J. pub health luisetto m, ghulam r m. research article intensive care units the clinical pharmacist role to improve clinical outcomes and Reducing Mortality Rate A Undeniable Function ,#ICU, SEMANTIC SCHOLAR
The document summarizes research that shows the benefits of clinical pharmacists in intensive care units (ICUs). Several studies found that ICUs with clinical pharmacist services had lower mortality rates, shorter hospital stays, fewer medication errors and adverse drug events, lower infection rates, and reduced costs compared to ICUs without these services. Specifically, one study found a 2.4-day decrease in length of stay and a reduction in mortality from 8.28% to 6.61% with a clinical pharmacist-led antimicrobial control program. Another study found that mortality rates were 23.6% higher in ICUs without clinical pharmacists for nosocomial infections. The inclusion of clinical pharmacists in direct patient care in the ICU has
The document summarizes research that shows clinical pharmacists play an important role in intensive care units (ICUs) by improving clinical outcomes and reducing mortality rates. Several studies cited found that ICUs with clinical pharmacist involvement had lower mortality rates, shorter hospital stays, fewer adverse drug events, and lower costs compared to ICUs without clinical pharmacist services. Direct involvement of pharmacists in ICU patient care was associated with reduced complications and improved outcomes for conditions like infections, bleeding, and sepsis.
The document summarizes research that shows clinical pharmacists play an important role in intensive care units (ICUs) by improving clinical outcomes and reducing mortality rates. Several studies are cited that found clinical pharmacist involvement in ICUs was associated with lower mortality rates, decreased adverse drug events, reduced medication errors, shorter hospital stays, lower costs, and fewer infections. Without clinical pharmacists, mortality rates, complications, and resource use were often significantly higher. The evidence demonstrates that clinical pharmacists improve care and outcomes for critically ill patients in the ICU.
Clinical pharmacists play a crucial role in intensive care units (ICUs) by reducing mortality rates and improving clinical outcomes. A review of relevant literature found that pharmacist involvement on medical rounds, antimicrobial stewardship programs led by pharmacists, and higher levels of clinical pharmacist staffing were associated with lower mortality, shorter hospital stays, fewer adverse drug events, and lower costs. Ensuring pharmacists are integrated members of the multidisciplinary ICU team can help optimize medication management and safety for critically ill patients.
The document discusses the role of clinical pharmacists in improving outcomes in intensive care units (ICUs). It reviews literature showing that clinical pharmacist involvement is associated with reduced mortality rates, shorter hospital stays, fewer medication errors and adverse drug events, lower infection rates, and decreased costs. Specifically, studies found that mortality rates were reduced by 23-43% and lengths of stay decreased by 1.3-2.4 days with clinical pharmacist services involved in ICU care. Pharmacists helped optimize medication management and drug protocols, which improved safety and outcomes for critically ill patients.
The document summarizes research on the benefits of clinical pharmacists participating as members of medical teams. Several studies found that including clinical pharmacists reduced mortality rates in hospitals and improved outcomes across disease states. Pharmacists improved medication management by addressing drug-related problems, which led to decreased mortality for conditions like heart attacks. Their interventions enhanced clinical outcomes for diabetes, cardiovascular disorders, and other conditions. Effective implementation of these pharmacy services requires support from healthcare organizations and infrastructure support within facilities.
This study analyzed healthcare resource utilization and costs for 12,165 patients with 24 chronic pain conditions within an integrated healthcare system in the US. The researchers found that after pharmacy costs, outpatient visits were the most utilized resource, with a mean of 18.8 visits per patient in the post-index period. Specialty visits accounted for 59% of outpatient visits. Imaging tests averaged 5.2 per patient. Opioids were the most commonly prescribed medication. Total annual direct costs for all conditions were $386 million, a 40% increase from pre-index costs. Pharmacy costs comprised 14.3% of total costs, while outpatient visits were the primary cost driver. Musculoskeletal conditions were associated with the highest overall costs
Preliminary study of Prescription audit for evaluation of prescribing pattern...SriramNagarajan16
Prescription audit is necessary to know the art of prescription practices to improve rational pharmacotherapy.
Present study is an observational study and was undertaken from August 2018 to October 2018 for which data
was collected from Medical OPD. Prescribing is a technique with an expert academic pharmacological
knowledge.
Irrational prescribing leads to diminished therapeutic outcome. The present study is the first preliminary one at
Pandit Jawaharlal Lal Nehru Govt. Medical College and Hospital, Chamba- HP Before July 2016, it was a
district hospital College. It is a hilly district and caters the need of 5 Lakh people. A total of 420 prescriptions
were analyzed. These prescriptions comprised of 3000 drugs. Average drugs prescribed per patient were 7.3 .
male and female ratio was 40% and 60% respectively. More prescription were carried out in the age group of 51
- 60 yrs. Prescriptions in generic were only 3.65% fixed dose combination was used in 300 prescriptions and
comprised of 71.4% drugs. Oral prescriptions were used maximally and intravenous medication was minimally
used. Multivitamin prescriptions were observed in bulk.
The document summarizes research that shows clinical pharmacists play an important role in intensive care units (ICUs) by improving clinical outcomes and reducing mortality rates. Several studies cited found that ICUs with clinical pharmacist involvement had lower mortality rates, shorter hospital stays, fewer adverse drug events, and lower costs compared to ICUs without clinical pharmacist services. Direct involvement of pharmacists in ICU patient care was associated with reduced complications and improved outcomes for conditions like infections, bleeding, and sepsis.
The document summarizes research that shows clinical pharmacists play an important role in intensive care units (ICUs) by improving clinical outcomes and reducing mortality rates. Several studies are cited that found clinical pharmacist involvement in ICUs was associated with lower mortality rates, decreased adverse drug events, reduced medication errors, shorter hospital stays, lower costs, and fewer infections. Without clinical pharmacists, mortality rates, complications, and resource use were often significantly higher. The evidence demonstrates that clinical pharmacists improve care and outcomes for critically ill patients in the ICU.
Clinical pharmacists play a crucial role in intensive care units (ICUs) by reducing mortality rates and improving clinical outcomes. A review of relevant literature found that pharmacist involvement on medical rounds, antimicrobial stewardship programs led by pharmacists, and higher levels of clinical pharmacist staffing were associated with lower mortality, shorter hospital stays, fewer adverse drug events, and lower costs. Ensuring pharmacists are integrated members of the multidisciplinary ICU team can help optimize medication management and safety for critically ill patients.
The document discusses the role of clinical pharmacists in improving outcomes in intensive care units (ICUs). It reviews literature showing that clinical pharmacist involvement is associated with reduced mortality rates, shorter hospital stays, fewer medication errors and adverse drug events, lower infection rates, and decreased costs. Specifically, studies found that mortality rates were reduced by 23-43% and lengths of stay decreased by 1.3-2.4 days with clinical pharmacist services involved in ICU care. Pharmacists helped optimize medication management and drug protocols, which improved safety and outcomes for critically ill patients.
The document summarizes research on the benefits of clinical pharmacists participating as members of medical teams. Several studies found that including clinical pharmacists reduced mortality rates in hospitals and improved outcomes across disease states. Pharmacists improved medication management by addressing drug-related problems, which led to decreased mortality for conditions like heart attacks. Their interventions enhanced clinical outcomes for diabetes, cardiovascular disorders, and other conditions. Effective implementation of these pharmacy services requires support from healthcare organizations and infrastructure support within facilities.
