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Arredondo E, Udeani G, Horseman M, Hintze TD, Surani S. Role of Clinical Pharmacists in Intensive Care Units. Cureus 2021; 13:e17929. [PMID: 34660121 PMCID: PMC8513498 DOI: 10.7759/cureus.17929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 01/22/2023] Open
Abstract
The cost of health care has been rising in the United States and globally and will continue to increase. Intensive care unit (ICU) care carries a significant portion of the cost for the hospitals. The Institute of Medicine and subsequent studies have suggested that medication errors account for significant morbidity, mortality, and cost, frequently encountered in the ICU. Over the past three decades, clinical pharmacists have emerged from dispensing medication to getting involved in direct patient care and have become an integral part of the multidisciplinary critical care team. Clinical pharmacists play a significant role in reducing medication errors and costs, medication reconciliation, antibiotic stewardship, and patient and health care provider education. This review will discuss the health care and ICU cost, the evolving role of clinical pharmacists in managing critically ill patients, and their contributions in the ICU to mitigate the risks, improve patient outcomes, and decrease health care costs.
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Affiliation(s)
- Enrique Arredondo
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - George Udeani
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - Michael Horseman
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - Trager D Hintze
- Pharmacy, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
| | - Salim Surani
- Anesthesiology, Mayo Clinic, Rochester, USA
- Medicine, Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, USA
- Medicine, University of North Texas, Dallas, USA
- Internal Medicine, Pulmonary Associates, Corpus Christi, USA
- Clinical Medicine, University of Houston, Houston, USA
- Medicine, College of Medicine, Texas A&M Health Science Center, Bryan, USA
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2
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Bosma BE, Hunfeld NGM, Roobol-Meuwese E, Dijkstra T, Coenradie SM, Blenke A, Bult W, Melief PHGJ, Dixhoorn MPV, van den Bemt PMLA. Voluntarily reported prescribing, monitoring and medication transfer errors in intensive care units in The Netherlands. Int J Clin Pharm 2020; 43:66-76. [PMID: 32812096 DOI: 10.1007/s11096-020-01101-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/08/2020] [Indexed: 12/11/2022]
Abstract
Background Medication errors occur frequently in intensive care units (ICU). Voluntarily reported medication errors form an easily available source of information. Objective This study aimed to characterize prescribing, monitoring and medication transfer errors that were voluntarily reported in the ICU, in order to reveal medication safety issues. Setting This retrospective data analysis study included reports of medication errors from eleven Dutch ICU's from January 2016 to December 2017. Method We used data extractions from the incident reporting systems of the participating ICU's. The reports were transferred into one database and categorized into type of error, cause, medication (groups), and patient harm. Descriptive statistics were used to calculate the proportion of medication errors and the distribution of subcategories. Based on the analysis, ICU medication safety issues were revealed. Main outcome measure The main outcome measure was the proportion of prescribing, monitoring and medication transfer error reports. Results Prescribing errors were reported most frequently (n = 233, 33%), followed by medication transfer errors (n = 85, 12%) and monitoring errors (n = 27, 4%). Other findings were: medication transfer errors frequently caused serious harm, especially the omission of home medication involving the central nervous system and proton pump inhibitors; omissions and dosing errors occurred most frequently; protocol problems caused a quarter of the medication errors; and medications needing blood level monitoring (e.g. tacrolimus, vancomycin, heparin and insulin) were frequently involved. Conclusion This analysis of voluntarily reported prescribing, monitoring and medication transfer errors warrants several improvement measures in these processes, which may help to increase medication safety in the ICU.
