Abstract
ObjectiveTo be utilized for the development of pharmacists’ intervention service by determining factors which affect pharmacists’ prescription interventions.SettingPatients who were admitted to intensive care units (ICUs) in internal medicine departments in Korea.MethodsData including age, gender, clinical departments, length of hospital stay, status of organ dysfunction, intervention status, frequently intervened drugs, and health care providers’ questions were prospectively collected in ICUs in the department of internal medicine in a tertiary teaching hospital from January to December, 2012.Main outcome measurePrimary outcome was factors which affect pharmacists’ prescription interventions. Secondary outcomes included frequencies of the intervention, intervention acceptance rates, intervention issues, and frequently intervened drugs.ResultsA total of 1,213 prescription interventions were made for 445 patients (33.1%) of the 1,344 patients that were analyzed. Length of hospital stay was significantly longer for the group that needed pharmacists’ interventions (p < 0.001). Pharmacists’ intervention requirements were significantly higher in patients with kidney dysfunction (p < 0.001). The percentage of intervention accepted was 96.8%, and interventions that were common were as follows (in order): clinical pharmacokinetic service, dosage or dosing interval changes, dosing time changes or dose changes, and total parenteral nutrition consultation. The five medications with the highest intervened frequency were (in order) vancomycin, famotidine, ranitidine, meropenem, and theophylline.ConclusionThe need for pharmacists’ prescription interventions was highest among patients with longer length of stay and patients with kidney dysfunction. Based on these findings, prescription intervention activities could be initiated with severely ill patients. The results could be utilized in countries which are planning to develop pharmacists’ intervention service.
Highlights
Major activities of hospital pharmacists in countries with advanced clinical pharmacies, such as the U.S, can be summarized as ones that provide safe medication administration to patients
During the study period, the number of patients who were admitted to the intensive care units (ICUs) at the department of internal medicine was 1,344, and the number of patients who needed pharmacists’ interventions was 445 (33.1%)
The relationship between the type of clinical departments and the number of pharmacist interventions was significant (p < 0.001), with the division of gastroenterology having a lower rate of patients in need of intervention than other divisions
Summary
Major activities of hospital pharmacists in countries with advanced clinical pharmacies, such as the U.S, can be summarized as ones that provide safe medication administration to patients. In Asia and other developing countries, due to the lack of awareness of the role of or the need for clinical pharmacists, clinical activities of hospital pharmacists are not as encouraged as in the U.S (Khalili et al 2011; Nissen 2009). This situation is the same in Korea in which clinical pharmacists’ role in hospital pharmacy has a greater emphasis on dispensing and drug distribution and a relatively smaller emphasis on clinical pharmacy interventions. It is true that large variations exist among hospitals, major hospitals provide pharmacy services that are comparable to those in countries such as drug information services, clinical pharmacokinetic consultation services, the development of specialized medication counseling, and the operation of services tailored to the needs of specific patients in clinical divisions
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