Category: Prevention of medication errors and drug misuse/abuse

Title: Impact of Clinical Pharmacist Interventions in a Non-teaching Cardiac Care Hospital

in Southern India.
Authors: Rahul Ray1, Parthasarathi G2, Rajesh Kenche, Himanshu Patel, Ramesh M3
Affiliation: Department of Pharmacy Practice, JSS Medical College Hospitaof Pharmacyl,
JSS University, Mysore, Karnataka, India.1, 2, 3
Objective: This study was conducted to assess the nature and extent of clinical pharmacists
interventions in cardiac care setting and to estimate the acceptance of clinical pharmacists
interventions among health care professionals. This study was also aimed to find out impact
of clinical pharmacist interventions on over all drug therapy of patients in a cardiac care
setting.
Methodology: The study was a prospective interventional study carried out in the cardiac
care department of Vikram hHospital in, Mysore, India for a period of one year. Clinical
pharmacist visited the cardiology units and reviewed the cases on daily basis. Medical notes
were analyzed comprehensively for possible drug related problems (DRPs). After
identification of DRPs, appropriate interventions were made to resolve them. Acceptance of
clinical pharmacist interventions among health care professionals, significance and impact of
pharmacist interventions were also assessed. Interventions made were categorised as minor,
moderate and major.
Results: A sum total of 1357 patients was were admitted to the cardiology department over a
period of 12 months out of which 950 patients/patient records were reviewed. A total of 185
DRPs were identified from 174 patients. Of the total interventions made Renal drug dDosage
aAdjustment 25.4% (n=47) was most commonly observed followed by dDrug iInteraction
16.8% (n= 31), iImproper dDrug sSelection 14.6% (n=27), dDrug dDuplication 11.3%
(n=21), oOverdose 10.3% (n=19), drug aAdministration eError 7.6% (n=14),
cContraindication 3.2% (n=6), ADR detectionadverse drug reaction 2.7% (n=5), dDrug use
without indication 2.2% (n=4) and sSub-therapeutic dose 0.5% (n=1). Acceptance of clinical
pharmacist intervention was found to be 96.1%. Upon acceptance, drug therapy was modified
by cChange in drug dosage 44.9% (n=83) followed by cCessation of dDrug 42.7% (n=79),
aAddition of a drug 2.7% (n=5), cChange in dosage form 2.2% (n=4), cChange in duration of
therapy 1.6% (n=3), sSubstitution of drug 1.6% (n=3). Significance of the clinical pharmacy
interventions made were 56.7% Major (n=105) and 43.2% Moderate (n=80). Majority of the
suggestions made were directed to the cCardiologist 70.8% (n=131) followed by pPhysicians
21% (n=39) and nNursing staff 8.1% (n=15). Perceived patient benefit which resulted from
pharmacist interventions were reduction in cCost of medications 44.3% (n=82), pPreventing
side-effects or toxicities 35.1% (n=65) and iImproved therapeutic outcome 20% (n=37).
Conclusion: Clinical pharmacist interventions provide a valuable contribution towards the
identification and prevention of drug related problems and significantly improve patient
outcome. Clinical pharmacist interventions were widely accepted and utilised for optimising

drug therapy in cardiac care settings. Pharmacist recommendations made significant changes
in practice in cardiac care units.
Key words: Interventions, clinical pharmacy, drug related problems, cardiac care unit.
Name & address of corresponding author:
Rahul Ray PharmD; Department of Pharmacy Practice, JSS Medical College Hospital, JSS
University, Mysore, Karnataka, India, Email: rahulray.al85@gmail.com; Mob:+9019628115.