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Hamadalneel YB, Ahmed HO. Impact of Clinical Pharmacist Intervention in the Intensive Care Unit, Wad Medani, Sudan: A Cross-Sectional, Prospective Study. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2024; 13:43-49. [PMID: 38741594 PMCID: PMC11090122 DOI: 10.2147/iprp.s459170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024] Open
Abstract
Purpose Critical care pharmacists are uniquely qualified to provide a key role within the critical care multi-disciplinary team in managing the aspect of therapy, given their contributions to improved patient outcomes, medication safety, and reduced cost of the drug. Therefore, the purpose of this study was to assess the frequency, type, and impact of clinical pharmacist interventions in the Intensive Care Unit and their physicians' acceptance. Methods This was a cross-sectional, prospective study. Data were gathered over six months (15th June 2023 to 15th December 2023) on a daily basis, with a minimum sample size of 384 interventions. All patients admitted to the ICU at Wad Medani Teaching Hospital, Gezira State, Sudan during the study period were included. Results In general, a total of 510 interventions were made for 123 patients throughout the six months course of study. Among them, 493 (96.7%) clinical pharmacist interventions were agreed by physicians. Among categories of interventions, most of the recommendations were concerned about safety 34.11% (174/510), in which drug discontinuation due to long duration was the highest one 48.27% (48/174) followed by the renal dose adjustment 30.46% (53/174). Another clinical intervention involving indication accounted for 23.33% (119/510) in second place. Regarding the cost-saving interventions the study showed that, of the total number of interventions, 124 had a costrelated component, accounting for (24.31%) of the total interventions. Among all the interventions, the addition of drug, with a frequency of 103 (20.2%) was the most recurring intervention, followed by dosing at 100 (19.6%), and renal dose adjustment at 53 (10.4%). Conclusion This study demonstrated how clinical pharmacists might enhance critical care patients' quality management while reducing the costs associated with medication and care. In addition, it contributes valuable insights into the integration of clinical pharmacists in ICU settings, especially in resource-limited environments.
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Affiliation(s)
- Yousif B Hamadalneel
- Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, University of Gezira, Wad Medani, Sudan
| | - Hifa O Ahmed
- Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, University of Gezira, Wad Medani, Sudan
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El Ansari W, Saad MO. Virtual Care? Telepharmacy in Critical Care Settings for Patient-Centered Care and Multidisciplinary Collaboration: A Scoping Review of Activities, Benefits, Economic Impact, Challenges, and Knowledge Gaps. Telemed J E Health 2024; 30:21-35. [PMID: 37406291 DOI: 10.1089/tmj.2023.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Background: Very few studies have investigated telepharmacy (TP) in critical care. This scoping review undertook this task. Methods: We searched the following five electronic databases (PubMed, Embase, WoS, Scopus, CINAHL). Data were extracted from the articles and mapped out. Arksey and O'Malley's 6-step framework was used, and data synthesis identified activities, benefits, economic impact, challenges, and knowledge gaps of TP in critical care. Results: Out of 77 reports retrieved, 14 were included in the review as per inclusion criteria. Eight studies (57%) were published since 2020, and 9 (64%) were from the United States. Tele-ICU was in place before TP implementation in six studies (43%). TP used a range of synchronous/asynchronous communications. Studies reported wide assortment of reactive/scheduled TP activities. Patient outcomes were evaluated in one study of sedation-related TP interventions but they were not different despite improved compliance with sedation protocol. Most common clinical interventions/drugs included glycemic, electrolyte, and antimicrobial therapy management and antithrombotic agents among others. Acceptance of TP interventions was 75% or more in four studies and 51-55% in two studies. Benefits of TP included resolved drug-related problems, increased compliance with guidelines, maintained interactions with other health care providers, and patient safety among others. Three studies (21%) reported cost avoidance with TP interventions. Challenges included communication, intervention documentation, tracking implementation of recommendations, and monetary/financial and legislative/regulatory issues. Knowledge gaps comprised lack of frameworks for implementation/evaluation of TP in critical care, methodological aspects, lack of patient-specific outcomes, as well as institution/health-system aspects, and documentation systems, cost, legislative, and sustainability issues. Conclusions: TP in critical care is underpublished, and comprehensive frameworks for its implementation and evaluation remain lacking. Assessments are needed to evaluate the effect of TP in critical care on patient-specific outcomes, its economic and legal dimensions, methods to sustain it, as well as the role of documentation systems, collaboration models, and institutional characteristics.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