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Affiliation(s)
- B E Bosma
- Department of Pharmacy, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 CH, The Hague, The Netherlands. .,Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - N G M Hunfeld
- Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Intensive Care, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - E Roobol-Meuwese
- Department of Hospital Pharmacy, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
| | - T Dijkstra
- Department of Pharmacy, Franciscus Gasthuis and Vlietland, Vlietlandplein 2, 3118 JH, Schiedam, The Netherlands
| | - S M Coenradie
- Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | - A Blenke
- Department of Clinical Pharmacy, Jeroen Bosch Hospital, PO Box 3406, 5203 DK, 's-Hertogenbosch, The Netherlands
| | - W Bult
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P H G J Melief
- Department of Critical Care, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 CH, The Hague, The Netherlands
| | - M Perenboom-Van Dixhoorn
- Department of Critical Care, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 CH, The Hague, The Netherlands
| | - P M L A van den Bemt
- Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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3
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Louzon P, Jennings H, Ali M, Kraisinger M. Impact of pharmacist management of pain, agitation, and delirium in the intensive care unit through participation in multidisciplinary bundle rounds. Am J Health Syst Pharm 2018; 74:253-262. [PMID: 28179250 DOI: 10.2146/ajhp150942] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A two-phase program to increase pharmacist involvement in management of pain, agitation and delirium (PAD) at a large community teaching hospital is described. SUMMARY Florida Orlando Hospital implemented a two-phase initiative to decrease intensive care unit (ICU) length of stay (LOS), ventilator use, sedative use, and hospital expenditures while advancing pharmacists' scope of practice. Phase 1 of the initiative involved a pilot project to evaluate pharmacist management of sedative therapy for mechanically ventilated patients. Using a newly developed PAD order set, a pharmacist performed daily sedation management in a cohort of patients; relative to physician-managed standard care, pharmacist-directed sedation management resulted in fewer hours of patient exposure to continuous sedation, with an overall 46% reduction in continuous infusions of sedatives and reductions in both ICU and total hospital LOS, resulting in estimated savings of $1.2 million in direct hospital costs and $183,216 in drug costs. In phase 2 of the project, an expanded group of pharmacists collaborated with interprofessional teams to manage PAD using an integrated "ABCDE bundle" to promote early mobility and weaning from sedatives and analgesics. A retrospective comparison of data on a cohort of medical ICU patients managed using the ABCDE bundle approach (n = 436) and a standard-care cohort (n = 499) demonstrated improvements in several outcomes, including mean ventilator days per patient, ICU LOS, and mortality. CONCLUSION The provision of proactive critical care pharmacist services directed at PAD management is an innovative approach to fostering interprofessional collaboration and optimizing clinical outcomes.
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Affiliation(s)
- Patricia Louzon
- Critical Care and ED Pharmacy Division, Florida Hospital Orlando, Orlando, FL .,University of Florida College of Pharmacy, Gainesville, FL
| | | | - Mahmood Ali
- Medical Intensive Care Unit, Florida Hospital Orlando, Orlando, FL.,Central Florida Pulmonary Group, Orlando, FL
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McDaniel J, Bass L, Pate T, DeValve M, Miller S. Doubling Pharmacist Coverage in the Intensive Care Unit: Impact on the Pharmacists' Clinical Activities and Team Members' Satisfaction. Hosp Pharm 2017; 52:564-569. [PMID: 29276290 DOI: 10.1177/0018578717723997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: National professional organizations have recognized pharmacists as essential members of the intensive care unit (ICU) team. Critical care pharmacists' clinical activities have been categorized as fundamental, desirable, and optimal, providing a structure for gauging ICU pharmacy services being provided. Objective: To determine the impact the addition of a second ICU pharmacist covering 30 adult ICU beds at a large regional medical center has on the complexity of pharmacists' interventions, the types of clinical activities performed by the pharmacists, and the ICU team members' satisfaction. Methods: A prospective mixed-method descriptive study was conducted. Pharmacists recorded their interventions and clinical activities performed. A focus group composed of randomly selected ICU team members was held to qualitatively describe the impact of the additional pharmacist coverage on patient care, team dynamics, and pharmacy services provided. Results: The baseline period consisted of 33 days, and the intervention period consisted of 20 days. The average complexity of interventions was 1.72 during the baseline period (mode = 2) versus 1.69 (mode = 2) during the intervention period. The number of desirable and optimal clinical activities performed daily increased during the intervention from 8.4 (n = 279) to 16.4 (n = 328) and 2.3 (n = 75) to 8.6 (n = 171) compared with the baseline, respectively. Focus group members qualitatively described additional pharmacist coverage as beneficial. Conclusion: The additional critical care pharmacist did not increase pharmacy intervention complexity; however, more interventions were performed per day. Additional pharmacist coverage increased the daily number of desirable and optimal clinical activities performed and positively impacted ICU team members' satisfaction.
