Pharmacist In Intensive Care Unit Research Articles

Effects of Clinical Pharmacist Intervention in a Saudi ICU: A Prospective, Cross-Sectional Study

Given their contributions to better patient outcomes, medication safety, and lower drug cost, critical care pharmacists are especially prepared to play a major role within the critical care interdisciplinary team in managing the therapeutic element. Consequently, this research set out to evaluate the ICU clinical pharmacist interventions' frequency, kind, and effect, as well as the acceptability of these interventions by the doctors who provide them. The research was prospective and cross-sectional in nature. Over the course of six months, from April 1, 2023, to October 1, 2023, data was collected daily from a minimum of 380 interventions. This research covered all patients hospitalized to the intensive care unit at Saudi Arabia throughout the specified time frame. Over the duration of the 6-month trial, 120 patients had a total of 500 interventions. Of these, 490 (98%) had physician approval for clinical pharmacist treatments. The majority of the recommendations (34.8%, or 174 out of 500) were related to safety concerns; among these, 48.27%, or 48 out of 174, were for medication cessation owing to extended duration, while 30.46%, or 53 out of 174, were for renal dosage modification. Coming up as a close second, another therapeutic intervention involving indication made up 22.8% (114/500). A total of 124 interventions, or 24.8 percent of the total, had some kind of cost-related component, according to the study's findings on cost-saving treatments. The results of this research showed that clinical pharmacists have the potential to improve quality treatment for critically ill patients and lower healthcare expenditures. Furthermore, it provides helpful information on the incorporation of clinical pharmacists in intensive care units, particularly in areas with limited resources.

The medical emergency team pharmacist: describing an overnight service

AbstractBackgroundClinical practice after hours and attendance at medical emergency team (MET) calls are two novel and emerging areas of pharmacy practice. During the COVID‐19 pandemic, our institution's pharmacy services expanded from 8 am–5 pm to 24 h daily, including MET call attendance.AimThis study aimed to describe pharmacist roles, including medications charted by the general medicine and intensive care unit pharmacists during the period of extended‐hours pharmacy practice and the characteristics of MET calls attended.MethodThis descriptive, cross‐sectional study included patients admitted to the Alfred Hospital, Victoria, Australia between 3 April 2020–28 February 2021, when a MET was called between 5 pm–8 am, a pharmacist attended, and medication changes occurred. Data collected included whether the MET call was medication related and a description of medication changes. Ethics approval was granted by the Alfred Hospital Human Research Ethics Committee (Reference no: 297/21).ResultsOne thousand six hundred and forty‐four MET calls (average 5.4 calls per night) were attended by pharmacists during extended hours. Medication changes were made in response to clinical deterioration at 627 (38%) calls. The most frequent change was the initiation of cardiovascular medications (n = 206). Partnered pharmacist medication charting, including commencing, ceasing, or changing medications, occurred at 39% of MET calls with therapy changes.ConclusionPharmacists can play a key role in managing deteriorating patients as part of a MET team. Medications may be implicated in clinical deterioration of patients and are frequently administered at MET calls. The expansion of pharmacy services provided the opportunity for pharmacists to contribute to MET calls across the 24‐h period.

Clinical impact of pharmacists’ interventions in intensive care units in a tertiary institution in Singapore – A retrospective cohort study

Background and aim Previous studies have deemed pharmacists essential in the intensive care units (ICU) to provide quality healthcare and ensure medication safety. As the impact of pharmacists in ICU varies according to different factors, our study aims to characterise and evaluate the impact of pharmacists’ interventions in ICUs in Singapore, to enable the identification of areas of improvement in our critical care pharmacy practice. Methods We retrospectively evaluated 7 months of pharmacists’ interventions in five ICUs at Singapore General Hospital. Interventions were classified based on the medication-related problems (MRPs) addressed. The impact of pharmacists’ interventions was assessed by rating the severity of error in medication order, the clinical relevance of intervention, and the probability of adverse drug events (pADE) that would have occurred without pharmacists’ interventions. Results There were 619 interventions addressing 775 MRPs, of which 91.1% were accepted. The main MRP identified was inappropriate drug regimen (49.2%) and the medication class most frequently involved in MRPs was anti-infectives (56.9%). Majority of the interventions were rated as significant for both the severity of error (76.9%) and clinical relevance (72.4%). However, the pADE was deemed to be low (61.2%). The rating of pADE may be affected by the lack of information in patient profiles. Conclusion This study demonstrated the crucial role of pharmacists in ensuring medication safety in ICUs. Possible areas of service improvement include educating medical residents on common medication errors and empowering pharmacists towards collaborative prescribing.