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Crosby A, Jennings JK, Mills AT, Silcock J, Bourne RS. Economic evaluations of adult critical care pharmacy services: a scoping review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:574-584. [PMID: 37607337 DOI: 10.1093/ijpp/riad049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 07/05/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES To summarise the extent and type of evidence available regarding economic evaluations of adult critical care pharmacy services in the context of UK practice. METHODS A literature search was conducted in eight electronic databases and hand searching of full-text reference lists. Of 2409 journal articles initially identified, 38 were included in the final review. Independent literature review was undertaken by two investigators in a two-step process against the inclusion and exclusion criteria; title and abstract screening were followed by full-text screening. Included studies were taken from high-income economy countries that contained economic data evaluating any key aspect of adult critical care pharmacy services. Grey literature and studies that could not be translated into the English language were excluded. RESULTS The majority were before-and-after studies (18, 47%) or other observational studies (17, 45%), and conducted in North America (25, 66%). None of the included studies were undertaken in the UK. Seven studies (18%) included cost-benefit analysis; all demonstrated positive cost-benefit values for clinical pharmacist activities. CONCLUSIONS Further high-quality primary research focussing on the economic evaluation of UK adult critical care pharmacy services is needed, before undertaking a future systematic review. There is an indication of a cost-benefit value for critical care pharmacist activities. The lack of UK-based economic evaluations is a limitation to further development and standardisation of critical care pharmacy services nationally.
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Affiliation(s)
- Alex Crosby
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jennifer K Jennings
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Anna T Mills
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jonathan Silcock
- Faculty of Life Sciences, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Richard S Bourne
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK
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Kansal A, Latour JM, See KC, Rai S, Cecconi M, Britto C, Conway Morris A, Dominic Savio R, Nadkarni VM, Rao BK, Mishra R. Interventions to promote cost-effectiveness in adult intensive care units: consensus statement and considerations for best practice from a multidisciplinary and multinational eDelphi study. Crit Care 2023; 27:487. [PMID: 38082302 PMCID: PMC10712165 DOI: 10.1186/s13054-023-04766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND There is limited evidence to guide interventions that promote cost-effectiveness in adult intensive care units (ICU). The aim of this consensus statement is to identify globally applicable interventions for best ICU practice and provide guidance for judicious use of resources. METHODS A three-round modified online Delphi process, using a web-based platform, sought consensus from 61 multidisciplinary ICU experts (physicians, nurses, allied health, administrators) from 21 countries. Round 1 was qualitative to ascertain opinions on cost-effectiveness criteria based on four key domains of high-value healthcare (foundational elements; infrastructure fundamentals; care delivery priorities; reliability and feedback). Round 2 was qualitative and quantitative, while round 3 was quantitative to reiterate and establish criteria. Both rounds 2 and 3 utilized a five-point Likert scale for voting. Consensus was considered when > 70% of the experts voted for a proposed intervention. Thereafter, the steering committee endorsed interventions that were identified as 'critical' by more than 50% of steering committee members. These interventions and experts' comments were summarized as final considerations for best practice. RESULTS At the conclusion of round 3, consensus was obtained on 50 best practice considerations for cost-effectiveness in adult ICU. Finally, the steering committee endorsed 9 'critical' best practice considerations. This included adoption of a multidisciplinary ICU model of care, focus on staff training and competency assessment, ongoing quality audits, thus ensuring high quality of critical care services whether within or outside the four walls of ICUs, implementation of a dynamic staff roster, multidisciplinary approach to implementing end-of-life care, early mobilization and promoting international consensus efforts on the Green ICU concept. CONCLUSIONS This Delphi study with international experts resulted in 9 consensus statements and best practice considerations promoting cost-effectiveness in adult ICUs. Stakeholders (government bodies, professional societies) must lead the efforts to identify locally applicable specifics while working within these best practice considerations with the available resources.
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Affiliation(s)
- Amit Kansal
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, Jurong Health Campus, National University Health System, Singapore, Singapore.
