scholarly journals Critical Care Pharmacist Using Free Drug-Interaction Checker Mobile Apps Can Ensure Medication Safety in Critically Ill Patients

2020 ◽  
Vol 12 (2) ◽  
Author(s):  
Md Jahidul Hasan ◽  
Raihan Rabbani ◽  
Sitesh C Bachar
Keyword(s):  
Critical Care ◽  
Drug Interaction ◽  
Drug Interactions ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medication Safety ◽  
Mobile Apps ◽  
Free Drug ◽  
Satisfaction Level ◽  
Resource Limited

Background: Critical care pharmacists (CCPs) have a key role in ensuring medication safety by screening drug-drug interactions (DIs) in polypharmacy prescriptions, mostly in critically ill patients. The drug-interaction checker mobile apps (DICMA) are freely available for smartphones. Objectives: The current study aimed to assess the utilization of smartphone-based free mobile apps by CCPs for ensuring drug-drug interaction-free polypharmacy prescriptions in critically ill patients. Methods: This observational study was conducted in an intensive care unit. Critical care pharmacists (CCPs) checked the medications of polypharmacy prescriptions to detect DIs or potential drug-drug interactions (PDIs) using free DICMA installed on their smartphones. DIs/PDIs were sent to physicians as suggestions, and the prescriptions were modified accordingly. Results: CCPs screened 2,967 prescriptions, where 11,128 and 3,932 DIs and PDIs were identified, respectively. Prescriptions with 6 to 10 medications and prescription with more than 10 medications, on average, had 3.28 and 7.53 DIs, respectively, and 1.42 and 4.7 PDIs, respectively. Physicians accepted 95.85% (n = 3,932) of PDI suggestions from CCPs and modified prescriptions, accordingly. CCPs reported a satisfaction level of 4 (on a scale of 5) concerning the use of free DICMA. Conclusions: Drug-drug interactions-free polypharmacy prescriptions can ensure medication safety in patients. CCPs are professionally responsible for this task, but resource-limited setups do not provide them scopes to accomplish this task efficiently. In this study, CCPs ensured medication safety in the prescriptions of critically ill patients efficiently using free DICMA installed on their smartphones.

scholarly journals Clinical Interventions of Critical Care Pharmacist in the Therapeutic Management of Critically Ill Patients: a Retrospective Study in Bangladesh

2019 ◽  
Vol 18 (1) ◽  
pp. 113-119
Author(s):  
Md Jahidul Hasan ◽  
Raihan Rabbani ◽  
Sitesh C Bachar
Keyword(s):  
Adverse Drug Reaction ◽  
Critical Care ◽  
Drug Reaction ◽  
Drug Interaction ◽  
Retrospective Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medication Management ◽  
Drug Management ◽  
Effective Medication

Critically ill patients at ICU are treated with poly pharmacy and conservative drug management is necessary for ensuring drugs’ safety and accuracy. The objective of this study was to analyze the qualitative intervention of critical care pharmacists (CCP) in critically ill patients’ effective medication management. This was a 6 months long observational study. All the provided suggestions of CCP were categorized into- A (drug-drug interaction), B (addition of new drug therapies), C (rational dosing of antibiotics), D (acceleration or deceleration of the doses) and E (adverse drug reaction). Out of total CCP’s 650 suggestions, 566 (87.08%) suggestions were accepted by doctors and modified the therapies, accordingly. CCP being a part of ICU’s multi professional team contribute the professional roles in generating safe, appropriate and quality prescriptions, which finally turns into quality pharmacotherapy for critically ill patients at ICU. Dhaka Univ. J. Pharm. Sci. 18(1): 113-119, 2019 (June)

scholarly journals Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
M. Ostermann ◽  
A. Schneider ◽  
T. Rimmele ◽  
I. Bobek ◽  
M. van Dam ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Critical Care ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Future Research ◽  
Knowledge Gaps ◽  
Blood Pressure Targets

