International Journal of Clinical Pharmacy

, Volume 35, Issue 6, pp 1137–1151 | Cite as

Clinical pharmacist service in the acute ward

  • Trine Rune Høgh NielsenEmail author
  • Stig Ejdrup Andersen
  • Mette Rasmussen
  • Per Hartvig Honoré
Research Article


Background The majority of hospitalised patients have drug-related problems. Clinical pharmacist services including medication history, medication reconciliation and medication review may reduce the number of drug-related problems. Acute and emergency hospital services have changed considerably during the past decade in Denmark, and the new fast-paced workflows pose new challenges for the provision of clinical pharmacist service. Objective To describe and evaluate a method for a clinical pharmacist service that is relevant and fit the workflow of the medical care in the acute ward. Setting Acute wards at three Danish hospitals. Methods The clinical pharmacist intervention comprised medication history, medication reconciliation, medication review, medical record entries and entry of prescription templates into the electronic medication module. Drug-related problems were categorised using The PCNE Classification V6.2. Inter-rater agreement analysis was used to validate the tool. Acceptance rates were measured as the physicians’ approval of prescription templates and according to outcome in the PCNE classification. Main outcome measure Acceptance rate of the clinical pharmacists’ interventions through the described method and inter-rater agreement using the PCNE classification for drug-related problems. Results During 17 months, 188 patients were included in this study (average age 72 years and 55 % women). The clinical pharmacists found drug-related problems in 85 % of the patients. In the 1,724 prescriptions, 538 drug-related problems were identified. The overall acceptance rate by the physicians for the proposed interventions was 76 % (95 % CI 74–78 %). There was a substantial inter-rater agreement when using the PCNE classification system. Conclusion The methods for a clinical pharmacist service in the acute ward in this study have been demonstrated to be relevant and timely. The method received a high acceptance rate, regardless of no need for oral communication, and a substantial inter-rater agreement when classifying the drug-related problems.


Acceptance rate Acute ward Clinical pharmacy Denmark DRP classification Drug-related problems Electronic prescription template Medication history Medication reconciliation Medication review 



We would like to thank the three wards in Region Zealand who participated in this study. A special thanks to Mie Dyrholm and Karen Søgaard for performing the clinical pharmacist service in the study period. Thank you to the management for support and to the colleagues who have been involved in the study period at Region Zealand Hospital Pharmacy.


This study was funded by Sygehusapotekernes og Amgros’ Forsknings- og Udviklingspulje, Region Sjællands Sundhedsvidenskabelige Forskningsfond, Region Sjælland Sygehusapoteket and Helsefonden.

Conflicts of interest



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Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • Trine Rune Høgh Nielsen
    • 1
    • 2
    Email author
  • Stig Ejdrup Andersen
    • 3
  • Mette Rasmussen
    • 4
  • Per Hartvig Honoré
    • 2
  1. 1.Region Zealand Hospital PharmacyNæstved HospitalNæstvedDenmark
  2. 2.Department of Drug Design and Pharmacology, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
  3. 3.Department of Clinical PharmacologyBispebjerg HospitalCopenhagen NVDenmark
  4. 4.HolteDenmark

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