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kay Choong See
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Sumeet Rai
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Carl Britto
- Division of Critical Care, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, USA
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
- John V Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Vinay M Nadkarni
- Department of Anesthesiology, Critical Care, and Pediatrics at the Children's Hospital of Philadelphia (CHOP), University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - B K Rao
- Department of Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Mehta R, Onatade R, Vlachos S, Sloss R, Maharaj R. The association of a critical care electronic prescribing system with the quality of patient care provided by clinical pharmacists - a prospective, observational cohort study. Int J Med Inform 2023; 177:105119. [PMID: 37311293 DOI: 10.1016/j.ijmedinf.2023.105119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/26/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite the strong face validity of electronic prescribing (EP), the empiric data in support of improved patient safety is sparse. The objective of this study was to compare the clinical significance of pharmacist contributions between an established EP and paper-based prescribing (PBP) system in the intensive care unit (ICU) to understand the EP impact on the quality of patient care. MATERIALS AND METHODS We conducted a prospective longitudinal study in two 18-bed ICUs; one with EP and the other, PBP. Pharmacist contributions were analysed over three months. Demographic, clinical and adjunctive intervention data were also collected. A multilevel ordinal logistic regression model was used and patients were followed up for 28 days. The primary outcome was the distribution of clinical significance levels of pharmacist contributions. RESULTS There were 303 patients admitted to the ICU between April 1st and June 30th 2018. EP was used in 171 patients and PBP in 132 patients. 1658 contributions were analysed. There were 14.9% highly clinically significant contributions with EP compared to 44.6% with PBP. The EP group had lower odds (OR 0.05, 95% CI 0.02-0.12) for a higher clinical significance contribution compared to the PBP group, but this changed over the admission and differed between groups, with decreasing odds of a higher-level clinical contribution for each additional admission day with PBP (OR 0.57, 95%CI 0.42-0.78). CONCLUSION This study showed a significant difference in the distribution of pharmacist contributions made over time, with clinical significance levels remaining stable in the EP group at low severity, as opposed to PBP which were initially high and then gradually decreased in severity over time. This contemporaneous controlled study found that the EP system required less significant input both in the severity and frequency of pharmacist contributions to maintain patient safety.
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Affiliation(s)
- Reena Mehta
- Pharmacy Department, King's College Hospital NHS Foundation Trust, London, UK; Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London, UK; School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | | | - Savvas Vlachos
- Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London, UK; School of Cardio-Vascular Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rhona Sloss
- Pharmacy Department, King's College Hospital NHS Foundation Trust, London, UK; Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Ritesh Maharaj
- Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London, UK; School of Health and Social Care Research, King's College London, London, UK; Department of Health Policy, London School of Economics & Political Science, London, UK
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Koeck JA, Dohmen SM, Marx G, Eisert A. Comparison of Drug-Related Problems in COVID-19 and Non-COVID-19 Patients Provided by a German Telepharmacy Service for Rural Intensive Care Units. J Clin Med 2023; 12:4739. [PMID: 37510855 PMCID: PMC10380643 DOI: 10.3390/jcm12144739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/05/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Telepharmacy is used to bridge the persisting shortage of specialist ward-based pharmacists, particularly in intensive care units (ICU). During the coronavirus disease 2019 (COVID-19), pharmacotherapy was rapidly developed, which resulted in multiple changes of guidelines. This potentially led to a differing risk for drug-related problems (DRPs) in ICUs. In this study, DRPs were detected in telepharmacy consultations of a German state-wide telemedicine network for adult patients in rural ICUs. The analysis included ICUs of ten general care hospitals with a total of 514 patients and 1056 consultations. The aim of this retrospective, observational cohort study was to compare and analyze the DRPs resulting from ICU patients with or without COVID-19. Furthermore, known risk groups for severe COVID-19 progression (organ insufficiency [kidney, liver], obesity, sex, and/or older age) were investigated with their non-COVID-19 counterparts. As a result, in both groups patients with acute renal insufficiency and without renal replacement therapy showed a significantly higher risk of being affected by one or more DRPs compared to patients with normal renal function. In COVID-19 patients, the initial recommendation of therapeutic anticoagulation (ATC-code B01AB 'Heparin group') resulted in significantly more DRPs compared to non-COVID-19 patients. Therefore, COVID-19 patients with therapeutic anticoagulation and all ICU patients with renal insufficiency should be prioritized for telepharmacy consultations.