This study analyzed healthcare resource utilization and costs for 12,165 patients with 24 chronic pain conditions within an integrated healthcare system in the US. The researchers found that after pharmacy costs, outpatient visits were the most utilized resource, with a mean of 18.8 visits per patient in the post-index period. Specialty visits accounted for 59% of outpatient visits. Imaging tests averaged 5.2 per patient. Opioids were the most commonly prescribed medication. Total annual direct costs for all conditions were $386 million, a 40% increase from pre-index costs. Pharmacy costs comprised 14.3% of total costs, while outpatient visits were the primary cost driver. Musculoskeletal conditions were associated with the highest overall costs
Preliminary study of Prescription audit for evaluation of prescribing pattern...SriramNagarajan16
Prescription audit is necessary to know the art of prescription practices to improve rational pharmacotherapy.
Present study is an observational study and was undertaken from August 2018 to October 2018 for which data
was collected from Medical OPD. Prescribing is a technique with an expert academic pharmacological
knowledge.
Irrational prescribing leads to diminished therapeutic outcome. The present study is the first preliminary one at
Pandit Jawaharlal Lal Nehru Govt. Medical College and Hospital, Chamba- HP Before July 2016, it was a
district hospital College. It is a hilly district and caters the need of 5 Lakh people. A total of 420 prescriptions
were analyzed. These prescriptions comprised of 3000 drugs. Average drugs prescribed per patient were 7.3 .
male and female ratio was 40% and 60% respectively. More prescription were carried out in the age group of 51
- 60 yrs. Prescriptions in generic were only 3.65% fixed dose combination was used in 300 prescriptions and
comprised of 71.4% drugs. Oral prescriptions were used maximally and intravenous medication was minimally
used. Multivitamin prescriptions were observed in bulk.
The document discusses the role of clinical pharmacists in medical teams treating severe and critical patients. It argues that including clinical pharmacists can reduce mortality rates by adding pharmaceutical knowledge and expertise to evaluate drug efficacy and make treatment decisions. The main focus of clinical pharmacists should be on the most critical patients, as their contributions can save lives. Their presence helps optimize pharmacological strategies and outcomes through competencies in areas like pharmacokinetics, drug design, and preventing antimicrobial resistance.
This document discusses medication errors that can occur in hospitals. It defines medication errors as any error in prescribing, dispensing, or administering drugs, regardless of whether harm occurs. Medication errors are a major cause of preventable patient harm. The document classifies medication errors as mistakes, slips, or lapses, depending on where the error occurs in the medication use process. It also discusses different ways medication errors have been estimated to cause deaths in other countries to highlight the significant impact of these errors.
The document describes a retrospective analysis of interventions made by a clinical pharmacist (CP) during their participation in the medical intensive care unit (ICU) team of a university hospital over a period of 9 months. The CP reviewed medications for 321 patients and made a total of 307 interventions in 95 patients. The interventions were categorized as: pharmacotherapy adjustments for kidney function (147 interventions), therapeutic drug monitoring (57), administration through a nasogastric tube (30), drug-drug interactions (22), and unspecified (51). The majority of interventions (203) were related to antimicrobial drugs. ICU physicians completely accepted 80.2% of the CP's suggestions. The analysis found that inclusion of a CP contributed to more individualized pharmacological
This study examined Jordanian critical care nurses' perceptions of medication errors through a survey of 83 nurses. The key findings were:
- Nurses perceived the top causes of medication errors to be nurse miscalculating doses, physicians prescribing wrong doses, and illegible physician handwriting.
- There were differences in what nurses considered reportable errors, with more agreement on fast TPN rates but disparate views on withholding digoxin due to late lab results.
- Only 41.8% of nurses believed all errors are reported. Barriers to reporting included fear of manager and peer reactions rather than disciplinary action. Nurses tended to inform physicians instead of completing incident reports.
- The study highlights
A study on prescription pattern and rational use of statins in tertiary care ...SriramNagarajan16
Objectives
Our objectives are to evaluate prescription pattern and rational use of statins in a tertiary care corporate hospital.
Methodology
It was a prospective observational study conducted for a period of 6 months and included various departments of 300
bedded multi specialty tertiary care corporate hospital. A total of 200 patients were included and the study criteria
was inpatients and induvial more than 18 years of either gender who are prescribed with HMG-CoA reductase
inhibitors.
Results
In the present study 200 patients belonged to the age group of above 18 years, out of which about 65% were male
and 35% were female. Atorvastatin (67%) was prescribed mostly and Rosuvastatin (29.5%) was also used.
Conclusion
It is finally concluded that Rational and prophylactic use of statins can reduce further complications of Diabetes
Mellitus (DM) and cardiac events.
Statins treatment is favourable in long term treatment of diseases, it is most effectively used in treatment of serious
disease conditions which has shown its immense therapeutic role in treatment
Evidence of the value of the pharmacistRodmonster73
This document summarizes key studies that demonstrate the broad range of pharmacist-provided patient care services that have resulted in improved disease and drug therapy management, greater patient satisfaction, improved quality of life, and significant cost containment and savings. Over 20 studies confirm that pharmacists add value by improving care and decreasing costs, with an average $16.70 return on investment for every $1 spent on clinical pharmacy services. Pharmacist interventions across various care settings have been shown to improve medication adherence, reduce medical errors and adverse drug events, lower healthcare costs, and optimize drug therapy for patients.
Impact of Antidepressant Medication Adherence on Health Services Utilization ...M. Christopher Roebuck
The document summarizes a study on the impact of antidepressant medication adherence on health services utilization and costs. The study found that patients who adhered to their antidepressant medication had fewer inpatient hospital days but more emergency department and outpatient physician visits. Adherent patients also had lower total healthcare costs of $646 compared to non-adherent patients. The results suggest that programs to increase antidepressant medication use and adherence may reduce total healthcare costs for payers and employers.
The process of healthcare is undertaken so that people can benefit from the intervention. An economic evaluation looks at all the implications of deciding to choose one way of providing care over another, not just the costs. This means that any effect the service, good or bad, has on the patient or customer needs to be investigated
Genomic variation partially explains interindividual variability in responses to perioperative stressors and drugs. The perioperative period represents an opportunity to implement precision medicine strategies through preemptive profiling, risk stratification incorporating genetics, and pharmacogenomics-guided drug selection. Specific genetic polymorphisms have shown associations with increased risk of perioperative adverse events like myocardial infarction and atrial fibrillation.
There is often more than one way of doing something in healthcare.
For
example, there may be two different drugs that can be used to treat
depres sion, or two surgical techniques for the management of dysmenorrhoea.
Note that interventions may be compared against each other ( for example
antibiotic A against antibiotic B) or against a ' do nothing' scenario.
There are different ways in which we can choose one of these options.
