Pharmacist clinical interventions in the ICU

Abstract

Pharmacist clinical interventions in the ICU NG Hunfeld*, PH Melief, RM Van Hest and BE Bosma * Corresponding author: NG Hunfeld Author Affiliations HagaTeaching Hospital, Den Haag, the Netherlands For all author emails, please log on. Critical Care 2010, 14(Suppl 1):P447 doi:10.1186/cc8679 The electronic version of this article is the complete one and can be found online at: http://ccforum.com/content/14/S1/P447 Published: 1 March 2010 © 2010 BioMed Central Ltd. Introduction We wanted to investigate the number and nature of pharmacotherapeutical interventions of a dedicated hospital pharmacist during rounds in the ICU. Methods A pharmacist specially trained in ICU practice participated in the patient rounds twice a week (from July to December 2008). The pharmacist focused on optimalization of pharmacotherapy based on ICU guidelines and standards as well as general pharmacotherapy. Medication overviews were generated from the ICU Patient Data Management System and were analyzed for each patient during the patient rounds. Interventions were made to comply with guidelines and to avoid interactions, contraindications, overtreatment and undertreatment and to recognize side effects. All pharmacist interventions were collected in a database and the percentage of interventions leading to a change in pharmacotherapy was analyzed. Results Fifty patient rounds were attended (160 patients, mean age: 64, male: 59%, mean APACHE II score: 25, mean length of stay: 8.7 days, number of drug orders analyzed: 4,227). A total of 342 interventions was made in 66% of patients (mean: 2.1 interventions/patient), resulting in a change in pharmacotherapy in 67% of the interventions. The kind of interventions were: start drug: 18%, stop drug: 15%, reduction of dosage: 3%, increase of dosage: 4%, toxicology: 12%, interaction: 6%, contra-indication: 9%, adverse events: 3%, double medication: 4%, switch in accordance to guidelines: 6%, software: 2%, dose reduction because of renal failure: 6% and other (for example, infusion incompatibility or administration by feeding tube): 13%. Classes of drugs most involved were: antiobiotics, gastrointestinal drugs and anticoagulants. Conclusions Frequent presence of a dedicated pharmacist during patient rounds in the ICU results in interventions in pharmacotherapy in 66% of the admitted patients. The mean number of interventions per patient is 2.1. Interventions lead to improved compliance with ICU guidelines and pharmacotherapy standards and warrants monitoring of pharmacotherapy. Interventions probably lead to improved efficacy and safety of pharmacotherapy, although future controlled research will have to prove to what extent drug-induced harm is prevented.