Pharmacy intervention at an intensive care rehabilitation clinic

MacTavish, P., McPeake, J. , Devine, H., Kinsella, J., Daniel, M., Fenlon, C. and Quasim, T. (2016) Pharmacy intervention at an intensive care rehabilitation clinic. Critical Care, 20(2), p. 167. (doi: 10.1186/s13054-016-1208-6)

Abstract

Introduction: During an intensive care stay, patients often have their chronic medications withheld for a variety of reasons and new drugs commenced [1]. As patients are often under the care of a number of different medical teams during their admission there is potential for these changes to be inadvertently continued [2]. Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) is a five week rehabilitation programme for patients and their caregivers after ICU (Intensive Care Unit) discharge at Glasgow Royal Infirmary. Within this programme a medication review by the critical care pharmacist provided an opportunity to identify and resolve any pharmaceutical care issues and also an opportunity to educate patients and their caregivers about changes to their medication. Methods: During the medication review we identified ongoing pharmaceutical care issues which were communicated to the patient’s primary care physician (GP) by letter or a telephone call. The patients were also encouraged to discuss any issues raised with their GP. The significance of the interventions was classified from those not likely to be of clinical benefit to the patient, to those which prevented serious therapeutic failure. Results: Data was collected from 47 of the 48 patients who attended the clinic (median age was 52 (IQR, 44-57) median ICU LOS was 15 (IQR 9-25), median APACHE II was 23 (IQR 18-27) and 32 of the patients were men (67%). The pharmacist made 69 recommendations; including 20 relating to drugs which had been withheld and not restarted, dose adjustments were suggested on 13 occasions and new drug recommendations were made for 10 patients. Duration of treatment for new medications started during hospital admission was clarified on 12 occasions. Lastly adverse drug effects were reported on 4 occasions and the incorrect drug was prescribed on 2 occasions. Of the interventions made 58% were considered to be of moderate to high impact. Conclusions: The pharmacist identified pharmaceutical care issues with 18.6% of the prescribed medications. Just over half of the patients reported that they were not made aware of any alterations to their prescribed medication on discharge. Therefore a pharmacy intervention is an essential part of an intensive care rehabilitation programme to address any medication related problems, provide education and to ensure patients gain optimal benefit from their medication.

• Item Type: Articles
• Status: Published
• Refereed: No
• Glasgow Author(s) Enlighten ID: Quasim, Professor Tara and Kinsella, Professor John and McPeake, Dr Jo
• Authors: MacTavish, P., McPeake, J., Devine, H., Kinsella, J., Daniel, M., Fenlon, C., and Quasim, T.
• Subjects: R Medicine > R Medicine (General); R Medicine > RT Nursing
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: Critical Care
• Publisher: BioMed Central
• ISSN: 1364-8535
• ISSN (Online): 1466-609X
• Copyright Holders: Copyright © 2016 The Authors
• First Published: First published in Critical Care 20(2):167
• Publisher Policy: Reproduced under a Creative Commons License