We may
decide to pick the more effective surgical technique, or we may decide to
select the less costly antidepressant. Economic evalu ation is a generic term for
techniques that are used to identify, measure and value both the costs and the
outcomes of healthcare interventions. An economic evaluation is concerned
with identifying the differences in costs and outcomes between options. It can
be defined as a study that compares the costs and benefits of two or more
alternative interventions; so, the main components are costs and benefits
More Predictive Modeling of Total Healthcare Costs Using Pharmacy Claims DataM. Christopher Roebuck
This study examined the relationship between medication adherence and future healthcare costs using pharmacy claims data. It found that increased medication adherence, as measured by compliance and persistence, was associated with lower total future healthcare costs. The study also found that using a boosted regression model that incorporated medication adherence measures provided similar or better predictive accuracy for future healthcare costs compared to other econometric models. However, overfitting was an issue with the boosted regression model that would need to be addressed through parameter respecification.
This study analyzed 150 prescriptions of patients with rheumatoid arthritis treated at a tertiary care hospital in India. The study found:
1. Hydroxychloroquine was the most commonly prescribed drug (20.1%), followed by paracetamol (18.6%). Combination therapy using 3 or more drugs was preferred over monotherapy.
2. The majority of patients were female (91.3%) and the average age was 50 years old. Common comorbidities included hypertension (60%), diabetes (26.6%), and asthma (13.3%).
3. A total of 552 drugs were prescribed and 221 drug-drug interactions were identified. The highest number of interactions occurred with
Applications of statistics in medical Research and HealthrMuhammadNafees42
This will help you to understand the applications of basic statistics.The application of stat in medical health and research.
#nafeesupdates
#nafeesmedicos
CUA is a formal economic technique for assessing the efficien
cy of healthcare interventions. It is
considered by some to be a specific type of cost effectiveness analysis in which the measure of
effectiveness is a utility or preference adjusted outcome.
This study assessed the costs and effects of different degrees of task shifting for anti-retroviral therapy (ART) from physicians to other health professionals in Ethiopia. The study found that (1) facilities with maximal task shifting, where non-physicians performed most ART tasks, had similar patient outcomes and costs as facilities with minimal/moderate task shifting; (2) over 88% of patients remained active on ART after two years across all facility types; and (3) maximal task shifting cost $36 more per patient over two years but resulted in 0.4% fewer patients remaining active, though this difference was not statistically significant.
This document discusses the ethical aspects of anesthesia care and euthanasia. It covers topics such as informed consent, do not resuscitate orders, truth telling about medical errors, end of life decision making, physician assisted suicide, organ transplantation, medical research ethics, and euthanasia. The document outlines various ethical theories and the four pillars of medical ethics: respect for patient autonomy, beneficence, nonmaleficence, and justice. It also discusses concepts like informed consent, surrogate decision making, conscientious objection, and the ethical treatment of children and animals in medical research.
This study analyzed 2,000 antibiotic prescription records from Bangladesh to evaluate rational antibiotic prescribing practices. It found that the majority (63%) of patients visited unlicensed village healthcare workers due to their widespread availability. The most commonly prescribed antibiotic classes were cephalosporins (36%), macrolides (25.5%), and quinolones (21%). However, 81% of prescriptions lacked clinical tests to justify antibiotic use. Only 66.5% of patients completed their full antibiotic course. The study concludes that irrational antibiotic prescribing in Bangladesh contributes to growing antibiotic resistance and calls for national treatment guidelines and public education programs.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This document presents a literature review and proposal to reduce medication errors in a 28-bed rehabilitation unit through the use of an electronic medication administration record (EMAR) over a 30-day period. Studies have shown EMARs can significantly reduce transcription and administration errors compared to handwritten records. The proposal is for physicians to enter all medication orders via the existing EMAR system for 30 days to evaluate if it decreases transcription errors versus the current paper method. Implementing EMARs has been shown to potentially prevent 84% of dosing, frequency and route errors.
This document discusses how clinical pharmaceutical care, medical laboratory imaging, and nuclear medicine can work together to improve clinical outcomes and reduce costs. It argues that clinical pharmacists are well-positioned to utilize data from these areas to better monitor drug therapies and collaborate as part of multidisciplinary medical teams. Several studies are cited that show involvement of clinical pharmacists on medical teams can significantly improve various clinical outcomes and lower mortality rates. The inclusion of pharmacists' expertise in areas like medical imaging and laboratory testing is posited to further aid rational drug therapy management and containment of treatment costs.
The document discusses how clinical pharmacists can help reduce healthcare costs when integrated into medical teams. It presents evidence from studies showing that pharmacists improve clinical outcomes and lower costs through various methods. When pharmacists apply diagnostic data and utilize management skills while collaborating with medical staff, they can optimize drug therapy selection and monitoring, reducing costs up to 30% while improving patient care. The inclusion of pharmacists in multidisciplinary teams provides an effective approach for health systems to both enhance quality of care and contain expenses.
The document discusses the role of clinical pharmacists in medical teams treating severe and critical patients. It argues that including clinical pharmacists can reduce mortality rates by adding pharmaceutical knowledge and expertise to evaluate drug efficacy and make treatment decisions. The main focus of clinical pharmacists should be on the most critical patients, as their contributions can save lives. Their presence helps optimize pharmacological strategies and outcomes through competencies in areas like pharmacokinetics, drug design, and preventing antimicrobial resistance.
This document discusses medication errors that can occur in hospitals. It defines medication errors as any error in prescribing, dispensing, or administering drugs, regardless of whether harm occurs. Medication errors are a major cause of preventable patient harm. The document classifies medication errors as mistakes, slips, or lapses, depending on where the error occurs in the medication use process. It also discusses different ways medication errors have been estimated to cause deaths in other countries to highlight the significant impact of these errors.
The document describes a retrospective analysis of interventions made by a clinical pharmacist (CP) during their participation in the medical intensive care unit (ICU) team of a university hospital over a period of 9 months. The CP reviewed medications for 321 patients and made a total of 307 interventions in 95 patients. The interventions were categorized as: pharmacotherapy adjustments for kidney function (147 interventions), therapeutic drug monitoring (57), administration through a nasogastric tube (30), drug-drug interactions (22), and unspecified (51). The majority of interventions (203) were related to antimicrobial drugs. ICU physicians completely accepted 80.2% of the CP's suggestions. The analysis found that inclusion of a CP contributed to more individualized pharmacological
This study examined Jordanian critical care nurses' perceptions of medication errors through a survey of 83 nurses. The key findings were:
- Nurses perceived the top causes of medication errors to be nurse miscalculating doses, physicians prescribing wrong doses, and illegible physician handwriting.
- There were differences in what nurses considered reportable errors, with more agreement on fast TPN rates but disparate views on withholding digoxin due to late lab results.
- Only 41.8% of nurses believed all errors are reported. Barriers to reporting included fear of manager and peer reactions rather than disciplinary action. Nurses tended to inform physicians instead of completing incident reports.
- The study highlights
A study on prescription pattern and rational use of statins in tertiary care ...SriramNagarajan16
Objectives
Our objectives are to evaluate prescription pattern and rational use of statins in a tertiary care corporate hospital.
Methodology
It was a prospective observational study conducted for a period of 6 months and included various departments of 300
bedded multi specialty tertiary care corporate hospital. A total of 200 patients were included and the study criteria
was inpatients and induvial more than 18 years of either gender who are prescribed with HMG-CoA reductase
inhibitors.
