Principles for improving the standards for drug-help in the intensive care units

Introduction

It is very important to maintain the balance between the clinical and the economical vectors in the situation of strictly limited resources in the real clinical practice in Russia. The system of clinical governance must be called into play for this purpose. The most important sector in the use of clinical governance is the intensive care units.

Materials and methods

Using a computer, the analysis of the quality of drug-prescribing in the intensive care units of the Sverdlovsk Area in Russia was carried out by the experts in clinical pharmacology. The methodology of constructing the models of drug help standards for the intensive care units by computer was based on the hierarchical principle of structured organization of the 'elementary syndromes' and the corresponding 'elementary standard drug protocols'. Databases were set up containing (a) a list of all drugs and their current market prices, and (b) protocols for the list of drugs allowed for a given diagnosis on a patient in intensive care. It became mandatory to use only those drugs in the list.

Results

It was established that 20% of drugs used in the intensive care units had no proven effectiveness and were therefore not included in the standards of drug help in the Government Programme. In 10% of clinical cases, when antibiotics were used, the choice of antibiotics was not optimal and rational. In order to regulate the quality and rationality of fulfilling the drug help standards within the framework of the Area Government Programme, stricter guidelines were laid down. These resulted in a 20–25% reduction in costs of the drugs used in intensive care. The strict protocol for using antibiotics has reduced the length of stay for patients in the ITU. Errors in prescribing have been prevented. This new system was welcomed by the clinicians.