The ICU pharmacist's contribution to antimicrobial optimization through routine pharmacist interventions.

Area of Science:

• Pharmacology
• Intensive Care Medicine
• Drug Safety

Background:

• Antimicrobials are frequently implicated in medication errors and adverse drug events within Intensive Care Units (ICUs).
• The role of Critical Care Pharmacists (CCPs) in antimicrobial stewardship is supported by evidence, yet their integration into European ICU teams is inconsistent.

Purpose of the Study:

• To evaluate the impact of Critical Care Pharmacists (CCPs) on identifying and intervening in antimicrobial-related drug problems within an Intensive Care Unit (ICU).
• To characterize the types and frequency of pharmaceutical interventions related to antimicrobial therapy.

Main Methods:

• A prospective observational study was conducted over five months in a medical-surgical ICU.
• A specialist pharmacist prospectively reviewed daily antimicrobial prescriptions via an electronic system.
• Pharmaceutical interventions (PIs) were classified as proactive or reactive and categorized by type.

Main Results:

• A total of 331 PIs were recorded, with 150 (45.31%) related to antimicrobial therapy, making it the most common medication group involved.
• Antimicrobial-related PIs averaged 1.50 per working day, with 76.67% being proactive.
• The most frequent interventions involved dose adjustments for overdosing (47.33%) and underdosing (18.00%), alongside therapeutic drug monitoring and drug information.

Conclusions:

• Critical Care Pharmacists (CCPs) effectively identify a significant number of antimicrobial-related drug issues in the ICU through routine prospective review.
• The prevalence of both overdosing and underdosing interventions underscores the pharmacokinetic challenges in critically ill patients.
• These findings advocate for the formal integration of CCPs into ICU antimicrobial stewardship initiatives.