Results
In the present study 200 patients belonged to the age group of above 18 years, out of which about 65% were male
and 35% were female. Atorvastatin (67%) was prescribed mostly and Rosuvastatin (29.5%) was also used.
Conclusion
It is finally concluded that Rational and prophylactic use of statins can reduce further complications of Diabetes
Mellitus (DM) and cardiac events.
Statins treatment is favourable in long term treatment of diseases, it is most effectively used in treatment of serious
disease conditions which has shown its immense therapeutic role in treatment
Evidence of the value of the pharmacistRodmonster73
This document summarizes key studies that demonstrate the broad range of pharmacist-provided patient care services that have resulted in improved disease and drug therapy management, greater patient satisfaction, improved quality of life, and significant cost containment and savings. Over 20 studies confirm that pharmacists add value by improving care and decreasing costs, with an average $16.70 return on investment for every $1 spent on clinical pharmacy services. Pharmacist interventions across various care settings have been shown to improve medication adherence, reduce medical errors and adverse drug events, lower healthcare costs, and optimize drug therapy for patients.
Impact of Antidepressant Medication Adherence on Health Services Utilization ...M. Christopher Roebuck
The document summarizes a study on the impact of antidepressant medication adherence on health services utilization and costs. The study found that patients who adhered to their antidepressant medication had fewer inpatient hospital days but more emergency department and outpatient physician visits. Adherent patients also had lower total healthcare costs of $646 compared to non-adherent patients. The results suggest that programs to increase antidepressant medication use and adherence may reduce total healthcare costs for payers and employers.
The process of healthcare is undertaken so that people can benefit from the intervention. An economic evaluation looks at all the implications of deciding to choose one way of providing care over another, not just the costs. This means that any effect the service, good or bad, has on the patient or customer needs to be investigated
Genomic variation partially explains interindividual variability in responses to perioperative stressors and drugs. The perioperative period represents an opportunity to implement precision medicine strategies through preemptive profiling, risk stratification incorporating genetics, and pharmacogenomics-guided drug selection. Specific genetic polymorphisms have shown associations with increased risk of perioperative adverse events like myocardial infarction and atrial fibrillation.
There is often more than one way of doing something in healthcare.
For
example, there may be two different drugs that can be used to treat
depres sion, or two surgical techniques for the management of dysmenorrhoea.
Note that interventions may be compared against each other ( for example
antibiotic A against antibiotic B) or against a ' do nothing' scenario.
There are different ways in which we can choose one of these options.
We may
decide to pick the more effective surgical technique, or we may decide to
select the less costly antidepressant. Economic evalu ation is a generic term for
techniques that are used to identify, measure and value both the costs and the
outcomes of healthcare interventions. An economic evaluation is concerned
with identifying the differences in costs and outcomes between options. It can
be defined as a study that compares the costs and benefits of two or more
alternative interventions; so, the main components are costs and benefits
More Predictive Modeling of Total Healthcare Costs Using Pharmacy Claims DataM. Christopher Roebuck
This study examined the relationship between medication adherence and future healthcare costs using pharmacy claims data. It found that increased medication adherence, as measured by compliance and persistence, was associated with lower total future healthcare costs. The study also found that using a boosted regression model that incorporated medication adherence measures provided similar or better predictive accuracy for future healthcare costs compared to other econometric models. However, overfitting was an issue with the boosted regression model that would need to be addressed through parameter respecification.
This study analyzed 150 prescriptions of patients with rheumatoid arthritis treated at a tertiary care hospital in India. The study found:
1. Hydroxychloroquine was the most commonly prescribed drug (20.1%), followed by paracetamol (18.6%). Combination therapy using 3 or more drugs was preferred over monotherapy.
2. The majority of patients were female (91.3%) and the average age was 50 years old. Common comorbidities included hypertension (60%), diabetes (26.6%), and asthma (13.3%).
3. A total of 552 drugs were prescribed and 221 drug-drug interactions were identified. The highest number of interactions occurred with
Applications of statistics in medical Research and HealthrMuhammadNafees42
This will help you to understand the applications of basic statistics.The application of stat in medical health and research.
#nafeesupdates
#nafeesmedicos
CUA is a formal economic technique for assessing the efficien
cy of healthcare interventions. It is
considered by some to be a specific type of cost effectiveness analysis in which the measure of
effectiveness is a utility or preference adjusted outcome.
This study assessed the costs and effects of different degrees of task shifting for anti-retroviral therapy (ART) from physicians to other health professionals in Ethiopia. The study found that (1) facilities with maximal task shifting, where non-physicians performed most ART tasks, had similar patient outcomes and costs as facilities with minimal/moderate task shifting; (2) over 88% of patients remained active on ART after two years across all facility types; and (3) maximal task shifting cost $36 more per patient over two years but resulted in 0.4% fewer patients remaining active, though this difference was not statistically significant.
This document discusses the ethical aspects of anesthesia care and euthanasia. It covers topics such as informed consent, do not resuscitate orders, truth telling about medical errors, end of life decision making, physician assisted suicide, organ transplantation, medical research ethics, and euthanasia. The document outlines various ethical theories and the four pillars of medical ethics: respect for patient autonomy, beneficence, nonmaleficence, and justice. It also discusses concepts like informed consent, surrogate decision making, conscientious objection, and the ethical treatment of children and animals in medical research.
This study analyzed 2,000 antibiotic prescription records from Bangladesh to evaluate rational antibiotic prescribing practices. It found that the majority (63%) of patients visited unlicensed village healthcare workers due to their widespread availability. The most commonly prescribed antibiotic classes were cephalosporins (36%), macrolides (25.5%), and quinolones (21%). However, 81% of prescriptions lacked clinical tests to justify antibiotic use. Only 66.5% of patients completed their full antibiotic course. The study concludes that irrational antibiotic prescribing in Bangladesh contributes to growing antibiotic resistance and calls for national treatment guidelines and public education programs.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This document presents a literature review and proposal to reduce medication errors in a 28-bed rehabilitation unit through the use of an electronic medication administration record (EMAR) over a 30-day period. Studies have shown EMARs can significantly reduce transcription and administration errors compared to handwritten records. The proposal is for physicians to enter all medication orders via the existing EMAR system for 30 days to evaluate if it decreases transcription errors versus the current paper method. Implementing EMARs has been shown to potentially prevent 84% of dosing, frequency and route errors.
Similar to J. pub health luisetto m, ghulam r m. research article intensive care units the clinical pharmacist role to improve clinical outcomes and Reducing Mortality Rate A Undeniable Function ,#ICU, SEMANTIC SCHOLAR
This document discusses how clinical pharmaceutical care, medical laboratory imaging, and nuclear medicine can work together to improve clinical outcomes and reduce costs. It argues that clinical pharmacists are well-positioned to utilize data from these areas to better monitor drug therapies and collaborate as part of multidisciplinary medical teams. Several studies are cited that show involvement of clinical pharmacists on medical teams can significantly improve various clinical outcomes and lower mortality rates. The inclusion of pharmacists' expertise in areas like medical imaging and laboratory testing is posited to further aid rational drug therapy management and containment of treatment costs.
