Evaluation of the role of the critical care pharmacist in identifying and avoiding or minimizing significant drug-drug interactions in medical intensive care patients

Rivkin, Anastasia; Yin, Hongjun

doi:10.1016/j.jcrc.2010.04.014

Cited by 81 publications

(65 citation statements)

References 8 publications

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“…As the number of prescriptions increases, the number of DDIs increases. The importance of DDIs in ICU patients has been defined in many studies (2,11). The frequency of DDIs may change for different ICU types, particularly for medical ICU and cardiac ICU patients (7).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Potential drug–drug interactions in a medical intensive care unit of a university hospital

M¹,

Kucukibrahimoglu²,

Karaalp³

et al. 2016

Turk J Med Sci

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Section: Discussionmentioning

confidence: 99%

“…The frequency of DDIs may change for different ICU types, particularly for medical ICU and cardiac ICU patients (7). It has been reported that there were more DDIs in the cardiac ICUs than the medical ICUs (11,12). The most frequent drug groups involved in DDIs can show variability in different ICUs due to the comorbid diseases of patients.…”

Section: Discussionmentioning

confidence: 99%

Potential drug–drug interactions in a medical intensive care unit of a university hospital

M¹,

Kucukibrahimoglu²,

Karaalp³

et al. 2016

Turk J Med Sci

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“…A prospective observational study was undertaken in 21 UK CCUs from [5][6][7][8][9][10][11][12][13][14][15][16][17][18] th Nov 2012. A data collection web portal was designed where the specialist critical care pharmacist (SCCP) reported all interventions at their site.…”

Section: Methodsmentioning

confidence: 99%

“…Firstly, the current evidence-base is composed of mainly North American reports and focuses on single centres and often specific intervention types, e.g. drug-drug interactions [13] or adverse drug events [14]. As such, how transferable is the existing evidence-base to UK or indeed European practice, how do single site reports reflect wider practice and what is the scope of direct patient care delivered by clinical pharmacy teams ?…”

Section: Introductionmentioning

confidence: 99%

Pharmacist’s review and outcomes: Treatment-enhancing contributions tallied, evaluated, and documented (PROTECTED-UK)

Shulman

McKenzie

Landa

et al. 2015

Journal of Critical Care

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PURPOSE.To describe clinical pharmacist interventions across a range of critical care units (CCUs) throughout the United Kingdom (UK). To identify CCU medication error rate, prescription optimisation and to identify the type and impact of each intervention in the prevention of harm and improvement of patient therapy. MATERIALS AND METHODS.A prospective observational study was undertaken in 21 UK CCUs from [5][6][7][8][9][10][11][12][13][14][15][16][17][18] th Nov 2012. A data collection web portal was designed where the specialist critical care pharmacist (SCCP) reported all interventions at their site. Each intervention was classified as either: medication error, optimisation or consult. In addition, a clinical impact scale was used to code the interventions. Interventions were scored as low, moderate, high impact and life saving. The final coding was moderated by blinded independent multidisciplinary trialists. RESULTS. 20,517 prescriptions were reviewed with 3,294 interventions recorded during the weekdays. This resulted in an overall intervention rate of 16.1%: 6.8% were classified as medication errors, 8.3 % optimisations and 1.0% consults. The interventions were classified as: low impact (34.0%), moderate impact (46.7%) high impact (19.3%) and one case was life saving. Almost three-quarters of interventions were to optimise the effectiveness of and improve safety of pharmacotherapy. CONCLUSIONS. This observational study demonstrated that both medication error resolution and pharmacist led optimisation rates were substantial. Almost 1 in 6 prescriptions required an intervention from the clinical pharmacist. The error rate was slightly lower than an earlier UK prescribing error study (EQUIP). Two thirds of the interventions were of moderate to high impact. Key wordsCritical care, interventions, specialist critical care pharmacist, medication errors, optimisations, impact coding IntroductionThe critically ill patient is at risk of medicines-related adverse events [1], drug interactions and on some occasions inadequate therapy [2]. This risk can be exacerbated by the presence of organ failure or by supportive therapies such as renal replacement therapy. Consequently, interventions to reduce medication errors and optimise therapy are an essential component of patient care. These include electronic prescribing, smart infusion pumps, medicines reconciliation, clinical guidelines and services normally led by a specialist critical care pharmacist (SCCP) [3]. Improving the safety and efficacy of medication therapy in critical care patients is the cornerstone of SCCP activity. Since the first reports of clinical pharmacist interventions in critical care in the mid-1980s [4], there has been a gradual progression from those focused on financial savings in medicine use, to reducing medication errors and more recently to the optimisation of medication therapy [5]. Clinical pharmacists have been reported to improve medicines-related patient outcomes in the use of sedation [6], antimicrobial therapy [7], therapeutic drug m...

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“…The large number of pDDIs between drugs prescribed to ICU patients has been documented by several studies (Smithburger, Kane-Gill, Seybert, 2012;Rivkin, Yin, 2011;Kane-Gill et al, 2012). A recent study conducted in the USA showed that 46.3% of ICU prescriptions included pDDIs (Smithburger, Kane-Gill, Seybert, 2012), while Brazilian studies have reported a prevalence of 67% or 70% (Hammes et al, 2008;Moreira, Cassiani, 2011).…”

Section: Introductionmentioning

confidence: 97%

Prevalence of potential drug-drug interactions in the intensive care unit of a Brazilian teaching hospital

Rodrigues

Stahlschmidt

Granja

et al. 2017

Braz. J. Pharm. Sci.

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Patients in intensive care unit are prescribed large numbers of drugs, highlighting the need to study potential Drug-Drug Interactions in this environment. The aim of this study was to delineate the prevalence and risk of potential drug-drug interactions between medications administered to patients in an ICU. This cross-sectional observational study was conducted during 12 months, in an adult ICU of a teaching hospital. Inclusion criteria were: prescriptions with 2 or more drugs of patients admitted to the ICU for > 24 hours and age of ≥18 years. Potential Drug-Drug Interactions were quantified and classified through Micromedex TM database. The 369 prescriptions included in this study had 205 different drugs, with an average of 13.04 ± 4.26 (mean ± standard deviation) drugs per prescription. Potential Drug-Drug Interactions were identified in 89% of these, with an average of 5.00 ± 5.06 interactions per prescription. Of the 405 different pairs of potentially interacting drugs identified, moderate and major interactions were present in 74% and 67% of prescriptions, respectively. The most prevalent interaction was between dipyrone and enoxaparin (35.8%), though its clinical occurrence was not observed in this study. The number of potential Drug-Drug Interactions showed significant positive correlations with the length of stay in the intensive care unit, and with the number of prescribed drugs. Acknowledging the high potential for Drug-Drug Interactions in the ICU represents an important step toward improving patient safety and best therapy results.Uniterms: Potential drug-drug interactions. Intensive care unit. Patient safety. University hospitals.

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Evaluation of the role of the critical care pharmacist in identifying and avoiding or minimizing significant drug-drug interactions in medical intensive care patients

Cited by 81 publications

References 8 publications

Potential drug–drug interactions in a medical intensive care unit of a university hospital

Potential drug–drug interactions in a medical intensive care unit of a university hospital

Pharmacist’s review and outcomes: Treatment-enhancing contributions tallied, evaluated, and documented (PROTECTED-UK)

Prevalence of potential drug-drug interactions in the intensive care unit of a Brazilian teaching hospital

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