School of Pharmacy, Northeastern University, Boston, MA, USA.
Ann Pharmacother. 2011 Oct;45(10):1217-29. doi: 10.1345/aph.1Q332. Epub 2011 Sep 20.
Pharmacists are key members of the intensive care unit (ICU) team; however, few data exist regarding their clinical role, perceptions, and current practices in recognizing and managing delirium.
To describe current practices and perceptions of ICU pharmacists regarding delirium recognition and treatment relative to current recommendations.
A self-administered survey was distributed to 457 pharmacists in 8 states who are members of the Society of Critical Care Medicine or the American College of Clinical Pharmacy and who spend 25% or more of their time providing clinical ICU pharmacy services.
A total of 250 (55%) pharmacists responded. A delirium screening tool was routinely used by few (7%) pharmacists. Lack of time (34%) and the belief that screening is a nursing role (24%) were key barriers to pharmacist screenings. Most (85%) said that delirium should be pharmacologically managed; 68% responded that 2 or more medications should be used. The treatments of first choice included haloperidol (76%), an atypical antipsychotic (14%), or a benzodiazepine (10%). Frequently used treatments were haloperidol (87%), quetiapine (59%), and lorazepam (47%). Haloperidol was perceived by many (42%) to have 1 or more randomized trials supporting its use for delirium and Food and Drug Administration approval for this indication (34%). Haloperidol was most often administered on a scheduled basis (62%), intravenously (92%), and at a daily dose of 5-10 mg (58%). While the QTc interval was frequently measured at least once per shift using an electrocardiogram strip (64%), it was not routinely measured in 20% of ICUs, and 60% continued haloperidol when the QTc exceeded 500 msec.
Current practices and perceptions surrounding recognition and treatment of delirium in patients in the ICU by the critical care pharmacists surveyed are heterogeneous. Antipsychotics are frequently recommended by pharmacists for delirium treatment, despite a lack of rigorous evidence to support their use. While pharmacists are ideally suited to lead delirium recognition efforts and provide treatment recommendations in this area, these roles need further elucidation. The optimal pedagogical strategy to support these efforts remains unclear, and the potential impact of pharmacists' efforts on patients' outcomes is unknown.
药剂师是重症监护病房（ICU）团队的关键成员；然而，关于他们在识别和管理谵妄方面的临床角色、认知和当前实践，数据很少。
描述 ICU 药剂师在识别和治疗谵妄方面的当前做法和认知，以及与当前建议的相关性。
对来自 8 个州的、在社会重症监护医学学会或美国临床药学学院任职的、有 25%或以上时间提供临床 ICU 药学服务的 457 名药剂师进行了一项自我管理式调查。
共有 250 名（55%）药剂师做出回应。只有少数（7%）药剂师常规使用谵妄筛查工具。缺乏时间（34%）和认为筛查是护理角色（24%）是药剂师进行筛查的关键障碍。大多数（85%）表示应通过药理学手段来管理谵妄；68%的人表示应使用 2 种或以上药物。首选治疗方法包括氟哌啶醇（76%）、非典型抗精神病药（14%）或苯二氮䓬类药物（10%）。常用的治疗方法包括氟哌啶醇（87%）、喹硫平（59%）和劳拉西泮（47%）。许多人（42%）认为氟哌啶醇有 1 项或多项支持其用于谵妄的随机试验和食品和药物管理局对此适应证的批准（34%）。氟哌啶醇最常按计划给药（62%）、静脉内给药（92%）和每日剂量 5-10mg（58%）。虽然至少每班次使用心电图条测量一次 QTc 间隔（64%），但 20%的 ICU 并未常规测量，60%的 ICU 在 QTc 超过 500msec 时仍继续使用氟哌啶醇。
接受调查的重症监护药剂师在 ICU 患者的谵妄识别和治疗方面的当前做法和认知存在异质性。尽管缺乏支持其使用的严格证据，但抗精神病药仍经常被药剂师推荐用于治疗谵妄。尽管药剂师非常适合在这一领域引领谵妄识别工作并提供治疗建议，但这些角色需要进一步阐明。支持这些工作的最佳教学策略尚不清楚，药剂师的努力对患者结局的潜在影响也尚不清楚。
