Hosp Pharm 2015;50(1):005–006 2015 © Thomas Land Publishers, Inc. www.hospital-pharmacy.com doi: 10.1310/hpj5001-005

Editorial Critical Care Series Joyce Generali, MS, RPh, FASHP*

A

dvancement in health care technology and new drugs continue to impact the complexity of patient care provided in the intensive care unit (ICU). As with all patient care directives, optimizing rational therapy while preventing errors and adverse events remains premier. In addition, ICU practices represent a significant proportion of hospital costs and utilization of resources. In a recent retrospective analysis, ICU drug use accounted for more than one-third (38.4%) of total hospital drug costs, with pharmacy charges ranking as the fourth most costly ICU charges.1 Because health care costs are not measured in dollars alone, several studies have also demonstrated the impact of adverse events and medication errors in the ICU setting.2-6 It has been well documented that factors associated with the care of critically ill patients increase the risk of adverse events including, but not limited to, significant polypharmacy with high-risk agents, acute changes in organ function that impact pharmacotherapy, dynamic comorbidities, severe illnesses, and lengthy hospital stays. Thus, the exploration of methods to provide safe and effective care in the ICU environment while maximizing health care resources has led to several studies evaluating patient outcomes, best-evidence practice models, and medication safety practices. One effective model is the team approach; multidisciplinary patient care in the ICU has been associated with improved outcomes and reductions in costs and adverse events.7-9 The role of the critical care pharmacist as a part of this team has been linked to enhanced patient outcomes and prevention of significant medications errors.9 As all aspects of health care, and in particular critical care, are a dynamic process, I am pleased to announce that a new series will be regularly published in Hospital Pharmacy regarding the importance of developing, implementing, and maintaining effective and safe critical care practices. This series, coordinated by Drs. Sandra Kane-Gill and

Zachariah Thomas, will provide a practical and thoughtful approach to several aspects of care for the critically ill adult patient in the ICU setting. The first article, included in this issue of Hospital Pharmacy, reports on adherence rates with national guideline recommendations regarding vitamin K use in the reversal of significant warfarin-related bleeding events. Additional articles in this series will contribute to the overall mission to examine the impact of pharmacologic interventions and practice model design on the treatment of the critically ill patient. Recent advances in drug therapy (including evolving and controversial data) for adult ICU patients will be reviewed and assessed in terms of clinical, humanistic, and economic outcomes.  In addition, this series can serve as a provocative educational tool for prompting discussion in pharmacy health systems. ­ I  commend the individuals involved in the creation of this series and look forward to the growth in discussion regarding these issues. REFERENCES 1. Weber RJ, Kane SL, Oriolo VA, Saul M, Skledar SJ, Dasta JF. Impact of intensive care unit (ICU) drug use on hospital costs: A descriptive analysis, with recommendations for optimizing ICU pharmacotherapy. Crit Care Med. 2003;31­ (1 suppl):S17-24. 2. Kane-Gill S, Rea RS, Verrico MM, Weber RJ. Adverse-drugevent rates for high-cost and high-use drugs in the intensive care unit. Am J Health Syst Pharm. 2006;63(19):1876-1881. 3. Kane-Gill SL, Kirisci L, Verrico MM, Rothschild JM. Analysis of risk factors for adverse drug events in critically ill patients. Crit Care Med. 2012;40(3):823-828. 4. Kane-Gill SL, Jacobi J, Rothschild JM. Adverse drug events in intensive care units: Risk factors, impact, and the role of team care. Crit Care Med. 2010;38(6 suppl):S83-89. 5. Farzanegan B, Alehashem M, Bastani M, Baniasadi S. Potential drug-drug interactions in cardiothoracic intensive care unit of a pulmonary teaching hospital [published online ahead of print November 5, 2014]. J Clin Pharmacol. doi: 10.1002/jcph.421

Editor-in-Chief, Hospital Pharmacy, and Clinical Professor, Emeritus, Department of Pharmacy Practice, University of Kansas, School of Pharmacy, Kansas City/Lawrence, Kansas

*

Hospital Pharmacy

08_hpj5001005_006.indd 5

5

24/12/14 12:19 PM

Editorial

6. Ahmed AH, Giri J, Kashyap R, et al. Outcome of adverse events and medical errors in the intensive care unit: A systematic review and meta-analysis [published online ahead of print December 19, 2013]. Am J Med Qual.

8. MacLaren R, Bond CA. Effects of pharmacist participation in intensive care units on clinical and economic outcomes of critically ill patients with thromboembolic or infarctionrelated events. Pharmacotherapy. 2009;29(7):761-768.

7. Preslaski CR, Lat I, MacLaren R, Poston J. Pharmacist contributions as members of the multidisciplinary ICU team. Chest. 2013;144(5):1687-1695.

9. Kane SL, Weber RJ, Dasta JF. The impact of critical care pharmacists on enhancing patient outcomes. Intens Care Med. 2003;29(5):691-698. 

6

08_hpj5001005_006.indd 6

Volume 50, January 2015

24/12/14 12:19 PM

Critical care series.

Critical care series. - PDF Download Free
98KB Sizes 0 Downloads 8 Views