PURPOSE.To describe clinical pharmacist interventions across a range of critical care units (CCUs) throughout the United Kingdom (UK). To identify CCU medication error rate, prescription optimisation and to identify the type and impact of each intervention in the prevention of harm and improvement of patient therapy. MATERIALS AND METHODS.A prospective observational study was undertaken in 21 UK CCUs from [5][6][7][8][9][10][11][12][13][14][15][16][17][18] th Nov 2012. A data collection web portal was designed where the specialist critical care pharmacist (SCCP) reported all interventions at their site. Each intervention was classified as either: medication error, optimisation or consult. In addition, a clinical impact scale was used to code the interventions. Interventions were scored as low, moderate, high impact and life saving. The final coding was moderated by blinded independent multidisciplinary trialists. RESULTS. 20,517 prescriptions were reviewed with 3,294 interventions recorded during the weekdays. This resulted in an overall intervention rate of 16.1%: 6.8% were classified as medication errors, 8.3 % optimisations and 1.0% consults. The interventions were classified as: low impact (34.0%), moderate impact (46.7%) high impact (19.3%) and one case was life saving. Almost three-quarters of interventions were to optimise the effectiveness of and improve safety of pharmacotherapy. CONCLUSIONS. This observational study demonstrated that both medication error resolution and pharmacist led optimisation rates were substantial. Almost 1 in 6 prescriptions required an intervention from the clinical pharmacist. The error rate was slightly lower than an earlier UK prescribing error study (EQUIP). Two thirds of the interventions were of moderate to high impact. Key wordsCritical care, interventions, specialist critical care pharmacist, medication errors, optimisations, impact coding IntroductionThe critically ill patient is at risk of medicines-related adverse events [1], drug interactions and on some occasions inadequate therapy [2]. This risk can be exacerbated by the presence of organ failure or by supportive therapies such as renal replacement therapy. Consequently, interventions to reduce medication errors and optimise therapy are an essential component of patient care. These include electronic prescribing, smart infusion pumps, medicines reconciliation, clinical guidelines and services normally led by a specialist critical care pharmacist (SCCP) [3]. Improving the safety and efficacy of medication therapy in critical care patients is the cornerstone of SCCP activity. Since the first reports of clinical pharmacist interventions in critical care in the mid-1980s [4], there has been a gradual progression from those focused on financial savings in medicine use, to reducing medication errors and more recently to the optimisation of medication therapy [5]. Clinical pharmacists have been reported to improve medicines-related patient outcomes in the use of sedation [6], antimicrobial therapy [7], therapeutic drug m...

Representative clinical impact grades for over 100 common prescribing error and optimisation cases are reported for potential clinical practice and research application. The between professional variability highlights the importance of multidisciplinary perspectives in assessment of medication error and optimisation cases in clinical practice and research.

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Pharmacist-led monitoring in a typical NHS hospital setting was effective at detecting ADRs in newly marketed drugs. However, this effort might have been substantially less time-consuming and more effective were electronic patient records (EPRs) available. Pharmacy computer systems are not designed to be patient focused and are therefore unable to identify patients taking newly marketed drugs. It is argued that future EPR and computerised patient-specific prescribing systems should be designed to capture this data in the same way as some US systems are currently able to do.

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SummaryA 32-year-old man, with a long history of chronic pain and bipolar disorder, was admitted to our emergency department 2 h after a mixed overdose, predominately consisting of carbamazepine. Following no clinical improvement after four days of ventilation on our intensive care unit (ICU), high-volume continuous veno-venous haemofiltration with dialysis was instituted to enhance the elimination of the carbamazepine. It had no significant effect on the patient's clinical status or serum carbamazepine level. It was discontinued after 48 h. He spontaneously recovered and was discharged uneventfully from ICU after 7 days. BACKGROUND

Introduction Critical care pharmacists improve the quality and efficiency of medication therapy whilst reducing treatment costs where they are available. UK critical care pharmacist deployment was described in 2015, highlighting a deficit in numbers, experience level, and critical care access to pharmacy services over the 7-day week. Since then, national workforce standards have been emphasised, quality indicators published, and service commissioning documents produced, reinforced by care quality assessments. Whether these initiatives have resulted in further development of the UK critical care pharmacy workforce is unknown. This evaluation provides a 2020 status update. Methods The 2015 electronic data entry tool was updated and circulated for completion by UK critical care pharmacists. The tool captured workforce data disposition as it was just prior to the COVID-19 pandemic, at critical care unit level. Main findings Data were received for 334 critical care units from 203 organisations (96% of UK critical care units). Overall, 98.2% of UK critical care units had specific clinical pharmacist time dedicated to the unit. The median weekday pharmacist input to each level 3 equivalent bed was 0.066 (0.043–0.088) whole time equivalents, a significant increase from the median position in 2015 (+ 0.021, p < 0.0001). Despite this progress, pharmacist availability remains below national minimum standards (0.1/level 3 equivalent bed). Most units (71.9%) had access to prescribing pharmacists. Geographical variation in pharmacist staffing levels were evident, and weekend services remain extremely limited. Conclusions Availability of clinical pharmacists in UK adult critical care units is improving. However, national standards are not routinely met despite widely publicised quality indicators, commissioning specifications, and assessments. Additional measures are needed to address persistent deficits and realise gains in organisational and patient-level outcomes. These measures must include promotion of cross-professional collaborative working, adjusted funding models, and a nationally recognised training pathway for critical care pharmacists.

This paper describes a strategy of clinical pharmacy development at Southampton as an example of a UK teaching hospital. The delivery of this plan puts pharmacists at the centre of managing the risks of the medicines use process. A series of surveys over two decades shows how clinical pharmacy activities have evolved.