Nationwide current situation of hospital pharmacists in intensive care units

ObjectiveTo describe the current situation of the hospital pharmacist in intensive care units and their activity in care, in teaching and in research. MethodMulticenter and prospective study through a survey disseminated by the Spanish Society of Hospital Pharmacy, which consisted of several sections: personal and hospital's data, hospital's characteristics, pharmacist's involvement in intensive care units and teaching. ResultsA number of 58 completed surveys were obtained. The number of pharmacists involved in intensive care units was 1 in 77.6% of cases, assisting an average of 30.8 beds (5-70). Experience of pharmacists in the intensive care unit was 5 years on average (2 months-25 years). Visitor's pass assistance and shift changes were between “never” by 36.2% to “daily” by 22.4%. Out of respondents, 93.1% reported a part-time intensive care unit involvement. Regarding activities undertaken, between 40-60% of pharmacists manage narcotics, teaching at intensive care unit, conciliation and safety. Between 60-80%, pharmacists cover clinical nutrition, notarization, optimization of pharmacokinetics and antibiotics; and 84.5% perform pharmacotherapy follow-up. Out of the surveyed pharmacists, 77.6% have specialized medical training, rotating intensive care unit residents in 86% of cases. ConclusionsMost of the surveyed hospitals have one part-time pharmacist in these units. In order to improve the quality of pharmaceutical care of critically ill patients, it would be necessary to extend the involvement in time and staff, regarding the current situation, and a greater number of hospitals should include pharmacists in hospital intensive care units.

Preparation/administration of push-dose versus continuous infusion epinephrine and phenylephrine: A simulation

BackgroundHypotension is a common problem in the emergency department (ED) and intensive care unit (ICU) and can increase risk for poor outcomes. Many EDs/ICUs utilize epinephrine and phenylephrine to treat hypotension and these medications are most often administered as a continuous infusion (CI). Push-dose (PD) is the administration of small medication doses as intermittent intravenous pushes (IVPs). There is limited information comparing the time required to prepare and administer PD versus CI and errors have been reported when preparing and administering these medications at bedside. This simulation study sought to estimate preparation and administration times and preparation and errors with PD and CI epinephrine and phenylephrine when prepared by an ED/ICU pharmacist. MethodsThis crossover simulation study took place in a simulation center at an academic medical center and utilized a multi-venous intravenous training arm kit equip with an 18-gauge intravenous line, an extension tubing set, and a luer-lock adapter. The primary outcome was total preparation and administration time in seconds. The secondary outcome was major preparation and administration errors, defined as errors causing a five-fold or greater overdose. ResultsIn total, 16 pharmacists participated, including nine ED and seven ICU pharmacists. PD had faster total preparation and administration time and administration time, but not preparation time; PD showed an approximate 70 s decrease in total preparation and administration time versus CI. PD had more major preparation and administration errors and six PD preparations (18.8%, 6/32) had at least one major preparation and administration error. CI, on the other hand, had no major preparation and administration errors. DiscussionThis simulation found faster total preparation and administration time with PD versus CI epinephrine and phenylephrine, but also found that PD had more major preparation and administration errors. Dilutional errors during medication preparation were the cause of 83.3% (5/6) of our overdoses. ConclusionThis simulation study showed that ED/ICU pharmacists had faster median total preparation and administration times for PD epinephrine and phenylephrine versus CI, but PD also had more preparation and administration errors.

Benefits of pharmacist intervention in the critical care patients with infectious diseases: A propensity score matching retrospective cohort study

