Pharmacist Remote Review of Medication Prescriptions for Appropriateness in Pediatric Intensive Care Unit

Abstract

Background: One aspect of ordering and prescribing medication is the requirement for a trained professional to review medication orders or prescriptions for appropriateness. In practice, this review process is usually performed by a clinical pharmacist. However, in many medical centers there is a shortage of staff and a pharmacist is not always available.Objective: To determine whether remote review of medication orders by a pharmacist is a plausible method in a pediatric intensive care unit (PICU).Methods: A pharmacist from the pharmacy department reviewed medication orders of patients admitted to our PICU over a 7-month period for appropriateness. A special form for medical orders was filled in and sent to the physician in the PICU, who replied informing whether the recommendation had been accepted. The time spent by the pharmacist for this activity was recorded.Results: The review time for one medical record was 8.9 (95% CI, 6.9–10.9) min. Every additional drug prescribed increased the total review time by 0.8 (95% CI, 0.45–1.11) min. The pharmacist filled in 186 forms on 117 admissions for 109 children. The median review time was 15 (12.8–18.8) and 12 (9–15) min, respectively, for patients with psychiatric-neurologic disorders compared to those without (p = 0.032). Usually, a daily workload of 240 min was needed for the pharmacist accompanying the round in contrast to 108 min per day needed to review all the medical records in 95% of the cases. The physician accepted 51.2%, rejected 11.9%, and made no comment on 36.9% of the recommendations.Conclusion: Hospitals facing budget shortages can carry out focused remote reviews of prescriptions by the pharmacist.

Ajuste de dose de antimicrobianos por função renal em Unidade de Terapia Intensiva adulto

“…When antimicrobial use time and ICU hospitalization time were evaluated, it was found that, in both outcomes, there was a significant reduction in days for patients who had their antimicrobial doses adjusted according to renal function when compared to those who did not have their doses adjusted and/or had inadequate adjustments. Findings consistent with this result have been described in previous studies which reported that the involvement of physicians and pharmacists to ensure appropriate antimicrobial dosage according to renal function was associated with shorter intensive care unit hospitalization times, fewer adverse events and reduced treatment costs 37,38,39,40 .…”

Registro Das Atividades Clínicas Do Farmacêutico Hospitalar: Uma Revisão Integrativa

“…Nos estudos apresentados pelos artigos A25 e 26, o farmacêutico clínico realizou revisão completa da prescrição de medicamentos do paciente internado em unidade de terapia intensiva, a fim de identificar melhorias e adequações na terapia medicamentosa (BOURNE; CHOO, 2012;LAZARYAN et al, 2016). Ambos os artigos informam que as intervenções clínicas do farmacêutico foram registradas em banco de dados e não mencionam o registro em prontuário do paciente.…”

“…, 2014); A21(LUO et al, 2017); A22(KHALIL et al, 2018); A23 (PULLINGER; FRANKLIN, 2010); A24(ALSULTAN et al, 2013); A25 (BOURNE; CHOO, 2012); A26(LAZARYAN et al, 2016).…”

Ajuste De Dose Dos Medicamentos De Acordo Com a Função Renal Em Um Hospital Universitário

“…Dentre as estratégias para redução de danos ao paciente, pode ser destacada a atuação do farmacêutico clínico, que por meio de revisões da prescrição e do acompanhamento da farmacoterapia, pode colaborar com a equipe multiprofissional e reduzir os EAM. Um estudo de Lazaryan e cols (2019) demonstrou que as intervenções farmacêuticas relacionadas à correção de dose dos medicamentos têm contribuído para melhorar a segurança do paciente e reduzir o tempo de hospitalização (6). A participação do farmacêutico na correção de dose dos medicamentos excretados por via urinária tem contribuído de forma positiva na função renal do paciente (7).…”