Journal of Research in Pharmacy Practice

Abstract Current literature indicates that the presence of clinical pharmacists in hospitals results in improved patient care, rational drug therapy, and treatment costs. This study assessed the clinical pharmacy services in the intensive care unit (ICU) of a tertiary hospital at Tabriz University of Medical Sciences, Iran. Methods: During a 9-month cross-sectional study (2014–2015), the clinical pharmacy interventions in 27 sessions and educational activities for patients and health-care professionals were randomly assessed based on the Australian guideline and standard of practice for clinical pharmacy. The interventions of clinical pharmacist were evaluated in terms of their clinical importance. Findings: In this study, a total of 832 interventions on 242 patients were performed by the clinical pharmacist, and approximately 93.6% of the interventions were approved by the attending physician. Most interventions concerned adding a new medication to a drug regimen or switching to a needed new medication. Each patient received an average of three interventions. The clinical pharmacist provided drug information to employees and medical staff in 108 of the total 832 interventions (13%). Medical residents who were surveyed indicated that the quality of education, research, and patient care was improved by the attendance of a clinical pharmacist. Conclusion: The results of this study show that the collaboration of a clinical pharmacist with the medical staff of an ICU can improve pharmacotherapy approach and increase the quality of education.

Abstract Objective: Pharmacy‑driven medication history (MH) programs have been shown 
to reduce the number of serious or potentially life‑threatening (S/PLT) medication 
discrepancies (MDs) in many settings, but not Intensive Care Units (ICUs).
Methods: MHs were repeated over a 6‑week period. Demographics, number, and nature 
of MDs were documented. Discrepancy severity was graded using a previously published 
method. Primary outcome was the proportion of MHs containing >1 S/PLT MDs.
Findings: Sixty‑three MHs were repeated. Pharmacy MHs were less likely to 
contain ≥1 S/PLT MDs (0% vs. 50%, P < 0.001).
Conclusion: Pharmacy MHs contained fewer S/PLT MDs in this small sample. S/PLT 
MDs on admission and home medication lists were common in patients admitted to 
the medical ICU. Pharmacy‑driven medication reconciliation (MR) reduced the number 
and frequency of these discrepancies. Further research is required to improve current 
MR procedures.