Standard of practice in intensive care for pharmacy services

Johnston, Karlee; Ankravs, Melissa J.; Badman, Belinda; Choo, Chui Lynn; Cree, Michele; Fyfe, Rachel; Roberts, Jason A.; Xu, Jessica H; Munro, Courtney

doi:10.1002/jppr.1718

Cited by 12 publications

(8 citation statements)

References 22 publications

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“…Standards of practice described for UK critical care pharmacists are commensurate with statements in other territories, such as Australia and New Zealand [ 6 ], and the USA [ 37 ]. Standards in the USA are long established and have recently been updated, although implementation is variable [ 20 ].…”

Section: Resultsmentioning

confidence: 96%

“…Standards in the USA are long established and have recently been updated, although implementation is variable [ 20 ]. Standards in Australia [ 6 ] are strongly endorsed by the College of Intensive Care Medicine of Australia and New Zealand [ 38 ]. The implications for the clinical pharmacy workforce, including the need for training and recognition, are highlighted [ 39 ].…”

Section: Resultsmentioning

confidence: 99%

“…The need for specialist clinical pharmacists in critical care (critical care pharmacists) is well recognised internationally [ 5 , 6 ]. In the UK, standards on critical care pharmacist staffing ratios and level of practice are in place to support practice delivery [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Critical care pharmacy workforce: a 2020 re-evaluation of the UK deployment and characteristics

et al. 2023

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Introduction Critical care pharmacists improve the quality and efficiency of medication therapy whilst reducing treatment costs where they are available. UK critical care pharmacist deployment was described in 2015, highlighting a deficit in numbers, experience level, and critical care access to pharmacy services over the 7-day week. Since then, national workforce standards have been emphasised, quality indicators published, and service commissioning documents produced, reinforced by care quality assessments. Whether these initiatives have resulted in further development of the UK critical care pharmacy workforce is unknown. This evaluation provides a 2020 status update. Methods The 2015 electronic data entry tool was updated and circulated for completion by UK critical care pharmacists. The tool captured workforce data disposition as it was just prior to the COVID-19 pandemic, at critical care unit level. Main findings Data were received for 334 critical care units from 203 organisations (96% of UK critical care units). Overall, 98.2% of UK critical care units had specific clinical pharmacist time dedicated to the unit. The median weekday pharmacist input to each level 3 equivalent bed was 0.066 (0.043–0.088) whole time equivalents, a significant increase from the median position in 2015 (+ 0.021, p < 0.0001). Despite this progress, pharmacist availability remains below national minimum standards (0.1/level 3 equivalent bed). Most units (71.9%) had access to prescribing pharmacists. Geographical variation in pharmacist staffing levels were evident, and weekend services remain extremely limited. Conclusions Availability of clinical pharmacists in UK adult critical care units is improving. However, national standards are not routinely met despite widely publicised quality indicators, commissioning specifications, and assessments. Additional measures are needed to address persistent deficits and realise gains in organisational and patient-level outcomes. These measures must include promotion of cross-professional collaborative working, adjusted funding models, and a nationally recognised training pathway for critical care pharmacists.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

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Critical care pharmacy workforce: a 2020 re-evaluation of the UK deployment and characteristics

et al. 2023

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“…Alle durchsuchten Literaturquellen ergaben, dass die klinische Pharmazie und der Stationsapotheker auf einer Intensivstation international fest etabliert sind [6,10,13,16,18,20,27]…”

Section: Ergebnisse Der Literaturrechercheunclassified

“…Im englischsprachigen Raum sind Apotheker bereits fester Bestandteil des multiprofessionellen Teams und übernehmen Verantwortung entsprechend ihrer Funktion und Qualifikation [10,13,17,19,26]. Inwiefern Apotheker auf deutschen Intensivstationen tätig sind, ist derzeit nicht bekannt.…”

Section: Introductionunclassified

Arzneimitteltherapiesicherheit gefördert durch die interprofessionelle Zusammenarbeit von Arzt und Apotheker auf Intensivstationen in Deutschland