The document discusses how clinical pharmacists can help reduce healthcare costs when integrated into medical teams. It presents evidence from studies showing that pharmacists improve clinical outcomes and lower costs through various methods. When pharmacists apply diagnostic data and utilize management skills while collaborating with medical staff, they can optimize drug therapy selection and monitoring, reducing costs up to 30% while improving patient care. The inclusion of pharmacists in multidisciplinary teams provides an effective approach for health systems to both enhance quality of care and contain expenses.
Medication errors that occur during hospital admission can lead to preventable adverse drug events. This study uses a model to assess the costs and health effects of interventions aimed at reducing medication errors during admission reconciliation. The model estimates that all five interventions identified by a literature review are highly cost-effective compared to current practice. A pharmacist-led reconciliation intervention has the highest expected cost-effectiveness. The study concludes that medication reconciliation interventions provide a cost-effective use of healthcare resources to improve patient safety.
Effect of nursing intervention on clinical outcomes and patient satisfaction ...Alexander Decker
1) The study aimed to determine the effect of nursing intervention on clinical outcomes and patient satisfaction among patients with upper gastrointestinal bleeding.
2) A quasi-experimental study was conducted on 50 patients divided into a study group that received nursing intervention and a control group.
3) Statistically significant differences were found between the groups in clinical outcomes like bleeding, vital signs, and lab tests as well as higher patient satisfaction scores in the study group compared to the control group, showing that nursing intervention improved patients' outcomes and satisfaction.
This document summarizes research on the benefits of clinical pharmacists working in emergency departments, intensive care units, and other medical settings. It finds that having clinical pharmacists as part of the medical team can reduce mortality rates and healthcare costs based on evidence from multiple studies. The document reviews literature showing reductions in mortality from conditions like heart disease when clinical pharmacists identify and address drug-related issues. It also finds clinical pharmacists improve outcomes for infections diseases by optimizing antibiotic use. In conclusion, integrating clinical pharmacists into medical teams through programs like pharmaceutical care can significantly improve clinical outcomes and reduce costs.
The document discusses the changing role of pharmacists and the benefits of integrating pharmacists into medical teams. It presents several studies that show pharmacists improving clinical outcomes when involved in patient care. The rationale is that pharmacists can help physicians optimize drug therapy and patient safety by providing expertise in areas like monitoring treatments, detecting interactions and adverse reactions, and managing costs. The conclusion is that applying pharmaceutical care principles can both improve health outcomes and reduce healthcare costs.
This document discusses the benefits of including clinical pharmacists as part of medical teams. It reviews studies that found clinical pharmacists improved patient outcomes and reduced mortality rates. Specifically, the presence of clinical pharmacists significantly enhanced clinical outcomes by utilizing their expertise in medical laboratory data and imaging to better monitor drug therapies. The document concludes that hospitals should engage clinical pharmacists, especially in fields involving medical laboratory work and imaging, to improve patient safety, health outcomes, and reduce costs through more rational drug therapy.
This document discusses the benefits of including clinical pharmacists as part of medical teams. It reviews several studies that found positive impacts of pharmacists' involvement, including reduced mortality rates, favorable effects on patient outcomes across settings and diseases, and positive influence on clinical outcomes. The document argues that utilizing clinical pharmacists' expertise in areas like medical laboratory work and imaging can further enhance therapy monitoring and improve safety, health outcomes, and cost reductions for patients. It concludes that hospitals should engage pharmacists more actively, especially in fields involving innovative treatments, to reduce risks and costs while improving care.
The document discusses medication therapy management (MTM) services provided by pharmacists. It notes that MTM aims to improve patient outcomes, promote safe medication use, and reduce costs. MTM services include comprehensive medication reviews, adherence support, and disease state management. Studies show MTM can identify and resolve medication-related problems, lower healthcare costs, and improve health outcomes for conditions like diabetes and asthma.
This document summarizes research on rethinking hospital pharmacist services through centralized logistics and clinical pharmaceutical care strategies. It finds that centralized logistics systems can reduce drug and medical device costs through bulk purchasing and inventory management. It also finds that incorporating clinical pharmacists into medical teams can improve clinical outcomes and reduce costs through optimizing medication management, avoiding errors, and monitoring drug therapies. The document reviews literature showing pharmacists improving outcomes and reducing costs by 35% when integrated into oncology medical teams. It proposes a new model with pharmacists playing a more active clinical role to help contain healthcare spending while improving patient care.
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This document discusses chronic prostatitis and the potential role of clinical pharmacists in improving treatment. It notes that current drug therapies for conditions like chronic prostatitis often have high relapse rates. The document suggests that clinical pharmacists could help develop new drug delivery systems to better target treatment to the prostate and improve outcomes. It argues pharmaceutical companies may underestimate the need for innovative delivery methods to more effectively treat chronic prostatitis and other conditions with current therapies.
This document discusses the role of clinical pharmacists in medical teams. It argues that pharmacists are experts in pharmacology and drug therapy who can improve clinical outcomes when working alongside physicians. The document outlines studies that found clinical pharmacist involvement on medical wards reduced drug errors, adverse drug reactions, morbidity and mortality rates, and healthcare costs. It advocates for pharmacists to take a more active role in multidisciplinary teams to aid physicians and help ensure the best and safest drug therapy for patients. Pharmacists' expertise in areas like drug interactions, delivery systems, and monitoring could benefit patient care and outcomes across many medical disciplines if their contributions were utilized more fully.
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Patient support programs have the potential to improve medication adherence and patient outcomes while also providing a return on investment. A personalized text message program for asthma patients improved adherence from 43% in the control group to 58% in the intervention group. The program continued to show benefits in adherence even after the intervention ended. A support program for age-related macular degeneration patients led to an 8-fold decrease in treatment discontinuation and a 941% return on investment. Personalized interventions that address patients' beliefs and perceptions have the most potential to positively impact adherence long-term.
This document lists publications by author M. Luisetto that are indexed in various international university libraries. The publications cover topics related to clinical pharmacy practice, pharmaceutical care, toxicology, management roles of pharmacists, and using multidisciplinary approaches to improve health outcomes. Many of the publications discuss the role of clinical pharmacists in improving patient care and reducing costs. The libraries indexing these publications include Harvard, Oxford, Yale, Berkeley, Duke, and several others.
The document summarizes the historical development of clinical pharmacy and pharmaceutical care from 1928 to 2016. It outlines key steps such as pharmacists beginning to participate in patient rounds in 1928. It also reviews studies showing the positive impact of clinical pharmacists on patient outcomes when included as part of the medical team. This includes reduced mortality, readmission rates, and healthcare costs. The conclusion is that incorporating clinical pharmacy expertise into medical care through a flexible team-based approach is essential for improving clinical outcomes, especially with new complex drug formulations.
1) The introduction of pharmaceutical care and clinical pharmacy practices in the 1920s positively impacted patient outcomes.
2) Over time from the 1920s-2016, clinical pharmacy evolved as its own discipline and pharmacists increasingly participated in direct patient care as part of medical teams.
3) Studies found the involvement of clinical pharmacists on medical teams generally had favorable effects on various outcomes across different healthcare settings and disease states.
