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Clinical pharmacy in a regional Australian intensive care unit
Author(s) -
Howle Lisa M.,
Kirkpatrick Carl M. J.,
Trethewy Christopher E.
Publication year - 2018
Publication title -
journal of pharmacy practice and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.222
H-Index - 22
eISSN - 2055-2335
pISSN - 1445-937X
DOI - 10.1002/jppr.1331
Subject(s) - medicine , pharmacy , clinical pharmacy , observational study , pharmacist , intensive care unit , prospective cohort study , emergency medicine , population , adverse effect , intensive care , cohort study , intensive care medicine , family medicine , environmental health
Background More than a quarter of reported incidents in hospitals are medication‐related. The critically ill population is at greater risk of medication‐related incidents due to a number of factors, including a higher number of drugs prescribed, lower physiological reserve and greater illness severity. Overseas studies have shown that the inclusion of on‐ward clinical pharmacy support may attenuate these drug‐related problems ( DRP s); however, local evidence in regional Australian intensive care units ( ICU s) is lacking. Aim To identify the frequency of DRP s and their risk to patients and the reporting of adverse drug reactions ( ADR s) and incidents through the integration of a clinical pharmacist into a regional Australian ICU . Method A single‐centre, cohort‐controlled observational study conducted in a regional ICU over a 16‐week period. Data was collected on ADR and incident reporting, on‐call pharmacy requests and medications ordered but not administered to patients. The prospective period additionally examined the number and type of DRP s, pharmacist recommendations and acceptance by clinicians. An independent panel review assessed DRP risk and clinical significance. Results There were 348 DRP s requiring intervention in the prospective period with a median of two DRP s per patient. ‘Change of therapy’ was the most common recommendation (75%) and its acceptance by clinicians was 86%. Level of agreement between panel members for assigning both risk and clinical significance to DRP s was poor. Instances where medications were ordered but not administered were reduced by 62% (p = 0.0045). Requests for after‐hours pharmacy services were reduced and reporting of ADR s and incidents was marginally increased in the prospective group. Conclusion The addition of a clinical pharmacist to the ICU facilitated the detection and resolution of DRP s in this patient group and increased both the likelihood that intended pharmaceutical care reached the patient and that drug reactions and incidents were reported. These results provide local evidence for the inclusion of clinical pharmacists to the multidisciplinary ICU team in a regional Australian hospital.