Table 1 Clinical reasons for non-acceptance of pharmacist recommendations mentioned by treating physicians

Dose increase of anticoagulants (13)

Presence of a (temporary) bleeding^a (4)

Thrombopenia (2)

High bleeding risk (2)

Presence of surgical drain (2)

Acute renal failure (CrCl still above the threshold for dose reduction) (1)

Low body weight (but still above the threshold for dose reduction) (1)

Registered weight not corrected for presence of large abdominal cyst (1)

Dose reduction of anticoagulants (5)

Portal vein thrombosis (1)

Transition to palliative care^a (1)

Stent in superior mesenteric artery (1)

Arteriovenous malformation (1)

Intestinal ischemia (1)

IV to oral switch of paracetamol (4)

Difficult oral intake^a (2)

Patient in a lot of pain (1)

High fevers (1)

De-escalation of broad-spectrum antimicrobial therapy (3)

Based on clinical status (2)

Based on history of positive cultures (1)

Dose reduction of antibiotics based on renal function (2)

Pseudomonas aeruginosa colonisation^a (1)

Based on clinical status (1)

Dose increase of antibiotics (1)

Low body weight (1)

Switch from LMWH to oral anticoagulant (1)

Bloody wound (1)

Dose reduction of paracetamol (1)

Transition to palliative care^a (1)