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CP-160 Clinical pharmacist interventions in the critical patient: Evolution of a 4 year project
  1. L Fernandes1,
  2. H Melo1,
  3. MJ Rei1,
  4. A Duarte1,
  5. C Santos1,
  6. J Andrade Gomes2
  1. 1Hospital Da Luz, Pharmacy, Lisbon, Portugal
  2. 2Hospital Da Luz, Intensive Care Unit, Lisbon, Portugal


Background Since 2011, a pharmacist has been part of the multidisciplinary team for critically ill patients in an eight bed polyvalent intensive care unit (ICU). Daily tasks include team ward round and in ward evaluation of all patient therapeutic profiles. Pharmacist interventions (PI) have to take into account the specific characteristics of the critically ill patients and address virtually all pharmaceutical problems. The post implementation evaluation showed a rate of 3.5 interventions/patient and an acceptance rate of around 70%. In order to assess the evolution of the pharmacist role, the same evaluation was conducted in 2015.

Purpose To characterise the evolution of PI and identify major contribution areas for a clinical pharmacist in a polyvalent ICU.

Material and methods PI were registered from March to June 2015 on a daily bases using the formulary developed and used in 2011. The information collected included patient process number, drug intervened, PI cause, expected results and outcomes. A descriptive statistical analysis and association of variables were performed and compared with the results obtained in 2011.

Results 217 interventions were registered, resulting in an average of 2.24 interventions/patient. The acceptance rate was 82% and the medical specialties with more interventions were internal medicine, cardiac surgery and general surgery. The most frequent causes of intervention were ‘potential adverse reaction/toxicity’ (18%), including vancomycin pharmacokinetic monitoring; and ‘drug absence’ (14%), primarily antiplatelet therapy and venous thromboembolism prophylaxis. The most prevalent outcomes were ‘prevented problem’ (52%) and ‘cost savings associated with therapy’ (24%). The drug classes with more interventions were proton pump inhibitors, antibacterials and heparins. Compared with the 2011 results, there was a higher acceptance rate and a greater dispersion of intervention causes, mostly with respect to the suggestion of outpatient therapy introduction or events related to hospital admission prophylaxis.

Conclusion The results suggest good pharmacist integration into the clinical team, as seen by the number of interventions and the high acceptance rate. Moreover, the spectrum of the PI areas increased which helps to define the role of the pharmacist in this setting. Assessing pharmacist impact on patient outcomes remains however the biggest challenge for future work.

No conflict of interest.

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