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Affiliation(s)
- Joshua McDaniel
- Cape Fear Valley Health System, Fayetteville, NC, USA.,Southern Regional Area Health Education Center, Fayetteville, NC, USA
| | - Lynn Bass
- Cape Fear Valley Health System, Fayetteville, NC, USA
| | - Toni Pate
- Cape Fear Valley Health System, Fayetteville, NC, USA
| | | | - Susan Miller
- Southern Regional Area Health Education Center, Fayetteville, NC, USA
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Lee AJ, Chiao TB, Lam JT, Khan S, Boro MS. Improving Medication Safety in the ICU: The Pharmacist's Role. Hosp Pharm 2017. [DOI: 10.1310/hpj4204-337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Audrey J. Lee
- University of the Pacific (UOP) Thomas J. Long, School of Pharmacy and Health Sciences, Stockton, CA, Clinical Pharmacist, Medicine, San Francisco Veterans Affairs Medical Center (SFVAMC), San Francisco, CA, University of California at San Francisco (UCSF), School of Pharmacy, San Francisco, CA
| | - Teresa B. Chiao
- Drug Information Specialist, SFVAMC, San Franscisco, FA, UOP, Thomas J. Long School of Pharmacy and Health Sciences, Stockton, CA, UCSF, School of Pharmacy, San Franscisco, CA
| | - Jerika T. Lam
- Fellow, HIV Pharmacotherapy, University of Southern California, School of Pharmacy, Los Angeles, CA
| | - Shamima Khan
- North Dakota State University, College of Pharmacy, Nursing and Allied Sciences, Fargo, ND
| | - Maureen S. Boro
- SFVAMC, San Francisco, CA, UCSF, School of Pharmacy San Francisco, CA, UOP, Thomas J. Long School of Pharmacy and Health Sciences, Stockton, CA
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6
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Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2017; 6:37-46. [PMID: 29354549 PMCID: PMC5774321 DOI: 10.2147/iprp.s108047] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Global healthcare expenditure is escalating at an unsustainable rate. Money spent on medicines and managing medication-related problems continues to grow. The high prevalence of medication errors and inappropriate prescribing is a major issue within healthcare systems, and can often contribute to adverse drug events, many of which are preventable. As a result, there is a huge opportunity for pharmacists to have a significant impact on reducing healthcare costs, as they have the expertise to detect, resolve, and prevent medication errors and medication-related problems. The development of clinical pharmacy practice in recent decades has resulted in an increased number of pharmacists working in clinically advanced roles worldwide. Pharmacist-provided services and clinical interventions have been shown to reduce the risk of potential adverse drug events and improve patient outcomes, and the majority of published studies show that these pharmacist activities are cost-effective or have a good cost:benefit ratio. This review demonstrates that pharmacists can contribute to substantial healthcare savings across a variety of settings. However, there is a paucity of evidence in the literature highlighting the specific aspects of pharmacists' work which are the most effective and cost-effective. Future high-quality economic evaluations with robust methodologies and study design are required to investigate what pharmacist services have significant clinical benefits to patients and substantiate the greatest cost savings for healthcare budgets.