Abstract Purpose Critical Care Nephrology is an emerging sub-specialty of Critical Care. Despite increasing awareness about the serious impact of acute kidney injury (AKI) and renal replacement therapy (RRT), important knowledge gaps persist. This report represents a summary of a 1-day meeting of the AKI section of the European Society of Intensive Care Medicine (ESICM) identifying priorities for future AKI research. Methods International Members of the AKI section of the ESICM were selected and allocated to one of three subgroups: “AKI diagnosis and evaluation”, “Medical management of AKI” and “Renal Replacement Therapy for AKI.” Using a modified Delphi methodology, each group identified knowledge gaps and developed potential proposals for future collaborative research. Results The following key research projects were developed: Systematic reviews: (a) epidemiology of AKI with stratification by patient cohorts and diagnostic criteria; (b) role of higher blood pressure targets in patients with hypertension admitted to the Intensive Care Unit, and (c) specific clearance characteristics of different modalities of continuous renal replacement therapy (CRRT). Observational studies: (a) epidemiology of critically ill patients according to AKI duration, and (b) current clinical practice of CRRT. Intervention studies:( a) Comparison of different blood pressure targets in critically ill patients with hypertension, and (b) comparison of clearance of solutes with various molecular weights between different CRRT modalities. Conclusion Consensus was reached on a future research agenda for the AKI section of the ESICM.

scholarly journals Feasibility of cardiac output measurements in critically ill patients by medical students

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Geert Koster ◽  
Thomas Kaufmann ◽  
Bart Hiemstra ◽  
Renske Wiersema ◽  
Madelon E. Vos ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Critical Care ◽  
Medical Students ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Left Ventricular ◽  
Percentage Error ◽  
Poor Agreement ◽  
Cardiac Output Measurements

Abstract Background Critical care ultrasonography (CCUS) is increasingly applied also in the intensive care unit (ICU) and performed by non-experts, including even medical students. There is limited data on the training efforts necessary for novices to attain images of sufficient quality. There is no data on medical students performing CCUS for the measurement of cardiac output (CO), a hemodynamic variable of importance for daily critical care. Objective The aim of this study was to explore the agreement of cardiac output measurements as well as the quality of images obtained by medical students in critically ill patients compared to the measurements obtained by experts in these images. Methods In a prospective observational cohort study, all acutely admitted adults with an expected ICU stay over 24 h were included. CCUS was performed by students within 24 h of admission. CCUS included the images required to measure the CO, i.e., the left ventricular outflow tract (LVOT) diameter and the velocity time integral (VTI) in the LVOT. Echocardiography experts were involved in the evaluation of the quality of images obtained and the quality of the CO measurements. Results There was an opportunity for a CCUS attempt in 1155 of the 1212 eligible patients (95%) and in 1075 of the 1212 patients (89%) CCUS examination was performed by medical students. In 871 out of 1075 patients (81%) medical students measured CO. Experts measured CO in 783 patients (73%). In 760 patients (71%) CO was measured by both which allowed for comparison; bias of CO was 0.0 L min−1 with limits of agreement of − 2.6 L min−1 to 2.7 L min−1. The percentage error was 50%, reflecting poor agreement of the CO measurement by students compared with the experts CO measurement. Conclusions Medical students seem capable of obtaining sufficient quality CCUS images for CO measurement in the majority of critically ill patients. Measurements of CO by medical students, however, had poor agreement with expert measurements. Experts remain indispensable for reliable CO measurements. Trial registration Clinicaltrials.gov; http://www.clinicaltrials.gov; registration number NCT02912624

A Systematic Review of Anticoagulation Strategies for Patients With Atrial Fibrillation in Critical Care.

