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Res Social Adm Pharm. 2019 Jul 8. pii: S1551-7411(19)30663-1. doi: 10.1016/j.sapharm.2019.07.006. [Epub ahead of print]

Clinical and economic impact of clinical pharmacist interventions regarding antimicrobials on critically ill patients.

Author information

1
Pharmacy Service, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, 31008, Spain. Electronic address: lleache@unav.es.
2
Pharmacy Service, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, 31008, Spain. Electronic address: iaquerreta@unav.es.
3
Pharmacy Service, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, 31008, Spain. Electronic address: aaldaz@unav.es.
4
Department of Anaesthesia and Intensive Care, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, 31008, Spain. Electronic address: pmonedero@unav.es.
5
Pharmacy Service, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, 31008, Spain. Electronic address: aidoate@unav.es.
6
Pharmacy Service, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, 31008, Spain. Electronic address: aortega@unav.es.

Abstract

BACKGROUND:

Incorporating in the Intensive Care Unit (ICU) a clinical pharmacist who performs interventions on antimicrobials may be cost-effective.

OBJECTIVES:

To evaluate the clinical and economic impact of clinical pharmacist interventions on antimicrobials in an ICU. To identify drug related problems and medication errors detected by the pharmacist.

METHODS:

A retrospective observational study was performed to analyze drug related problems, medication errors and clinical pharmacist interventions related to antimicrobials in adults admitted to an ICU in a 5-month period. The economic impact of pharmacist interventions was estimated considering difference in cost derived from antimicrobial treatment, adverse drug events and clinical pharmacist time.

RESULTS:

A total of 212 drug related problems were detected in 114 patients, 18 being medication errors. Clinical pharmacist developed one intervention for each problem identified. 204 interventions (96.2%) were considered important with improved patient care and 7 (3.3%) very important. No negative impact of any intervention was identified. Physicians accepted 97.6% of the interventions. A potential saving of 10,905 € was estimated as a result of pharmacist interventions and 4.8 € were avoided per euro invested in a clinical pharmacist.

CONCLUSIONS:

A clinical pharmacist performing interventions on antimicrobials in the ICU has a positive impact on patient care and decreases costs.

KEYWORDS:

Anti-infective agent; Antimicrobial agent; Clinical pharmacist; Cost analysis; Critical care; Critically ill

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