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Affiliation(s)
- Joachim Andreas Koeck
- Pharmacy Department, Erlangen University Hospital, 91054 Erlangen, Germany
- Department of Intensive Care and Intermediate Care, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Sandra Maria Dohmen
- Department of Intensive Care and Intermediate Care, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Gernot Marx
- Department of Intensive Care and Intermediate Care, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Albrecht Eisert
- Hospital Pharmacy, RWTH Aachen University Hospital, 52074 Aachen, Germany
- Institute of Clinical Pharmacology, RWTH Aachen University Hospital, 52074 Aachen, Germany
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Mishra RC, Sodhi K, Prakash KC, Tyagi N, Chanchalani G, Annigeri RA, Govil D, Savio RD, Subbarayan B, Arora N, Chatterjee R, Chacko J, Khasne RW, Chakravarthi RM, George N, Ahmed A, Javeri Y, Chhallani AK, Khanikar RG, Margabandhu S, Lopa AJ, Chaudhry D, Samavedam S, Kar A, Dixit SB, Gopal P. ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy. Indian J Crit Care Med 2022; 26:S13-S42. [PMID: 36896356 PMCID: PMC9989875 DOI: 10.5005/jp-journals-10071-24109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/31/2022] [Indexed: 11/09/2022] Open
Abstract
Acute kidney injury (AKI) is a complex syndrome with a high incidence and considerable morbidity in critically ill patients. Renal replacement therapy (RRT) remains the mainstay of treatment for AKI. There are at present multiple disparities in uniform definition, diagnosis, and prevention of AKI and timing of initiation, mode, optimal dose, and discontinuation of RRT that need to be addressed. The Indian Society of Critical Care Medicine (ISCCM) AKI and RRT guidelines aim to address the clinical issues pertaining to AKI and practices to be followed for RRT, which will aid the clinicians in their day-to-day management of ICU patients with AKI. How to cite this article Mishra RC, Sodhi K, Prakash KC, Tyagi N, Chanchalani G, Annigeri RA, et al. ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy. Indian J Crit Care Med 2022;26(S2):S13-S42.
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Affiliation(s)
- Rajesh C Mishra
- EPIC Hospital, Sanjivani Super Speciality Hospital, Ahmedabad, Gujarat, India
| | | | | | - Niraj Tyagi
- Institute of Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Rajeev A Annigeri
- Department of Nephrology, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Deepak Govil
- Institute of Critical Care and Anaesthesiology, Medanta, Gurugram, Haryana, India
| | - Raymond D Savio
- Department of Critical Care Medicine, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | | | - Nitin Arora
- Department of Intensive Care, University Hospitals Birmingham, Birmingham, West Midlands, United Kingdom
| | - Ranajit Chatterjee
- Department of Anaesthesiology and Critical Care, Swami Dayanand Hospital, New Delhi, India
| | - Jose Chacko
- Narayana Health City, Bengaluru, Karnataka, India
| | - Ruchira W Khasne
- Department of Critical Care Medicine, SMBT Institute of Medical Sciences and Research Centre, Nashik, Maharashtra, India
| | | | - Nita George
- VPS Lakeshore Hospital, Kochi, Kerala, India
| | - Ahsan Ahmed
- KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Yash Javeri
- Department of Critical Care, Anesthesia and Emergency Medicine, Regency Super Speciality Hospital, Lucknow, Uttar Pradesh, India
| | | | - Reshu G Khanikar
- Department of Critical Care Medicine, Health City Hospital, Guwahati, Assam, India
| | | | - Ahsina J Lopa
- Intensive Care Unit, MH Samorita Hospital and Medical College, Tejgaon, Dhaka, Bangladesh
| | | | - Srinivas Samavedam
- Department of Critical Care, Vrinchi Hospital, Hyderabad, Telangana, India
| | - Arindam Kar
- Reliance Hospital, Mumbai, Maharashtra, India
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Palepu Gopal
- Department of Critical Care Medicine, Continental Hospitals, Hyderabad, Telangana, India