Hilgarth

Waydhas

Dörje

et al. 2022

Med Klin Intensivmed Notfmed

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Zusammenfassung Hintergrund Kritisch kranke Patienten sind besonders anfällig für unerwünschte Arzneimittelereignisse. Internationale Studien zeigen, dass pharmazeutische Betreuung die Patienten- und Arzneimitteltherapiesicherheit positiv beeinflusst. National wird die Integration von Apothekern in das multidisziplinäre Team und eine Teilnahme an Visiten gefordert. Ziel dieser Arbeit ist es, Art und Umfang der pharmazeutischen Betreuung in der Intensivmedizin in Deutschland zu erheben. Methode In einer Literatur- und Datenbankrecherche wurden 13 relevante pharmazeutische Tätigkeiten identifiziert. Darauf aufbauend wurde von einem Expertengremium ein Onlinesurvey mit 27 Fragen zur Implementierung der pharmazeutischen Betreuung auf Intensivstationen erstellt. Die Umfrage wurde an Leiter deutscher Intensivstationen versandt. Ergebnisse Eine regelmäßige pharmazeutische Betreuung ist bei 35,3 % (59/167) der Intensivstationen etabliert. Arzneimittelinformation (89,7 % [52/58]), pharmazeutische Interventionen mit Therapieumstellung (z. B. in der Visite; 67,2 % [39/58]), regelmäßige Evaluation der Verordnung (Medikationsanalyse; 65,5 % [38/58]) sowie die Überwachung der Medikation (hinsichtlich von Nebenwirkungen, Effektivität und Kosten; 63,8 % [37/58]) zählen zu den meistgenannten Tätigkeiten. Die Teilnehmer mit pharmazeutischer Betreuung (58/168) stufen 7 von 13 Tätigkeiten als „essenziell/unverzichtbar“ ein, wohingegen es nur zwei bei den Teilnehmern ohne pharmazeutische Betreuung (104/168) sind. Schlussfolgerung Nur wenige Intensivstationen in Deutschland haben den Stationsapotheker bereits in das multidisziplinäre Team integriert. Ist ein pharmazeutischer Service etabliert, wird mehreren pharmazeutischen Tätigkeitsfeldern eine höhere Gewichtung/Bedeutung zugeschrieben.

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Characterization of drug‐related problems and evaluation of pharmacist interventions in the cardiovascular intensive care settings in Thailand

Wattanaruengchai

Kongwatcharapong

Nathisuwan

2023

J Am Coll Clin Pharm

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Introduction Data regarding drug‐related problems (DRPs) and pharmacist's role in the cardiovascular intensive care units (CICU) from low‐ to middle‐income countries (LMIC) are limited. Objective The study aimed to characterize the DRP and interventions provided by clinical pharmacists in the CICU settings. Method A retrospective, cross‐sectional study was conducted in patients admitted to CICU of a tertiary‐care hospital in Thailand during January 2021 to March 2022 was performed. Data were collected from patient's medical records and pharmacy service records. DRPs were categorized according to the Pharmaceutical Care Network Europe classification. Two board‐certified pharmacotherapy specialists, pharmacy residents, and trained clinical pharmacists staffed the units 5 days a week. The pharmacist team conducted a medication review and provided interventions to the cardiology team either verbally during the ward round or in writing, as appropriate. Pharmacist interventions were categorized into two groups including retrospective intervention (interventions made to resolve DRPs after an order was made) and prospective interventions (interventions made prior to ordering process). Outcome measures were (1) number of DRPs identified; (2) category of DRPs; (3) number interventions; and (4) acceptance rate of interventions by the medical team. Results Among 576 patients admitted to the CICU, 345 DRPs were identified in 203 patients. The pharmacist team provided a total of 790 interventions including 345 retrospective interventions to resolve DRPs and 445 prospective interventions to guide medication use prior to the ordering process. The most frequent intervention was related to dosage adjustment, drug administration, adding drugs for existing conditions, and suggesting laboratory monitoring. The acceptance rate of the pharmacist intervention was 97.4%, most of which led to changes in drug therapy. Conclusion DRPs in CICU settings are common. Trained clinical pharmacists can effectively resolve DRPs and provide recommendations to improve quality of care through both clinical and distribution functions.

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Standard of practice in intensive care for pharmacy services

Cited by 12 publications

References 22 publications

Critical care pharmacy workforce: a 2020 re-evaluation of the UK deployment and characteristics

Critical care pharmacy workforce: a 2020 re-evaluation of the UK deployment and characteristics

Arzneimitteltherapiesicherheit gefördert durch die interprofessionelle Zusammenarbeit von Arzt und Apotheker auf Intensivstationen in Deutschland

Characterization of drug‐related problems and evaluation of pharmacist interventions in the cardiovascular intensive care settings in Thailand

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