Impact of Clinical Pharmacist Interventions on Medication Safety and Therapy Optimization in a Tertiary Care Hospital

Background Medication-related problems remain a significant concern in hospital-based care, particularly in critically ill and pediatric populations where pharmacotherapy is complex and frequently modified. Clinical pharmacist-led medication review may improve medication safety through structured identification of therapy-related issues. Methodology This retrospective quality improvement evaluation analyzed structured inpatient medication review encounters conducted over a 14-month period at a tertiary care hospital. Intervention frequency, category distribution, and prescriber acceptance were assessed. Descriptive statistics were calculated, and chi-square testing was performed to evaluate associations between intervention category and acceptance status. Results Over 5,800 medication review encounters resulted in 2,441 clinical interventions. Dose optimization constituted the largest intervention category. The overall acceptance rate was 2,212 (90.6%). A statistically significant association was observed between intervention category and acceptance status (χ² = 46.46, df = 5, p < 0.001). Conclusions Structured clinical pharmacist involvement resulted in frequent and widely accepted interventions during inpatient medication review. Significant variability in acceptance patterns across intervention categories supports the clinical integration of pharmacist services within tertiary care hospital settings.