Characterization of drug‐related problems and evaluation of pharmacist interventions in the cardiovascular intensive care settings in Thailand

Abstract

Introduction Data regarding drug‐related problems (DRPs) and pharmacist's role in the cardiovascular intensive care units (CICU) from low‐ to middle‐income countries (LMIC) are limited. Objective The study aimed to characterize the DRP and interventions provided by clinical pharmacists in the CICU settings. Method A retrospective, cross‐sectional study was conducted in patients admitted to CICU of a tertiary‐care hospital in Thailand during January 2021 to March 2022 was performed. Data were collected from patient's medical records and pharmacy service records. DRPs were categorized according to the Pharmaceutical Care Network Europe classification. Two board‐certified pharmacotherapy specialists, pharmacy residents, and trained clinical pharmacists staffed the units 5 days a week. The pharmacist team conducted a medication review and provided interventions to the cardiology team either verbally during the ward round or in writing, as appropriate. Pharmacist interventions were categorized into two groups including retrospective intervention (interventions made to resolve DRPs after an order was made) and prospective interventions (interventions made prior to ordering process). Outcome measures were (1) number of DRPs identified; (2) category of DRPs; (3) number interventions; and (4) acceptance rate of interventions by the medical team. Results Among 576 patients admitted to the CICU, 345 DRPs were identified in 203 patients. The pharmacist team provided a total of 790 interventions including 345 retrospective interventions to resolve DRPs and 445 prospective interventions to guide medication use prior to the ordering process. The most frequent intervention was related to dosage adjustment, drug administration, adding drugs for existing conditions, and suggesting laboratory monitoring. The acceptance rate of the pharmacist intervention was 97.4%, most of which led to changes in drug therapy. Conclusion DRPs in CICU settings are common. Trained clinical pharmacists can effectively resolve DRPs and provide recommendations to improve quality of care through both clinical and distribution functions.