Evaluation of a Dedicated Pharmacist Staffing Model in the Medical Intensive Care Unit

Abstract

Purpose: Published studies have shown that pharmacists on medical rounds reduce the incidence of preventable adverse drug events (ADEs). However, the impact of a dedicated pharmacist who provides consistent patient care in a critical care unit remains to be evaluated. Objective: To determine the impact of a pharmacist who is permanently assigned to the medical intensive care unit (MICU) on the incidence of preventable ADEs, drug charges, and length of stay (LOS) in the MICU. Design: A randomized, experimental versus historical control group design was used. Preventable ADEs were identified and validated by 2 pharmacists and a critical care physician. Information about MICU drug charges and LOS were obtained from the hospital administrative database. Results: The intervention group had fewer occurrences of ADEs (10 ADEs/1,000 patient days) when compared to the control group (28 ADEs/1,000 patient days) at a significance level of .03. No significant differences were found between the 2 groups in MICU drug charges and LOS. The vast majority of the 596 documented recommended interventions (99%) were accepted by the medical team. Nutrition monitoring, medication indicated but not prescribed, and dosage modification were the top 3 problems identified by the pharmacist. Conclusion: The addition of a dedicated critical care pharmacist to the MICU medical team improves the safe use of medication. The services of a dedicated critical care pharmacist should be expanded to include weekend hours to ensure the benefits of improved medication safety.Key Words-adverse drug events, medication safety, pharmacist, staffing model Hosp Pharm-2013;48(11):922-930 A dverse drug events (ADEs), injuries resulting from the administration of a drug, levy serious costs on health care institutions and patients by requiring further complex care, prolonged lengths of hospital stay, and increased risk of death. The incidence rates of ADEs range from 10 ADEs per 1,000 patient days, of which 56% were preventable, 1 to 6.5 ADEs per 100 patient admissions, of which 28% of all ADEs were preventable.2 The cost of ADEs is estimated to be $2,000 per admission.2 This amount varies by institution and is a conservative estimate for 2013. Systems-related factors, such as drug ordering and administration processes, are likely contributing factors to preventable ADEs rather than patient-related characteristics.2 Specifically, drug information not available to physicians at the time of ordering medication was found to account for 29% of errors.3 The availability of up-to-date drug information, including guidelines and recommendations about monitoring, doses, drug interactions, and duration of therapy, is critical when prescribing medication.

Intervenções Farmacêuticas Em Uma Unidade De Terapia Intensiva De Um Hospital Universitário

“…Assim, o farmacêutico passou a integrar a equipe de saúde e atuar mais efetivamente na assistência prestada ao usuário, empregando seus conhecimentos para a melhoria do cuidado [1][2][3] .…”

“…A intervenção farmacêutica é uma ação planejada que faz parte do processo de acompanhamento farmacoterapêutico, requer registro e deve ser realizada em conjunto com profissionais de saúde e paciente, com o objetivo de solucionar ou prevenir resultados clínicos negativos oriundos da utilização de medicamentos 3,[4][5][6][7] .…”

“…Diante do exposto, salienta-se a importância da atuação do farmacêutico na equipe multiprofissional direcionado a cuidados intensivos, com o intuito de promover uma melhor assistência e colaborar para o incremento da segurança do paciente, além de propiciar resultados que influenciem diretamente nos indicadores em saúde 3,5,[12][13][14][15] . Entretanto, apesar da existência de uma vasta literatura internacional a respeito da atuação do farmacêutico clínico intensivista, no Brasil, estudos como este, são ainda escassos [3][4][5]11,14 .…”

“…Entretanto, apesar da existência de uma vasta literatura internacional a respeito da atuação do farmacêutico clínico intensivista, no Brasil, estudos como este, são ainda escassos [3][4][5]11,14 . Para tanto, pesquisas que evidenciem as atividades desenvolvidas por farmacêuticos em UTI brasileiras se fazem necessárias a fim de expor e registrar como esta pratica vem sendo desenvolvida em nosso país, permitindo uma avaliação fidedigna do impacto que este importante profissional exerce tanto na equipe multiprofissional como, sobretudo, na segurança do usuário 4,14 .…”

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“…pharmacist involvement at healthcare centers proved dedicated role in clinical time and in minimizing medication related discrepancies and clinical pharmacist involvement proved gradual decline in medication error, proper discharge record regarding medications and understanding about their medication in outpatients. They proved their dedicated role in critical units by providing quality of services 4 chronic disease [5][6][7] like diabetes and life threatening diseases [8][9] and by built up relationship with trust 10 to reduce drug cost 11 by facing challenging task 12 and by reducing their duration of stay in hospital 13 and by collaborative role with physician based on scientific evidence and pharmacy care planes [14][15][16][17] .…”