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Althomali A, Altowairqi A, Alghamdi A, Alotaibi M, Althubaiti A, Alqurashi A, Harbi AA, Algarni MA, Haseeb A, Elnaem MH, Alsenani F, Elrggal ME. Impact of Clinical Pharmacist Intervention on Clinical Outcomes in the Critical Care Unit, Taif City, Saudi Arabia: A Retrospective Study. PHARMACY 2022; 10:pharmacy10050108. [PMID: 36136841 PMCID: PMC9498917 DOI: 10.3390/pharmacy10050108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/28/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Objectives: Clinical pharmacists are now playing a significant role in hospitals aiming to reduce medication errors, adverse drug reactions, and healthcare costs. Therefore, the main objective of this study was to assess the interventions provided by a clinical pharmacist in the intensive care unit at the King Faisal Hospital in Taif city. (2) Methods: For this single-center retrospective study, patients were included from December 2021 to May 2022. In the present study, all the interventions of clinical pharmacists made over six months were included. The Intensive care unit (ICU) ward was covered by three clinical pharmacists, and the interventions made were categorized into four groups: (1) interventions related to indications; (2) interventions regarding safety; (3) interventions regarding dosing, and (4) miscellaneous. Descriptive statistics was applied to evaluate the results in the form of frequencies and percentages. Analysis was performed using the statistical package SPSS 20.0. (3) Results: Overall, a total of 404 interventions were recommended for 165 patients during the six- month period of study. Among them, 370 interventions (91.5%) were accepted by physicians. Among all the interventions, the majority were suggested regarding ‘indication’ (45.7%), including the addition of drugs, drugs with no indications, and duplication. The acceptance rate of clinical pharmacist intervention was 98.5%. (4) Conclusions: This retrospective study shows that clinical pharmacists played a critical role in optimizing drug therapy which could subsequently help to prevent drug-related issues and lower drug costs. More research is needed to do a thorough cost-benefit analysis.
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Affiliation(s)
- Abdullah Althomali
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Ahmed Altowairqi
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Afnan Alghamdi
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Musim Alotaibi
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | | | | | - Adnan Al Harbi
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Majed Ahmed Algarni
- Clinical Pharmacy Department, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
| | - Abdul Haseeb
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Mohamed Hassan Elnaem
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University, Kuantan 53100, Pahang, Malaysia
| | - Faisal Alsenani
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Mahmoud E. Elrggal
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
- Correspondence: or
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Drug Utilization and Potential Drug-Drug Interactions within an Intensive Care Unit at a University Tertiary Care Hospital in Egypt. PHARMACY 2022; 10:pharmacy10040096. [PMID: 36005936 PMCID: PMC9416082 DOI: 10.3390/pharmacy10040096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
There are few reports on drug utilization and drug-drug interactions in Intensive Care Units (ICUs) in Egypt. A total of 94 patients participated in this retrospective observational study. Patient's medical records were used to collect demographics, medical history, admission and discharge dates and medications used. The mean ± SD of the Glasgow Coma Scale (GCS) scores was 9.9 ± 4.4 and the median length of stay was 7 days (range 1-47 days). The total number of prescribed medications ranged from 4-29 with a mean ± SD of 14.1 ± 5.5 medications per patient. The top three most prescribed categories belonged to (1) anti-infective agents (23.9%); (2) electrolyte, caloric and water balance agents (14.6%); and (3) blood formation, coagulation and thrombosis (11.3%). The proton pump inhibitor, esomeprazole, was the most frequently prescribed medication accounting for 6.5% of total prescriptions, followed by clindamycin and magnesium sulfate each accounting for 3.5% of total prescriptions. The potential Drug-Drug Interactions (pDDIs) showed a total of 968 pDDIs with a mean ± SD (range) of 10.2 ± 9.4 (0-43) pDDIs per patient: severe (contraindicated) (3), major (178), moderate (618) and minor (169). Overall, the drug utilization patterns in this study were consistent with ICU drug utilization from other countries in the region. The implementation of clinical decision support systems and the involvement of clinical pharmacists may help improve medication safety.
