Article by Pharmacy Times

“Critical care pharmacists ensure optimal pharmaceutical care in critically ill patients. Studies have shown that critical care pharmacists reduce medication errors, reduce cost, and improve patient outcomes.1 I recently had the opportunity to spend a week training with pharmacists in the intensive care unit. I hope to share what I learned about how pharmacy can improve outcomes in this patient population.

Below are just a few of the interventions critical care pharmacists make to enhance patient care:

DVT prophylaxis: Limitations in mobility lead to an increased risk of developing deep vein thrombosis (DVT). DVT prophylaxis is an aspect of supportive care where pharmacists play a key role. At our facility, we were able to run a VTE prophylaxis report with the most recent DVT prophylaxis ordered for a patient, including sequential compression devices, enoxaparin, or unfractionated heparin. Pharmacists review the patient’s INR, platelet count, hemoglobin, and hematocrit to assess appropriateness of chemical prophylaxis. The general chief complaint or reason for admission can also indicate whether a patient may be a candidate for chemical prophylaxis. For example, chemical prophylaxis may not be the best choice in a patient who has received a thrombolytic within the past 24 hours. If anticoagulation is suspended for this reason, pharmacists may review follow-up CT scans, and consult with the neurologist on the plan for DVT prophylaxis going forward.

Stress ulcer prophylaxis: Critical care pharmacists determine whether patients are appropriate candidates for stress ulcer prophylaxis, and make recommendations to order or discontinue such therapy as necessary. Currently, guidelines recommend the use of stress ulcer prophylaxis in patients with mechanical ventilation for >48 hours or nonintentional coagulopathy. Prophylaxis is also recommended in patients with a history of GI bleed within 1 year of admission or who meet 2 or more minor criteria, which are detailed in the ASHP Guidelines on Stress Ulcer Prophylaxis.2 Pharmacists continue to monitor these patients, and recommend discontinuation of stress ulcer prophylaxis if the patient no longer meets the requirements for therapy.”

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