Self reported clinical pharmacist interventions under-estimate their input to patient care

Objective: Pharmacists' impact on individual patient care is difficult to measure especially the contribution made by clinical pharmacy ward visits. This study set out to determine what activities pharmacists actually undertook on a clinical pharmacy ward visit and compare this with the usual method of measuring clinical pharmacist performance, self-reported pharmacist interventions. Method: Observational analysis was carried out on 16 pharmacists providing a ward clinical pharmacy service in four acute hospitals. Main outcome measure: Percentage of pharmacist interventions recorded. Results: A total of 34 wards were visited during the study which included both medical and surgical specialities. Average time spent per patient was less than two minutes for most pharmacists and three-quarters of the pharmacists checked over 80% of patient drug charts. Interventions represented 68% of pharmacist activities on the wards but on questioning the pharmacists reported that they would record only 31% of those interventions. Comparison of the interventions the pharmacists stated they would record with an historical sample of recorded interventions from the four hospitals showed a similar pattern in each intervention category. However, pharmacists were more likely to record interaction type interventions and less likely to record interventions on incomplete/illegal prescriptions, which were regarded as routine practice. Conclusion: Pharmacists reported they would record less than one-third of interventions observed. If recorded pharmacist interventions continue to be used the main source of evidence of outputs of clinical pharmacy service, a better way of capturing this data needs to be developed.