Medication appropriateness review: The effect of clinical pharmacist intervention on patients’ safety and medication errors

Background: Medication errors are a significant threat to patient safety, often resulting in increased morbidity and mortality. The Medication Appropriateness Index (MAI) is a validated tool to evaluate the suitability of prescribed medications. Inadequate medication review, particularly in complex clinical settings, exacerbates these issues. 

Objective:
This study aimed to evaluate the effect of clinical pharmacist-led medication appropriateness reviews on patient safety and medication errors, specifically using the MAI in a Palestinian tertiary care hospital. 

Methods: A retrospective cohort study was conducted at Ibn Sina Specialized Hospital, Palestine, including adult inpatients admitted between February 2021 and January 2023 who received at least two medications. A total of 600 patients were enrolled, with 301 in the pre-intervention group and 299 in the post-intervention group. Medication orders were assessed using the MAI by trained personnel, and statistical analyses were performed using SPSS to compare the appropriateness of medications before and after the intervention. 

Results: Post-intervention, the proportion of appropriate medications increased from 68.3% to 82.6%, while inappropriate prescriptions were eliminated (decreased from 1.4% to 0%). Clinical pharmacist intervention significantly improved MAI scores across most domains (p < 0.05). No significant association was found between polypharmacy and medication appropriateness, while no significant correlation was observed with the Charlson Comorbidity Index. Antimicrobial agents were the most reviewed medications. Overall, 89.35% of pharmacist interventions were accepted and implemented. 

Conclusion: The study demonstrates that clinical pharmacist interventions significantly improve medication appropriateness in hospitalized patients, supporting their essential role in multidisciplinary healthcare teams. These findings advocate for expanded pharmacist involvement in medication management to enhance patient safety and reduce medication-related risks. Future studies should assess the long-term impacts of such interventions on clinical outcomes and healthcare utilization in various clinical settings.