An Assessment of the need of pharmaceutical services in the intensive care unit and high care unit of Steve Biko Academic hospital

Abstract

The role of the pharmacist has evolved over the last two decades beyond the traditional functions of dispensing and stock control. The focus has shifted toward patient-oriented functions, in which the pharmacist assumes responsibility for the patient’s drug- and healthcare needs as well as the outcome of treatment. The aim of this research was to assess the need for pharmaceutical care to the Surgical Intensive Care Unit of Steve Biko Hospital. The surgical and trauma ICU is a 12 bed unit to which the researcher rendered pharmaceutical care over an eight week period, from 14 February to 26 March 2011. Interventions to assess drug therapy and achieve definite outcomes to improve patients’ quality of life were documented for 51 study patients according to the system developed by the American Society of Health-System Pharmacists (1992). Of the 51 patients, 35 were male and 16 were female. The age of the patients ranged from 12 years to 86 years, with most patients admitted to the unit in the age groups 21 to 30 years, and 51 to 60 years. The patients’ estimated weights ranged from 40kg to 120kg with older patients, from age 41 upwards, weighing more. The average stay in the unit was 8.7 days, with the minimum stay for one patient being only one day, and the maximum stay for one patient was 26 days. In the study, the HIV status of only 13 of the 51 patients was tested. Of the 13 patients, six were HIV positive, while seven tested negative. All the patients admitted to the unit were not tested for HIV, because they were not admitted to the unit for HIV-related causes, and test results would not have had an effect on their outcome. Diagnoses encountered most frequently in the unit were trauma (21 patients), skeletal involvement or fractures (16 patients), infections or sepsis (15 patients) and gastro-intestinal bleeds (14 patients). In most cases more than one diagnosis applied to the same patient, since patients admitted with trauma also had skeletal or gastro-intestinal involvement. An Assessment of the need of Pharmaceutical Services in the Intensive Care Unit and High Care Unit of Steve Biko Academic Hospital viii The medications prescribed most frequently were enoxaparin (49 patients), sucralfate (41 patients) and multivitamin syrup (47 patients); in accordance with the standard ward protocol for prophylactic regimens. The drug class most often used was the anti-infectiveshaving124 items prescribed during the study period. Of these, the broad spectrum antibiotics were used most frequently, e.g. piperacillin/tazobactam (22 patients), meropenem (11 patients) and imipenem (11 patients). An average of 12 medications was prescribed for each patient in the ward. A total of 181 interventions were suggested for the 51 patients during the study period, of which 127 (70%) were accepted and implemented by the medical and nursing staff. The average number of interventions per patient ranged from 0 to 13 with a median of 3.5 interventions per patient. The four most frequent problem types were untreated medical conditions (15.5%), length or course of therapy inappropriate (13.8%), investigations indicated or outstanding (12.2%) and prescribed doses and dosing frequency appropriate (11%). Interventions were also made regularly to address system errors or non-compliance and factors hindering achievement of therapeutic effect. The perceived need for pharmaceutical care by healthcare professionals in the SICU was measured by questionnaires before and after the study period. The feedback by staff regarding the pharmacist working in the ward was very positive. They appreciated the researchers input on ward rounds, as well as assistance with problems encountered with the pharmacy. Of the total time spent in the ward, the researcher spent 28% of her time on patient evaluation. Ward rounds also took up a great deal of time (21.7%), since ward rounds were done with different members of the multidisciplinary team. Most interventions were suggested during ward rounds. The costs saved during the study period were enough to justify the appointment of a pharmacist to the ward on a permanent basis, albeit for limited hours daily. The researcher designed an antibiotic protocol for the unit. The protocol was designed according to international standards, and after discussion with the microbiologists, adapted for use in the specific unit. An Assessment of the need of Pharmaceutical Services in the Intensive Care Unit and High Care Unit of Steve Biko Academic Hospital ix In conclusion, the study results have demonstrated that a pharmacist’s contribution to patient care at ward level in a surgical ICU resulted in clinical outcomes that improved the patient’s quality of life. Drug-related problems were identified and addressed. Medical staff in the S-ICU accepted the pharmacist’s interventions and even welcomed her contribution to other ward functions, for instance managing medication and providing education. Pharmaceutical care should be rendered on a permanent basis to the Surgical ICU and the pharmacist should increasingly become a key part of the multidisciplinary team, taking responsibility for patients’ medication needs.