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Affiliation(s)
- Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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7
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Maclaren R, Devlin JW, Martin SJ, Dasta JF, Rudis MI, Bond CA. Critical Care Pharmacy Services in United States Hospitals. Ann Pharmacother 2016; 40:612-8. [PMID: 16569803 DOI: 10.1345/aph.1g590] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Critical care pharmacy activities have been described as fundamental, desirable, and optimal, but actual services provided have not been evaluated. Objective: To characterize the type and level of pharmacy services provided to intensive care units (ICUs). Methods: A 38 question survey was sent in 2 consecutive mailings to all US institutions (N = 3238) with an ICU. Questions were categorized according to clinical, educational, administrative, and scholarly activities, with levels of services stratified as fundamental, desirable, or optimal. Results: Completed surveys were received from 382 (11.8%) institutions encompassing 1034 ICUs. Direct clinical pharmacy activities were provided at 62.2% of ICUs. The pharmacists in those programs attended rounds 4.4 ± 1.5 days/wk, mean ± SD, and had a workweek that consisted of patient care (43% of hours worked), drug distribution (26.2%), administration (12.6%), education (10.9%), and scholarly activities (7.3%). Fundamental clinical activities performed during at least 75% of patient ICU days were providing drug information, drug therapy evaluation, drug therapy intervention, and pharmacokinetic monitoring. Conducting inservices (92.8%), a fundamental service, was the only educational activity frequently provided. Most respondents were involved with at least one multidisciplinary committee, and 45.5% conducted scholarly activities. Desirable or optimal activities were not frequently provided across all service categories. Conclusions: Clinical pharmacists are directly involved as caregivers in nearly two-thirds of ICUs in the US. Although they provide a range of clinical and administrative services, involvement in educational and scholarly activities is variable. The level of services provided is consistent with the criteria deemed fundamental for improving patient care. Higher-order services are far less likely to be provided.
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Affiliation(s)
- Robert Maclaren
- Department of Clinical Pharmacy, School of Pharmacy, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
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8
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Rudall N, McKenzie C, Landa J, Bourne RS, Bates I, Shulman R. PROTECTED-UK - Clinical pharmacist interventions in the UK critical care unit: exploration of relationship between intervention, service characteristics and experience level. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:311-319. [PMID: 27699912 DOI: 10.1111/ijpp.12304] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 07/27/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Clinical pharmacist (CP) interventions from the PROTECTED-UK cohort, a multi-site critical care interventions study, were further analysed to assess effects of: time on critical care, number of interventions, CP expertise and days of week, on impact of intervention and ultimately contribution to patient care. METHODS Intervention data were collected from 21 adult critical care units over 14 days. Interventions could be error, optimisation or consults, and were blind-coded to ensure consistency, prior to bivariate analysis. Pharmacy service demographics were further collated by investigator survey. KEY FINDINGS Of the 20 758 prescriptions reviewed, 3375 interventions were made (intervention rate 16.1%). CPs spent 3.5 h per day (mean, ±SD 1.7) on direct patient care, reviewed 10.3 patients per day (±SD 4.2) and required 22.5 min (±SD 9.5) per review. Intervention rate had a moderate inverse correlation with the time the pharmacist spent on critical care (P = 0.05; r = 0.4). Optimisation rate had a strong inverse association with total number of prescriptions reviewed per day (P = 0.001; r = 0.7). A consultant CP had a moderate inverse correlation with number of errors identified (P = 0.008; r = 0.6). No correlation existed between the presence of electronic prescribing in critical care and any intervention rate. Few centres provided weekend services, although the intervention rate was significantly higher on weekends than weekdays. CONCLUSIONS A CP is essential for safe and optimised patient medication therapy; an extended and developed pharmacy service is expected to reduce errors. CP services should be adequately staffed to enable adequate time for prescription review and maximal therapy optimisation.
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Affiliation(s)
- Nicola Rudall
- Pharmacy Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne
| | - Catherine McKenzie
- Institute of Pharmaceutical Sciences, Kings College London, London.,Pharmacy and Critical Care, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London
| | - June Landa
- Pharmacy and Critical Care, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London
| | - Richard S Bourne
- Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield
| | - Ian Bates
- School of Pharmacy, University College London, London
| | - Rob Shulman
- Pharmacy and Critical Care, University College Hospital NHS Foundation Trust, London
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Krzyzaniak N, Bajorek B. A global perspective of the roles of the pharmacist in the NICU. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:107-120. [DOI: 10.1111/ijpp.12284] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 05/23/2016] [Indexed: 11/29/2022]
Abstract
Abstract
Objectives
To describe pharmacist practice and roles performed in the neonatal intensive care unit (NICU) worldwide and to map these findings along the medicines management pathway (MMP).
