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4CPS-263 Analysis of clinical pharmacist interventions carried out in an intensive care unit

Background The clinical instability of patients in intensive care units (ICU), makes them subject to drug-related problems (DRP) that may have an impact on the efficacy and safety of treatments. Purpose To analyse clinical pharmacist interventions (PIs) carried out over DRP registered in an ICU. Material and methods This prospective and descriptive study was carried out in 1 month (15 t May to 15 June) in an ICU of 18 beds in a tertiary hospital. PIs were detected by a resident pharmacist in his ICU period during the validation of physician orders. The variables of this study were: demographic data (sex, age); type of medical intervention; degree of response (accepted if they changed the physician order or rejected if the change was not accepted); and the drugs used. PIs were carried out in relation to DRP in the Third Consensus of Granada and the prescribing physician was orally informed of all of them. Results A total of 31 interventions were registered, 71% of which were males and 29% females, with an average age of 74 years (41–92). PIs were classified in this way: 15.2% drug dose adjustment; 9.2% start of medication; 8.2% pharmacokinetics monitoring; 6.2% routes of administration of drugs; 4.2% interruption of treatment; 4.2% mistakes in the transcription of physician orders; 4.2% drug interaction prevention; and 4.2% allergic reaction prevention. 93.3 per cent of PIs were accepted. The group of drugs J (systemic antiinfectious) was the most involved, with 35.5% of PIs, followed by group C (cardiovascular system) with 19.4% and group B (blood and haematopoietic organs) with 12.1%, among others. Regarding DRP, 51.7% were related to safety, 25.7% to the efficacy of the treatment and 22.6% to the indication. Conclusion The high level of acceptance of the proposed interventions and its clinical relevance demonstrates the significance of clinical pharmacists that prevent, detect and solve DRP in the prescription process before they affect the patient. According to the published literature, the presence of a clinical pharmacist in critical patient care multidisciplinary teams provides improvements in terms of safety, efficacy and cost of treatments. References and/or acknowledgements 1. Erstad BL, Haas CE, O’Keeffe T, et al. Interdisciplinary patient care in the intensive care unit: focus on the pharmacist. Pharmacother 2011;31:128–37. No conflict of interest.