Implementation of pharmaceutical care in acute medical cardiovascular patients

All inpatients who were admitted to one designated cardiologist at a private community hospital were followed by a pharmacist. The pharmacist prospectively evaluated the patients' medications in order to identify, resolve, and prevent any medication related problems. Recommendations concerning these medication related problems were made to the physician involved. In addition, the pharmacist documented medication information questions, medication dosing consultations, and patient medication counseling consults. Ninety-seven percent of the recommendations were accepted by the prescriber. The most common categories of recommendations were for drugs belonging to cardiovascular (40.3%) and anti-infective (18.4%) classes. Improper medication selection (19.6%), untreated indication (17.4%), overdosage (16.3%), and medication given without an indication (13%) were the most common medication related problems and accounted for over two-thirds of the total accepted recommendations. Sixty-six percent of the recommendations were considered significant and 4% were considered extremely significant. Based on the pharmacist's interventions, an annual patient medication charge savings of $17,576.00 was estimated.