Method
Quasi-systematic review.
Search Strategy
Google Scholar, Medline/PubMed and Embase were searched utilising the selected MeSH terms.
Results
Thirty sources of information were reviewed. Overall, pharmacist practice in the NICU involves a wide-range of roles, with the most commonly reported involving patient medication chart review, therapeutic drug monitoring and the provision of medication information. Studies highlight that pharmacist contribution to total parenteral nutrition (TPN) regimens and patient medication chart review is beneficial to patient outcomes. Roles beyond the regular scope of practice included involvement in immunisation programmes and research. Most of the data were collected from the USA (13 of 30), followed by the UK (6 of 30) and reports from other countries. The American, British, South African and Australian articles have reported very similar roles, with a pharmacist firmly integrated into the overall structure of the NICU team.
Conclusion
The literature identifies that there is insufficient evidence to describe what roles are currently performed in NICUs worldwide. This is due to the lack of recently published articles leading to a large gap in knowledge in understanding what contemporary pharmaceutical services in the NICU comprise. Further research is required to address these gaps in knowledge, and identify the impact of the pharmacist's role on neonatal patient outcomes as well as to determine how to better resource NICUs to access pharmacy services.
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Affiliation(s)
- Natalia Krzyzaniak
- University of Technology Sydney, Graduate School of Health (Pharmacy), Broadway, NSW, Australia
| | - Beata Bajorek
- University of Technology Sydney, Graduate School of Health (Pharmacy), Broadway, NSW, Australia
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Abstract
As our health care system has begun to place more emphasis on the provision of direct patient care activities and adherence to clinical guidelines, the profession of pharmacy has adapted to provide services, and practitioners, that meet these demands. Two areas of the hospital where pharmacy services are in high demand are the intensive care units and the emergency department; 2 dynamic environments that place a premium on providing appropriate medication therapy in a timely manner. The pharmacists working in these areas can provide a wide range of services that can expedite the arrival of medications and improve adherence to clinical practice guidelines and patient outcomes. In addition to processing medication orders and coordinating the arrival of medications, these pharmacists can also assist with therapeutic drug monitoring (vancomycin, aminoglycosides, and warfarin), medication dosing, renal dosing, and responding to medical emergencies (stroke, code blue, therapeutic hypothermia, rapid sequence intubation, etc). Critical care pharmacists also play an active role on hospital committees, in the education of staff, students, and residents (pharmacy and medical), and in the implementation of new institutional policies and protocols.
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Penm J, Li Y, Zhai S, Hu Y, Chaar B, Moles R. The impact of clinical pharmacy services in China on the quality use of medicines: a systematic review in context of China's current healthcare reform. Health Policy Plan 2013; 29:849-72. [PMID: 24056897 DOI: 10.1093/heapol/czt067] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Recently, China initiated an ambitious healthcare reform aiming to provide affordable and equitable basic health care to all by 2020. To meet these goals, new policies issued by China's Ministry of Health mandate clinical pharmacy services be integrated into China's hospitals. This review aims to highlight the impact of clinical pharmacy services on the quality use of medicines in hospitals in China. METHODS Both English and Chinese databases were used. For the English databases, Web of Science, Medline, International Pharmaceutical Abstracts and Embase were searched using the following keywords ('pharmacists' OR 'pharmacy' OR 'pharmaceutical services/pharmaceutical care') AND ('China'). For the Chinese database, Chinese Biomedical Literature Database on disc was searched using the following keywords ('clinical pharmacist' OR 'clinical pharmacy' OR 'pharmaceutical care' OR 'pharmaceutical services'). Articles were then retrieved from WanFang database and China Knowledge Resource Integrated Database. RESULTS A total of 75 published papers were included in this review. The majority of studies were conducted in the inpatient setting (68%), which included clinical pharmacy interventions such as educating doctors and patients, evaluating and monitoring the implementation of hospital policies and/or reviewing medications on the ward. In the outpatient setting, the majority of studies conducted involved educating patients. Clinical pharmacy services frequently focused on antimicrobials (44%). More than half of these studies employed an administrative intervention alongside the clinical pharmacy service. CONCLUSION Clinical pharmacy services in China, with its unique healthcare system and cultural nuances, appear to positively influence patient care and the appropriate use of medications. From the published literature, it is expected that clinical pharmacy services can make a strong contribution to China's healthcare reform with further governmental and educational support.
