4CPS-218 Assessment of clinical pharmacist interventions in an intensive care unit

BackgroundTraditionally, 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), the preparation of these formulas and checking that the composition was adapted to the nutritional requirements and the clinical situation of the patient. Nevertheless, the same pharmacist can also collaborate with the ICU staff (physicians or nurses) in the optimisation of the pharmacological treatment of critically ill patients.PurposeTo describe the number and type of PIs upon medical prescriptions of critical care patients and to assess the impact of these PIs according to the degree of acceptance by the ICU staff.Material and methodsWe carried out a prospective study between 1 April and 31 May 2018 in an ICU of 18 beds of a tertiary teaching hospital. Inclusion criteria: ICU patients who received PN during the stay. Variables included: type of PI (made after daily review of the nutrition and drugs prescriptions that were communicated verbally to the ICU staff), demographics and acceptance by the ICU staff.ResultsDuring the study period, 232 patients were admitted to the ICU, 30 (12.9%) of whom received PN (mean age 62, range 13–93; 32% females; mean length of stay 3 days: range 1–36). A total of 134 PIs were recorded: 56.7% were related to PN prescriptions (27.6% of this kind of PI were modifications of insulin, 14.5% were modifications of electrolytes); 16.4% enteral nutrition PIs; 7.5% administration of drugs via the nasogastric tube; 7.5% giving information about drugs administration; 4.5% stability of intravenous mixtures; 3% conciliation of medication; 3% suggestions for changing one drug for another (due to inefficiency); and 1.5% concerning maximum dose alerts. Eighty-three per cent of PIs were accepted by the ICU staff.ConclusionMore than four PIs were performed per patient and the percentage of rejected PIs was very low. Although the main task of our clinical pharmacist was focused on clinical nutrition, this study demonstrates the role and importance of this professional incorporated into the ICU multidisciplinary team, since PIs contribute to prevent medication errors and to improve the effectiveness and safety of the total pharmacological treatment in critically ill patients.References and/or acknowledgementsNo conflict of interest.