The contribution of a clinical pharmacist to the improvement of medication at a geriatric hospital unit in Norway

Main Article Content

Turid Veggeland
Sigurd Dyb


Pharmaceutical Services, Aged, Norway


The aim of the study was to use a clinical pharmacist in order to improve the medication of patients in a geriatric hospital unit. The hospital had no experience of  using a clinical pharmacist before.

Methods: A clinical pharmacist participated in the therapeutic team for 27 days during a 4-year period. Drug-related problems were recorded prospectively and discussed before and at the ward round. The results of the physician’s decisions on the current day about potential changes in medication proposed by the pharmacist were continuously recorded.

Results: The pharmacist evaluated the medication of 250 patients. At least one drug- related problem was found in 188 (75%) of the patients. For these patients, the physician made 606 decisions concerning potential changes in the medication (3.2 per patient). Thirty percent (184/606) of the decisions were connected to further measurements and to the follow-up of laboratory results, mainly (82%, 151/184) for cardiovascular drugs. Forty-two percent (255/606) of the decisions resulted in the discontinuation of drugs, dosage reduction or a decision to revise the assessment at a later stage during hospitalisation. Medicines with anticholinergic adverse effects were to a great extent withdrawn. Twenty-one percent (129/606) of the decisions were made on drugs with an addiction potential:  hypnotics, anxiolytics, as well as analgesics containing tramadol and codeine. The result was often (71%, 91/129) dosage reduction, a change from fixed medication to medication on demand or to discontinuation.

Conclusion: Even with a modest participation of once a month, the evaluation of  a patient’s medication by a clinical pharmacist led to improved changes and the follow-up of the medication of the elderly.


Download data is not yet available.
Abstract 943 | PDF Downloads 784


1. Ebbesen J, Buajordet I, Erikssen J, Brørs O, Hilberg T, Svaar H, Sandvik L. Drug related deaths in a department of internal medicine. Arch Intern Med. 2001;161:2317-23.

2. Moore N, Lecointre D, Noblet C, Mabille M. Frequency and cost of serious adverse drug reactions in a department of general medicine. Br J Clin Pharmacol. 1998;45:301-8.

3. Kjustad L, Klemetsdal B, Pape J. Adverse effects of drugs in the elderly – reasons for hospitalization. [in Norwegian] Tidsskr Nor Lægeforen 1987;107:551-2.

4. Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc. 2001;41:192-9.

5. Calvert RT. Clinical pharmacy – a hospital perspective. J Clin Pharmacol. 1999;47:231-8.

6. Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, Bates DW. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA 1999;282:267-70.

7. Wood J, Bell D, Clark C. Pharmaceutical care in patient medical records – putting a system of documentation into practice. Pharm J. 1998;260:717-9.

8. Boorman S, Cairns C. Another way forward for pharmaceutical care: a team-based clinical pharmacy service. Pharm J. 2000;264:343-6.

9. Pretsch P, Hertzenberg SW, Humerfelt S. Clinical pharmacist improves the use of drugs in a hospital ward. [in Norwegian, english summary] Tidsskr Nor Lægeforen 2004;124:1923-25.

10. Olsson A. [Cooperation increase the quality in the health care.] [in Swedish] Läkemedelsvärlden 2001;105:22-3.

11. Blix HS, Viktil KK, Reikvam A, Moger TA, Hjemaas BJ, Pretsch P, Vraalsen TF, Walseth EK. The majority of hospitalised patients have drug-related problems: results from a prospective study in general hospitals. Eur J Clin Pharmacol. 2004;60:651-8.

12. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice. New York: McGraw-Hill, 1998: 82-3.

13. Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug related problems: their structure and function. Ann Pharmacother. 1990;24:1093-7.

14. PROMISe. Phase One Final Report. UTAS School of Pharmacy. Pharmacy Guild of Australia, Research Tender, RFT 2003-01.

15. Straand J, Rokstad KS. Elderly patients in general practice: diagnoses, drugs and inappropriate prescriptions. A report from the Møre and Romsdal Prescription Study. Fam Pract. 1999;16:380-8.

16. Linjakumpu T, Hartikainen S, Klaukka T et al. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol. 2002;55:809-17.

17. Viktil KK, Blix HS, Reikvam A, Moger TA, Hjemaas BJ, Walseth EK, Vraalsen TF, Pretsch P, Jorgensen F. Comparison of drug-related problems in different patient groups. Ann Pharmacother. 2004;38:942-8.

18. Ruths S, Straand J, Nygaard HA. Multidisciplinary medication review in nursing home residents: what are the most significant drug-related problems ? The Bergen District Nursing Home (BEDNURS) study. Qual Saf Health Care 2003;12:176-80.

19. O’Keeffe ST, Lavan JN. Clinical significance of delirium subtypes in older people. Age Ageing 1999; 28: 115-9.