EVALUATION OF CLINICAL PHARMACY INTERVENTIONS AND MEDICATION-RELATED PROBLEMS AT PRINCESS HAYA BINT AL-HUSSEIN MILITARY HOSPITAL: A RETROSPECTIVE OBSERVATIONAL STUDY

Background: In the hospital setting, clinical pharmacy services are an integral part of optimizing medication therapy, improving patient safety, and reducing healthcare costs. Pharmacists’ interventions in identification and resolution of drug-related problems (DRPs) are crucial for improving patient outcomes and reducing adverse drug events. The clinical pharmacy service at Princess Haya Bint Al-Hussein Military Hospital is increasingly being recognized as an integral part of multidisciplinary patient care. However, comprehensive data on the nature, frequency and clinical impact of pharmacist-led interventions at the hospital level are limited. Electronic health systems such as “Hakeem” have been found to improve medication management and prescribing patterns in the military hospital settings.
Objective: This retrospective study aimed to evaluate the types, frequency and clinical significance of clinical pharmacy interventions and medication-related problems in Princess Haya Bint Al-Hussein Military Hospital.
Methods: This retrospective observational study was conducted at the Department of Clinical Pharmacy, Princess Haya Bint Al-Hussein Military Hospital, Royal Medical Services, Ajloun, Jordan for a period of 5 months (April 2026–August 2026). Clinical pharmacy documentation records, including pharmacist intervention logs, medication reconciliation forms, and medication order review sheets, were reviewed for 200 hospitalized adult patients (≥18 years) who received clinical pharmacy services during the study period. Data extracted included patient demographics, primary diagnosis, number and type of medications, identified drug-related problems (DRPs) classified per the Pharmaceutical Care Network Europe (PCNE) classification, pharmacist interventions, acceptance rates by prescribers, and time to intervention resolution.
Results: Among 200 patients (mean age 62.4 ± 14.8 years, 52.0% male), a total of 486 DRPs were identified, corresponding to a rate of 48.6 DRPs per 100 patient-days (95% CI: 44.2–53.0). The most common DRPs were inappropriate dosage selection (28.4%, n=138), drug-drug interactions (22.6%, n=110), untreated indications (16.5%, n=80), and adverse drug reactions (12.8%, n=62). The most frequent pharmacist interventions were dose adjustments (34.2%, n=166), therapeutic substitutions (22.4%, n=109), and addition of new therapy (18.7%, n=91). The overall acceptance rate of pharmacist interventions by prescribers was 82.4% (n=401/486). On multivariate logistic regression, independent predictors of intervention acceptance included: clinical specialty (internal medicine vs. surgery: OR=2.14, 95% CI: 1.32–3.48), intervention type (dose adjustment vs. other: OR=1.86, 95% CI: 1.12–3.08), and prescriber experience (years since graduation: OR=1.42, 95% CI: 1.04–1.94). The number of medications per patient was significantly correlated with the number of DRPs identified (r=0.62, p<0.001). Patients with ≥10 medications had 3.2 times higher rate of DRPs than those with <5 medications (p<0.001).
Conclusion: Clinical pharmacy interventions at Princess Haya Bint Al-Hussein Military Hospital are effective in identifying and resolving a substantial number of medication-related problems, with a high acceptance rate by prescribers (82.4%). Inappropriate dosage selection and drug-drug interactions were the most common DRPs. The number of DRPs was strongly associated with polypharmacy. These findings provide evidence for ongoing growth of clinical pharmacy services and identify the necessity of focused interventions in high-risk patient populations.