Pharmacy World & Science

, Volume 30, Issue 1, pp 31–38 | Cite as

Evaluation of pharmacist clinical interventions in a Dutch hospital setting

  • Liesbeth BosmaEmail author
  • Frank G. A. Jansman
  • Anton M. Franken
  • Johannes W. Harting
  • Patricia M. L. A. Van den Bemt
Research Article



Assessing the relevance of a clinically active pharmacist method compared to the traditional working method.


The study was carried out in a general internal/gastro-enterology unit during two 8-weeks periods in 2004. It was an observational, non-randomized prospective study. Outcome measures were compared before and during the intervention. The intervention was the active presence of a junior hospital pharmacist on the unit. The pharmacist focused on the pharmacotherapy of the individual patient. Patients were included when they used 5 or more medicines on day 1 or 2 of their stay at the ward and/or used at least 1 high-risk drug. Clinical pharmacist interventions were counted and classified. A hospital pharmacist and an internal medicine specialist assessed the clinical relevance of all clinical pharmacist interventions retrospectively. The degree of acceptance of the interventions by physicians was measured. Finally, time associated with the clinical activities was measured.

Main outcome measures

Number of interventions (related to number of medication orders), clinical relevance and degree of acceptance.


In the pre-intervention period 79 patients were included versus 84 in the during-intervention period. About 82 interventions in the pre-intervention period were made compared to 173 during the during-intervention period. There was little agreement between the professional raters (weighted κA–E = 0.30 and weighted κ1–5 = 0.20). Nevertheless both ratings showed a substantial increase of clinically relevant interventions. The number of interventions accepted by the physician increased from 16 in the pre-intervention period to 75 in the during-intervention period. Working with this method took over 4 h a day.


Clinical pharmacy services provided by a junior hospital pharmacist on an internal medicine ward contribute to rationalization of drug therapy and are therefore likely to increase medication safety.


Clinical pharmacy Clinical pharmacist intervention Drug related problem Hospital pharmacy Medication Error Pharmaceutical care Prescription error The Netherlands 



We would very much like to thank dr. A.M.L. Kerremans (internal medicine specialist/clinical pharmacologist) for rating all interventions. Likewise we like to thank the junior doctors, internal medicine specialists and nurses of the internal medicine ward A2, location Sophia, Isala klinieken for participating in this study.


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Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Liesbeth Bosma
    • 1
    • 6
    Email author
  • Frank G. A. Jansman
    • 1
    • 2
  • Anton M. Franken
    • 3
  • Johannes W. Harting
    • 1
  • Patricia M. L. A. Van den Bemt
    • 4
    • 5
  1. 1.Hospital Pharmacy, Isala KliniekenZwolleThe Netherlands
  2. 2.Department of Social Pharmacy, Pharmacoepidemiology and PharmacotherapyGroningen University Institute for Drug ExplorationGroningenThe Netherlands
  3. 3.Department of Internal Medicine, Isala KliniekenZwolleThe Netherlands
  4. 4.Hospital Pharmacy, St. Lucas Andreas HospitalAmsterdamThe Netherlands
  5. 5.Department of Pharmaco-epidemiology & PharmacotherapyUtrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht UniversityUtrechtThe Netherlands
  6. 6.Apotheek Haagse ZiekenhuizenThe HagueThe Netherlands

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