심장외과 중환자실에서 임상약사의 약처방 중재 활동 분석
Analysis of Clinical Pharmacist Interventions in the Cardio-Surgical Intensive Care Unit
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background : It has been reported that clinical pharmacists’ participation in the multidisciplinary intensive care unit (ICU) team reduces the number of medication errors and improves the clinical outcome. However, studies assessing the role of pharmacists in a cardio-surgical ICU (CSICU) are limited. The aim of this study was to analyze pharmacologic interventions and identify pharmacologic problems that require pharmacist intervention in a CSICU. Methods : The research was conducted by retrospectively reviewing the electronic medical records of patients aged 18 years or older who were admitted to the CSICU of Samsung Medical Center from April 1 2019 to June 30 2019. Results : During the study, the clinical pharmacist monitored 12,021 drug prescriptions for 205 patients and conducted 379 pharmacologic interventions. The most common pharmacologic intervention recommended by the pharmacist was nutritional support (19.0%), followed by therapeutic drug monitoring (TDM) (18.5%) and provision of drug information (14.8%). The most frequently mediated group of drugs was antibiotics (31.1%), and the causes for pharmacologic intervention of antibiotics were mostly TDM (51.7%) and inappropriate dosage (20.3%). The intervention rate of ‘pain, sedation and delirium-related drugs’ was 17.2%, while the intervention rate of ‘antiarrhythmics, anticoagulant, and antiplatelet agents’ was 13.2%. The most common reason for intervention in both groups was missed prescriptions, followed by adverse drug events and inappropriate dosages. The acceptance rate of intervention was 92.2%. Conclusion : Clinical pharmacists’ participation in the ICU has enabled active drug prescription monitoring, proper nutrition support, and TDM. The acceptance rate of intervention is high. The CSICU requires pharmacologic intervention of pain, sedation and delirium-related drugs specific to critically ill patients, as well as drugs indicated for cardio-surgery.
Abstract
Background : It has been reported that clinical pharmacists’ participation in the multidisciplinary intensive care unit (ICU) team reduces the number of medication errors and improves the clinical outcome. However, studies assessing the role of pharmacists in a cardio-surgical ICU (CSICU) are limited. The aim of this study was to analyze pharmacologic interventions and identify pharmacologic problems that require pharmacist intervention in a CSICU. Methods : The research was conducted by retrospectively reviewing the electronic medical records of patients aged 18 years or older who were admitted to the CSICU of Samsung Medical Center from April 1 2019 to June 30 2019. Results : During the study, the clinical pharmacist monitored 12,021 drug prescriptions for 205 patients and conducted 379 pharmacologic interventions. The most common pharmacologic intervention recommended by the pharmacist was nutritional support (19.0%), followed by therapeutic drug monitoring (TDM) (18.5%) and provision of drug information (14.8%). The most frequently mediated group of drugs was antibiotics (31.1%), and the causes for pharmacologic intervention of antibiotics were mostly TDM (51.7%) and inappropriate dosage (20.3%). The intervention rate of ‘pain, sedation and delirium-related drugs’ was 17.2%, while the intervention rate of ‘antiarrhythmics, anticoagulant, and antiplatelet agents’ was 13.2%. The most common reason for intervention in both groups was missed prescriptions, followed by adverse drug events and inappropriate dosages. The acceptance rate of intervention was 92.2%. Conclusion : Clinical pharmacists’ participation in the ICU has enabled active drug prescription monitoring, proper nutrition support, and TDM. The acceptance rate of intervention is high. The CSICU requires pharmacologic intervention of pain, sedation and delirium-related drugs specific to critically ill patients, as well as drugs indicated for cardio-surgery.
참고문헌 (14)
- Kessemeier N, "A new approach on assessing clinical pharmacists’ impact on prescribing errors in a surgical intensive care unit", Int J Clin Pharm, 41(5), pp.1184~1192 (2019)
- 김효정, "내과계 중환자실 팀활동을 통한 약사의 처방중재 활동 평가", 병원약사회지, 35(3), pp.319~330 (2018), 한국병원약사회[DOI]
- Ridley SA, "Prescription errors in UK critical care units", Anaesthesia, 59(12), pp.1193~1200 (2004)
- Rudis MI, "Position paper on critical care pharmacy services. Society of Critical Care Medicine and American College of Clinical Pharmacy Task Force on Critical Care Pharmacy Services", Crit Care Med, 28(11), pp.3746~3750 (2000)
- 손유민, "중환자실 임상약사의 약물처방 검토 시 필요한 필수점검 항목 개발", 병원약사회지, 36(1), pp.26~46 (2019), 한국병원약사회[DOI]
- Kim JM, "Development of clinical pharmacy services for intensive care units in Korea", Springerplus, 3, pp.34~ (2014)
- Tae Yun Park, "Pharmacotherapeutic Problems and Pharmacist Interventions in a Medical Intensive Care Unit", Acute and Critical Care, 30(2), pp.82~88 (2015), 대한중환자의학회
- McClave SA, "Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM)and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)", JPEN J Parenter Enteral Nutr, 40(2), pp.159~211 (2016)
- Rybak M, "Therapeutic monitoring of vancomycin in adult patients : a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists", Am J Health Syst Pharm, 66(1), pp.82~98 (2009)
- Bond CA, "Clinical and economic outcomes of pharmacist-managed aminoglycoside or vancomycin therapy", Am J Health Syst Pharm, 62(15), pp.1596~1605 (2005)
- Tisdale JE, "Development and validation of a risk score to predict QT interval prolongation in hospitalized patients", Circ Cardiovasc Qual Outcomes, 6(4), pp.479~487 (2013)
- Rosner MH, "Acute kidney injury associated with cardiac surgery", Clin J Am Soc Nephrol, 1(1), pp.19~32 (2006)
- Heintz BH, "Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis", Pharmacotherapy, 29(5), pp.562~577 (2009)
- 정정원, "외과계 중환자실 약사의 처방중재효과 평가", 병원약사회지, 31(4), pp.908~918 (2014), 한국병원약사회[DOI]