Tharanon Vichapat, Putthipokin Krongtong, Sakthong Phantipa
Clinical Pharmacy Section, Pharmacy Division, Ramathibodi Hospital, Bangkok, Thailand.
Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
SAGE Open Med. 2022 Apr 19;10:20503121221090881. doi: 10.1177/20503121221090881. eCollection 2022.
Drug-related problems could potentially worsen the clinical outcomes in critically ill patients. Critically ill patients are generally considered more vulnerable to harm from drug-related problems due to frequent medication-related events and complicated clinical courses. However, drug-related problems identified by on-ward clinical pharmacists in medical intensive care units in Thailand are not well reported. This study reports clinically relevant data with the description of identified problems, common causes of drug-related problems, and pharmacists' interventions performed in real world, so that it may serve as an educational material for pharmacists who implement a pharmaceutical care and participate in medical intensive care units.
A retrospective descriptive study was conducted at a tertiary university hospital in Bangkok, Thailand, from January 2015 to December 2020. The drug-related problems were categorized according to Cipolle et al.'s classification. The severity of drug-related problems in this study was rated by modifying the definition of The National Coordinating Council for Medication Error Reporting and Prevention Taxonomy of Medication Error to report harm from drug-related problem-related patient outcomes.
A total of 698 drug-related problems were detected in 374 critically ill patients. The prevalence of drug-related problems occurring in critically ill patients admitted to the medical intensive care unit was 73.9%. The most frequent drug-related problems were dosage too high (27.7%), ineffective drug (17.2%), need for additional drug therapy (15.3%), unnecessary drug therapy (14.6%), dosage too low (14.3%), adverse drug reaction (9.7%), and non-adherence (1.2%). The severity of drug-related problems in the medical intensive care unit was assessed as a drug-related problem with no harm (78.2%). Pharmacists' interventions were advised according to drug-related problem identification to provide personalized pharmacotherapy optimization in critically ill patients.
The most frequent drug-related problem identified during pharmaceutical care interventions in the medical intensive care unit at tertiary university hospital is dosage too high. The severity of drug-related problems is mostly determined as drug-related problems with no harm.
药物相关问题可能会使重症患者的临床结局恶化。由于频繁发生与用药相关的事件以及复杂的临床病程，重症患者通常被认为更容易受到药物相关问题的伤害。然而，泰国医疗重症监护病房中临床药师发现的药物相关问题尚未得到充分报道。本研究报告了具有临床相关性的数据，包括已识别问题的描述、药物相关问题的常见原因以及在现实世界中实施的药师干预措施，以便为实施药学服务并参与医疗重症监护病房工作的药师提供教育资料。
于2015年1月至2020年12月在泰国曼谷的一所三级大学医院进行了一项回顾性描述性研究。药物相关问题根据西波勒等人的分类进行归类。本研究中药物相关问题的严重程度通过修改国家药物错误报告和预防协调委员会药物错误分类法的定义来评定，以报告药物相关问题对患者结局造成的伤害。
在374例重症患者中总共检测到698个药物相关问题。入住医疗重症监护病房的重症患者中药物相关问题的发生率为73.9%。最常见的药物相关问题是剂量过高（27.7%）、药物无效（17.2%）、需要额外药物治疗（15.3%）、不必要的药物治疗（14.6%）、剂量过低（14.3%）、药物不良反应（9.7%）和不依从（1.2%）。医疗重症监护病房中药物相关问题的严重程度被评估为无伤害的药物相关问题（78.2%）。根据药物相关问题的识别情况建议药师进行干预，以在重症患者中提供个性化的药物治疗优化。
在三级大学医院的医疗重症监护病房进行药学服务干预期间发现的最常见药物相关问题是剂量过高。药物相关问题的严重程度大多被确定为无伤害的药物相关问题。
