Drug-related problems identified by pharmacist-led medication review in Slovak hospitalised patients.

Medication review is an effective tool for identification of drug-related problems (DRPs). It has become an integral part of healthcare systems worldwide, however, it is still rare in Slovakia. Therefore, the aim of the present study was to assess the implementation of a medication review in hospitalised patients and to describe prevalence and nature of DRPs. A prospective 3-month study was conducted at Cardiology Department of Teaching Hospital in Nitra. All patients admitted during this period were included and their medications were reviewed regularly during the whole hospitalisation. Information on patient status and medication was obtained from admission reports, medication charts, laboratory results, ward rounds and consultations with attending physicians. Identified DRPs were classified using APS-Doc classification. A total of 261 medication records were analysed (52.1% women; average age 71.4±12.7 years). Geriatric patients (≥ 65 years) accounted for 72.8%. The patients had on average 7.7±4.0 drugs in medication history. Polypharmacy (≥ 5 drugs) was found in 75.1 % of them. At least one DRP was identified in 78.2 % of all records. Totally, 514 DRPs were recorded. The most frequent DRPs were clinically significant drug-drug interactions (n = 121; 23.5%), incomplete or missing drug history (n = 73; 14.2 %) and inappropriate time of administration (n = 67; 13.0 %). All identified potential and manifested DRPs were consulted with attending physicians. This study describes early outcomes of implementation of regular medication review in hospitalised patients in one Slovak hospital. Our results highlight the need for a wide implementation of medication review in hospitalised patients.