Pharmacists' active interventions in a children's hospital: an Australian context.

Abstract

PURPOSE: This study documented pharmacists’ active interventions leading to changes in drug therapy in order to (i) compare the nature of clinical pharmacists’ active interventions made in different practice settings within a children’s hospital, and (ii) identify the predictors for physician acceptance of the interventions. METHODS: The primary investigator observed and documented all clinical interventions performed by clinical pharmacists for between 35 – 37 days on five study wards. The rates and types of pharmacists’ interventions on the different wards were then com- pared. Multivariate logistic regression analysis using SPSS version 22.0 was performed to identify the predictors of physician acceptance of the interventions. RESULTS: The Hematology-Oncology Ward had a higher rate of active interventions (2.43 interventions per 100 medication orders) compared to general medical settings and general surgical setting. Active interventions contributed for less than a quarter of all interventions on the general medical and surgical wards com- pared to nearly half (46.2%, p < 0.001) on the specialty Hematology-Oncology Ward. Dose adjustment was the most frequent active interventions in the general settings, whilst drug addition constituted the most common active interventions on the Hematology-Oncology Ward. The degree of acceptance of pharmacists’ intervention by physicians was high (90% for active interventions). There were three variables significantly predicting the intervention acceptance, namely patients’ age (OR = 0.893; 95% CI 0.813, 0.981), non high-risk medication category (OR = 2.801; 95% CI 1.094, 7.169), and pharmacists’ experience (OR = 1.114; 95% CI 1.033, 1.200). CONCLUSIONS: The rate of pharmacists’ active interventions documented on Hematology-Oncology Ward was higher than the general medical and surgical wards. The pattern of the interventions documented on Hematology-Oncology Ward was also different compared to that of other wards. The interventions involving younger patients, addressing non high-risk medication related problems, being recommended by more experienced pharmacists were associated with increased likelihood of acceptance by physicians.