2021 ◽  
Author(s):  
Alexandra Jayne Nelson ◽  
Brian W Johnston ◽  
Alicia Achiaa Charlotte Waite ◽  
Gedeon Lemma ◽  
Ingeborg Dorothea Welters
Keyword(s):  
Atrial Fibrillation ◽  
Critical Care ◽  
Critically Ill ◽  
Major Bleeding ◽  
Critically Ill Patients ◽  
Thromboembolic Events ◽  
Bleeding Events ◽  
Major Bleeding Events ◽  
The Impact ◽  
Anticoagulated Patients

Background. Atrial fibrillation (AF) is the most common cardiac arrhythmia in critically ill patients. There is a paucity of data assessing the impact of anticoagulation strategies on clinical outcomes for general critical care patients with AF. Our aim was to assess the existing literature to evaluate the effectiveness of anticoagulation strategies used in critical care for AF. Methodology. A systematic literature search was conducted using MEDLINE, EMBASE, CENTRAL and PubMed databases. Studies reporting anticoagulation strategies for AF in adults admitted to a general critical care setting were assessed for inclusion. Results. Four studies were selected for data extraction. A total of 44087 patients were identified with AF, of which 17.8-49.4% received anticoagulation. The reported incidence of thromboembolic events was 0-1.4% for anticoagulated patients, and 0-1.3% in non-anticoagulated patients. Major bleeding events were reported in three studies and occurred in 7.2-8.6% of the anticoagulated patients and up to 7.1% of the non-anticoagulated patients. Conclusions. There was an increased incidence of major bleeding events in anticoagulated patients with AF in critical care compared to non-anticoagulated patients. There was no significant difference in the incidence of reported thromboembolic events within studies, between patients who did and did not receive anticoagulation. However, the outcomes reported within studies were not standardised, therefore, the generalisability of our results to the general critical care population remains unclear. Further data is required to facilitate an evidence-based assessment of the risks and benefits of anticoagulation for critically ill patients with AF.

Efficacy of Epidural Analgesia for Pain Management of Critically Ill Patients and the Implications for Nursing Care

1991 ◽  
Vol 2 (4) ◽  
pp. 729-740 ◽  
Author(s):  
Jeanne F. Slack ◽  
Margaret Faut-Callahan
Keyword(s):  
Critical Care ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Critically Ill ◽  
Nursing Care ◽  
Critically Ill Patients ◽  
Continuous Epidural Analgesia ◽  
Analgesic Agents ◽  
Care Problems ◽  
Critical Care Patients

Management of pain for critically ill patients has been shown to be inadequately controlled and can have serious deleterious effects on a patient’s recovery. Continuous epidural analgesia can be used to control pain in critical care patients. This mode of analgesia administration provides pain relief without the delays inherent in the as-needed administration of analgesics. Fifteen critical care unit patients were part of a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 43 thoracic and 66 abdominal surgery patients. The purpose of the study was to identify the benefits and problems associated with continuous epidural analgesia administration and the implications for the nursing care of critically ill patients. Evaluation of the effectiveness of the analgesia was based on the following measures: 1) pain measured at regular intervals in the 72-hour period with a visual analog; 2) pain as measured after 72 hours with the word descriptor section of the McGill pain questionnaire; 3) amount of supplemental systemic narcotic analgesic needed; 4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; 5) occurrence of adverse effects, and 6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used as-needed systemic administration of narcotics. Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and the management of patient care

scholarly journals Iatrogenic forearm compartment syndrome

2016 ◽  
Vol 18 (1) ◽  
pp. 63-65
Author(s):  
Ahmed Elmorsy ◽  
James Nutt ◽  
Nick Taylor ◽  
Justin Kirk-Bayley ◽  
Sean Hughes
Keyword(s):  
Critical Care ◽  
Compartment Syndrome ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Sampling ◽  
Forearm Compartment Syndrome ◽  
Arterial Damage

Limb compartment syndrome may be sequelae of trauma, but in the context of critical care blood sampling, arterial damage may have profound consequences. We describe a series of three cases and their progress and discuss guidelines for prevention of this potentially devastating occurrence in critically ill patients.

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