BackgroundThe importance of optimising antimicrobial therapy is highlighted in the hospital intensive care unit (ICU) patients. But roles of ICU pharmacists are still in its infancy in China. ObjectivesThis study's objective was to evaluate the values of clinical pharmacist interventions in the antimicrobial stewardship (AMS) on ICU patients with infections. AimThe aim of this study was to evaluate the value of clinical pharmacist interventions in the antimicrobial stewardship (AMS) in critically ill patients with infections. MethodsFrom 2017 to 2019, a propensity score matching retrospective cohort research was conducted on critically ill patients with infectious illnesses. The trial was split into groups that received pharmacist assistance and those who did not. Baseline demographics, pharmacist actions, and clinical results were compared between the two groups. Factors influencing mortality were demonstrated using univariate analysis and bivariate logistic regression. The State Administration of Foreign Exchange in China monitored the exchange rate between the RMB and the US dollar and also gathered the charges of the agents as an economic indicator. ResultsOut of the 1523 patients who were evaluated, 102 critically ill patients with infectious diseases were included in each group after matching. The top five prescription regimens adjusted were settled by sickness progression, microbiological results, de-escalation, drug withdrawal, and therapeutic drug monitoring suggestions. The pharmacist exposure group's antibiotic use density (AUD) decreased significantly (p = 0.018) compared to the control group, going from 241.91 to 176.64 defined daily doses/100 bed days. Following pharmacist interventions, the AUD proportion for carbapenems dropped from 23.7 to 14.43%, while for tetracyclines, it dropped from 11.5 to 6.26%. In the group exposed to the pharmacist, the median cost of antibiotics decreased significantly from $836.3 to $362.15 per patient stay (p < 0.001), and the median cost of all medications dropped from $2868.18 to $1941.5 per patient stay (p = 0.06). RMB was converted into US dollars according to the current exchange rate. According to univariate analyses, pharmacist interventions did not differ between the groups that survived and died (p = 0.288). ConclusionsThis study showed that antimicrobial stewardship had a significant financial return on investment without raising the mortality rate.

The Impact of a Pharmacist-Driven Multicomponent Sleep-Promoting Protocol on Delirium in Critically Ill Patients

Background: Sleep deprivation is reported in 80% of patients in the intensive care unit (ICU) and is associated with delirium. Guidelines recommend implementing a sleep-promoting protocol in critically ill patients which may increase the quantity and quality of sleep and may decrease delirium. Our objective was to implement a pharmacist-led interdisciplinary sleep-promoting protocol and analyze its impact on delirium in ICU patients receiving mechanical ventilation (MV). Methods: The study involved pre-implementation education, protocol development, and post-implementation analysis. ICU pharmacists completed prospective patient chart reviews to reduce exposure to deliriogenic medications and assess the need for a pharmacologic sleep aid. The primary outcome was the incidence of delirium and delirium-free days. Secondary outcomes included ICU length of stay (LOS), incidence of MV, and pharmacist medication interventions. Results: Post-protocol patients (n = 185) had a higher incidence of delirium compared to pre-protocol patients (n = 237) (51.3% vs 39.0%; P = .01). Post-protocol patients had a higher average APACHE III score (P = <.001). Delirium-free days were not significantly different between groups (P = .97). Difference in ICU LOS was not significant (P = .80). More patients received MV post-protocol implementation (55.7% vs 36.1%; P < .001). Pharmacists documented a total of 113 medication interventions. Conclusion and Relevance: A pharmacist-led, ICU sleep-promoting protocol was successfully implemented but did not reduce the incidence of delirium or the administration of insomnia agents. Post-protocol patients had higher disease severity and were more likely to receive MV. Incidence of delirium was consistent with the national reported prevalence of ICU delirium. ICU pharmacists on all shifts had an active role in optimizing sleep.

789: IMPACT OF A PHARMACIST-DRIVEN SLEEP-PROMOTING PROTOCOL ON DELIRIUM IN THE CRITICALLY ILL

Introduction: Sleep deprivation is reported in nearly 80% of patients in the intensive care unit (ICU) and is associated with delirium. Guidelines recommend implementing a multicomponent sleep-promoting protocol in critically ill patients. ICU sleep protocols may increase the quantity and quality of sleep and may decrease delirium. Our objective was to develop and implement a pharmacist-led interdisciplinary sleep-promoting protocol and analyze its impact on delirium in intubated and non-intubated ICU patients. Methods: The study involved pre-implementation education and protocol development, and post-implementation analysis. ICU pharmacists completed prospective patient chart reviews to reduce exposure to deliriogenic medications and assess the patient’s need for a pharmacological sleep aid. The primary outcome was to assess the difference in the incidence of delirium and delirium-free days pre- and post-implementation. Secondary outcomes included ICU length of stay, incidence and duration of mechanical ventilation (MV), documented pharmacist medication interventions, and patients receiving a pharmacologic sleep agent (%), Results: Post-protocol patients (n=185) had a higher incidence of delirium compared to pre-protocol patients (n=237) (51.3% vs 39.0%; p=0.01). Post-protocol patients had a higher average APACHE III score (p=< 0.001). Delirium-free days were not significantly different between groups (p=0.97). Difference in ICU length of stay was not significant (p=0.80). More patients received MV post-protocol implementation (55.7% vs 36.1%; p< 0.001). MV days were similar between groups (p=0.053). Pharmacists documented a total of 113 medication interventions. Half of the study patients did not receive an insomnia agent during their ICU admission. Conclusions: A pharmacist-led, ICU sleep-promoting protocol was successfully implemented at our institution. The protocol did not reduce the incidence of delirium or the administration of insomnia agents in our ICUs. Post-protocol patients had a higher disease severity and were more likely to receive mechanical ventilation which may have impacted our results. The incidence of delirium in our patients was consistent with the national reported prevalence of ICU delirium. ICU pharmacists on all shifts had an active role in optimizing sleep in the critically ill.

