Background and importance Critical care pharmacists have demonstrated their contribution to the management of drug therapy and impact on patient and medication safety. Traditionally, the functions of the clinical pharmacist in the intensive care unit (ICU) of our hospital were based on pharmaceutical interventions (PIs) concerning parenteral nutrition (PN). Currently, a computerised physician order entry (CPOE) system has been implemented. This system reduces the incidence of medication errors and allows pharmaceutical validation.

Aim and objectives To analyse the evolution in the number of PIs before and after implementation of the CPOE; to describe the type of PIs carried out by clinical pharmacists after CPOE implementation; and to assess the degree of acceptance by ICU physicians.

Material and methods A 2 month descriptive and prospective study was conducted between 1 January and 28 February 2020 in an 18 bed ICU of a tertiary teaching hospital, 3 months after CPOE implementation. Every type of PI and degree of acceptance were recorded. Total PIs recorded were compared with those recorded in the same period of time before implementation of the CPOE (between 1 July and 31 August 2020).

Results During the current study period, 227 patients were admitted to the ICU, and 366 PIs were recorded. PIs increased by 173% compared with the previous study period before the implementation of CPOE (232 patients, 134 PIs). Regarding the number of PIs during the current study period, 25.4% were related to PN prescriptions, 8.4% were related to antimicrobial stewardship programme, 5.7% were related to optimising drug therapy, 3.3% were related to route of administration, 4.6% were related to incorrect drug based on the indication, 2.7% were related to therapeutic drug monitoring and 46.4% were related to fluid therapy. 91% of PIs were accepted by the ICU staff.

Conclusion and relevance CPOE in the ICU promoted the pharmacist’s participation in improving the safety of medical prescriptions by increasing the number of accepted PIs. The high number of interventions related to fluid therapy was highlighted. We consider it necessary to start corrective measures regarding this aspect, such as the preparation of prescription protocols, training talks, etc.

Conflict of interest No conflict of interest