Impact on safety and cost of pharmaceutical interventions in the emergency department (INTERPHAR): a standardized methodology for multicenter documentation

Objectives.

To design a standardized methodology for documenting pharmaceutical interventions (PIs) in hospital emergency departments (EDs), to identify the clinical situations in which they are most frequently performed, and evaluate their economic impact.

Methods.

We conducted a multicenter, observational, prospective study of PIs over a 2-month period (from April 12th through June 11th, 2021). A total of 36 types of PIs were identified and grouped into 5 categories: prevention of medication-related adverse events, resource utilization, individualized care, direct patient care, and administrative or support tasks. Clinical impact was evaluated using the GRADE system, based on the level of evidence and strength of recommendation for each intervention. Economic impact was calculated from the potential cost avoided by each PI.

Results.

A total of 46 hospital pharmacists from 38 hospitals in Spain and Portugal participated, performing 5,667 PIs. Of these, 86.6% (4,907) were accepted and 95.3% (5,402) were proactive. By category, 36.5% (2,068) corresponded to administrative tasks, 35.9% (2,035) to
individualized care, 22.4% (1,269) to adverse event prevention, 2.4% (135) to direct patient care, and 1.3% (75) to resource
optimization; 1.5% (85) were not classifiable. Overall, 94.5% of PIs had a level of evidence III, 4.2% level IV, 1.2% level Ib, and 0.1% level IIa. The potential cost avoided amounted to €1,984,474.90.

Conclusions.

The implementation of a standardized documentation methodology in EDs across Spain and Portugal highlights the value of clinical pharmacy in optimizing pharmacotherapy, supporting the care team, and reducing health care costs.