The impact of a pharmacist intervention at an intensive care rehabilitation clinic

Mactavish, P., Quasim, T. , Shaw, M., Devine, H., Daniel, M., Kinsella, J., Fenlon, C., Kishore, R., Iwashyna, T. J. and McPeake, J. (2019) The impact of a pharmacist intervention at an intensive care rehabilitation clinic. BMJ Open Quality, 8(3), e000580. (doi:10.1136/bmjoq-2018-000580)

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Abstract

Objective: While disruptions in medications are common among patients who survive critical illness, there is limited information about specific medication-related problems among survivors of critical care. This study sought to determine the prevalence of specific medication-related problems detected in patients, seen after critical care discharge. Design: Consecutive patients attending an intensive care unit (ICU) follow-up programme were included in this single-centre service evaluation. Setting: Tertiary care regional centre in Scotland (UK). Participants: 47 patients reviewed after critical care discharge at an ICU follow-up programme. Interventions: Pharmacists conducted a full medication review, including: medicines reconciliation, assessing the appropriateness of each prescribed medication, identification of any medication-related problems and checking adherence. Measurements: Medication-related problems in patients following critical care discharge. Interventions and medication-related problems were systematically graded and risk factors were identified using an adapted version of the National Patient Safety Agency Risk Matrix. Main results: 69 medication-related problems were identified in 38 (81%) of the 47 patients. The most common documented problem was drug omission (29%). 64% of the medication-related problems identified were classified as either moderate or major. The number of pain medications prescribed at discharge from intensive care was predictive of medication-related problems (OR 2.02, 95% CI 1.14 to 4.26, p=0.03). Conclusions: Medication problems are common following critical care. Better communication of medication changes both to patients and their ongoing care providers may be beneficial following a critical care admission. In the absence of highly effective communication, a pharmacy intervention may contribute substantially to an intensive care rehabilitation or recovery programme.

Item Type:Articles
Additional Information:Funding: PM, HD, TQ, JK, MD and JM were funded from the Health Foundation (UK) when undertaking this work. JM was funded by the CNO (Scotland). TJI's work was supported, in part, by the US Department of Veterans Affairs, Health Services Research and Development (IIR 13-079).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mactavish, Mrs Pamela and Quasim, Dr Tara and Kinsella, Professor John and Daniel, Malcolm and McPeake, Dr Joanne and Shaw, Mr Martin
Authors: Mactavish, P., Quasim, T., Shaw, M., Devine, H., Daniel, M., Kinsella, J., Fenlon, C., Kishore, R., Iwashyna, T. J., and McPeake, J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:BMJ Open Quality
Publisher:BMJ Publishing Group
ISSN:2399-6641
ISSN (Online):2399-6641
Published Online:27 September 2019
Copyright Holders:Copyright © Authors (or their employers) 2019
First Published:First published in BMJ Open Quality 8(3):e000580
Publisher Policy:Reproduced under a Creative Commons license

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
653971A study exploring the feasibility of an ICU rehabilitation programmeTara QuasimThe Health Foundation (HEALFOU)N/AMVLS MED - ANAESTHESIA