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VOLUME 20 , ISSUE 2 ( 2016 ) > List of Articles

RESEARCH ARTICLE

Impact of clinical pharmacist in an Indian Intensive Care Unit

Mudalipalayam N. Sivakumar, Ganesh Veerasekar

Keywords : Adverse drug reaction, critical care pharmacist, drug interaction, medication error

Citation Information : Sivakumar MN, Veerasekar G. Impact of clinical pharmacist in an Indian Intensive Care Unit. Indian J Crit Care Med 2016; 20 (2):78-83.

DOI: 10.4103/0972-5229.175931

License: CC BY-ND 3.0

Published Online: 00-02-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background and Objectives: A critically ill patient is treated and reviewed by physicians from different specialties; hence, polypharmacy is a very common. This study was conducted to assess the impact and effectiveness of having a clinical pharmacist in an Indian Intensive Care Unit (ICU). It also evaluates the clinical pharmacist interventions with a focus on optimizing the quality of pharmacotherapy and patient safety. Materials and Methods: The prospective, observational study was carried out in medical and surgical/trauma ICU over a period of 1 year. All detected drug-related problems and interventions were categorized based on the Pharmaceutical Care Network Europe system. Results: During the study period, average monthly census of 1032 patients got treated in the ICUs. A total of 986 pharmaceutical interventions due to drug-related problems were documented, whereof medication errors accounted for 42.6% (n = 420), drug of choice problem 15.4% (n = 152), drug-drug interactions were 15.1% (n = 149), Y-site drug incompatibility was 13.7% (n = 135), drug dosing problems were 4.8% (n = 47), drug duplications reported were 4.6% (n = 45), and adverse drug reactions documented were 3.8% (n = 38). Drug dosing adjustment done by the clinical pharmacist included 140 (11.9%) renal dose, 62 (5.2%) hepatic dose, 17 (1.4%) pediatric dose, and 104 (8.8%) insulin dosing modifications. A total of 577 drug and poison information queries were answered by the clinical pharmacist. Conclusion: Clinical pharmacist as a part of multidisciplinary team in our study was associated with a substantially lower rate of adverse drug event caused by medication errors, drug interactions, and drug incompatibilities.


