An assessment of the impact of a clinical Pharmacist on an intensive Care Unit at a Private Hospital

Abstract

Background: The role of the pharmacist is changing. They are assuming greater roles and responsibilities. These roles and responsibilities have not been established or evaluated in the private sector in South Africa. Objectives: To determine whether there was a decrease in the rand-value of the monthly credits (medications not used by the patient and returned to the pharmacy for a credit) for the ICU pre- and post-implementation of clinical pharmacy services. To determine whether there was a decrease in the number of daily scripts from the ICU reaching the pharmacy pre- and post-implementation of clinical pharmacy services. To determine whether there was a decrease in the average ICU stay (a decrease in the average amount of days that the patient spends in ICU) pre- and post-implementation of clinical pharmacy services. To compare the total medication bill of patients pre- and post-implementation of clinical pharmacy services. Patients with the same type of diseases were grouped and compared. A breakdown of the classes of the drugs used pre- and post-implementation of clinical pharmacy services were given and the amount of each drug and the rand value over both years were explored. To assess the incidence of interventions performed by a pharmacist during the provision of clinical pharmacy services. To determine the need of a clinical pharmacist by the number of interventions made. Method: Aims To determine whether there is a need for a clinical pharmacist in the intensive care unit. To determine whether there were cost-savings involved with a clinical pharmacist attending to the intensive care unit. Study site The study was conducted in the intensive care units at a private hospital in Pretoria. The intensive care units consists out of the Medical ICU (11 beds) and the Trauma ICU (17 beds). Study design The design of the study was quantitative and non-experimental. Data were collected retrospectively. Study period Patients admitted to the ICU one year before (October 2008 – September 2009) and one year after (October 2009 – September 2010) the implementation of dedicated ICU pharmacy services were retrospectively reviewed. Clinical pharmacy services were implemented from the 1st of October 2009. Sample population The records of all patients, adults and children, admitted to the ICU unit over the study period October 2008 to September 2010 were included. Results: ICU stay and diagnoses Average ICU days for the year pre-clinical pharmacy services were 5.56 days per patient and for the year post-clinical pharmacy services 5.25 days per patient. The two groups were very similar regarding ICU days. Patients with the same type of diseases were grouped and compared. Monthly credits The total amount of credits in the year post-clinical pharmacy services, decreased with an amount of R335 160.30. That equals a decrease of 48.86%. Number of daily scripts There was a decrease of 809 prescriptions in the year post-clinical pharmacy services. Breakdown of the classes of drugs The total number of items dispensed in the year post-clinical pharmacy services decreased with 19 678 items. The stock value for the year post-clinical pharmacy services decreased with R1 595 622. Total medication bill The ICU drug total for the year pre-clinical pharmacy services was R14 563 687. The ICU drug total for the year post-clinical pharmacy services was R13 030 335.39. The total decreased with R1 533 351.61. Interventions made by the clinical pharmacist The clinical pharmacist made 349 interventions for the year post-clinical pharmacy services, compared to the 105 interventions made by the nursing staff and attending physicians for the year pre-clinical pharmacy services. These interventions included detection or prevention of allergies, clinical recommendations, detecting of dispensing errors, detecting of dosing errors, duplicate therapy and transcribing errors. Conclusions: There is a need for clinical pharmacy services in a private hospital. The pharmacist positively contributes to and is directly involved in the care of critically ill patients. Pharmacy education programmes in South Africa will have to be adjusted to accommodate this new branch of pharmacy.