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Affiliation(s)
- Jonathan Penm
- Sydney Hospital and Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW, 2000 Australia Faculty of Pharmacy, World Hospital Pharmacy Research Consortium, University of Sydney, Sydney, NSW, 2006, Australia Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China and School of Pharmaceutical Sciences, Department of Pharmacy Administration and Clinical Pharmacy, Peking University Health Science Center, Beijing, 100083, China Sydney Hospital and Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW, 2000 Australia Faculty of Pharmacy, World Hospital Pharmacy Research Consortium, University of Sydney, Sydney, NSW, 2006, Australia Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China and School of Pharmaceutical Sciences, Department of Pharmacy Administration and Clinical Pharmacy, Peking University Health Science Center, Beijing, 100083, China
| | - Yan Li
- Sydney Hospital and Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW, 2000 Australia Faculty of Pharmacy, World Hospital Pharmacy Research Consortium, University of Sydney, Sydney, NSW, 2006, Australia Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China and School of Pharmaceutical Sciences, Department of Pharmacy Administration and Clinical Pharmacy, Peking University Health Science Center, Beijing, 100083, China Sydney Hospital and Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW, 2000 Australia Faculty of Pharmacy, World Hospital Pharmacy Research Consortium, University of Sydney, Sydney, NSW, 2006, Australia Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China and School of Pharmaceutical Sciences, Department of Pharmacy Administration and Clinical Pharmacy, Peking University Health Science Center, Beijing, 100083, China
| | - Suodi Zhai
- Sydney Hospital and Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW, 2000 Australia Faculty of Pharmacy, World Hospital Pharmacy Research Consortium, University of Sydney, Sydney, NSW, 2006, Australia Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China and School of Pharmaceutical Sciences, Department of Pharmacy Administration and Clinical Pharmacy, Peking University Health Science Center, Beijing, 100083, China
| | - Yongfang Hu
- Sydney Hospital and Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW, 2000 Australia Faculty of Pharmacy, World Hospital Pharmacy Research Consortium, University of Sydney, Sydney, NSW, 2006, Australia Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China and School of Pharmaceutical Sciences, Department of Pharmacy Administration and Clinical Pharmacy, Peking University Health Science Center, Beijing, 100083, China
| | - Betty Chaar
- Sydney Hospital and Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW, 2000 Australia Faculty of Pharmacy, World Hospital Pharmacy Research Consortium, University of Sydney, Sydney, NSW, 2006, Australia Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China and School of Pharmaceutical Sciences, Department of Pharmacy Administration and Clinical Pharmacy, Peking University Health Science Center, Beijing, 100083, China
| | - Rebekah Moles
- Sydney Hospital and Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW, 2000 Australia Faculty of Pharmacy, World Hospital Pharmacy Research Consortium, University of Sydney, Sydney, NSW, 2006, Australia Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China and School of Pharmaceutical Sciences, Department of Pharmacy Administration and Clinical Pharmacy, Peking University Health Science Center, Beijing, 100083, China
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Hasan SS, Wong PS, Ahmed SI, Chong DWK, Mai CW, Pook P, Kairuz T. Perceived impact of clinical placements on students' preparedness to provide patient-centered care in Malaysia. CURRENTS IN PHARMACY TEACHING & LEARNING 2013. [DOI: 10.1016/j.cptl.2013.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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13
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Al-azzam SI, Shara M, Alzoubi KH, Almahasneh FA, Iflaifel MH. Implementation of clinical pharmacy services at a university hospital in Jordan. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2013; 21:337-40. [PMID: 23418903 DOI: 10.1111/ijpp.12009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 10/08/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Clinical pharmacy services are still in the early stages of implementation in the Middle East. This study assessed the implementation of clinical pharmacy services at a major university hospital. METHODS All recommendations and services provided by clinical pharmacists were recorded for a period of 7 months. KEY FINDINGS During the study period a total of 3026 patients were followed up and 10,783 recommendations and services were provided. The physicians' rate of acceptance of clinical pharmacists' recommendations was 69.4%. CONCLUSION The implementation of clinical pharmacy services in this setting was successful and should positively impact patient care.