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  1. Kane-Gill SL, Jacobi J, Rothschild JM. Adverse drug events in intensive care units: Risk factors, impact, and the role of team care. Crit Care Med 2010;38 6 Suppl: S83-9.
  2. Haupt MT, Bekes CE, Brilli RJ, Carl LC, Gray AW, Jastremski MS, et al. Guidelines on critical care services and personnel: Recommendations based on a system of categorization of three levels of care. Crit Care Med 2003;31:2677-83.
  3. Rudis MI, Brandl KM. Position paper on critical care pharmacy services. Society of Critical Care Medicine and American College of Clinical Pharmacy Task Force on Critical Care Pharmacy Services. Crit Care Med 2000;28:3746-50.
  4. Boyko WL Jr., Yurkowski PJ, Ivey MF, Armitstead JA, Roberts BL. Pharmacist influence on economic and morbidity outcomes in a tertiary care teaching hospital. Am J Health Syst Pharm 1997;54:1591-5.
  5. Smythe MA, Shah PP, Spiteri TL, Lucarotti RL, Begle RL. Pharmaceutical care in medical progressive care patients. Ann Pharmacother 1998;32:294-9.
  6. Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA 1999;282:267-70.
  7. Van Mil JW, Westerlund LO, Hersberger KE, Schaefer MA. Drug-related problem classification systems. Ann Pharmacother 2004;38:859-67.
  8. Schaefer M. Discussing basic principles for a coding system of drug-related problems: The case of PI-Doc. Pharm World Sci 2002;24:120-7.
  9. PCNE.org. Pharmaceutical Care Network Europe, PCNE Classification for Drug Related Problems V6.2; c2010-15. Available from: http://www.pcne.org/upload/files/11_PCNE_classification_V6-2.pdf. [Last updated on 2010 Jan 14; Last cited on 2014 Dec 05].
  10. Erstad BL, Haas CE, O'Keeffe T, Hokula CA, Parrinello K, Theodorou AA. Interdisciplinary patient care in the intensive care unit: Focus on the pharmacist. Pharmacotherapy 2011;31:128-37.
  11. Kim MM, Barnato AE, Angus DC, Fleisher LA, Kahn JM. The effect of multidisciplinary care teams on intensive care unit mortality. Arch Intern Med 2010;170:369-76.
  12. Ng TM, Bell AM, Hong C, Hara JM, Touchette DR, Danskey KN, et al. Pharmacist monitoring of QTc interval-prolonging medications in critically ill medical patients: A pilot study. Ann Pharmacother 2008;42:475-82.
  13. Weant KA, Armitstead JA, Ladha AM, Sasaki-Adams D, Hadar EJ, Ewend MG. Cost effectiveness of a clinical pharmacist on a neurosurgical team. Neurosurgery 2009;65:946-50.
  14. Kalina M, Tinkoff G, Gleason W, Veneri P, Fulda G. A multidisciplinary approach to adverse drug events in pediatric trauma patients in an adult trauma center. Pediatr Emerg Care 2009;25:444-6.
  15. Jain M, Miller L, Belt D, King D, Berwick DM. Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change. Qual Saf Health Care 2006;15:235-9.
  16. Klopfer JD, Einarson TR. Acceptance of pharmacists' suggestions by prescribers: A literature review. Hosp Pharm 1990;25:830-2, 834-6.
  17. Natasha TG, Carvalho CS, Correia LC, Tenorio DS, Cristina TM, Dias AO, et al. Pharmaceutical intervention assessment in the identification and management of drug interactions in an intensive care unit. J Appl Pharm Sci 2015;5:13-8.
  18. Spriet I, Meersseman W, de Hoon J, von Winckelmann S, Wilmer A, Willems L. Mini-series: II. clinical aspects. clinically relevant CYP450-mediated drug interactions in the ICU. Intensive Care Med 2009;35:603-12.
  19. Bertsche T, Mayer Y, Stahl R, Hoppe-Tichy T, Encke J, Haefeli WE. Prevention of intravenous drug incompatibilities in an intensive care unit. Am J Health Syst Pharm 2008;65:1834-40.
  20. Gikic M, Di Paolo ER, Pannatier A, Cotting J. Evaluation of physicochemical incompatibilities during parenteral drug administration in a paediatric intensive care unit. Pharm World Sci 2000;22:88-91.
  21. Klopotowska JE, Kuiper R, van Kan HJ, de Pont AC, Dijkgraaf MG, Lie-A-Huen L, et al. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: An intervention study. Crit Care 2010;14:R174.
  22. Scaglione F, Paraboni L. Pharmacokinetics/pharmacodynamics of antibacterials in the Intensive Care Unit: Setting appropriate dosing regimens. Int J Antimicrob Agents 2008;32:294-301.
  23. Scarsi KK, Fotis MA, Noskin GA. Pharmacist participation in medical rounds reduces medication errors. Am J Health Syst Pharm 2002;59:2089-92.
  24. MacLaren R, Bond CA, Martin SJ, Fike D. Clinical and economic outcomes of involving pharmacists in the direct care of critically ill patients with infections. Crit Care Med 2008;36:3184-9.
  25. MacLaren R, Bond CA. Effects of pharmacist participation in intensive care units on clinical and economic outcomes of critically ill patients with thromboembolic or infarction-related events. Pharmacotherapy 2009;29:761-8.
  26. Marshall J, Finn CA, Theodore AC. Impact of a clinical pharmacist-enforced intensive care unit sedation protocol on duration of mechanical ventilation and hospital stay. Crit Care Med 2008;36:427-33.
  27. Kanji S, Singh A, Tierney M, Meggison H, McIntyre L, Hebert PC. Standardization of intravenous insulin therapy improves the efficiency and safety of blood glucose control in critically ill adults. Intensive Care Med 2004;30:804-10.
  28. ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998. Am J Health Syst Pharm 1999;56:347-79.
  29. De Rijdt T, Willems L, Simoens S. Economic effects of clinical pharmacy interventions: A literature review. Am J Health Syst Pharm 2008;65:1161-72.
  30. Kopp BJ, Mrsan M, Erstad BL, Duby JJ. Cost implications of and potential adverse events prevented by interventions of a critical care pharmacist. Am J Health Syst Pharm 2007;64:2483-7.
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