Table 1. Comparison of intervention and standard care models (adapted from Grimes et al. 2014) ¹⁰ .

	Standard care	Intervention
Service alignment	Aligned to a ward	Aligned to a medical team
Clinical pharmacist involved	Service delivered by routine clinical pharmacists	Service delivered by one of two intervention clinical pharmacists
Pharmaceutical care delivered by pharmacist:
At admission	Contributed to admission medication history taking	Led admission medication history taking and reconciliation
During admission	Made minor changes and endorsements to the drug prescription and administration chart (drug chart), for example, clarify an intended formulation or notate to facilitate appropriate administration, for example, ‘before food’ Delivered routine clinical pharmacy tasks (drug chart review; therapeutic drug monitoring; medication review; contribution of suggestions to optimise medication use and medication information queries)	Made minor and major changes to the drug chart, as required, and these were co-signed by a medical practitioner Delivered routine clinical pharmacy tasks (drug chart review; therapeutic drug monitoring; medication review; contribution of suggestions to optimise medication use and medication information queries)
At discharge	No service at discharge	Discharge medication reconciliation Made minor and major changes to the discharge medication list, as required, and these were co-signed by a medical practitioner
Pharmacist attributes	Either basic grade or senior grade; some with postgraduate qualifications in hospital (clinical) pharmacy. No restriction in terms of postgraduate qualifications or years of experience applied.	Minimum three years post-registration experience with postgraduate qualification in hospital (clinical) pharmacy