Drug-Related Problems Identified During Pharmacy Intervention and Consultation: Implementation of an Intensive Care Unit Pharmaceutical Care Model

Abstract

Aim: To identify common drug-related problems (DRPs) during pharmacy intervention and consultation in an intensive care unit (ICU); to explore the gap between physicians and pharmacists on their understanding of each other's capabilities and needs. Method: We conducted a single-center prospective study in the ICU of a tertiary academic hospital for 21 months. A pharmaceutical care (PC) model was implemented by a pharmacy team, and data were collected during pharmacy intervention and consultation. Data analysis was performed on identified DRPs, causes and their relationships. DRPs' frequency during intervention and consultation was compared. Problem-level descriptive analysis and network analysis were conducted using R 3.6.3. Result: Implementation of PC model greatly improved the efficacy of pharmacists in both interventions proposed to solve DRPs (from 13.6 to 20.1 cases per month) and number of patients being closely monitored (from 7.7 to 16.9 per month). Pharmacists identified 427 DRPs during pharmacy intervention with primarily adverse drug events (ADEs, 34.7%) and effect of treatment not optimal (25.5%), and 245 DRPs during consultation (mainly ADEs, 58.4%). About three-fifths DRPs were caused by antibiotics. Comparing DRPs identified during pharmacy intervention and consultation, physicians consulted pharmacists more on questions related to medication safety, while pharmacists also paid attention to treatment effectiveness, which was consulted less commonly. Conclusion: Implementation of PC model is beneficial in guiding pharmacy practice and improving efficacy especially under limited human resources. Physicians and pharmacists

Pharmacists’ Interventions on Electronic Prescriptions from Various Specialty Wards in a Malaysian Public Hospital: A Cross-Sectional Study

“…Overall, the acceptance rate of pharmacists' interventions in this study was high (95.5%), indicating doctors were receptive to the pharmacists' recommendations. Similar results on high acceptance among prescribers were shown in studies by Al Rahbi et al, Li et al and Kuo et al, which were 98.2, 97.3 and 89%, respectively [3,4,17]. In this study, the acceptance of interventions among prescribers in most of the specialty wards was more than 85%, except the psychiatric ward which recorded 60% acceptance.…”

“…The rate of e-prescription intervention by pharmacists was 3.2%, which is similar to the rate of interventions (3.8%) reported at chain community pharmacies which had implemented e-prescribing [16] but lower than the intervention rate (7.1%) reported for manual medication charts and orders at an inpatient pharmacy in a teaching hospital within a month [3]. E-prescribing has been advocated as a potential medication error reduction mechanism by studies showing lower rates of interventions [4,17]: 2.3 and 0.68%, respectively, for discharged patients. However, other studies [8] recorded a higher rate of interventions: 9.1 and 10.1%, respectively, at an inpatient pharmacy and at an emergency department for discharge prescriptions with the implementation of computerised prescribing order entry.…”

“…The e-prescribing system is believed to provide dose checking but it seems the potential of this function is still lacking or underutilised. In addition, common types of interventions might be affected by the setting; for example, a study at an emergency department demonstrated that the common types of interventions conducted by pharmacists were dosage (35%), dilution (9.77%), administration route (8.48%), infusion time (6.13%) and frequency (5.89%) [17]. Medication errors appeared to be reduced over time with interventions but there remain some common types of medication errors related to dose during medicine reconciliation [24].…”

Terapia medicamentosa segura: perspectivas da enfermagem e da farmácia no cuidado de paciente em Unidade de Terapia Intensiva (UTI)

“…Ao avaliar os dados apresentados por Li et al, (2020), a partir de estudo prospectivo conduzido em um hospital acadêmico em Pequim, na qual avaliou serviços farmacêuticos em uma unidade de terapia intensiva segundo um modelo de cuidado proposto pela equipe de farmácia. Como resultado, foram atendidos 354 pacientes, foram identificados durante consulta farmacêutica 427 PRM e foram realizadas 486 intervenções.…”

“…Embora algumas resoluções e recomendações que reafirmam a importância dos serviços clínicos farmacêuticos, na prática isso não acontece. Além disso, há uma lacuna de profissionais farmacêuticos capacitados e treinados para execução de serviços clínicos, assim como existe resistência por parte de alguns profissionais de saúde e gestores de hospitais (Li et al, 2020).…”