Background and Objectives:A critically ill patient is treated and reviewed by physicians from different specialties; hence, polypharmacy is a very common. This study was conducted to assess the impact and effectiveness of having a clinical pharmacist in an Indian Intensive Care Unit (ICU). It also evaluates the clinical pharmacist interventions with a focus on optimizing the quality of pharmacotherapy and patient safety.Materials and Methods:The prospective, observational study was carried out in medical and surgical/trauma ICU over a period of 1 year. All detected drug-related problems and interventions were categorized based on the Pharmaceutical Care Network Europe system.Results:During the study period, average monthly census of 1032 patients got treated in the ICUs. A total of 986 pharmaceutical interventions due to drug-related problems were documented, whereof medication errors accounted for 42.6% (n = 420), drug of choice problem 15.4% (n = 152), drug-drug interactions were 15.1% (n = 149), Y-site drug incompatibility was 13.7% (n = 135), drug dosing problems were 4.8% (n = 47), drug duplications reported were 4.6% (n = 45), and adverse drug reactions documented were 3.8% (n = 38). Drug dosing adjustment done by the clinical pharmacist included 140 (11.9%) renal dose, 62 (5.2%) hepatic dose, 17 (1.4%) pediatric dose, and 104 (8.8%) insulin dosing modifications. A total of 577 drug and poison information queries were answered by the clinical pharmacist.Conclusion:Clinical pharmacist as a part of multidisciplinary team in our study was associated with a substantially lower rate of adverse drug event caused by medication errors, drug interactions, and drug incompatibilities.

Intensive care unit (ICU) healthcare professionals work under a stressful environment which can lead to burnout syndrome. We conducted this study to evaluate the prevalence of stress and burnout syndrome among doctors and other healthcare professionals in ICU. We also evaluated the individual contributing factors for stress and burnout syndrome among these ICU healthcare workers. The cross-sectional survey was conducted among the healthcare professionals (doctors, nurses, clinical pharmacists, respiratory therapists and physiotherapists) in the ICUs of multispecialty hospital in south India. The survey was conducted using well-accepted tools which included job satisfaction scale, perceived stress scale and Maslach burnout inventory–human service survey. Overall, 204 healthcare professionals completed the survey. The prevalence of high burnout in our study was 80% which included 6% (n = 12) of doctors and 69% (n = 140) of nurses. Our study showed statistically significant correlation between level of job satisfaction and the level of burnout. There was a significant correlation between the level of stress and the emotional exhaustion and depersonalization domains of Maslach burnout inventory. Critical care societies and institutional committees should step forward to draft policies and benchmarks to curb the causes of stress, reduce burnout and to increase the job satisfaction.How to cite this articleLakshmikanthcharan S, Sivakumar MN, Hisham M. Stress and Burnout among Intensive Care Unit Healthcare Professionals in an Indian Tertiary Care Hospital. Indian J Crit Care Med 2019;23(10):462–466.

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Background and Aim:Intensive-care practices and settings may differ for India in comparison to other countries. While international guidelines are available to direct the use of enteral nutrition (EN), there are no recommendations specific to Indian settings. Advisory board meetings were arranged to develop the practice guidelines specific to Indian context, for the use of EN in critically ill patients and to overcome challenges in this field.Methods:Various existing guidelines, meta-analyses, randomized controlled trials, controlled trials, and review articles were reviewed for their contextual relevance and strength. A systematic grading of practice guidelines by advisory board was done based on strength of the supporting evidence. Wherever Indian studies were not available, references were taken from the international guidelines.Results:Based on the literature review, the recommendations for developing the practice guidelines were made as per the grading criteria agreed upon by the advisory board. The recommendations were to address challenges regarding EN versus parenteral nutrition; nutrition screening and assessment; nutrition in hemodynamically unstable; route of nutrition; tube feeding and challenges; tolerance; optimum calorie-protein requirements; selection of appropriate enteral feeding formula; micronutrients and immune-nutrients; standard nutrition in hepatic, renal, and respiratory diseases and documentation of nutrition practices.Conclusion:This paper summarizes the optimum nutrition practices for critically ill patients. The possible solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance in critical care settings regarding appropriate critical-care nutrition practices and to set up Intensive Care Unit nutrition protocols.

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