Nature, Frequency, and Clinical Impact of Clinical Pharmacist Interventions in an Internal Medicine Ward: A 1-Year Retrospective Study from Saudi Arabia
Mohammed Abutaleb, Adel HakamiAbstract
Background:
Medication-related problems remain a major threat to patient safety, particularly in internal medicine wards where multimorbidity, polypharmacy, and rapidly changing clinical conditions heighten risk. Although clinical pharmacists play a key role in optimizing therapy and preventing harm, real-world evidence from Saudi Arabia remains limited.
Objective:
To describe the nature, frequency, and documented clinical impact of clinical pharmacist interventions in a Saudi Arabian internal medicine ward over 1 year.
Materials and Methods:
A retrospective descriptive study was conducted using a routinely maintained clinical pharmacist intervention log. All interventions recorded between January 1 and December 31, 2025, were included. Collected variables included patient demographics, intervention category and type, medications involved, clinical condition, and documented clinical impact. Descriptive statistics were used for analysis.
Results:
A total of 230 interventions were recorded for 131 patients. Most interventions (70.4%) directly contributed to patient safety or harm prevention, with 25.3% preventing major potential harm. Physician acceptance was high (86.1%). The most frequent intervention categories were dose adjustment (30.4%) and inappropriate medication selection (29.6%). Antimicrobial stewardship accounted for 10.4% of interventions, commonly involving broad-spectrum or high-risk medications. The intervention rate was 16.2 per 100 admissions, and nearly 40% of patients received multiple interventions.
Conclusion:
Clinical pharmacists made frequent and clinically meaningful contributions to medication safety and therapeutic optimization in this internal medicine ward. High acceptance of recommendations reflects strong interdisciplinary collaboration and underscores the value of clinical pharmacy services. These findings provide important local evidence supporting continued investment in clinical pharmacy practice to enhance patient care across Saudi Arabia.