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General and Risk Management, Patient Safety (including: medication errors, quality control)
Pharmaceutical intervention assessment in critically ill patients
  1. M. Domínguez Cantero,
  2. M.V. Manzano Martín,
  3. M. Calleja Hernández,
  4. S. Pedraza López,
  5. M.E. Rodríguez Mateos
  1. 1H.U. Puerta Del Mar, Servicio de Farmacia, Cádiz, Spain
  2. 2H.U. Virgen De Las Nieves, Servicio de Farmacia, Granada, Spain
  3. 3H.U. Puerta Del Mar, Servicio Cuidados Intensivos, Cádiz, Spain

Abstract

Background Patients admitted to the intensive care unit (ICU) are exposed to medication errors twice as compared to other hospital units. Pharmaceutical care in critically ill patients may increase the quality of patient care by reducing medication errors.

Purpose To assess the impact of pharmaceutical interventions (PI) on the health of patients admitted to an intensive care unit.

Materials and methods Study to evaluate PI in patients admitted to an ICU with electronic prescribing. Were obtained from medical records data on age, gender, APACHE-II score at admission. The authors defined the impact of PI such as the presence of negative results, positive or no change in the patient's health, potentially avoided by PI and assessed by the rating scale proposed by Overhage et al.1 The medication error detected with PI undertaken provides the clinical relevance of the intervention, the reason for the intervention preceded the detection of a medication error, measured by classifying Overhage et al. modified2

Results 25 patients were included, 19 were men, mean age 53.88±16.69 years. 68% of patients had a APACHE-II score less than 10. A total of 35 PI, 1.4 interventions / patient. 71% of the PI made were accepted. In terms of assessing the impact of PI by the rating scale proposed by Overhage et al1, 8.57% were extremely significant (PI avoids a situation that potentially generate extremely serious consequences), 40% very significant (PI prevents actual or potential damage a vital organ), significant 8.57%(PI leads to better patient care), 28.57% something significant (the benefit of the patient is neutral), 14.29% non-significant(only general information or recommendations, not individualised per patient). The clinical relevance of the PI measured by classifying Overhage et al modified2 was: 5.71% could avoid death (medical error has high potential to produce adverse effects that threaten the patient's life), serious 24.71% (dose of 4 to 10 times higher than normal in a narrow therapeutic index drugs, doses can lead to potentially toxic concentrations…), 28.57% significant lower 31.43%(doses too low for the patient's condition, inappropriate dosage range…), 8.57% absence of error (clarification of the medical order, economic savings).

Conclusions The impact of PI evaluated was mostly significant. Half of the PI had a significant or serious clinical relevance. The authors did not perform any action detrimental to the patient.

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