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Liu K, Nakamura K, Katsukawa H, Nydahl P, Ely EW, Kudchadkar SR, Takahashi K, Elhadi M, Gurjar M, Leong BK, Chung CR, Balachandran J, Inoue S, Lefor AK, Nishida O. Implementation of the ABCDEF Bundle for Critically Ill ICU Patients During the COVID-19 Pandemic: A Multi-National 1-Day Point Prevalence Study. Front Med (Lausanne) 2021; 8:735860. [PMID: 34778298 PMCID: PMC8581178 DOI: 10.3389/fmed.2021.735860] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Data regarding delivery of evidence-based care to critically ill patients in Intensive Care Units (ICU) during the COVID-19 pandemic is crucial but lacking. This study aimed to evaluate the implementation rate of the ABCDEF bundle, which is a collection of six evidence-based ICU care initiatives which are strongly recommended to be incorporated into clinical practice, and ICU diaries for patients with and without COVID-19 infections in ICUs, and to analyze the impact of COVID-19 on implementation of each element of the bundle and independent associated factors. Methods: A world-wide 1-day point prevalence study investigated the delivery of the ABCDEF bundle and ICU diary to patients without or with COVID-19 infections on 27 January 2021 via an online questionnaire. Multivariable logistic regression analysis with adjustment for patient demographics evaluated the impact of COVID-19 and identified factors in ICU administrative structures and policies independently associated with delivery. Results: From 54 countries and 135 ICUs, 1,229 patients were eligible, and 607 (49%) had COVID-19 infections. Implementation rates were: entire bundle (without COVID-19: 0% and with COVID-19: 1%), Element A (regular pain assessment: 64 and 55%), Element B (both spontaneous awakening and breathing trials: 17 and 10%), Element C (regular sedation assessment: 45 and 61%), Element D (regular delirium assessment: 39 and 35%), Element E (exercise: 22 and 25%), Element F (family engagement/empowerment: 16 and 30%), and ICU diary (17 and 21%). The presence of COVID-19 was not associated with failure to implement individual elements. Independently associated factors for each element in common between the two groups included presence of a specific written protocol, application of a target/goal, and tele-ICU management. A lower income status country and a 3:1 nurse-patient ratio were significantly associated with non-implementation of elements A, C, and D, while a lower income status country was also associated with implementation of element F. Conclusions: Regardless of COVID-19 infection status, implementation rates for the ABCDEF bundle, for each element individually and an ICU diary were extremely low for patients without and with COVID-19 infections during the pandemic. Strategies to facilitate implementation of and adherence to the complete ABCDEF bundle should be optimized and addressed based on unit-specific barriers and facilitators.
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Affiliation(s)
- Keibun Liu
- Critical Care Research Group, Faculty of Medicine, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Japan
| | | | - Peter Nydahl
- Nursing Research, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Eugene Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University School of Medicine, Nashville, TN, United States.,Department of Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, TN, United States
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Be Kim Leong
- Department of Rehabilitation Medicine, Sarawak General Hospital, Kuching, Malaysia
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Shigeaki Inoue
- Emergency and Critical Care Center, Kobe University Hospital, Kobe, Japan.,Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | | | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
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11
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Kurttila M, Saano S, Laaksonen R. Describing voluntarily reported fluid therapy incidents in the care of critically ill patients: Identifying, and learning from, points of risk at the national level. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 2:100012. [PMID: 35481122 PMCID: PMC9030324 DOI: 10.1016/j.rcsop.2021.100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background Fluid therapy is a common intervention in critically ill patients. Fluid therapy errors may cause harm to patients. Thus, understanding of reported fluid therapy incidents is required in order to learn from them and develop protective measures, including utilizing expertise of pharmacists and technology to improve patient safety at the national level. Objectives To describe fluid therapy incidents voluntarily reported in intensive care and high dependency units (ICUs) to a national incident reporting system, by investigating the error types, fluid products, consequences to patients and actions taken to alleviate them, and to identify at which phase of the medication process the incidents had occurred and had been detected. Methods Medication related voluntarily reported incident (n = 7623) reports were obtained from all ICUs in 2007–2017. Incidents concerning fluid therapy (n = 2201) were selected. The retrospective analysis utilized categorized data and narrative descriptions of the incidents. The results were expressed as frequencies and percentages. Results Most voluntarily reported incidents had occurred during the dispensing/preparing phase (n = 1306, 59%) of the medication process: a point of risk. Most incidents (n = 1975, 90%) had reached the patient and passed through many phases in the medication process and nursing shift change checks before detection. One third of the errors (n = 596, 30%) were reported to have caused consequences to patients. One quarter (n = 492, 25%) of the errors were reported to have required an additional procedure to alleviate or monitor the consequences. Conclusions Utilizing national incident report data enabled identifying systemic points of risk in the medication process and learning to improve patient safety. To prevent similar incidents, initial interventions should focus on the dispensing/preparing phase before implementing active medication identification procedures at each phase of the medication process and nursing shift changes. Strengthening clinical pharmacy services, utilizing technology, coordinated by IV Fluid Coordinators and Medication Safety Officers, could improve patient safety in the ICUs.
