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 pharmaceutical 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 A single-center prospective study was conducted in the ICU of a tertiary academic hospital for 21 months. A pharmaceutical care (PC) model was implemented by pharmacy care team, and data was collected during pharmaceutical 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 pharmaceutical 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 pharmaceutical intervention and consultation, physicians consulted pharmacists more on questions related to medication safety, while pharmacists also paid attention to treatment effectiveness being 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 shall continue ensuring drug safety and be familiar with the scope of PC and clinical need for a better cooperation.

Clinical pharmacist assessment of drug-related problems among intensive care unit patients in a Turkish university hospital

“…There is still insufficient number of academic staff and few clinical pharmacists routinely work in hospitals. Although there are many studies evaluating the impact of the clinical pharmacist in intensive care units [ 7 , 11 , 12 ], there are many differences between international health systems such as health management, local population numbers and pharmacist education. Studies related to the implementation of clinical pharmacy services, such as identifying drug-related problems, are critical for developing countries where clinical pharmacy services are emerging.…”

The effect of the clinical pharmacist in minimizing drug‐related problems and related costs in the intensive care unit in Turkey: A non‐randomized controlled study

“…In other studies, DRPs numbers per patient; 0.13-2.46, which is considerably lower than the average in this study. 4,6,[12][13][14][15][16][17][18][19] These differences in results may be due to various factors such as the technological resources used, characteristics specific to the ICU environment and patients, the method used for DRP detection, and the accepted definition of DRP. The lack of familiarity with CP recommendations in the ICU team where the study was conducted is also one of the factors affecting the DRP numbers.…”

The pharmacist's professional identity: Preventing, identifying, and managing medication therapy problems as the medication specialist

“…Inpatient pharmacists in both acute and intensive care units tend to identify effectiveness-and safety-related MTPs, most commonly including incorrect dose (too high or too low) or dosage form (intravenous to oral conversion), adverse drug event prevention or management, and drug interactions. [54][55][56][57] These MTPs also stem from antimicrobial and insulin orders as opposed to medications for chronic conditions. [54][55][56][57] Perhaps the best evidence of MTPs unifying the pharmacy profession is the effort to reduce MTPs when transitioning patients from the hospital to home, and vice versa.…”

“…[54][55][56][57] These MTPs also stem from antimicrobial and insulin orders as opposed to medications for chronic conditions. [54][55][56][57] Perhaps the best evidence of MTPs unifying the pharmacy profession is the effort to reduce MTPs when transitioning patients from the hospital to home, and vice versa. 58,59 Schullo-Feulner and colleagues described the overlap and differences between inpatient and ambulatory care pharmacists, noting both frequently identify the need for additional drug therapy and patient education due to lack of understanding; however, inpatient pharmacists more frequently identify medication order inaccuracies whereas ambulatory care pharmacists identify adherence issues and adverse drug events more commonly.…”