Intervenciones farmacéuticas y factores asociados a su aceptación en unidades de cuidados intensivos en Brasil

Ana Vitória Martins de Oliveira; Elana Figueiredo Chaves; Amanda Mota Conceição; Liana Moreira Magalhães; Breno Queiroz de Araújo; Cinthya Cavalcante de Andrade; José Martins de Alcântara Neto; Alene Barros de Oliveira

doi:10.30827/ars.v64i3.27249

Autores/as

Ana Vitória Martins de Oliveira Federal University of Ceará, Walter Cantídio University Hospital, Multiprofessional Integrated Residency Program in Hospital Health Care, Fortaleza, Brazil. https://orcid.org/0000-0002-9413-4717
Elana Figueiredo Chaves Federal University of Ceará, Walter Cantídio University Hospital, Multiprofessional Integrated Residency Program in Hospital Health Care, Fortaleza, Brazil. https://orcid.org/0000-0002-5817-0999
Amanda Mota Conceição Federal University of Ceará, Walter Cantídio University Hospital, Multiprofessional Integrated Residency Program in Hospital Health Care, Fortaleza, Brazil. https://orcid.org/0000-0002-4638-8130
Liana Moreira Magalhães Federal University of Ceará, Walter Cantídio University Hospital, Multiprofessional Integrated Residency Program in Hospital Health Care, Fortaleza, Brazil. https://orcid.org/0000-0002-2950-8540
Breno Queiroz de Araújo Federal University of Ceará, Walter Cantídio University Hospital, Multiprofessional Integrated Residency Program in Hospital Health Care, Fortaleza, Brazil https://orcid.org/0000-0002-6354-5660
Cinthya Cavalcante de Andrade Federal University of Ceará, Walter Cantídio University Hospital, Hospital Pharmacy Service, Fortaleza, Brazil.
José Martins de Alcântara Neto Federal University of Ceará, Walter Cantídio University Hospital, hospital pharmacy service, Fortaleza, Brazil.
Alene Barros de Oliveira Federal University of Ceará, Walter Cantídio University Hospital, hospital pharmacy service, Fortaleza, Brazil. https://orcid.org/0000-0002-4767-2256

DOI:

https://doi.org/10.30827/ars.v64i3.27249

Palabras clave:

Farmacoterapia, Servicios Farmacéuticos, Unidades de Cuidados Intensivos

Resumen

Objetivo: El propósito de este estudio es evaluar las intervenciones farmacéuticas (IF) realizadas sobre PRM y los factores asociados a su aceptación.

Método: Se trata de un estudio descriptivo y transversal que analizó las IF realizadas a pacientes adultos de dos UCI de Fortaleza, Brasil, en 2019. Las IF se analizaron en las categorías cantidad de fármaco y estrategia farmacológica, utilizando la clasificación propuesta por Sabater et al. Los fármacos se clasificaron además por el Sistema de Clasificación Anatómica, Terapéutica, Química y por la clasificación de Fármacos de Alta Vigilancia (FAV).

Resultados: Se incluyeron 305 pacientes, siendo la mayoría del sexo masculino (55,1 %), ancianos (52,8 %) y atendidos en la UCI quirúrgica (51,4 %). Se analizaron 1.317 IF y se aceptaron el 88,0 %, siendo la sustitución de uno o más fármacos (28,0 %) y la adición de uno o más fármacos (27,7 %) las más frecuentes. La clase terapéutica más prevalente fue antiinfeccioso de uso sistémico (24,1 %) y los FAV estuvieron implicados en el 21,7 % de las IF. Se observó asociación entre las IF aceptadas e ingreso en UCI clínica (p<0,0001), FAV (p=0,0013), sustitución de uno o más fármacos (p=0,0062) y la clase sustitutos sanguíneos y soluciones de perfusión (p= 0,0187).

Conclusiones: Se realizaron y aceptaron un elevado número de IF, lo que refuerza la importancia del farmacéutico en la revisión de las prescripciones médicas en UCI.

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Donovan AL, