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JEROME LEE, PHARM.D., is Staff Pharmacist, Walgreens Pharmacy, Baltimore, MD; at the time of the study he was Resident in Palliative Care, School of Pharmacy, University of Maryland (UM), Baltimore. MARY LYNN MCPHERSON, PHARM.D., BCPS, CDE, is Professor, Department of Pharmacy Practice and Science, School of Pharmacy, UM.

Address correspondence to Dr. McPherson at the Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, 20 North Pine Street, Room 443, Baltimore, MD 21201 (mmcphers{at}rx.umaryland.edu).

Purpose. The value of pharmaceutical care recommendations made by consultant pharmacists and the outcomes of these recommendations were studied. Methods. The study was conducted at three hospice programs, and the investigators were consultant pharmacists who shared the responsibility of providing drug therapy recommendations to the three programs. A literature search was conducted to determine if any tools had been developed to evaluate recommendations made by pharmacists in clinical practice settings. One tool was identified and adapted for use in a hospice clinical setting. Drug-related problems (DRPs) (n = 98), clinical interventions (n = 87), and outcomes data were collected by two hospice consultant pharmacists and evaluated by a panel of experts using the assessment tool. Results. Ninety-eight interventions were collected and evaluated. Eighty-seven of the 98 interventions were classified as clinical interventions with specific therapeutic goals established. Of these 87 interventions, 73 (84%) were accepted by the prescriber and 56 (77%) out of the 73 helped achieve the therapeutic goals. An additional 6 (8%) interventions partially achieved the therapeutic goals. Over 75% of all of the pharmacists’ recommendations achieved their intended therapeutic effect, which resulted in better management of the patients’ physical symptoms. None of the accepted recommendations resulted in the patient coming to harm or having an adverse effect. Overall agreement between raters for severity and value was moderately high, 60–70% and 63–80%, respectively. Kappa scores were low. Conclusion. Hospice-based clinical pharmacists influenced patient outcomes positively by identifying DRPs and recommending appropriate drug therapy. Index terms: Drug use; Hospices; Interventions; Outcomes; Pharmaceutical care; Pharmaceutical services; Pharmacists, consultant; Rational therapy; Toxicity