Clinical pharmacy in a regional Australian intensive care unit

Background: More than a quarter of reported incidents in hospitals are medication-related. The critically ill population is at greater risk of medication-related incidents due to a number of factors, including a higher number of drugs prescribed, lower physiological reserve and greater illness severity. Overseas studies have shown that the inclusion of on-ward clinical pharmacy support may attenuate these drug-related problems (DRPs); however, local evidence in regional Australian intensive care units (ICUs) is lacking. Aim: To identify the frequency of DRPs and their risk to patients and the reporting of adverse drug reactions (ADRs) and incidents through the integration of a clinical pharmacist into a regional Australian ICU. Method: A single-centre, cohort-controlled observational study conducted in a regional ICU over a 16-week period. Data was collected on ADR and incident reporting, on-call pharmacy requests and medications ordered but not administered to patients. The prospective period additionally examined the number and type of DRPs, pharmacist recommendations and acceptance by clinicians. An independent panel review assessed DRP risk and clinical significance. Results: There were 348 DRPs requiring intervention in the prospective period with a median of two DRPs per patient. ‘Change of therapy’ was the most common recommendation (75%) and its acceptance by clinicians was 86%. Level of agreement between panel members for assigning both risk and clinical significance to DRPs was poor. Instances where medications were ordered but not administered were reduced by 62% (p = 0.0045). Requests for after-hours pharmacy services were reduced and reporting of ADRs and incidents was marginally increased in the prospective group. Conclusion: The addition of a clinical pharmacist to the ICU facilitated the detection and resolution of DRPs in this patient group and increased both the likelihood that intended pharmaceutical care reached the patient and that drug reactions and incidents were reported. These results provide local evidence for the inclusion of clinical pharmacists to the multidisciplinary ICU team in a regional Australian hospital.