1103: MULTIDISCIPLINARY ICU RECOVERY CLINIC VISITS: QUALITATIVE ANALYSIS OF PATIENT-PROVIDER INTERACTIONS

Introduction: Research confirms the heterogeneous nature of patient challenges during Intensive Care Unit (ICU) recovery and supports the need for modifying care experiences, but there are little data guiding clinicians seeking to support individualized recovery trajectories for patients. Thus, we evaluated the content of patient-provider interactions during a telemedicine multidisciplinary ICU Recovery Clinic (ICU-RC) visit to better understand support needs. Methods: We conducted a qualitative descriptive study in a telemedicine multidisciplinary ICU-RC at a tertiary academic medical center in the Southeastern United States. The sample included 17 patients and 13 care partners (>=18 years) attending a telemedicine ICU-RC visit following a critical illness due to sepsis or acute respiratory failure. Patients and care partners met with an ICU pharmacist, ICU physician, and a psychologist via a secure web-conferencing platform for 31 ICU-RC visits within 12 weeks of hospital discharge. Telemedicine ICU-RC visits were audio-recorded and transcribed verbatim for analysis. A coding system was developed using iterative inductive and deductive approaches. Results: Two themes were identified from the patient-provider dialogue: 1) problem identification and 2) problem-solving strategies. We identified five subthemes that capture problem identification: health status, mental health and cognition, medication management, health care access and navigation, and quality of life. Problem-solving subthemes included facilitating care coordination and transitions (e.g., inter-provider communication, medication refills), education (e.g., information resources), and anticipatory guidance (e.g., clarifying misconceptions). Patient-provider dialogue illustrated the interactive nature of finding and solving problems during an ICU-RC visit. The ICU-RC visit provided teachable moments to impact health and prevent future problems. Conclusions: The content and interactions between patients and clinicians in our sample convey the depth and breadth of problems found and problems solved in a multidisciplinary telemedicine ICU-RC. Our analysis provided a fuller description of post-hospital ICU aftercare, and how ICU clinicians can identify recovery problems, decrease fragmentation, and promote follow-up care after a critical illness.

Instant Gratification and Overtreating to Be Safe: Perceptions of U.S. Intensive Care Unit Pharmacists and Residents on Antimicrobial Stewardship.

Antimicrobial stewardship programs have been associated with numerous impacts on medical practice including reductions in costs, antimicrobial resistance, and adverse events. While antimicrobial stewardship is now considered an essential element of medical practice, the understandings of the value of antimicrobial stewardship among medical practitioners vary. Additionally, non-physician practitioners are regularly left out of antimicrobial stewardship interventions targeting antimicrobial decision-making. Here, we contribute the perspective from resident physicians and specialists in pharmacy regarding their involvement in antimicrobial prescribing. Notably, our semi-structured interviews with 10 residents and pharmacy specialists described their limited autonomy in the clinical setting. However, the participants regularly worked alongside primary antimicrobial decision-makers and described feeling pressure to overtreat to be safe. The clear rationales and motivations associated with antimicrobial prescribing have a noticeable impact on physicians in training and non-physician practitioners, and as such, we argue that antimicrobial stewardship interventions targeting primary antimicrobial decision-makers are missing an opportunity to address the breadth of antimicrobial prescribing culture. By looking at the perspectives and rationales of physicians in training and non-physician practitioners, we can see evidence that the act of antimicrobial prescribing is impacted by individuals on all levels of the hierarchies present in medical practice.