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Affiliation(s)
- Sayer I Al-azzam
- Department of Clinical Pharmacy, King Abdulla University Hospital, Irbid, Jordan
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14
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MacLaren R, Bond CA. Effects of Pharmacist Participation in Intensive Care Units on Clinical and Economic Outcomes of Critically Ill Patients with Thromboembolic or Infarction-Related Events. Pharmacotherapy 2009; 29:761-8. [DOI: 10.1592/phco.29.7.761] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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MacLaren R, Bond CA, Martin SJ, Fike D. Clinical and economic outcomes of involving pharmacists in the direct care of critically ill patients with infections*. Crit Care Med 2008; 36:3184-9. [DOI: 10.1097/ccm.0b013e31818f2269] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kopp BJ, Mrsan M, Erstad BL, Duby JJ. Cost implications of and potential adverse events prevented by interventions of a critical care pharmacist. Am J Health Syst Pharm 2007; 64:2483-7. [DOI: 10.2146/ajhp060674] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | - Brian L. Erstad
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson
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Willink DP, Isetts BJ. Becoming ‘Indispensable’: Developing Innovative Community Pharmacy Practices. J Am Pharm Assoc (2003) 2005; 45:376-86; quiz 387-9. [PMID: 15991760 DOI: 10.1331/1544345054003859] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe common characteristics of successful innovative community pharmacy practices. DATA SOURCES Four pharmacists who are successfully incorporating pharmaceutical care services into their pharmacy practices were identified for inclusion by key informants. Sites considered for inclusion were within 300 miles of the University of Minnesota College of Pharmacy. The four innovative community pharmacy practices were located in Maquoketa, Iowa, and in Bemidji, Anoka, and Minneapolis, Minn. Published articles identified through a Medline search-using the terms pharmaceutical care, Medicaid, Medicare, pharmacist, pharmacy, and collaborative practice-provided information to prepare for pharmacist interviews. STUDY SELECTION By the authors. DATA EXTRACTION Previsit telephone interviews with each pharmacist, combined with literature selected by the authors, were used to identify common characteristics of successful practices. Structured, on-site empirical observation was then performed to devise a tool for pharmacists to use for the development of innovative community pharmacy practices. The tool was then validated by two additional practitioners. DATA SYNTHESIS Components of successful innovative community pharmacy practices include philosophy of practice, patient care process, management system, and clinical knowledge. A checklist tool is presented to be used in conjunction with the narrative description of the four components. CONCLUSION Advanced pharmacy services delivered within pharmaceutical care practices can be a successful business opportunity for community pharmacists. Community pharmacists motivated to develop an innovative practice and provide pharmaceutical care services can use the checklist tool during practice implementation.
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Affiliation(s)
- David P Willink
- College of Pharmacy, University of Minnesota, Minneapolis 55455, USA
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Hackett TB, Lehman TL. Practical considerations in emergency drug therapy. Vet Clin North Am Small Anim Pract 2005; 35:517-25, viii. [PMID: 15698922 DOI: 10.1016/j.cvsm.2004.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Drug therapy is integral to emergency and critical care medicine but can also be the source of serious medical errors. There are important considerations with regard to drug, route, and interactions that require close attention in critical patients. The continuous development of new therapeutics and new information concerning current therapies requires practitioners to continually review drug therapies. This article addresses general guidelines, routes of administration, dosage calculations, interactions, monitoring recommendations, and resources available to help clinicians improve their drug therapy practices.
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Affiliation(s)
- Tim B Hackett
- Department of Clinical Sciences and Critical Care Unit, Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO 80523, USA.
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Saab YB, Hachem AH. Attitudes of Physicians to Professional Roles of Community Pharmacists in Lebanon. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2004. [DOI: 10.1002/jppr200434118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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