Implementing ward based clinical pharmacy services in an Ethiopian University Hospital

  • Alemayehu B. Mekonnen
  • Elias A. Yesuf
  • Peggy S. Odegard
  • Sultan S. Wega
Keywords: Medication Errors, Inpatients, Pharmaceutical Services, Professional Practice, Ethiopia


Background: Clinical pharmacy practice has developed internationally to expand the role of a pharmacist well beyond the traditional roles of compounding, dispensing and supplying drugs to roles more directly in caring for patients. Studies on the activities of the clinical pharmacist in an inpatient ward in resource constrained settings are scarce, however.

Objective: To assess ward based clinical pharmacy services in an internal medicine ward of Jimma University Specialized Hospital.

Methods: The study was carried out in the internal medicine ward from March to April, 2011 at Jimma University Specialized Hospital. The study design was a prospective observational study where pharmaceutical care services provided by clinical pharmacists for inpatients were documented over a period of two months. Interventions like optimization of rational drug use and physician acceptance of these recommendations were documented. Clinical significance of interventions was evaluated by an independent team (1 internist, 1 clinical pharmacologist) using a standardized method for categorizing drug related problems (DRPs).

Results: A total of 149 drug related interventions conducted for 48 patients were documented; among which 133(89.3%) were clinical pharmacists initiated interventions and 16(10.7%) interventions were initiated by other health care professionals. The most frequent DRPs underlying interventions were unnecessary drug therapy, 36(24.2%); needs additional drug therapy, 34(22.8%) and noncompliance, 29(19.5%). The most frequent intervention type was change of dosage/instruction for use, 23(15.4%). Acceptance rate by physicians was 68.4%. Among the interventions that were rated as clinically significant, 46(48.9%) and 25(26.6%) had major and moderate clinical importance respectively.

Conclusion: Involving trained clinical pharmacists in the healthcare team leads to clinically relevant and well accepted optimization of medicine use in a resource limited settings. This approach can likely be generalized to other health care settings in the country to improve medication outcomes.


Download data is not yet available.


1. Chisholm-Burns MA, Kim Lee J, Spivey CA, Slack M, Herrier RN, Hall-Lipsy E, Graff Zivin J, Abraham I, Palmer J, Martin JR, Kramer SS, Wunz T. US pharmacists' effect as team members on patient care: systematic review and meta-analyses. Med Care. 2010;48(10):923-33. doi: 10.1097/MLR.0b013e3181e57962.

2. Barber N. Towards a philosophy of clinical pharmacy. Pharm J. 1996;257:289-91.

3. Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med. 2006;166(9):955-64.

4. Murray MD, Ritchey ME, Wu J, Tu W. Effect of a Pharmacist on Adverse Drug Events and Medication Errors in Outpatients With Cardiovascular Disease. Arch Intern Med. 2009;169(8):757-63. doi: 10.1001/archinternmed.2009.59.

5. Chisholm-Burns MA, Graff Zivin JS, Lee JK, Spivey CA, Slack M, Herrier RN, Hall-Lipsy E, Abraham I, Palmer J. Economic effects of pharmacists on health outcomes in the United States: A systematic review. Am J Health Syst Pharm. 2010;67(19):1624-34. doi: 10.2146/ajhp100077.

6. Matsoso MP. Future vision and challenges for hospital pharmacy. Am J Health Syst Pharm. 2009;66(5 Suppl 3):S9-12. doi: 10.2146/ajhp080628.

7. Hatoum HT, Catizone C, Hutchinson RA, Purohit A. An eleven year review of the pharmacy literature: documentation of the value and acceptance of clinical pharmacy. Drug Intell Clin Pharm. 1986;20(1):33-48.

8. Child D, Camtro JA, Cooke J. Effectiveness of hospital pharmacy: where is the evidence? Guild of Health care pharmacists, 2001. Available at: (Accessed 23/03/2012).

9. LeBlanc JM, Dasta JF. Scope of international hospital pharmacy practice. Ann Pharmacother. 2005;39(1):183-91.

10. King RC, Fomundam HN. Remodeling PC in Sub-Saharan Africa (SSA) amidst human resources challenges and the HIV/AIDS pandemic. Int J Health Plann Manage. 2010;25(1):30-48. doi: 10.1002/hpm.982.