Survey of critical care practices for alcohol withdrawal syndrome in the intensive care unit

AbstractIntroductionAlcohol use disorder affects up to 60% of intensive care unit (ICU) patients. Alcohol withdrawal syndrome (AWS) is associated with increased length of stay, mechanical ventilation, and mortality. The lack of clinical practice guidelines specific to ICU patients leads to ambiguity about the standard management of AWS in this population.ObjectivesThe aim of this study was to describe current practice patterns employed for AWS management in ICU settings across the United States.MethodsThis was a cross‐sectional survey of practicing critical care pharmacists identified via a pharmacy professional organization critical care listserv. Emails were sent four times to the recipient list from May 14, 2021 to June 25, 2021. Retired pharmacists and trainees on the listserv were excluded. The survey was conducted by REDCap and descriptive statistics were performed.ResultsThere were a total of 144/1534 (9.4%) responses. Predominant characteristics included university hospital settings (n = 71/143, 49.7%) with greater than 75 ICU beds (n = 54/144, 37.5%), and medical (n = 53/144, 36.8%) or mixed (n = 52/144, 36.1%) ICU populations. The majority reported having an institutional AWS guideline (n = 96/140, 68.6%). A total of 139/143 (97.2%) preferred benzodiazepines, with lorazepam (n = 136/143, 97.8%) as the primary benzodiazepine agent. Most preferred lorazepam as needed, rather than preemptively (n = 137/138, 99.3%). Phenobarbital use was reported by 82.6% (n = 119/144) of respondents, primarily for treatment of benzodiazepine‐refractory withdrawal (n = 96/117, 82.1%). Similarly, dexmedetomidine use was reported by 86.1% (n = 124/144) of respondents, primarily for refractory withdrawal (n = 48/121, 39.7%). Propofol was primarily preferred for patients on mechanical ventilation (n = 56/98, 57.1%) or refractory withdrawal (n = 51/98, 52.0%). Clonidine was preferred by 45.8% (n = 66/144) and atypical antipsychotics by 33.6% (n = 48/143) of respondents.ConclusionsMost ICU pharmacists prefer symptom‐triggered benzodiazepines first line, followed by propofol in intubated patients and dexmedetomidine and/or phenobarbital for refractory cases. Clinical practice guidelines may help provide guidance for the management of these patients.

Utilizing eye tracking to assess electronic health record use by pharmacists in the intensive care unit.

A study was conducted using high-fidelity electronic health record (EHR)-based simulations with incorporated eye tracking to understand the workflow of critical care pharmacists within the EHR, with specific attention to the data elements most frequently viewed. Eight critical care pharmacists were given 25 minutes to review 3 simulated intensive care unit (ICU) charts deployed in the simulation instance of the EHR. Using monitor-based eye trackers, time spent reviewing screens, clinical information accessed, and screens used to access specific information were reviewed and quantified to look for trends. Overall, pharmacists viewed 25.5 total and 15.1 unique EHR screens per case. The majority of time was spent looking at screens focused on medications, followed by screens displaying notes, laboratory values, and vital signs. With regard to medication data, the vast majority of screen visitations were to view information on opioids/sedatives and antibiotics. With regard to laboratory values, the majority of views were focused on basic chemistry and hematology data. While there was significant variance between pharmacists, individual navigation patterns remained constant across cases. The study results suggest that in addition to medication information, laboratory data and clinical notes are key focuses of ICU pharmacist review of patient records and that navigation to multiple screens is required in order to view these data with the EHR. New pharmacy-specific EHR interfaces should consolidate these elements within a primary interface.

Surgeons, Infectious Diseases, and Twitter Hit a Home Run for Antibiotic Stewardship.

Many infectious diseases (ID) clinicians join Twitter to follow other ID colleagues or "like" people. While there is great value in engaging with people who have similar interests, there is equal value in engaging with "unlike" or non-ID people. Here, we describe how Twitter connected an ID pharmacist with a pediatric surgeon, a vice chair of surgery, a surgeon chief medical officer from Spain, and a surgical intensive care unit pharmacist. This Twitter collaboration resulted in several scholarly activities related to antibiotic resistance and antibiotic stewardship and served as a conduit for global collaboration.

Role of Clinical Pharmacists in Intensive Care Units.

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.

