Department of Pharmacy, Sheffield Teaching Hospitals, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
Int J Clin Pharm. 2012 Apr;34(2):351-7. doi: 10.1007/s11096-012-9613-7. Epub 2012 Feb 22.
Specific data on the actual clinical practice of United Kingdom pharmacists in Critical Care are limited. Within the general critical care units of Sheffield Teaching Hospitals, clinical pharmacists have the facility to electronically document, communicate and follow-up proactive recommendations using a Pharmacy Review Form via the Clinical Information System, MetaVision(®).
The objective of the service evaluation was to describe the acceptance rate by medical staff of pharmacist proactive medication recommendations; including data on the types of recommendations and reasons thereof, for general intensive care patients of a UK teaching hospital trust.
Sheffield Teaching Hospitals National Health Service Foundation Trust with 20 intensive care beds located on two hospital sites admitting Level 3 and 2 mixed general medical, surgical, trauma, burns and haematology/ oncology patients.
Retrospective analysis of pharmacist proactive recommendations recorded electronically from January 2009 to July 2011 in general intensive care unit patients. Main outcome 5,623 electronic medication recommendations were documented, providing an average of 2.2 proactive recommendations per patient admitted to intensive care from January 2009 to July 2011. 5,101 (90.7%) of the recommendations were accepted and acted upon by medical staff.
The most common recommendations were Add Drug 1,862 (28.2%); Dose Review 1,707 (25.8%); Discontinue Drug 1,185 (17.9%); Alternative Drug 903 (13.7%); Alternative Route 770 (11.7%). The most common reasons for the proactive medication recommendations were related to changes in gastrointestinal absorption 951 (15.6%); compliance with medication guidelines 857 (14.1%); sedation/delirium/agitation management 764 (12.6%); dose adjustment for renal dysfunction or continuous renal replacement therapies 756 (12.4%); and medication reconciliation 612 (10.1%). The majority of medication recommendations involved drugs in Gastrointestinal, Central Nervous System, Cardiovascular, Infection, Nutrition and Blood classes (British National Formulary).
There was a high acceptance rate for proactive medication-related recommendations made by critical care pharmacists via the electronic review form. The majority of pharmacist recommendations were related to adding or refining currently prescribed medication. Ten percent of recommendations related to medication reconciliation of patients' pre-admission medication.
关于英国药师在重症监护中的实际临床实践的具体数据有限。在谢菲尔德教学医院的普通重症监护病房中，临床药师可以使用电子方式记录、交流并跟进通过临床信息系统 MetaVision（®）的药学审查表提出的主动建议。
该服务评估的目的是描述医务人员对药师主动药物建议的接受率；包括关于建议类型和原因的数据，适用于一家英国教学医院信托基金的普通重症监护患者。
谢菲尔德教学医院国民保健服务基金会信托基金，在两个医院站点设有 20 张重症监护床，收治三级和二级混合普通内科、外科、创伤、烧伤和血液/肿瘤患者。
对 2009 年 1 月至 2011 年 7 月期间普通重症监护病房患者的电子药学主动建议进行回顾性分析。主要结果是记录了 5623 份电子药物建议，为 2009 年 1 月至 2011 年 7 月期间每例入住重症监护病房的患者提供了 2.2 项主动建议。医务人员接受并执行了 5101 项（90.7%）建议。
最常见的建议是 Add Drug 1,862（28.2%）；剂量审查 1,707（25.8%）；停药 1,185（17.9%）；替代药物 903（13.7%）；替代途径 770（11.7%）。主动药物建议最常见的原因是与胃肠道吸收变化有关 951 项（15.6%）；遵守药物指南 857 项（14.1%）；镇静/谵妄/躁动管理 764 项（12.6%）；肾功能障碍或连续肾脏替代治疗的剂量调整 756 项（12.4%）；以及药物重整 612 项（10.1%）。大多数药物建议涉及胃肠道、中枢神经系统、心血管、感染、营养和血液类药物（英国国家处方集）。
重症监护药剂师通过电子审查表提出的主动药物相关建议接受率很高。药剂师的大多数建议与添加或改进当前处方药物有关。10%的建议与患者入院前药物的药物重整有关。