11. Ethiopia. The World Fact Book. Central Intelligence Agency: USA. Available at: (Accessed June 13, 2011).

12. Suleman S, Ketsela A, Mekonnen Z.Assessment of self medication practices in Assendabo town, Jimma zone, southwestern Ethiopia. Res Social Adm Pharm. 2009;5(1):76-81. doi: 10.1016/j.sapharm.2008.04.002.

13. Makonnen E, Yoseph M, Berhane Y. Quality of prescription at a tertiary care pharmacy in Addis Ababa. Ethiop Med J. 2002;40(3):233-9.

14. Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. DICP. 1990;24(11):1093-7.

15. Rao D, Gilbert A, Strand LM, Cipolle RJ. Drug therapy problems found in ambulatory patient populations in Minnesota and South Australia. Pharm World Sci. 2007;29(6):647-54.

16. Isetts BJ, Brown LM, Schondelmeyer SW, Lenarz LA. Quality assessment of a collaborative approach for decreasing drug-related morbidity and achieving therapeutic goals. Arch Intern Med. 2003;163(15):1813-20.

17. Becker C, Bjornson DC, Kuhle JW. Pharmacist care plans and documentation of follow-up before Iowa Pharmaceutical Case Management Program. J Am Pharm Assoc (2003). 2004;44(3):350-7.

18. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: The Clinician’s Guide. 2nd ed. New York: McGraw Hill; 2004.

19. Struck P, Pedersen KH, Moodley P, Rasmussen M. A pilot study of pharmacist-initiated interventions in drug therapy in an Australian pediatric hospital. EJHP Science. 2007;13(4):105-12.

20. Stuchbery P, Kong DCM, DeSantis GN, Lo SK. Identification by observation of clinical pharmacists’ activities in a hospital inpatient setting. Pharm Pract. 2007;5(1):10-6.

21. Veggeland T, Dyb S. The contribution of a clinical pharmacist to the improvement of medication at a geriatric hospital unit in Norway. Pharm Pract. 2008;6(1):20-4.

22. Spinewine A, Dhillon S, Mallet L, Tulkens PM, Wilmotte L, Swine C. Implementation of ward-based clinical pharmacy services in Belgium - description of the impact on a geriatric unit. Ann Pharmacother. 2006;40(4):720-8.

23. Connor SE, Snyder ME, Snyder ZJ, Steinmetzpater K. Provision of clinical pharmacy services in two safety net provider settings. Pharm Pract. 2009;7(2):94-9.

24. Altavela JL, Jones MK, Ritter M. A prospective trial of a clinical pharmacy intervention in a primary care practice in a capitated payment system. J Manag Care Pharm. 2008;14(9):831-43.

25. Rahmawati F, Pramantara IP, Rohmah W, Sulaiman SA. Polypharmacy and unnecessary drug therapy on geriatric hospitalized patients in yogyakarta hospitals, Indonesia. Int J Pharm Pharm Sci2009;1(1):6-11.

26. Dooley MJ, Allen KM, Doecke CJ, Galbraith KJ, Taylor GR, Bright J, Carey DL. A prospective multicentre study of pharmacist initiated changes to drug therapy and patient management in acute care government funded hospitals. Br J Clin Pharmacol. 2004;57(4):513-21.

27. Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammerlund-Udenaes M, Toss H, Kesttis-Lindblad A, Melhus H, Morlin C. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: A randomized controlled trial. Arch Intern Med. 2009;169(9):894-900. doi: 10.1001/archinternmed.2009.71.

28. MacKinnon NJ, Morais C, Rose T. Drug-related problems identified in a workplace asthma self-management program. Can Pharm J. 2007;140 (2):110-5.

29. Bosma L, Jansman FG, Franken AM, Harting JW, Van den Bemt PM. Evaluation of pharmacist clinical interventions in a Dutch hospital setting. Pharm World Sci. 2008;30(1):31-8.
Original Research