
Chen
Carole
C
Chevrot
Dominique
D
Tessier
Alexandre
A
Trivin
Caroline
C
Rousseau
Agnés
A
Calop
Jean
J
D005602:France; D006746:Hospital Bed Capacity, 500 and over; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients; D019300:Medical Errors / Q000517:prevention & control*; D010362:Patients' Rooms; D010607:Pharmacy Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*