The document discusses strategies for optimally using limited antimicrobial resources. It notes increasing antimicrobial resistance and a lack of new drug classes. A multidisciplinary team approach including clinical pharmacists can improve outcomes for severe infectious diseases. Clinical pharmacists can help ensure patients receive the most effective drugs while avoiding nephrotoxic options. Their expertise in pharmacology and drug design can also help address resistance and drug failures through modifications to drug molecules or delivery systems. Close monitoring of drug-resistant bacteria is needed to reduce the threat of antimicrobial resistance. Both chance discoveries and targeted research have led to new anti-infective drugs, so a balanced approach that allows creativity could help address current challenges.
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J. pub health luisetto m, ghulam r m. research article intensive care units the clinical pharmacist role to improve clinical outcomes and Reducing Mortality Rate A Undeniable Function ,#ICU, SEMANTIC SCHOLAR
2. How to cite this article: Luisetto M, Ghulam R M. Research Article Intensive Care Units: The Clinical Pharmacist Role to Improve Clinical Outcomes and
Reducing Mortality Rate: A Undeniable Function. JOJ Pub Health. 2017; 2(5): 555597. DOI: 10.19080/JOJPH.2017.02.555597.
002
Juniper Online Journal of Public Health
acquisition costs of intravenous antimicrobial agents for the
second baseline year and the entire program period were
tabulated and compared. The average daily inpatient census was
determined. The ACP was associated with a 2.4-day decrease
in length of stay and a reduction in mortality from 8.28 %(
control) to 6.61 %( intervention) (p0, 01). Than intravenous
antimicrobials decreased an average of only 5.7% over the two
program years, but the acquisition cost. An ACP directed by a
clinical pharmacist trained in infectious diseases was associated
with improvements in inpatient length of stay and mortality.
The ACP decreased intravenous antimicrobial costs and
facilitated the approval process for restricted and no formulary
antimicrobial agents” [4].
c) Bond CA et al.
“Education of medical and nursing staff, particularly by
clinical pharmacists, is a vital part of a strategy to prevent
medication errors”“Greatest association (slope) with a reduction
in the mortality rate, drug costs, and length of stay. As the
clinical pharmacist staff levels increased from the level of tenth
percentile (0.34/100 occupied beds) to the ninetieth percentile
level (3.23/100 occupied beds), hospital deaths declined from
113/1000 to 64/1000 admissions (43% decline). Reduction
of 395 deaths/hospital/year when clinical pharmacist staffing
went from the tenth to the ninetieth percentile. This translated
into a reduction of 1.09 deaths/day/hospital having clinical
pharmacy staffing between these staffing levels. About 3 hospital
pharmacy variables were associated with reduced length of
stay in 1024 hospitals: drug protocol management (slope -1.30,
p=0.008), pharmacist participation on medical grounds (slope
-1.71, p<0.001), and number of clinical pharmacists/occupied
bed (slope -26.59, p<0.001). As drug costs/occupied bed/year
increased, severity of illness-adjusted mortality rates decreased
(slope -38609852, R(2) 8.2%, p<0.0001). As the total healthcare
cost of care/occupied bed/year increased, those same mortality
rates decreased (slope -5846720642, R(2) 14.9%, p<0.0001).
Seventeen clinical pharmacy services were associated with
improvements in the 4 variables” [5].
d) Kane SL et al
“Pharmacists are integral members of this team. They
make valuable contributions to improve clinical, economic, and
humanistic outcomes of patients. Pharmacist interventions
includecorrecting/clarifyingorders,providingdruginformation,
suggesting alternative therapies, identifying drug interactions,
and therapeutic drug monitoring. Pharmacist involvement in
improving clinical outcomes of critically ill patients is associated
with optimal fluid management and substantial reductions in
the rates of adverse drug events, medication administration
errors, and ventilator-associated pneumonia” [6].
e) Rothschild JM
We conducted a prospective 1-year observational study.“Most
serious medical errors occurred during the ordering or execution
of treatments, especially medications (61%; 170/277).
Performance level failures were most commonly slips and lapses
(53%; 148/277), rather than rule-based or knowledge-based
mistakes.Adverse events and serious errors involving critically
ill patients were common and often potentially life-threatening”
[6]. Bond CA et al in 2007clinical pharmacy service, pharmacy
staffing, and hospital mortality rates. “In seven hospitals, clinical
pharmacy service reduces mortality rates in a significant way”
[7].
f) MacLaren R1. et al
In this retrospective database review, ” In hospitals with ICU
clinical pharmacy services, mortality rates in patients with TIE
only and TIE with bleeding complications were higher by 37%
(odds ratio [OR] 1.41, 95% confidence interval [CI] 1.36-1.46)
and 31% (OR 1.35, 95% CI 1.13-1.61), respectively, than in ICUs
with clinical pharmacy services. Without clinical pharmacy
services, bleeding complications increased by 49% (OR 1.53,
95% CI 1.46-1.60), resulting in 39% more patients requiring
transfusions (OR 1.47, 95% CI 1.28-1.69); these patients also
received more blood products (mean +/- SD 6.8 +/- 10.4 vs. 3.1
+/- 2.6 units/patient, p=0.006). Involving clinical pharmacists in
the direct care of intensive care patients with TIE was associated
with reduced mortality, improved clinical and charge outcomes,
and fewer bleeding complications. Hospitals should promote
direct involvement of pharmacists in the care of patients in the
ICU” [8].
g) MacLaren R1, Bond CA, Martin SJ, Fike D
“Compared to ICUs with clinical pharmacists, mortality rates
in ICUs that did not have clinical pharmacists were higher by
23.6% (p < 0.001, 386 extra deaths), 16.2% (p = 0.008, 74 extra
deaths), and 4.8% (p = 0.008, 211 extra deaths) for nosocomial-
acquired infections, community-acquired infections, and sepsis,
respectively. The involvement of clinical pharmacists in the care
of critically ill Medicare patients with infections is associated
with improved clinical and economic outcomes. Hospitals should
consider employing clinical ICU pharmacists”[9].
h) Valentin A et al
“Observational, prospective, (0.9% of the studied)
experienced permanent harm or died because of therapy errors
at the administration. Parenteral medication errors at the
administration stage are common and a serious safety problem
in intensive care units. With the increase of the complexity of
therapy in critically ill patients, the organisation factors (as
error reporting systems and routine checks) reduce the risk for
this kind of errors” [10].
i) Chisholm et al 2010
“Pharmacist’s effect as team members on patient care:
systematic review and meta-analyses”: pharmacists provided
direct patient care has favorable effects across various patient
outcomes, health care settings, and disease states.(Significant p
0.005) “[11].
3. How to cite this article: Luisetto M, Ghulam R M. Research Article Intensive Care Units: The Clinical Pharmacist Role to Improve Clinical Outcomes and
Reducing Mortality Rate: A Undeniable Function. JOJ Pub Health. 2017; 2(5): 555597. DOI: 10.19080/JOJPH.2017.02.555597.
