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Background Family caregivers play an important role for patients admitted to the intensive care unit (ICU), and delirium is a common clinical syndrome. Little is known about the experiences of family caregivers when a relative is a patient with delirium, especially for caregivers in Asian cultures. Aims and Objective To understand the experience of family caregivers with a family member as a patient with delirium in the ICU in Taiwan. Design A descriptive qualitative study with in‐depth face‐to‐face semi‐structured interviews. Methods Interviews were conducted with 20 family caregivers of 20 patients with delirium in the ICU of a hospital in northern Taiwan. Results The core theme describing the phenomenon of family caregivers of a patient with delirium was “Sailing in a sea of perplexity,” which described family caregivers' uncertainty of navigating the ICU and providing support for a relative. Three subthemes described the core theme: (a) perplexity of the ICU environment, (b) perplexity of making decisions, and (c) perplexity of Chinese cultural constraints. Conclusion “Sailing in a sea of perplexity” underscores how uncertainty among family caregivers of patients with delirium in ICUs can lead to feelings of fear and anxiety. Therefore, nursing professionals should not only focus on patient care but also be sensitive to caregivers' feelings of uncertainty and their cultural beliefs. Relevance to clinical practice Unfamiliarity and lack of knowledge about intensive care and patient treatments were a source of family caregivers' perplexity. To reduce uncertainty, we recommend increased communication between staff and caregivers. Hospitals can also provide information on their websites, including treatment of delirium and visitation hours. Information access could be enhanced by developing a smartphone app linked to a QR code that families can scan to obtain information, which would be useful during restricted visitation.

BackgroundPharmaceutical care provided by well‐educated clinical pharmacists improves the safety and effectiveness of health care, especially regarding medication use, and can thus save costs.AimsThe aim of this study is to illustrate the implementation of the reimbursement policy of National Health Insurance for pharmaceutical care in Taiwan, to determine its influences on current health care practices, and to evaluate the quantity of pharmacy interventions.Materials & MethodsThe inclusion criteria for this study were qualified pharmacists working in intensive care units (ICUs) at medical centers and regional hospitals or in clinics at district hospitals who provided pharmaceutical care services. Details of the pharmaceutical care they provided—including pharmacy notes (in the subjective, objective, assessment, and plan sequence), intervention type, and acceptance by physicians—were uploaded and documented via an online virtual private network platform, from which data were later collected and analyzed.ResultsDuring the first quarter of 2019, a total of 260 pharmacists were included in the analysis, 109 of whom were from medical centers, 94 from regional hospitals, and 57 from district hospitals. The total person‐days of pharmaceutical care during the study period was 12 158 for medical centers, 7090 for regional hospitals, and 757 for district hospitals. The acceptance rates of the doctors were 98.3%, 89.5%, and 90.5% for medical centers, regional hospitals, and district hospitals, respectively.DiscussionThe cost savings of pharmaceutical care was estimated by adverse drug events (ADEs) avoidance based on an average prolonged ICU stay of 2 days per ADE. Pharmaceutical care in ICUs resulted in a savings of 57 931 710 New Taiwan Dollars during the study period, with a cost‐benefit ratio of 13.7.ConculsionBased on the cost effectiveness of pharmaceutical care in early 2019, the program should be reserved and expanded to different settings, and it will hopefully become an essential service provided by pharmacists in Taiwan.

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