Pharmacist proactive medication recommendations using electronic documentation in a UK general critical care unit.

Area of Science:

• Pharmacy Practice
• Critical Care Medicine
• Health Services Research

Background:

• Limited data exists on UK critical care pharmacists' clinical practice.
• Clinical pharmacists at Sheffield Teaching Hospitals use an electronic system (MetaVision®) for documenting and tracking medication recommendations.

Purpose of the Study:

• To evaluate the acceptance rate of pharmacist-led proactive medication recommendations by medical staff.
• To analyze the types and reasons for these recommendations in a UK teaching hospital's general intensive care unit.

Main Methods:

• Retrospective analysis of 5,623 electronic pharmacist recommendations from January 2009 to July 2011.
• Data collected from general intensive care unit patients at Sheffield Teaching Hospitals NHS Foundation Trust.

Main Results:

• Medical staff accepted 90.7% (5,101) of the 5,623 recommendations.
• Top recommendations included adding drugs (28.2%), dose reviews (25.8%), and discontinuing drugs (17.9%).
• Key reasons for recommendations involved gastrointestinal absorption changes (15.6%), guideline compliance (14.1%), and sedation management (12.6%).

Conclusions:

• A high acceptance rate (90.7%) was observed for proactive medication recommendations by critical care pharmacists.
• Most recommendations involved optimizing existing medication regimens.
• Medication reconciliation for pre-admission medications accounted for 10% of recommendations.