Evaluation of the role of the critical care pharmacist in identifying and avoiding or minimizing significant drug-drug interactions in medical intensive care patients

Abstract The role of procalcitonin (PCT) plasma levels as a diagnostic tool for intensive care patients has been intensively investigated during the past years. In particular for recognition of bacterial infections, PCT levels have been shown to be superior to other clinical and biochemical markers. Furthermore, some very recent studies show that in patients with lower respiratory tract infections PCT guided antibiotic therapy reduces antibiotic use and thereby may also reduce duration of stay of patients in hospital and thus cut hospitalisation costs. However, various studies indicate that the value of PCT as a prognostic marker is limited because of false positive or negative values. Despite these limitations PCT plasma levels are currently measured in intensive care units. The present study summarises the possible clinical uses of this laboratory marker as a diagnostic tool for the assessment of critically ill patients.

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Does Gender Impact Intensity of Care Provided to Older Medical Intensive Care Unit Patients?

Critical Care Research and Practice ◽

10.1155/2010/404608 ◽

2010 ◽

Vol 2010 ◽

pp. 1-8

Author(s):

Kathleen M. Akgün ◽

Terrence E. Murphy ◽

Katy L. B. Araujo ◽

Peter H. Van Ness ◽

Margaret Pisani

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Medical Intensive Care Unit ◽

Demographic Data ◽

University Teaching ◽

Explanatory Variables ◽

Health Differences ◽

Medical Intensive Care ◽

Gender Based

Introduction. Women receive less aggressive critical care than men based on prior studies. No documented studies evaluate whether men and women are treated equally in the medical intensive care unit (MICU). The Therapeutic Intervention Scoring System-28 (TISS-28) has been used to examine gender differences in mixed ICU studies. However, it has not been used to evaluate equivalence of care in older MICU patients. We hypothesize that given nonsignificant, baseline health differences between genders at MICU admission, the level of care provided would be equivalent.Methods. Prospective cohort of 309 patients≥60 years old in the MICU of an urban university teaching hospital. Explanatory variables were demographic data and baseline measures. Primary outcomes were TISS-28 scores and MICU interventions. We compare TISS-28 scores by gender using a statistical test of equivalence.Results. Women were older and had more chronic respiratory failure at MICU admission. Using equivalence limits of±15% on gender-based scores of TISS-28, MICU interventions were equivalent. Supplementary analysis showed no statistically significant association between gender and mortality.Conclusions. In contrast with other reports from the cardiac critical care literature, as measured by the TISS-28, gender-based care delivered to older MICU patients in this cohort was equivalent.

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Organization and Structure of the Cardiothoracic Intensive Care Unit

Advances in Medical Technologies and Clinical Practice - Modern Concepts and Practices in Cardiothoracic Critical Care ◽

10.4018/978-1-4666-8603-8.ch004 ◽

2015 ◽

pp. 86-104

Author(s):

Michael H. Wall

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Patient Outcomes ◽

Nurse Practitioners ◽

Physician Assistants ◽

Cost Of Care ◽

Team Members ◽

Low Intensity

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

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Organization and Structure of the Cardiothoracic Intensive Care Unit

Oncology ◽

10.4018/978-1-5225-0549-5.ch027 ◽

2017 ◽

pp. 709-727

Author(s):

Michael H. Wall

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Patient Outcomes ◽

Nurse Practitioners ◽

Physician Assistants ◽

Cost Of Care ◽

Team Members ◽

Low Intensity

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

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Mechanical Thromboprophylaxis in Critically Ill Patients: A Systematic Review and Meta-Analysis

American Journal of Critical Care ◽

10.4037/ajcc2006.15.4.402 ◽

2006 ◽

Vol 15 (4) ◽

pp. 402-412 ◽

Cited By ~ 47

Author(s):

Anthony Limpus ◽

Wendy Chaboyer ◽

Ellen McDonald ◽

Lukman Thalib

Keyword(s):

Intensive Care ◽

Randomized Controlled Trials ◽

Observational Studies ◽

Meta Analysis ◽

Controlled Trials ◽

Trauma Patients ◽

Intensive Care Patients ◽

Randomized Controlled ◽

Confounding Variables

• Objective To systematically review the randomized trials, observational studies, and survey evidence on compression and pneumatic devices for thromboprophylaxis in intensive care patients. • Methods Published studies on the use of compression and pneumatic devices in intensive care patients were assessed. A meta-analysis was conducted by using the randomized controlled trials. • Results A total of 21 relevant studies (5 randomized controlled trials, 13 observational studies, and 3 surveys) were found. A total of 811 patients were randomized in the 5 randomized controlled trials; 3421 patients participated in the observational studies. Trauma patients only were enrolled in 4 randomized controlled trials and 4 observational studies. Meta-analysis of 2 randomized controlled trials with similar populations and outcomes revealed that use of compression and pneumatic devices did not reduce the incidence of venous thromboembolism. The pooled risk ratio was 2.37, indicative of favoring the control over the intervention in reducing the deep venous thrombosis; however, the 95% CI of 0.57 to 9.90 indicated no significant differences between the intervention and the control. A range of methodological issues, including bias and confounding variables, make meaningful interpretation of the observational studies difficult. • Conclusions The limited evidence suggests that use of compressive and pneumatic devices yields results not significantly different from results obtained with no treatment or use of low-molecular-weight heparin. Until large randomized controlled trials are conducted, the role of mechanical approaches to thromboprophylaxis for intensive care patients remains uncertain.

