Impact of the introduction of a specialist critical care pharmacist on the level of pharmaceutical care provided to the critical care unit.

OBJECTIVES: To evaluate the impact of a dedicated specialist critical care pharmacist service on patient care at a UK critical care unit (CCU). METHODS: Pharmacist intervention data was collected in two phases. Phase 1 was with the provision of a non-specialist pharmacist chart review service and Phase 2 was after the introduction of a specialist dedicated pharmacy service. Two CCUs with established critical care pharmacist services were used as controls. The impact of pharmacist interventions on optimising drug therapy or preventing harm from medication errors was rated on a 4-point scale. KEY FINDINGS: There was an increase in the mean daily rate of pharmacist interventions after the introduction of the specialist critical care pharmacist (5.45 versus 2.69 per day, P < 0.0005). The critical care pharmacist intervened on more medication errors preventing potential harm and optimised more medications. There was no significant change to intervention rates at the control sites. Across all study sites the majority of pharmacist interventions were graded to have at least moderate impact on patient care. CONCLUSION: The introduction of a specialist critical care pharmacist resulted in an increased rate of pharmacist interventions compared to a non-specialist pharmacist service thus improving the quality of patient care.

Diabetic ketoacidosis and hyperglycaemic hyperosmolar syndrome - clinical guidelines.

BACKGROUND: The aim of this study was to establish a standardized approach to the initial care of patients with diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar syndrome (HHS). DKA and HHS are metabolic emergencies. Effective and efficient management is the responsibility of the multidisciplinary team. The admission of patients to the intensive care unit (ICU) with DKA and HHS is rare, and management of patients' diverse problems is prone to error because of a lack of familiarity. AIM: The paper's aim is to set the developmental process of a clinical guideline following a review of the literature. DISCUSSION: This clinical guideline is based on a review of the evidence available within the literature in the early phase of resuscitation. Collaborative working among the multidisciplinary team through clinical practice group was the method adopted. Management of DKA and HHS is divided into three main areas: intravenous fluid replacement, insulin therapy and electrolyte management. The controversy associated with the administration of sodium bicarbonate is discussed. CONCLUSION: Effective treatment requires a rapid initial assessment of the patient based on current medical history and clinical presentation. To this end, a quick reference algorithm and guide to management were also developed. Key criteria for evaluating the effectiveness of treatment are provided and complications of treatment are addressed. The formation of the practice development group that led to this innovation is outlined, and in conclusion, the success of the group is reflected upon.

National Patient Safety Agency: improving patient safety across all critical care areas.

The National Patient Safety Agency (NPSA) reviews patient safety incidents throughout the National Health Service (NHS) in the United Kingdom and aims to initiate preventative measures. Recent alerts include injectable medication, oral syringes for enternal administration, preventing hyponatraemia in children and anticoagulation. This article gives an insight into the rationale and steps currently being undertaken to respond to these recommendations.

Rasburicase in the prevention and treatment of tumour lysis syndrome.

Tumour lysis syndrome (TLS) can be a life threatening complication of cancer therapy where cells undergo overwhelming lysis. The result is a pattern of metabolic abnormalities leading to acute renal failure and possible coagulopathy. Prophylactic pharmaceutical interventions can prevent this syndrome in almost all patients reducing possible admission to the intensive care unit. This article reviews the clinical efficacy, side effect profile, dosing and administration of rasburicase, an intravenous recombinant urate oxidase used in patients at risk of Tumour lysis syndrome due to a high tumour burden or where treatment is required. Rasburicase is an expensive but effective treatment option in the prevention and treatment of tumour lysis syndrome.

Caspofungin in the treatment of invasive fungal infections.

Caspofungin is a member of a new class of antifungals called Echinocandins and is the first to have marketing authorisation in the United Kingdom. This article reviews the clinical efficacy, side effect profile, dosing and administration schedule of caspofungin. The article also discusses the warnings and precautions associated with the use of this drug. Caspofungin is an effective treatment option in the management of fungal infections.

Voriconazole in the treatment of invasive fungal infections.

Fungal infections in immunocompromised patients in the Intensive Care Unit (ICU) are a major cause of mortality and morbidity and can lead to extended stays on the ICU. New antifungal drugs have been developed to increase treatment options to improve the clinical outcome. This article reviews the clinical efficacy, side effect profile, dosing and administration schedule of voriconazole, a recently launched second generation triazole. The article also discusses the warnings and precautions associated with the use of this drug. Voriconazole is an effective treatment option in the management of fungal infections.