Table 4 Potential impact of 2149 pharmacist interventions assessed by the review committee

1. Extremely significant

24 (1.1)

A patient taking cilostazol for a history of stroke was admitted for surgery. Cilostazol was discontinued before the surgery but was not restarted since the risk of bleeding decreased after surgery. With pharmacist intervention, cilostazol was restarted. Restarting (adding) cilostazol reduces the risk of cerebral infarction recurrence.

2. Very significant

222 (10.3)

A patient with a history of penicillin allergy was prescribed penicillin to treat an infection. With pharmacist intervention, penicillin was switched to another medication before it was administered. Avoiding the administration of penicillin to a patient with a history of penicillin allergy inhibits the recurrence of allergy.

3. Significant

1833 (85.3)

A patient receiving treatment for infection had a vancomycin trough value of less than 10. With pharmacist intervention, the vancomycin dose was adjusted and a trough value of 15 was achieved. Appropriate vancomycin trough values can support the treatment of infection.

4. Somewhat significant

61 (2.8)

A patient receiving treatment for hypertension prior to hospitalization was not taking medication properly before admission. With pharmacist intervention, it was decided to discontinue the antihypertensive medication and monitor the patient’s condition.

5. No significance

9 (0.4)

Ceftriaxone was prescribed for intravenous infusion without dissolution. With pharmacist intervention, saline was added to ceftriaxone. Ceftriaxone should be dissolved before administration.

6. Adverse significance

0

None reported.