003
Juniper Online Journal of Public Health
j) Shulman R et al
“A prospective observational study Interventions were
scored as low impact, moderate impact, high impact, and life
saving. The final coding was moderated by blinded independent
multidisciplinarytrialists.Thisresultedinanoverallintervention
rate of 16.1%: 6.8% were classified as medication errors, 8.3%
optimizations, and 1.0% consults. The interventions were
classified as low impact (34.0%), moderate impact (46.7%), and
high impact (19.3%); and 1 case was life saving. Almost three
quarters of interventions were to optimize the effectiveness
of and improve safety of pharmacotherapy. This observational
study demonstrated that both medication error resolution and
pharmacist-led optimization rates were substantial. Two thirds
of the interventions were of moderate to high impact” [12].
k) Hisham M
ICU polypharmacy is a very common. A total of 986
pharmaceutical interventions due to drug-related problems were
documented, whereof medication errors accounted for 42.6%
(n = 420), drug of choice problem 15.4% (n = 152), drug-drug
interactions were 15.1% (n = 149), Y-site drug incompatibility
was 13.7% (n = 135), drug dosing problems were 4.8% (n
= 47), drug duplications reported were 4.6% (n = 45), and
adverse drug reactions documented were 3.8% (n = 38). Drug
dosing adjustment done by the clinical pharmacist included 140
(11.9%) renal dose, 62 (5.2%) hepatic dose, 17 (1.4%) pediatric
dose, and 104 (8.8%) insulin dosing modifications. Clinical
pharmacist as a part of multidisciplinary team in our study
was associated with a substantially lower rate of adverse drug
event caused by medication errors, drug interactions, and drug
incompatibilities” [13].
Luisetto M et al writed that (2017) “We think that the clinical
ph. main focus must beinvolved in priority way to the most
critical patients in order to achieve the best results available . In
this condition even benefit of 1 life achieved in mortality rate is
a real golden endpoint (we can think for example to a pediatric
poisoning, or severe infectious disease in pregnancy or the effect
of inefficacy immunosuppressive therapy in transplanted et
other) . This can be considered in example as a reduction in NNT
to improve a therapeutic strategy” [14].
l) Amine Ali Zeggwagh et al
“The present study demonstrated that the preventable
in-ICU deaths are a serious problem occurring in 14.1% of all
deaths observed in our ICU” [15].
m) Dilip Kothari et al
“Medication error is a major cause of morbidity and mortality
in medical profession, and anesthesia and critical care are no
exception to it. Man, medicine, machine and modus operandi
are the main contributory factors to it. In this review, incidence,
types, risk factors and preventive measures of the medication
errors are discussed in detail” [16].
n) Eric Moyen et al
“Pharmacists, similarly, have an crucial role to play in
medication safety. First, all intravenous medications should
be prepared within the pharmacy department by pharmacists
using a standardized process and standardized medication
concentrations. Second, participation of a pharmacist in clinical
rounds improves patient safety by reducing preventable ADEs
by 66% [61] while shortening patients’ length of hospital stay
[62, 63], decreasing mortality [64], and decreasing medication
expenditures ” [17].
o) Amine Ali Zeggwagh, et al
“In general, following things should be kept in mind while
working in the operation room to minimize the incidence of
medication errors: Reducing the complexity of the system
to simple and linear to enhance the safety. Redundancy and
standardization are the basic principles in the design of a
safe system. Double checking of ampoules, syringes and
equipment before starting the procedure. Simple vigilance
during the handling and administration of drugs is of utmost
importance. After a systemic review, Jenson and colleagues
[55] recommended a 12-point strategy to prevent medication
errors during anesthesia and critical care: The label on any
drug ampoule or syringe should be read carefully before the
drug is drawn up or injected. Legibility and contents of labels on
ampoules and syringes should be optimized according to agreed
standards with respect to font, size, colour and information.
Syringes should always be labeled. Formal organization of
drug drawers and work space should be used with attention to
tidiness, position of ampoules and syringes, separation of look-
alike drugs and removal of dangerous drugs from the operation
room.
Labels should be checked specifically with the help
of a second person or a device like bar code reader before
administration. Error during administration should be reported
and reviewed.
Managementofinventoryshouldfocusonminimizingtherisk
of drug error. Look-alike packaging and presentation of the drug
should be avoided where possible. Drug should be presented in
prefilled syringes rather than ampoules. Drug should be drawn
up and labeled by the anesthesia provider himself/herself.
Colour coding by class of drugs should be according to an agreed
national or international standard. Coding of syringe according
to position or size should be done. Several other measures to
promote safe drug administration during anesthesia and critical
care have been suggested.
The provision of all labels in a standardized format
emphasizing the class and generic name of each drug
incorporating the bar code and class-specific colour code as per
international standard. The bar code reader use to detect the
drug at the point of administration immediately way before it
is given linked to an auditory prompt to facilitate the checking
4. How to cite this article: Luisetto M, Ghulam R M. Research Article Intensive Care Units: The Clinical Pharmacist Role to Improve Clinical Outcomes and
Reducing Mortality Rate: A Undeniable Function. JOJ Pub Health. 2017; 2(5): 555597. DOI: 10.19080/JOJPH.2017.02.555597.
004
Juniper Online Journal of Public Health
control of the drug identity. Integration of scanned information
into an automated anesthesia record and reducing the cognitive
load on the anesthetist. The use of the medical devices at
the point of care to automatically measure the dose of the
administered pharmacological drug. A dosing nomograph on
the infusion syringe label to avoid the need of look-up tables or
dose calculations.The automatized drug dispensing system with
features such as single issue drawers and bar code scanners to
facilitate safer dispensing of the pharmacological drugs.
Camire et al in a review article have suggested seven
strategies to prevent errors in ICU. These are as follows:
Eliminating extended physician work schedules.
Computerized physician order entry. Implement support system
for clinical decisions. Computerized intravenous devices. Active
participation of pharmacists in ICU. Medication reconciliation.
Merali et al made many recommendations to reduce medication
errors at different stages .Recommendations to reduce
medication errors. Many organizations are now dedicated to
patient safety” [15].
p) Giovanni Montini Andrade Fideles et al
“The number of PhRs considered to exert high impact on
pharmacological strategy increased in the last period of the
study, including those concerning dose adjustment, treatment
discontinuation, and recommendation of treatment onset. This
finding might be due to improvement of the clinical knowledge
of the pharmacist and his/her more thorough integration with
the ICU multi-professional staff. According to the BIOMEDICAL
literature, pharmacist’s actions in the ICU should not to be
limited to providing advice to the equip but also include pro-
active participation in decision-making in the maintenance of
pharmacological treatment” [18,19].
Preslaski CR et al showed that “ Augmented by ICT technology
and resource Use , to provide valuable services in the form of
assisting physicians and clinicians with pharmacotherapy
decision-making, reducing drug therapy errors, and improving
medication safety systems to optimize patient outcomes. The
addition of a pharmacist to an interprofessional critical care
team should be encouraged as health-care systems focus on
improving the quality and efficiency of care delivered to improve
patient outcomes.”
Calloway S et al “Health care organizations are turning to
electronic clinical decision support systems (CDSSs) to increase
quality of patient care and promote a safer environment. The
value of having both clinical and staff pharmacists utilizing the
CDSS has improved communication and knowledge among staff
and improved relationships with medical staff, nursing, and case
management. The department of pharmacy increased its clinical
interventions from an average of 1,986 per month to 4,065
per month; this represents a 105% increase in the number of
interventions” [20].
q) Kucukarslan SN
“To determine the impact of a pharmacist who is
permanently assigned to the medical intensive care unit (MICU)
on the incidence of preventable ADEs, drug charges, and length
of stay (LOS) in the MICU.A randomized, experimental versus
historical control group design was used. Preventable ADEs
were identified and validated by 2 pharmacists and a critical
care physician. Information about MICU drug charges and LOS
were obtained from the hospital administrative database.