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Affiliation(s)
- Minna Kurttila
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
- KUH Pharmacy, Hospital Pharmacy of Kuopio University Hospital (KUH), Finland
- Corresponding author at: KUH Pharmacy, Hospital Pharmacy of Kuopio University Hospital (KUH), PL 100, 70029 KYS, Finland.
| | - Susanna Saano
- KUH Pharmacy, Hospital Pharmacy of Kuopio University Hospital (KUH), Finland
| | - Raisa Laaksonen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
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12
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Pinder M, Bevan R, Kruger P. From dispensary to bedside and beyond: the evolving role of the intensive care unit pharmacist. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mary Pinder
- College of Intensive Care Medicine of Australia and New Zealand Prahran Australia
| | - Rob Bevan
- College of Intensive Care Medicine of Australia and New Zealand Prahran Australia
| | - Peter Kruger
- College of Intensive Care Medicine of Australia and New Zealand Prahran Australia
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13
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Johnston K, Ankravs MJ, Badman B, Choo CL, Cree M, Fyfe R, Roberts JA, Xu J, Munro C. Standard of practice in intensive care for pharmacy services. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Karlee Johnston
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Australian National University Medical School Garran Australia
- Canberra Hospital Garran Australia
| | - Melissa J. Ankravs
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department and Intensive Care Unit Royal Melbourne Hospital Parkville Australia
- Department of Medicine and Radiology Melbourne Medical School Royal Melbourne Hospital The University of Melbourne Parkville Australia
| | - Belinda Badman
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Princess Alexandra Hospital Metro South Health Service Brisbane Australia
| | - Chui Lynn Choo
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department and Intensive Care Services John Hunter Hospital New Lambton Heights Australia
| | - Michele Cree
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Queensland Children’s Hospital and Children’s Health Brisbane Australia
| | - Rachel Fyfe
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department and Intensive Care Unit Barwon Health Geelong Australia
| | - Jason A. Roberts
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Faculty of Medicine & Centre for Translational Anti‐infective Pharmacodynamics School of Pharmacy The University of Queensland Centre for Clinical Research The University of Queensland Brisbane Australia
- Departments of Pharmacy and Intensive Care Medicine Royal Brisbane and Women’s Hospital Brisbane Australia
| | - Jessica Xu
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department Fiona Stanley Hospital Perth Australia
| | - Courtney Munro
- The Society of Hospital Pharmacists of Australia Collingwood Australia
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14
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Edwards Z, Mulvey MR, Chapman EJ, Bennett MI. A national survey of hospice pharmacists and a comparison with international models. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:252-257. [PMID: 33864465 DOI: 10.1093/ijpp/riab002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/25/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Pharmacists can contribute to improved patient outcomes, improve medicine knowledge, reduce drug costs and minimise errors. However, their role within hospice-based services is not well described. OBJECTIVE The objective of this paper was to explore the role of pharmacists within UK hospices. METHODS Methods include an online survey and follow-up telephone contact of pharmacists working in UK hospices assessing pharmacist provision, duties, communication, medicine sourcing and training. RESULTS Eighty-nine responses were received from 82 hospices (response rate 50%). Pharmacists had a role in 75% of hospices providing between 6.6 min and 5.5 hrs of pharmacist support per bed per week. The most frequent duty reported was provision of medicines information to the clinical team. Access to patient records varied considerably: 13% had full read and write access to GP records while 29% had no access. Job-specific training had not been received by 36% of the respondents and 47% reported training needs including basic training in palliative care. CONCLUSIONS Three-quarters of UK hospices have pharmacy provision, although this falls below the recommended levels in the majority. Hospice pharmacists lack access to training and records. Medicines sourcing for hospices is variable and could provide opportunities for efficiencies with further research.
