Bourne Richard S, Choo Chui Lynn, Dorward Ben J
Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals, Northern General Hospital, Sheffield, UK.
Int J Pharm Pract. 2014 Apr;22(2):146-54. doi: 10.1111/ijpp.12046. Epub 2013 Jun 13.
Clinical pharmacists working in critical-care areas have a beneficial effect on a range of medication-related therapies including improving medication safety, patient outcomes and reducing medicines' expenditure. However, there remains a lack of data on specific factors that affect the reason for and type of interventions made by clinical pharmacists, such as unit speciality.
To compare the type of proactive medicines-related interventions made by clinical pharmacists on different critical-care units within the same institution.
A retrospective evaluation of proactive clinical pharmacist recommendations, made in three separate critical-care areas. Intervention data were analysed over 18 months (general units) and 2 weeks for the cardiac and neurological units. Assessment of potential patient harm related to the medication interventions were made in the neurological and cardiac units.
Overall, 5623, 211 and 156 proactive recommendations were made; on average 2.2, 3.8 and 4.6 per patient from the general, neurological and cardiac units respectively. The recommendations acceptance rate by medical staff was approximately 90% for each unit. The median potential severity of patient harm averted by the interventions were 3.6 (3; 4.2) and 4 (3.2; 4.4) for the neurological and cardiac units (P = 0.059). The reasons for, types and drug classification of the medication recommendations demonstrated some significant differences between the units.
Clinical pharmacists with critical-care training make important medication recommendations across general and specialist critical-care units. The patient case mix and admitting speciality have some bearing on the types of medication interventions made. Moreover, severity of patient illness, scope of regular/routine specialist pharmacist service and support systems provided also probably affect the reason for these interventions.
在重症监护领域工作的临床药师对一系列与药物相关的治疗具有有益影响，包括提高用药安全性、改善患者预后以及降低药品费用。然而，关于影响临床药师干预原因和类型的具体因素，如科室专业等，仍然缺乏数据。
比较同一机构内不同重症监护科室临床药师进行的主动药物相关干预的类型。
对在三个不同重症监护区域做出的临床药师主动建议进行回顾性评估。对18个月（普通科室）以及心脏和神经科2周内的干预数据进行分析。对神经科和心脏科与药物干预相关的潜在患者伤害进行评估。
总体而言，共提出了5623条、211条和156条主动建议；普通科室、神经科和心脏科平均每位患者分别为2.2条、3.8条和4.6条。各科室医务人员对建议的接受率约为90%。神经科和心脏科通过干预避免的患者伤害的潜在严重程度中位数分别为3.6（3；4.2）和4（3.2；4.4）（P = 0.059）。药物建议的原因、类型和药物分类在各科室之间存在一些显著差异。
经过重症监护培训的临床药师在普通和专科重症监护科室都能提出重要的药物建议。患者病例组合和收治专科对药物干预的类型有一定影响。此外，患者病情的严重程度、常规/日常专科药师服务的范围以及提供的支持系统可能也会影响这些干预的原因。
