Impact on practice
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The implementation of a clinical pharmacist in the ICU team may help to reduce clinically important complications.
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Both pharmacists and physicians must be encouraged to further expand their cooperation on clinical wards.
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By implementing clinical pharmacists in an ICU, hospitals increase usage of the resources and skills of the clinical pharmacists’ for the sake of patient safety, whichwould otherwise lie idle.
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Despite the country-specific differences in work-tasks and education, the impact of German clinical pharmacists’ on patient safety is comparable to that of international clinical pharmacy services.
Introduction
Aim of the study
Ethics approval
Method
Study design
P0—Control phase
Evaluation phase
P1—Intervention phase 1
P2—Intervention phase 2
Setting
Inclusion and exclusion criteria
Outcomes
Definition of prescribing errors
Unnecessary drug |
Drug indicated but not prescribed |
Drug allergy or medical history not considered |
Double prescription |
Inappropriate or not most suitable drug formulation in terms of indication |
Inappropriate or not most suitable drug in terms of indication |
Prescription/Documentation incomplete/incorrect |
Transcription error |
Inappropriate administration (route) prescribed |
Inappropriate administration (duration) prescribed |
Failure to adjust dose for organ dysfunction |
Inappropriate dose |
Inappropriate administration interval |
TDM not performed or neglected |
Contraindication |
Failure to discontinue relevant drugs preoperatively |
Interaction |
Potentially severe prescribing errors
May have increased the risk of mortality |
May have resulted in organ damage |
May have resulted in prolongation of the LOS |
Increased costs > 100 €/day |
Qualitative analysis
Monitored days without systemic anti-infective therapy
Calculation of the case numbers and statistical analysis
Variables | Statistical test |
---|---|
Age | Mann–Whitney-U |
Sex | Fisher’s Exact |
SAPS II score | Mann–Whitney-U |
Number of medications on the first day on ICU | Mann–Whitney-U |
LOS all ICU at KKS | Mann–Whitney-U |
LOS KKS | Mann–Whitney-U |
Days of invasive mechanical ventilation | Mann–Whitney-U |
Days of mechanical ventilation | Mann–Whitney-U |
Renal replacement therapy | Fisher’s exact |
Acute renal failure on admission to ICU | Fisher’s exact |
Acute kidney damage for ≥ 3 days during ICU stay | Fisher’s exact |
Hepatic insufficiency | Fisher’s exact |
Prescribing errors | Fisher’s exact |
Potentially severe prescribing errors | Fisher’s exact |
Monitored days without SAIT per study phase | Fisher’s exact |
Monitored days without SAIT per patient | Mann–Whitney-U |
Results
Demographic and clinical characteristics of the study population
Characteristics | P0 (n = 117) | P1 (n = 121) | P2 (n = 98) |
---|---|---|---|
Age [median (25th; 75th quartiles)]a | 64.0 (53; 76.5) | 68.0 (59.0; 76.0) | 68.0 (56.75;77.0) |
Male [n (%)]b | 70 (59.8) | 80 (66.1) | 66 (67.3) |
SAPS II [median (25th; 75th quartiles)]a | 37.5 (27.25; 52.0) | 39.0 (28.0; 50.5) | 40.0 (29.75; 48.25) |
Number of medications on the first day on ICU [median (25th; 75th quartiles)]a | 13.0 (10.0; 17.0) | 14.0 (11.0; 16.0) | 13.0 (10.0; 17.0) |
LOS all ICU at KKS [days, median (25th; 75th quartiles)]a | 10.0 (5.5; 21.0) | 9.0 (4.0; 17.0) | 11.0 (5.0; 24.25) |
LOS KKS [days, median (25th; 75th quartiles)]a | 26.0 (18.0; 41.0) | 29.0 (16.5; 41.5) | 32.0 (19.0; 55.0)* |
Days of invasive mechanical ventilation [median (25th; 75th quartiles)]a | 4.0 (2.0; 11.0) | 2.0 (0.0; 7.0)* | 4.5 (1.0; 13.5)* |
Days of mechanical ventilation [median (25th; 75th quartiles)]a | 6.0 (2.0; 13.0) | 3.0 (1.0; 12.0)* | 7.0 (2.0; 15.0)* |
Renal replacement therapy [n (%)]b | 22 (18.8) | 29 (24.0) | 23 (23.5) |
Acute renal failure on admission to ICU [n (%)]b | 24 (20.5) | 20 (16.5) | 10 (10.2) |
Acute renal failure for ≥ 3 days during ICU stay [n (%)]b | 22 (18.8) | 24 (19.8) | 17 (17.3) |
Hepatic insufficiency (Bilirubin > 5 mg/dL or ALAT > 100 U/L [n (%)]b | 39 (33.3) | 44 (36.4) | 35 (35.7) |
Prescribing errors
Potentially severe prescribing errors
Descriptive analysis
P0 (nMM = 11,755) | P1 (nMM = 12,135) | P2 (nMM = 12,329) | |
---|---|---|---|
1 | Drug indicated but not prescribed nPE = 361 | Drug indicated but not prescribed nPE = 126 | Drug indicated but not prescribed nPE = 82 |
2 | Inappropriate administration route or handling prescribed nPE = 240 | TDM not performed or neglected nPE = 79 | Inappropriate dose nPE = 59 |
3 | Failure to adjust dose for organ dysfunction nPE = 196 | Documentation incorrect nPE = 74 | Documentation incorrect nPE = 56 |
4 | Discontinuation of long-term medication nPE = 183 | Inappropriate dose nPE = 70 | TDM not performed or neglected nPE = 53 |
5 | Inappropriate dose nPE = 177 | Unnecessary drug nPE = 66 | Unnecessary drug nPE = 37 |