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Affiliation(s)
- Zoe Edwards
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew R Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Emma J Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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15
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Cvikl M, Sinkovič A. Interventions of a clinical pharmacist in a medical intensive care unit - A retrospective analysis. Bosn J Basic Med Sci 2020; 20:495-501. [PMID: 32070269 PMCID: PMC7664781 DOI: 10.17305/bjbms.2020.4612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/08/2020] [Indexed: 12/01/2022] Open
Abstract
Several studies demonstrated a significant decrease in prescription errors, adverse drug events, treatment costs and improved patient outcomes, when a clinical pharmacist (CP) was a full member of a multidisciplinary team in the intensive care unit (ICU). Our aim was to evaluate the activities of a CP, included in a 12-bed medical ICU team of a university hospital in the course of several months. We conducted a retrospective analysis of all the CP’s interventions from March 2017 to November 2017, carried out and documented after reviewing and discussing patients’ medical data with the treating ICU physicians. We identified four main categories of CP’s interventions: pharmacotherapy adjustments to kidney function (PAKF category), drug-drug interactions (DDIs category), therapeutic monitoring of drugs with narrow therapeutic index (TDM category), and drug administration by the nasogastric tube (NGT category). During the study period, 533 patients were admitted to the medical ICU. The CP reviewed the medical data of 321 patients and suggested 307 interventions in 95 patients. There were 147 interventions of the PAKF category, 57 interventions of the TDM category, 30 interventions of the NGT category, and 22 interventions of the DDIs category. Fifty-one interventions were unspecified. The majority of all interventions (203/307) were related to antimicrobial drugs. ICU physicians completely accepted 80.2% of the CP’s suggestions. We observed that regular participation of the CP in the medical ICU team contributed to more individualized and improved pharmacological treatment of patients. Therefore, ICU teams should be encouraged to include CPs as regular team members.
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Affiliation(s)
- Maja Cvikl
- Central Pharmacy, University Medical Centre Maribor, Maribor, Slovenia
| | - Andreja Sinkovič
- Department of Medical Intensive Care, University Medical Centre Maribor, Maribor, Slovenia
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16
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Bissell BD, Mefford B. Pathophysiology of Volume Administration in Septic Shock and the Role of the Clinical Pharmacist. Ann Pharmacother 2019; 54:388-396. [PMID: 31694386 DOI: 10.1177/1060028019887160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective: To review physiological rationale and evidence base surrounding fluid harm to prepare the clinical pharmacist for accountability regarding volume-related outcomes. Data Sources: A PubMed/MEDLINE search was conducted using the following terms: (fluid therapy) AND [(critical care) OR (sepsis)] from 1966 to August 2019 published in English. Study Selection and Data Extraction: A total of 3364 citations were reviewed with only relevant clinical data extracted. Data Synthesis: Although early fluid resuscitation may be a necessary component to decrease mortality in the majority of patients with septic shock admitted to the intensive care unit (ICU), the benefit of continued administration after the first 24 hours is uncertain. Paradoxically, a positive fluid balance secondary to intravenous fluid receipt has been associated with diverse and perpetuating detriment on a multitude of organ systems after the first 24 hours of ICU stay. Continued clinical harm has been demonstrated on patient outcomes such as rates of mortality and length of stay. Despite the growing body of evidence supporting the potential adverse aspects of positive fluid balance, fluid overload remains common during critical care admission. Conclusion: Physiological concerns to overly zealous fluid administration and subsequent volume overload are vast. Relevance to Patient Care and Clinical Practice: Optimization of fluid balance in critically ill patients with sepsis is primed for clinical pharmacy intervention. Critical care pharmacists have the potential to improve patient care by optimizing fluid pharmacotherapy while potentially reducing adverse events, days on mechanical ventilation, and length of ICU stay.
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17
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Shalansky S. The Advanced Pharmacist Practitioner: A New Series in the Canadian Journal of Hospital Pharmacy. Can J Hosp Pharm 2019; 72:42-48. [PMID: 30828093 PMCID: PMC6391237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Stephen Shalansky
- , BSc(Pharm), ACPR, PharmD, FCSHP, is Clinical Coordinator with the Pharmacy Department, Providence Healthcare, Lower Mainland Pharmacy Services, and Clinical Professor with the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia. He is also the Editor of the Canadian Journal of Hospital Pharmacy
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