Clinical Pearls

Burnout results from chronic workplace stress that has not been successfully managed. Excellent teamwork lessens negative outcomes for patients and providers, but little work has examined factors that contribute to burnout across disciplines working in the intensive care unit (ICU).Colbenson and colleagues interviewed ICU pharmacists, physicians, registered nurses, and respiratory therapists to understand their experiences. They identified 2 themes related to factors contributing to burnout: interdisciplinary dynamics (eg, providers feeling their opinion was not valued, inattention given to their contributions, and shared decision-making that was deficient) and work stressors: Many nonphysician team members did not feel heard or respected during multidisciplinary rounds. Although more work is needed, the authors suggest team-based care include well-defined roles and respect to provide a culture of safety for both staff and patients.See Article, pp 391-396Many children hospitalized in the pediatric intensive care unit (PICU) require mechanical ventilation, a necessary therapy that can cause stress, anxiety, and even pain. Researchers have used music therapy as a nonpharmacological pain-reducing intervention in adults receiving mechanical ventilation; however, there are few studies with children and those done used recorded music with contradictory findings.Bush and colleagues compared the use of live music, with a trained board-certified music therapist who adapted the music to the patient’s needs, versus recorded music in children <2 years of age who are sedated and receiving mechanical ventilation. They found Although further research is needed with larger samples, the findings suggest use of live music with a trained therapist may be effective in reducing anxiety in children receiving mechanical ventilation in the PICU.See Article, pp 343-349The Glasgow Coma Scale (GCS) has been used for more than 4 decades as a prediction tool in the care of patients with traumatic brain injury (TBI). The GCS has been used successfully to predict outcomes, including mortality, for TBI patients, but it has not been validated for use in non-TBI patients.Li et al compared admission GCS scores with scores on the modified Rankin Scale (mRS), a tool used for evaluating functional outcomes in stroke patients. In a sample of >3000 patients with a non-TBI neurological diagnosis, they found Although further work is needed, the authors caution against use of GCS scores to predict outcomes in non-TBI patients and instead recommend further exploration of alternative tools designed for non-TBI conditions.See Article, pp 350-355The Society of Critical Care Medicine guidelines indicate that patients with lower-level care needs can be admitted to an intermediate-care unit (IMCU). However, unplanned admissions of patients with potentially unstable conditions to the IMCU have been associated with worse outcomes owing to difficulty with predicting deterioration.Ramos and colleagues evaluated 3 patterns of urgent admissions to the IMCU and the intensive care unit (ICU): admission directly to ICU; admission to IMCU with no transfer to ICU; admission to IMCU and subsequent transfer to ICU (“step-up”). They found Although study findings show greater negative outcomes with step-up patients, the authors suggest further research on objective criteria for identifying patients with potentially unstable conditions that may quickly deteriorate.See Article, pp 397-400

From dispensary to bedside and beyond: the evolving role of the intensive care unit pharmacist

From dispensary to bedside and beyond: the evolving role of the intensive care unit pharmacist

The Impact of Clinical Pharmacist Interventions on Medication Errors Management in the Postoperative Cardiac Intensive Care Unit

Background: Medication errors (MEs) frequently occur in intensive care unit (ICU) admittedpatients. The present study aimed to evaluate the frequency and types of MEs in an open heartsurgery heart ICU and clinical pharmacists’ role in the management of them. Methods: This cross-sectional, observational study was performed from October 2016 toMarch 2017 in the Shahid Madani Heart Center. A clinical pharmacist reviewed patients’ files,laboratory data, and physician orders during morning hours. All of the MEs and the clinicalpharmacies’ recommendations for the management of them were analyzed. Results: A total of 311 MEs were observed in the medical files of 152 patients. The rate of MEswas 2.04 errors per patient and 0.19 errors per ordered medication. The acceptance rate of MEswas 72.6%. The most type of MEs was ‘forgot to order’ (75 cases, 24.1%) followed by "wrongfrequency" and "adding a drug" in 56 (18%) and 49 (15.8) patients, respectively. Most MEs wereinsignificant. Conclusion: MEs occur at different stages of the therapeutic process in the postoperative cardiacintensive care unit, and clinical pharmacists play an essential role in detecting and managingMEs.

Impact of interoperability of smart infusion pumps and an electronic medical record in critical care.

