Documentation of Clinical Pharmacy Activities in a VA Hospital

A nine-month study conducted on a general medical ward of the Veterans Administration Hospital in Danville, Illinois, was designed to investigate several aspects of the pharmacist's clinical roles. The pharmacist detected and evaluated suspected adverse drug reactions (SADR) and deviations from medication administration procedures (DMAP) and maintained a log of all questions and contributions to the patient's therapy. A SADR was defined as any unintended or undesired effect of a drug. A DMAP was defined as a change from the physician's order as written on the chart. The pharmacist collected demographic data and maintained medication records on all patients. If a SADR or DMAP was detected by the pharmacist, he evaluated the event and completed the appropriate records describing the event. Eighty-six SADR were detected in 60 (35.5 percent) of the 169 hospitalized patients in the 9-month study. Discontinuation of the drug, additional treatment or hospitalization, and/or a change in the administration of the drug was required in 66 (76.7 percent of the 86 SADR. Patients experiencing SADR received a higher average number of drugs and had a longer average duration of hospitalization than the patients without SADR. Ten DMAP were detected in 4504 doses in the 6-month study, resulting in a 0.2 percent deviation rate. The wrong dose was the type of DMAP in 50 percent of the cases. There were 276 questions and contributions to patient care encountered by the pharmacist in the 5-month study. The majority were classified as therapeutic. In conclusion, the clinical pharmacist can and should be utilized in both research and service functions in the clinical setting.