The intervention group had fewer occurrences of ADEs (10
ADEs/1,000 patient days) when compared to the control group
(28 ADEs/1,000 patient days) at a significance level of .03. No
significant differences were found between the 2 groups in MICU
drug charges and LOS. The vast majority of the 596 documented
recommended interventions (99%) were accepted by the
medical team. Nutrition monitoring, medication indicated but
not prescribed, and dosage modification were the top 3 problems
identified by the pharmacist. The addition of a dedicated critical
care pharmacist to the MICU medical team improves the safe use
of medication [21].
r) Rudis MI et al writed
“By combining the strengths and expertise of critical care
pharmacy specialists with existing supporting literature, these
recommendations define the level of clinical practice and
specialized skills that characterize the critical care pharmacist as
clinician, educator, researcher, and manager. This Position Paper
recommends fundamental, desirable, and optimal pharmacy
services as well as personnel requirements for the provision of
pharmaceutical care to critically ill patients” [22].
s) Randolph AG et al
“Criticallyillpatientsareathighriskfordeathandpermanent
disability. The method of delivering critical care services to
these patients can have an impact on their clinical and economic
outcomes. We review the challenges faced when evaluating the
impact of ICU organizational characteristics on patient outcomes
and highlight ICU characteristics that are consistently associated
with improved patient outcomes. These include: (i) the presence
of specialist physicians devoted to the ICU; (ii) increased nurse
: patient ratios; (iii) decreased use of tests and evaluations that
will not change clinical management; (iv) development and
implementation of evidence-based protocols and guidelines;
(v) use of computer-based alerting and reminding systems; and
(vi) having a pharmacist participate in daily rounds in the ICU.
Given the growing evidence supporting the association between
specific ICU characteristics and improved patient outcomes, we
hope the the future realizes wide broad implementation of these
beneficial characteristics” [23].
t) Rachel M Kruer et al
“The Institute of Medicine has reported that medication
errors are the single most common type of error in health care,
5. How to cite this article: Luisetto M, Ghulam R M. Research Article Intensive Care Units: The Clinical Pharmacist Role to Improve Clinical Outcomes and
Reducing Mortality Rate: A Undeniable Function. JOJ Pub Health. 2017; 2(5): 555597. DOI: 10.19080/JOJPH.2017.02.555597.
005
Juniper Online Journal of Public Health
representing 19% of all adverse events, while accounting for
over 7,000 deaths annually. The frequency of medication errors
in adult intensive care units can be as high as 947 per 1,000
patient-days, with a median of 105.9 per 1,000 patient-days. The
formulation of drugs is a potential contributor to medication
errors. Challenges related to drug formulation are specific to
the various routes of medication administration, though errors
associated with medication appearance and labeling occur
among all drug formulations and routes of administration.
Addressing these multifaceted challenges requires a multimodal
approach. Changes in technology, training, systems, and safety
culture are all strategies to potentially reduce medication errors
related to drug formulation in the intensive care unit” [24-26].
A Practical experience
Emergency drug hospital cabinet systems practical
experience- PC (society of Italian hospital pharmacist POSTER
ABSTRATC) MILAN national congress 2016 (this poster has win
the best presentation award in young pharmacist section) [24].
In this example the ICT tool can make possible to have the real
situation of the emergency drug (quali- quantitative ) in every
SPOKE and rapid information about emergency drugs position
in order to achieve they in rapid way to have availability of other
emergency drugs (h24 also with central pharmacy closed) in a
safety way and containing costs. This experience is linked with
a correct management of the systems with a really rational way
and recognized officially by SIFO society of hospital pharmacist
(Italy). In this practical experience [13] no near miss event or
other patient risk or even fatal event was observed related to
emergency drugs stokes. During 6 Mont it was covered the the
emergency need of drugs in the 99% of cases, and only 1 time
was necessary the central pharmacy call by night or in week end.
(The same result was observed during 1 year, Provincial public
hospital with about 700 beds, 4 hospitals linked).
This kind of project was introduced by a multidisciplinary
team according a risk management and ICT Approach.
(Emergency and ICU clinicians, clinical pharmacist, informatics,
engineers, nurse, toxicological med lab professionals and other).
This system in fact make possible to know rapidly the situation
of expiration time of all emergency drugs stoked and so make
more easy the ordering process to have continuity in providing.
Discussion
a) From the analysis of the cited literature we can say
that
The pharmacy services are associated to reduce mortality
rate with a low rate in ADES by prescribing errors. That in an
antimicrobial control program with clinical pharmacist involved
it was obtained a reduction in mortality rate in significative
way (p=001) [4] That the mortality rate involved in clinical
pharmacist in medical team reduced hospital deaths about
43% [5] Medications are heavily involved in most serious
medical errors .in many hospital clinical ph. Service reduced
mortality rate in significant way [7] clinical pharmacist involved
in patient therapy with infectious disease improved clinical
outcomes .related to the therapy of critically ill patients in
ICT organizational factor can reduce risk for errors [23] that
related a systematic review and misanalysis various favorable
effect on patient’s outcome by pharmacists effective member
of medical team[11] in reviewing of therapies the pharmacist
interventions was classified as HIGH IMPACT ( 19,3%) [12] And
that polipharmacy is very common in ICU SETTINGS is very
common (obviously).
And at least according the editorial the clinical hospital
pharmacist main focus “ the clinical pharmacist must be
applied in priority way to the most critical patients situations to
achieve the best results available “ and “ this can be considered
as a reduction in NNT number needed to treat to improve a
therapeutic strategy [14].
Related to the results of a a practical experience (emergency
drug cabinet systems) we have see during 1 year no near
miss event or other patient risk using an ICT system managed
by clinical pharmacist to cover hospital need of emergency
drugs placed in ICU WARD [24] (An example of collaboration
with emergency dep, ICU, hospital pharmacy and blood bank
and biomedical engineer software house. This kind of results
obtained by literature confirms the fundamental role (and not
ancillar) of the clinical pharmacist in ICU MEDICAL TEAM.
Conclusion
Observing the results of the bio medical literature reported
in this work we can say that the clinical pharmacist presence in
stabile way in ICU medical team gives improving in some clinical
patient’s outcomes and reducing mortality rate. This conclusion
is related to the complexity of ICU SETTINGS and by critical
patients condition .To adequately managed this situations are
needed the most complete medical equips (multidisciplinariety)
We observe that the role played by hospital pharmacists can be
in more clinical activities, as educator (towards all healthcare
professionals) , researcher, and manager functions.
References
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hospital mortality rates. Pharmacotherapy 19(5):556-64.
2. JAMA (2000) 283(10): 1293.
3. Gentry CA, Greenfield RA, Slater LN, Wack M, Huycke MM (2000)
Outcomes of an antimicrobial control program in a teaching hospital.
Am J Health Syst Pharm 57(3): 268-274.
4. Bond CA, Raehl CL, Franke T (2001) Interrelationships among
mortality rates, drug costs, total cost of care, and length of stay in
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DOI:10.19080/JOJPH.2017.02.555597