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Moral Distress of Staff Nurses in a Medical Intensive Care Unit

American Journal of Critical Care ◽

10.4037/ajcc2005.14.6.523 ◽

2005 ◽

Vol 14 (6) ◽

pp. 523-530 ◽

Cited By ~ 257

Author(s):

Ellen H. Elpern ◽

Barbara Covert ◽

Ruth Kleinpell

Keyword(s):

Job Satisfaction ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Moral Distress ◽

Medical Intensive Care Unit ◽

Well Being ◽

Individual Characteristics ◽

Medical Intensive Care ◽

Distress Scale

• Background Moral distress is caused by situations in which the ethically appropriate course of action is known but cannot be taken. Moral distress is thought to be a serious problem among nurses, particularly those who practice in critical care. It has been associated with job dissatisfaction and loss of nurses from the workplace and the profession.• Objectives To assess the level of moral distress of nurses in a medical intensive care unit, identify situations that result in high levels of moral distress, explore implications of moral distress, and evaluate associations among moral distress and individual characteristics of nurses.• Methods A descriptive, questionnaire study was used. A total of 28 nurses working in a medical intensive care unit anonymously completed a 38-item moral distress scale and described implications of experiences of moral distress.• Results Nurses reported a moderate level of moral distress overall. Highest levels of distress were associated with the provision of aggressive care to patients not expected to benefit from that care. Moral distress was significantly correlated with years of nursing experience. Nurses reported that moral distress adversely affected job satisfaction, retention, psychological and physical well-being, self-image, and spirituality. Experience of moral distress also influenced attitudes toward advance directives and participation in blood donation and organ donation.• Conclusions Critical care nurses commonly encounter situations that are associated with high levels of moral distress. Experiences of moral distress have implications that extend well beyond job satisfaction and retention. Strategies to mitigate moral distress should be developed and tested.

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858: EDUCATION FOR ROLE OF ICU SURROGATE IN THE MEDICAL INTENSIVE CARE UNIT

Critical Care Medicine ◽

10.1097/01.ccm.0000528867.16356.b1 ◽

2018 ◽

Vol 46 (1) ◽

pp. 413-413

Author(s):

Jennifer Johnson ◽

Carla Hannon ◽

Aydin Pinar ◽

Wei Teng ◽

Janet Parkosewich

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Medical Intensive Care Unit ◽

Medical Intensive Care

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A multicentered pharmacoepidemiological approach to evaluate clinically significant potential drug–drug interactions in medical intensive care settings in Pakistan

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918765510 ◽

2018 ◽

Vol 25 (4) ◽

pp. 190-195 ◽

Cited By ~ 1

Author(s):

Faisal Shakeel ◽

Jamshaid Ali Khan ◽

Muhammad Aamir ◽

Syed Muhammad Asim ◽

Irfan Ullah

Keyword(s):

Intensive Care ◽

Drug Interactions ◽

Intensive Care Units ◽

Potential Drug ◽

Significant Potential ◽

Significant Difference ◽

Tertiary Hospitals ◽

Medical Intensive Care ◽

Clinically Significant ◽

Multiple Drugs

Background: Iatrogenic injuries due to drug–drug interactions are particularly significant in critical care units because of the severely compromised state of the patient. The risk further increases with the use of multiple drugs, increasing age, and stay of the patient. Objective: The aim was to assess potential drug–drug interactions, evaluate clinically significant potential drug–drug interactions and their predictors in medical intensive care units of tertiary hospitals in Pakistan. Methods: Analysis of patient data collected from medical intensive care units of tertiary hospitals in Pakistan were carried out using Micromedex DrugReax. Various statistical tools were applied to identify the significance of associated predictors. Results: In a total of 830 patients, prevalence of potential drug–drug interactions was found to be 39%. These attributed to 190 drug combinations, of which 15.4% were clinically significant. A significant association of potential drug–drug interactions was present with number of prescribed drugs, age, and gender. In terms of clinically significant potential drug–drug interactions, the association was significant with increasing age. Moreover, one-way analysis of variance revealed a significant difference in the means of potential drug–drug interactions among the four hospitals. Conclusion: A prevalence of 39% potential drug–drug interactions was observed in patients of medical intensive care unit, with 22.8% being clinically significant. These attributed to nine drug pairs and could easily be avoided to reduce the risk of adverse effects from potential drug–drug interactions.

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