Table 1

Detailed description of the risk categories that were systematically addressed for each drug in each patient during the medicines reviews, and examples of sources used by clinical pharmacists to address them

Risk category	Detailed description	Examples of sources
Drug monitoring	Need for therapeutic drug monitoring or laboratory monitoring, for example, digoxin, warfarin, antiepileptics	The Pharmacology Portal—Norwegian portal for drug and intoxicant analyses-http://www.farmakologiportalen.no/ Norwegian National Centre for Epilepsy Centre for Psychopharmacology, Diakonhjemmet Hospital, Norway
Adverse effect	Presence of symptoms or changes in laboratory values possibly caused by drug(s)	Summary of Product Characteristics (SPC) UpTo Date Micromedex CredibleMeds, QTDrugs List,-https://crediblemeds.org/
Drug–drug interaction	Clinically relevant drug–drug interactions	The Norwegian Medicines Agency–Drug interactions checker Micromedex–Drug interactions Drugs.com–Drug interactions checker
Non-optimal drug therapy	Lack of drug treatment or non-optimal drug treatment of a symptom/disease	Therapy guidelines BMJ Best Practice Up To Date SPC
Reduced organ function/contraindication	Drug or dosage of drug inappropriate due to reduced kidney function, reduced liver function, contraindications or other diseases.	The Renal Drug Handbook - https://renaldrugdatabase.com/ UpTo Date Micromedex Internetmedicin https://www.internetmedicin.se/searchresult.aspx?search=lever (reduced liver function/drugs that can harm the liver) SPC
Inappropriate drug in elderly	Use of less favourable drug in patients over 65 years old, for example, anticholinergics	Screening Tool of Older Persons’ Prescriptions V.2 Beers criteria
Unnecessary drug	Drug in use is not indicated	Therapy guidelines SPC Up To Date
Course length	Consideration of appropriate duration of course length, for example, duration of antibiotics	SPC The Norwegian Directorate of Health-National guideline for the use of antibiotics in hospitals The European Committee on Antimicrobial Susceptibility Testing-minimum inhibitory concentrations
Practical problem	Practical challenges in drug handling, for example, inhalation devices	SPC Local procedure for tablets and capsules-dividing, opening and crushing Handbook of Drug Administration via Enteral Feeding Tubes-https://about.medicinescomplete.com/publication/drug-administration-via-enteral-feeding-tubes/
Adherence issue	Patient does not, intentionally or unintentionally, use/take drug as agreed	Quick guide inhalators-https://sykehusapoteket.no/Documents/Inhalasjonsmedisin_for_sykehusleger.pdf Videos-use of inhalators-https://www.felleskatalogen.no/medisin/bruk-av-inhalatorer/aerochamber
Other	Problem not applicable in other subgroups, for example, prescription errors, documentation errors	The patient’s medical record