Proactive Clinical Pharmacist Interventions in Critical Care: Effect of Unit Speciality and Other Factors

Int J Pharm Pract. 2014 Apr;22(2):146-54. doi: 10.1111/ijpp.12046. Epub 2013 Jun 13.

Abstract

Background: Clinical pharmacists working in critical-care areas have a beneficial effect on a range of medication-related therapies including improving medication safety, patient outcomes and reducing medicines' expenditure. However, there remains a lack of data on specific factors that affect the reason for and type of interventions made by clinical pharmacists, such as unit speciality.

Objective: To compare the type of proactive medicines-related interventions made by clinical pharmacists on different critical-care units within the same institution.

Methods: A retrospective evaluation of proactive clinical pharmacist recommendations, made in three separate critical-care areas. Intervention data were analysed over 18 months (general units) and 2 weeks for the cardiac and neurological units. Assessment of potential patient harm related to the medication interventions were made in the neurological and cardiac units.

Key findings: Overall, 5623, 211 and 156 proactive recommendations were made; on average 2.2, 3.8 and 4.6 per patient from the general, neurological and cardiac units respectively. The recommendations acceptance rate by medical staff was approximately 90% for each unit. The median potential severity of patient harm averted by the interventions were 3.6 (3; 4.2) and 4 (3.2; 4.4) for the neurological and cardiac units (P = 0.059). The reasons for, types and drug classification of the medication recommendations demonstrated some significant differences between the units.

Conclusions: Clinical pharmacists with critical-care training make important medication recommendations across general and specialist critical-care units. The patient case mix and admitting speciality have some bearing on the types of medication interventions made. Moreover, severity of patient illness, scope of regular/routine specialist pharmacist service and support systems provided also probably affect the reason for these interventions.

Keywords: UK; clinical pharmacist; critical care; drug therapy; medicines reconciliation.

MeSH terms

  • Adult
  • Aged
  • Cardiology Service, Hospital
  • Crisis Intervention / statistics & numerical data*
  • Critical Care / statistics & numerical data*
  • Drug Therapy
  • Female
  • Harm Reduction
  • Hospital Units
  • Humans
  • Male
  • Middle Aged
  • Neurology
  • Patient Harm / prevention & control
  • Pharmacists*
  • Pharmacy Service, Hospital / organization & administration
  • Retrospective Studies
  • Specialization
  • United Kingdom