Pharmaceutical service development in anaesthesia

Abstract

Intensive Therapy Units (ITUs) are amongst the most resource challenging and demanding areas of hospitals mainly because such settings care for the critically ill hospitalised patients. The delivery of direct, proactive, patient-centered care by pharmacists has been correlated with actual and perceived patient outcome improvement. The aim of this research was to develop and establish a pharmaceutical service within the ITU at Mater Dei Hospital (MDH) specifically tailored to the needs of this area. Prior to commencement of the research, approval by the University Research Ethics Committee was sought. Phase I of the study focused on the development of the pharmaceutical service. During this phase, the pharmacist-researcher attended ward rounds and observed the current care practice delivered. This current practice was compared to international standards of practice for clinical pharmacy services issued specifically for an ITU setting. Phase II of the study targeted the implementation of the pharmaceutical service where the patient medical record was used for patient profile compilation. Pharmaceutical care issues identified were discussed with the interdisciplinary team and the outcomes recorded. Forty patient ward rounds each lasting approximately 3 hours were attended between December 2020 and January 2021. Over the 2 month interval a total of 165 patients were admitted to the ITU and 133 pharmaceutical care issues (PCIs) were identified by the pharmacist-researcher. Classification of identified PCIs revealed that the most common PCI category encountered was drug selection (N=59), followed by dose selection (N=26), drug administration (N=18) and dispensing (N=13). A pharmaceutical intervention was proposed by the pharmacist-researcher for every identified PCI and a 95% acceptance and implementation rate was observed. The results of this research highlight the benefits of the pharmacist as part of the interdisciplinary team tendering care to patients admitted at the ITU for intensive care. The implementation of the developed service at the ITU further builds on the continuous and relentless effort in improving care standards provided to patients admitted to MDH and lays the groundwork for future implementation of structured improved pharmaceutical services supporting anaesthesia within operating theatres.