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Impact of medication therapy management on pharmacotherapy safety in an intensive care unit

International Journal of Clinical Pharmacy volume 41, pages 179–188 (2019)Cite this article

Abstract

Background Drug-related problems are mostly preventable or predictable circumstances that may impact on health outcomes. Clinical pharmacy activities such as medication therapy management can identify and solve these problems, with potential to improve medication safety and effectiveness. Objective To evaluate ability of medication therapy management service to detect drug-related problems and prevent adverse drug events. This study also aimed to assess the risk factors for drugrelated problem occurrence. Setting Medical intensive care unit of a public tertiary hospital in Brazil. Methods Patients were evaluated by a clinical pharmacist, who provided medication therapy management service. Detected drug-related problems were categorized according to the Pharmaceutical Care Network Europe methodology and analyzed in multinomial regression to identify risk factors. Main outcome measure Potential risk factors for drug-related problem occurrence. Results The proposed medication therapy management service allowed detection of 170 drug-related problems that had potential to reach patients causing harm and other 50 unavoidable adverse events. Drug-related problems identified were more often associated with antibacterial use, caused by improper combinations or inadequate drug dosage. These problems required interventions that were accepted by the multidisciplinary team, resulting in more than 85% adherence and total problem solving. Main risk factors identified were previous diagnosis of kidney injury (OR = 8.38), use of midazolam (OR = 7.96), furosemide (OR = 5.87) and vancomycin (OR = 4.82). Conclusion Medication therapy management proved to be an effective method not only for drug-related problem detection, but also for adverse drug event prevention, contributing to improve patient safety.

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Acknowledgements

The authors thank Prof. Nathalie de L. S. Dewulf and Prof. Ana Elisa B. C. Silva for their suggestions, support and encouragement.

Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001—grants AUXPE 1665/2016 and Fundação de Amparo à Pesquisa do Estado de Goiás (FAPEG).

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  1. Laboratório de Pesquisa em Ensino e Serviços de Saúde (LaPESS), Faculdade de Farmácia, Universidade Federal de Goiás – UFG, 240th street corner of 5th Avenue, Goiânia, GO, 74650-170, Brazil

    Renato Rocha Martins, Lunara Teles Silva & Flavio Marques Lopes

  2. Divisão de Farmácia, Hospital Geral de Goiânia Dr. Alberto Rassi, 6479, Anhanguera Avenue, Goiânia, GO, 74110-010, Brazil

    Renato Rocha Martins

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  1. Renato Rocha Martins
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  2. Lunara Teles Silva
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Correspondence to Flavio Marques Lopes.

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Martins, R.R., Silva, L.T. & Lopes, F.M. Impact of medication therapy management on pharmacotherapy safety in an intensive care unit. Int J Clin Pharm 41, 179–188 (2019). https://doi.org/10.1007/s11096-018-0763-0

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Keywords

  • Adverse drug events
  • Brazil
  • Clinical pharmacists
  • Drug-related problems
  • Medication therapy management
  • PCNE DRP-classification