Pharmacotherapeutic Problems and Pharmacist Interventions in a Medical Intensive Care Unit

Abstract

Background: Interest in pharmacist participation in the multidisciplinary intensive care team is increasing. However, studies examining pharmacist interventions in the medical intensive care unit (MICU) are limited in Korea. The aim of this study was to describe the current status of pharmacist interventions and to identify common pharmacologic problems requiring pharmacist intervention in the MICU. Methods: Between September 2013 and August 2014, a retrospective, observational study was conducted in the 22-bed MICU at a university hospital. Data were obtained from two trained pharmacists who participated in MICU rounds three times a week. In addition to patient characteristics, data on the cause, type, related drug, and acceptance rate of interventions were collected. Results: In 340 patients, a total of 1211 pharmacologic interventions were performed. The majority of pharmacologic interventions were suggested by pharmacists at multidisciplinary rounds in the MICU. The most common pharmacologic interventions were adjustment of dosage and administration (n = 328, 26.0%), followed by parenteral/enteral nutritional support (n = 228, 18.1%), the provision of drug information (n = 228, 18.1%), and advice regarding pharmacokinetics (n = 118, 9.3%). Antimicrobial agents (n = 516, 42.6%) were the most frequent type of drug associated with pharmacist interventions. The acceptance rate of interventions was 84.1% with most accepted by physicians within 24 hours (n = 602, 92.8%). Conclusions: Medication and nutritional problems are frequently encountered pharmacotherapeutic problems in the MICU. Pharmacist interventions play an important role in the management of these problems.

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

“…The acceptance rate in this study was high (97.4%), both overall and when breaking down into retrospective interventions to resolve DRPs or prospective interventions. This is consistent with previous studies reporting acceptance rate of 84.1–97.3% 20,23,24 . In addition, the acceptance rate was similarly high either when interventions were provided through face‐to‐face interaction (97.6%) or in writing (96.8%).…”

“…As a result, the most frequent intervention in this study was related to dosage adjustment. This finding is consistent with previous studies where dose adjustment was ranked as one of the most common interventions provided by pharmacists 23–25 . In addition, high usage of IV drugs requires careful consideration on drug administration, particularly on compatibility issues 16 .…”

“…There was an average of 1.8 DRPs/ patient which is similar to this study (1.7 DRPs/patient). Other studies reported a wide range of average DRPs/patient ranging from 0.3–3.5 DRPs/patient 20,23–25 . In this study, 51% of patients received at least one intervention from pharmacists.…”

“…Consistent with previous studies, DRPs were common in CICU/ICCU in Thailand. 9,17,20,[23][24][25] Johansen and colleagues conducted a study evaluating pharmacist intervention among 363 patients admitted to intensive care units in Norway. 24 There was an average of 1.8 DRPs/ patient which is similar to this study (1.7 DRPs/patient).…”

“…This finding is consistent with previous studies where dose adjustment was ranked as one of the most common interventions provided by pharmacists. [23][24][25] In addition, high usage of IV drugs requires careful consideration on drug administration, particularly on compatibility issues. 16 As a result, interventions related to drug administration was also common.…”