Yin Jingwen, Shi Haiwen, Li Changjun
Department of Pharmacy, Tianjin 4th Center Hospital, Tianjin, 300142, China.
Heliyon. 2023 Mar 9;9(3):e14345. doi: 10.1016/j.heliyon.2023.e14345. eCollection 2023 Mar.
To investigate and study the impact on patient recovery of pharmacists' participation in the medication guidance and intervention of patients in intensive care units (ICUs).
We analyzed the drug use and typical cases of patients in the ICU of our hospital during clinical pharmacists' consultations or active monitoring from July 2019 to December 2020. This study included a total of 292 cases, which were distributed in the following eight areas: drug adjustment based on patients with hepatic and renal insufficiency,optimisation of treatment regimens based on drug interaction, identification and intervention based on adverse drug reactions, selection of blood purification methods based on drug intoxication, infusion access adjustment based on drug compatibility, drug adjustment based on genetic testing, antibiotic dose adjustment based on pharmacokinetics/pharmacodynamics (PK/PD) and others. The main observation indexes included consultation opinion efficiency rates and acceptance rates. The acceptance rate is calculated according to the acceptance of the clinical pharmacist's opinion by the competent doctor (fully accepted, partially accepted, not accepted). Calculate the efficiency rate according to the effect of the intervention measures. Definition of effectiveness: improvement of therapeutic effect of drugs; Avoid the occurrence of potential adverse drug reactions; Avoid the occurrence of potential drug compatibility reaction (for example, adjust the infusion sequence to avoid turbidity and sedimentation in the infusion pathway).
The results showed that clinical pharmacists participated in 292 cases of consultation or active monitoring of patients in the hospital's ICU based mainly on specific patient medications, drug interactions, adverse drug reactions, blood purification therapy, drug compatibility/venous infusion pathways, blood drug concentrations/drug-gene monitoring, drug PK/PD, etc. The doctor in charge acceptance rate of the consultation advice was 88.46% (completely accepted by 59.3%, partially accepted by 30.8%), and the effective rate of the consultation was 80.2%.
Based on different purposes of intervention, the acceptance rate and efficiency rate were different. The efficiency rate with complete acceptance was significantly higher than that with partial acceptance or non-acceptance. The intervention opinions proposed by a comprehensive team in which pharmacists participate are of great help to patients and can reduce adverse reactions and medication risks. The higher the acceptance rate of their opinions, the higher the effective rate.
探讨和研究药剂师参与重症监护病房（ICU）患者用药指导及干预对患者康复的影响。
我们分析了2019年7月至2020年12月期间我院ICU患者在临床药师会诊或主动监测期间的用药情况及典型病例。本研究共纳入292例病例，分布在以下八个方面：基于肝肾功能不全患者的药物调整、基于药物相互作用的治疗方案优化、基于药物不良反应的识别与干预、基于药物中毒的血液净化方法选择、基于药物配伍的输液通路调整、基于基因检测的药物调整、基于药代动力学/药效学（PK/PD）的抗生素剂量调整等。主要观察指标包括会诊意见有效率和接受率。接受率根据主管医生对临床药师意见的接受情况（完全接受、部分接受、未接受）计算。根据干预措施的效果计算有效率。有效性定义：提高药物治疗效果；避免潜在药物不良反应的发生；避免潜在药物配伍反应的发生（例如，调整输液顺序以避免输液通路中出现浑浊和沉淀）。
结果显示，临床药师参与了我院ICU 292例患者的会诊或主动监测，主要基于特定患者用药、药物相互作用、药物不良反应、血液净化治疗、药物配伍/静脉输液通路、血药浓度/药物基因监测、药物PK/PD等。会诊建议的主管医生接受率为88.46%（完全接受占59.3%，部分接受占30.8%），会诊有效率为80.2%。
基于不同的干预目的，接受率和有效率有所不同。完全接受的有效率显著高于部分接受或未接受的有效率。药剂师参与的综合团队提出的干预意见对患者有很大帮助，可减少不良反应和用药风险。他们意见的接受率越高，有效率越高。
