Pharmacists crucial to ICU follow-up

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More than 80% of COVID-19 ICU patients required a medication intervention in this study, with a pharmacist stepping in to identify changes

Pharmacists can deliver interventions that provide significant benefit to COVID-19 ICU patients post-discharge, new UK research has found.

Thirty-nine patients were enrolled in the study following discharge from Belfast Trust hospitals between 26 March 2020 and 15 May 2020 following COVID-19 ICU admission.

During their ICU admission, 100% (n=39) of patients required mechanical ventilation; 21% (n=8) required renal replacement therapy; and 66% (n=26) received cardiovascular support.

The clinical pharmacist provided a total of 64 interventions, with 46% (n=18) of patients requiring two or more interventions and 18% (n=7) requiring three of more interventions.

Many of the interventions in the study were related to symptom management and are consistent with emerging evidence on COVID-19 complications, such as fatigue, dysphagia, cough, neuromuscular weakness, pain and neuropathy.

Medication-related interventions were identified in 83% (n=32) of the patients who were involved with the service, according to the The Pharmaceutical Journal study.

The most common medication-related intervention was patient education, followed by review of medication that was no longer appropriate.

Most interventions 65% (n=42) were graded as Eadon ≥4, meaning they were significant interventions resulting in improved care standards.

Classes of medication most associated with requiring an intervention were analgesics with 30% of patients (n=19) followed by cardiovascular with 16% (n=10).

“This is unsurprising given those surviving critical illness with COVID-19 are at a risk of developing chronic pain,” said Stephen Ward clinical pharmacy lead, Belfast City Hospital and co-authors Rosalind O’Reilly and Paula Crawford.

COVID-19 ICU patients are likely to have undergone multiple interventions that are potentially painful or can lead to persistent neuropathic and musculoskeletal pain.

Emerging evidence from the pandemic suggests that COVID-19 itself can cause painful symptoms, including arthralgia, headache and myalgia as well as painful neurological disease, they added.

The clinical pharmacist in the study was able to make recommendations on dose titration, choice and appropriate use of analgesics, said the researchers.

Other examples of interventions included drug–herb interaction advice; discontinuing proton pump inhibitor therapy no longer required; inhaler technique counselling; highlighting key messages when non-adherence identified; and restarting a statin based on elevated lipid profile.

Source: The Pharmaceutical Journal.

Total measurable potential savings in terms of reduction in healthcare resource utilisation and drug cost savings were estimated to be between AU$1,859–AU$3,803 per clinic day, or up to AU$15.45 per AU$1.80 invested.

In Australia right now, there are currently 47 people in hospital with COVID-19, of which one is in the ICU.

Meanwhile in the UK, there are 2,004 COVID-19 patients still in hospital of which 300 COVID-19 patients are in ventilation beds.

However the researchers say their study contributes to a general body of evidence demonstrating the role of a pharmacist in identifying and treating medication-related problems in an ICU recovery clinic.

“Although this evaluation is set in the context of COVID-19, it adds weight to the benefits a critical care clinical pharmacist can deliver beyond patient discharge from ICU and the hospital setting,” they said.

Read the full article in The Pharmaceutical Journal

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