Ali Hussain Alsayed Hawra, Saheb Sharif-Askari Fatemeh, Saheb Sharif-Askari Narjes, Halwani Rabih
Department of Pharmacy, Rashid Hospital, Dubai Academic Health Corporation, Dubai, United Arab Emirates.
Research Institute for Medical and Health Science, University of Sharjah, Sharjah, United Arab Emirates.
Explor Res Clin Soc Pharm. 2024 Mar 9;14:100431. doi: 10.1016/j.rcsop.2024.100431. eCollection 2024 Jun.
Drug-related problems (DRPs) are prevalent in critical care settings and can be life-threatening. Involving clinical pharmacists (CP) within the critical care team is recommended to optimize therapy and improve patient survival.
To classify DRPs identified by a CP in the Intensive Care Unit (ICU) and to assess the impact of CP interventions accepted by physicians on the length of ICU stay and in-hospital survival.
This study was conducted prospectively at the Medical ICU of Rashid Hospital, a tertiary hospital in Dubai, over a 16-month period from September 2021 to December 2022. The study included patients admitted to ICU during the study period. CP interventions were documented, and DRPs were classified using the modified Pharmaceutical Care Network Europe V.9.1.
During the study period, 1004 interventions were recommended for 200 patients. The majority of these interventions, 92% ( = 922), received physician acceptance, and 82% ( = 820) were fully implemented by the physician. In total, 1033 drug-related problems (DRPs) were identified, with a median of 3 DRPs per patient. The most common DRPs was drug selection (61%), followed by dose selection (22%). There were 337 DRPs related to antimicrobial agents. Interestingly, we noted that when we adjusted for patients' demographic data and the Glasgow Coma Scale severity score, patients who received >4 implemented interventions exhibited lower cumulative hazard of death within 90 days of their ICU stay in comparison to their counterparts (adjusted Hazard Ratio: 0.10, 95% CI of 0.02-0.41; = 0.027).
The study emphasizes the critical role of CP in the ICU, addressing DRPs, and enhancing overall patient care. Furthermore, it highlights the potential impact of pharmacist interventions in improving patient survival outcomes. This underscores the importance of implementing CP services in ICUs across the UAE.
药物相关问题（DRPs）在重症监护环境中普遍存在，且可能危及生命。建议在重症监护团队中纳入临床药师（CP）以优化治疗并提高患者生存率。
对重症监护病房（ICU）中临床药师识别出的药物相关问题进行分类，并评估医生接受的临床药师干预措施对ICU住院时间和院内生存率的影响。
本研究于2021年9月至2022年12月在迪拜一家三级医院拉希德医院的医学重症监护病房进行了为期16个月的前瞻性研究。该研究纳入了研究期间入住ICU的患者。记录了临床药师的干预措施，并使用改良的欧洲药学保健网络V.9.1对药物相关问题进行分类。
在研究期间，为200名患者推荐了1004项干预措施。这些干预措施中的大多数，92%（n = 922）得到了医生的认可，82%（n = 820）由医生完全实施。总共识别出1033个药物相关问题（DRPs），每位患者的药物相关问题中位数为3个。最常见的药物相关问题是药物选择（61%），其次是剂量选择（22%）。有337个药物相关问题与抗菌药物有关。有趣的是，我们注意到，在对患者的人口统计学数据和格拉斯哥昏迷量表严重程度评分进行调整后，与未接受相应干预的患者相比，接受>4项已实施干预措施的患者在ICU住院90天内的累积死亡风险较低（调整后的风险比：0.10，95%置信区间为0.02 - 0.41；P = 0.027）。
该研究强调了临床药师在ICU中解决药物相关问题和加强整体患者护理方面的关键作用。此外，它突出了药师干预措施在改善患者生存结局方面的潜在影响。这强调了在阿联酋各地的ICU中实施临床药师服务的重要性。
