Li Xiao-Xiao, Zheng Si-Qian, Gu Jia-Hui, Huang Tao, Liu Fang, Ge Qing-Gang, Liu Bin, Li Chao, Yi Min, Qin You-Fa, Zhao Rong-Sheng, Shi Lu-Wen
Department of Pharmacy, Peking University Third Hospital, Beijing, China.
Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.
Front Pharmacol. 2020 Sep 11;11:571906. doi: 10.3389/fphar.2020.571906. eCollection 2020.
To identify common drug-related problems (DRPs) during pharmacy intervention and consultation in an intensive care unit (ICU); to explore the gap between physicians and pharmacists on their understanding of each other's capabilities and needs.
We conducted a single-center prospective study in the ICU of a tertiary academic hospital for 21 months. A pharmaceutical care (PC) model was implemented by a pharmacy team, and data were collected during pharmacy intervention and consultation. Data analysis was performed on identified DRPs, causes and their relationships. DRPs' frequency during intervention and consultation was compared. Problem-level descriptive analysis and network analysis were conducted using R 3.6.3.
Implementation of PC model greatly improved the efficacy of pharmacists in both interventions proposed to solve DRPs (from 13.6 to 20.1 cases per month) and number of patients being closely monitored (from 7.7 to 16.9 per month). Pharmacists identified 427 DRPs during pharmacy intervention with primarily adverse drug events (ADEs, 34.7%) and effect of treatment not optimal (25.5%), and 245 DRPs during consultation (mainly ADEs, 58.4%). About three-fifths DRPs were caused by antibiotics. Comparing DRPs identified during pharmacy intervention and consultation, physicians consulted pharmacists more on questions related to medication safety, while pharmacists also paid attention to treatment effectiveness, which was consulted less commonly.
Implementation of PC model is beneficial in guiding pharmacy practice and improving efficacy especially under limited human resources. Physicians and pharmacists shall continue ensuring drug safety and be familiar with the scope of PC and clinical need for a better cooperation.
识别重症监护病房（ICU）药学干预与咨询过程中常见的药物相关问题（DRP）；探讨医生和药师在相互了解对方能力和需求方面的差距。
在一家三级学术医院的ICU进行了一项为期21个月的单中心前瞻性研究。一个药学团队实施了药学服务（PC）模式，并在药学干预和咨询期间收集数据。对识别出的DRP、原因及其关系进行数据分析。比较干预和咨询期间DRP的发生频率。使用R 3.6.3进行问题层面的描述性分析和网络分析。
PC模式的实施大大提高了药师在提出解决DRP的干预措施方面的效率（从每月13.6例增加到20.1例）以及密切监测的患者数量（从每月7.7例增加到16.9例）。药师在药学干预期间识别出427个DRP，主要是药物不良事件（ADE，34.7%）和治疗效果不佳（25.5%），在咨询期间识别出245个DRP（主要是ADE，58.4%）。约五分之三的DRP由抗生素引起。比较药学干预和咨询期间识别出的DRP，医生就药物安全相关问题向药师咨询更多，而药师也关注治疗效果，而这方面的咨询较少见。
PC模式的实施有利于指导药学实践并提高效率，尤其是在人力资源有限的情况下。医生和药师应继续确保用药安全，并熟悉PC的范围和临床需求，以实现更好的合作。
