Bates, I

Bourne, R

Jones, A

Landa, J

Mckenzie, C

PROTECTED-ICU UK investigators,

Shulman, R

Tomlin, M

PROTECTED-ICU UK investigators

UCL Discovery

Pharmacist´s contribution to the intensive care unit (ICU)   Authors: J. Landa1, C. Mckenzie1, A. Jones1, R. Bourne2, M. Tomlin3, I. Bates4, R. Shulman5, on behalf of the PROTECTED-ICU UK investigators  Institutions: 1Guy's and St Thomas' NHS Foundation Trust and Kings College London, Pharmacy and Intensive Care, LONDON, United Kingdom, 2Sheffield Teaching Hospitals NHS Foundation Trust, Pharmacy, Sheffield, United Kingdom, 3University Hospital Southampton NHS Foundation Trust, Pharmacy, Southampton, United Kingdom, 4School of Pharmacy, University College London, London, United Kingdom, 5University College London Hospital NHS Foundation Trust, Pharmacy, London, United Kingdom     INTRODUCTION. It is recognised that critically ill patients require the multidisciplinary team to receive optimum care. Specialist clinical Pharmacists (SCPs) have been shown to improve clinical and economic outcomes of patients contributing to their care by preventing medication errors, rationalising therapy, identifying interactions or suggesting alternative therapies. [1,2] OBJECTIVES. To describe SCP activity and interventions across a range of critical care units in the UK. To provide essential data 1,2n rate of ICU prescribing error and prescription optimization, to identify the mechanism and impact of each intervention in the prevention of harm and improve patient therapy.  METHODS. A prospective observational study was undertaken in 21 critical care units over the United Kingdom (UK) from 5-18th Nov 2012 inclusive. A data collection web portal was designed where SCP recorded all interventions. Each intervention was classified into either: prescribing error, optimisation and consult. In addition, a scale of clinical impact was used to code the interventions. Interventions were scored as low, moderate, high impact and life saving.  RESULTS. 20,740 prescriptions were reviewed with 3,390 interventions recorded by the SCP. This resulted in an overall intervention rate of 16.3%: 6.8% were classified as prescribing errors, 8.3 % optimisations and 1% consults. Using the scale the interventions were classified as: low impact (33.6%), moderate impact (47.1%) high impact (19.3%) and one as life saving. CONCLUSIONS. This observational study demonstrates that both prescribing error and optimisation rates were high. Almost 1 in 6 prescriptions required an intervention from the SCP. Error rate was similar to an 3earlier error study (EQUIP) [3]. Two thirds of the interventions were of at least moderate impact. SCPs embedded into the critical care team provide a valuable contribution, reducing patient harm from medication errors and optimising pharmacotherapy.  REFERENCE(S).  [1] Kane SL, Weber RJ, et al. The impact of critical care pharmacists on enhancing patient outcomes. Intensive Care Med. 2003;29:691–698.  [2] MacLaren R, Bond CA, et al. Clinical and economic outcomes of involving pharmacists in the direct care of critically ill patients with infections. Crit Care Med. 2008;36:3184–3189.  [3] How to reduce prescribing errors. The Lancet. 2009;374:1945 GRANT ACKNOWLEDGMENT.  United Kingdom Clinical Pharmacy Association (UKCPA) The NIHR Biomedical Research Centre, GSTT   References   1.  Ackland G, Safadeh M, Smith M, Shulman R. Etomidate Is Not Associated with Greater Need for Vasopressor Support in Critically Ill Patients (abstract). American Society of Anaesthesiologists Annual Meeting 2007;1735 Ref Type: Journal  2.  Costa MH, Shulman R, Bates I. A credentialing process for advanced level pharmacists: participant feedback. Pharmaceutical Journal 2012;288:1-5 Ref Type: Journal  3.  Eilsbroek E, Howell DCJ, Smith F, Shulman R. Medication issues experienced by patients and carers after discharge from the intensive care uni. J Crit Care 2013;28:46-50 Ref Type: Journal   

Pharmacist's interventions in the Intensive Care Unit

http://discovery.ucl.ac.uk/1478145/3/Bates_esicm%20abstract%202014.pdf

Pharmacist's interventions in the Intensive Care Unit

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