Clinical pharmacy in the intensive care unit of a private hospital in Brazil

Introduction

Patient safety is one of the major concerns of healthcare professionals, especially in an intensive care setting. For identifying risk factors for adverse events and drug-related problems (DRPs), a clinical pharmacy (CP) service in the adult and pediatric ICUs of the Albert Einstein Jewish Hospital (HIAE) was created to work directly with medical prescriptions. This service, started in 2001, assesses factors such as: the route and frequency of administration, dose, compatibility, dilution, drug interaction, adverse drug reactions, allergy, infusion time, and indication. After the acceptance of a pharmacist in this team, in 2005, the clinical pharmacy has been expanded, with one pharmacist in each ICU, and in 2006 the clinical pharmacist has also started to act in procedures managed by the institution.

Objective

To show progressively the role of a clinical pharmacist in the hospital ICU, and to identify and classify DRPs in these units.

Materials and methods

A prospective study from 2004 to 2006 of the daily follow-up of patient prescriptions and medical charts at ICUs, identifying and intervening with DRPs.

Results

A total of 583 interventions were recorded in 2004, 1,970 in 2005, and 5,800 in 2006. We have seen an increase in interventions during this period of 994%, especially in compatibility studies (4,017%), drug interactions (2,150%), and adverse drug reactions (1,000%).

Conclusion

The clinical pharmacy program that was implemented, besides providing a direct addition to the quality of the critical patient's care, enables the identification of the DRP profile and make the prevention of adverse events feasible. We concluded that the program was successful, well accepted, and further expanded, evidencing the pharmacist's role as a member of a team.