To describe the benefits of smart infusion pump interoperability with an electronic medical record (EMR) system in an adult intensive care unit (ICU) setting. In order to assess the impact of smart infusion pump and EMR interoperability, we observed whether there were changes in the frequency of electronic medication administration record (eMAR) documentation of dose titrations in epinephrine and norepinephrine infusions in the ICU setting. As a secondary endpoint, we examined whether smart pump/EMR interoperability had any impact on the rate of alerts triggered by the dose-error reduction software. Pharmacist satisfaction was measured to determine the impact of smart pump/EMR interoperability on pharmacist workflow. In the preimplementation phase, there were a total of 2,503 administrations of epinephrine and norepinephrine; 13,299 rate changes were documented, for an average of 5.31 documented rate changes per administration. With smart pump interoperability, a total of 13,024 rate changes were documented in association with 1,401 administrations, for an average of 9.29 documented rate changes per administration (a 74.9% increase). A total of 1,526 dose alerts were triggered in association with 76,145 infusions in the preimplementation phase; there were 820 dose alerts associated with 48,758 autoprogammed infusions in the postimplementation phase (absolute difference, -0.32%). ICU pharmacists largely agreed (75% of survey respondents) that the technology provided incremental value in providing patient care. Interoperability between the smart pump and EMR systems proved beneficial in the administration and monitoring of continuous infusions in the ICU setting. Additionally, ICU pharmacists may be positively impacted by improved clinical data accuracy and operational efficiency.

Benefit of Incorporating Clinical Pharmacists in an Adult Intensive Care Unit: A Cost-saving Study.

A framework to evaluate the impact of clinical pharmacists in intensive care units (ICUs) in Chile has not yet been established. This study evaluates the cost avoidance and cost-benefit ratios of clinical pharmacist interventions in terms of treatment optimization in an adult ICU in southern Chile. Clinical pharmacist interventions in a multidisciplinary adult ICU were assessed between January and December 2019. Only interventions suggested by pharmacists and accepted by the healthcare team were included in the analysis. Interventions were classified into six categories, and cost avoidance (in US dollars) was calculated for each category using a systematic validated approach. A cost-benefit ratio for clinical pharmacy services in the adult ICU was also calculated. Over the 12-month period, 505 interventions were performed in 169 patients, of whom 62% were male. Interventions were classified into the following six categories: adverse drug event prevention (18%), which led to $87882 in savings; resource utilization (ie change in medication route) (10%), which led to $50525 in savings; individualization of patient care (ie dose adjustment) (36%), which led to $57089 in savings; prophylaxis (ie initiation of stress ulcer prophylaxis) (<1%), which led to $167 in savings; hands-on care (ie bedside monitoring) (23%), which led to $57846 in savings; and administrative and supportive tasks (ie patient own medication evaluation) (13%), which led to $9988 in savings. The total cost savings over the year-long period were $263500, resulting in a cost-benefit ratio of 1:24.2. The participation of a clinical pharmacist in a multidisciplinary ICU team reduces healthcare expenditures through treatment optimization translated into cost avoidance. This study has corroborated prior evidence that clinical pharmacist involvement in ICUs provides economic value and quality assurance in healthcare settings.

Emergency intensive care unit pharmacist\u2019s intervention may reduce time to four-factor prothrombin complex concentrate administration: a retrospective study

BackgroundFour-factor prothrombin complex concentrate (4F-PCC) must be administered as soon as possible, and in our emergency intensive care unit (EICU), pharmacists are available on weekdays for consultation on expediting 4F-PCC administration. Although recent reports have described a reduction in time to 4F-PCC administration, few studies have addressed if this is because of EICU pharmacist’s intervention, and there are no such studies in Japan. Therefore, we aimed to examine whether EICU pharmacist’s intervention reduced time to 4F-PCC administration.MethodsThis single-center retrospective cohort study was conducted from December 2017 to May 2019. We enrolled patients who received 4F-PCC due to major bleeding or requirement of urgent surgical/invasive procedures (n = 10). Patients were divided into two groups, namely, the intervention group (n = 5), in which EICU pharmacists consulted on weekdays, and the nonintervention group (n = 5), in which an intervention was not possible because of the absence of the EICU pharmacist.ResultsThe median time from patient presentation to the EICU to 4F-PCC administration (103 min vs. 111 min, p = 0.4) was similar between the two groups; however, the median time from 4F-PCC prescription ordering to administration was significantly shorter in the intervention group than in the nonintervention group (21 min vs. 60 min, p = 0.02).ConclusionsEICU pharmacist’s intervention improves the process from 4F-PCC prescription to administration and can reduce time to 4F-PCC administration.