Impact on the work of clinical pharmacist at the pharmacotherapy management of critically ill patient: Local experience in a clinical hospital

Context: The complexity in critical patient management and polypharmacy, raise the need for support from a clinical pharmacist to optimize drug therapies. Aims: To evaluate the clinical pharmacist participation in an Adult Intensive Care Unit in a local context where the practice is not well established. Methods: The study was conducted in a teaching hospital. Consisted of two stages a retrospective in which were collected of pharmacotherapy follow-up during a period of two years and a prospective phase of observational and cross-sectional character, which picked up the clinical history of patients and pharmaceutical interventions. These pharmaceutical interventions were evaluated by two intensive care physicians and two external pharmacist, using a default score to each one of these, the degree of concordance was obtained using the kappa coefficient. Results: In the retrospective phase were collected 182 patients, who were performed a total of 750 interventions, of which 99.7% was accepted by physician. In the prospective phase, were analyzed 53 patients that involved 263 pharmaceutical interventions with 96.6% of acceptance on the part of the medical staff. The degree of correlation of the interventions was κ = 0.61 between two physicians of the unit, and κ = 0.71 between two external pharmacists. Conclusions: The contribution that a clinical pharmacist can provide in an adult intensive care has a positive impact on the treatment of patients with a high percentage of acceptances on the part of the medical team.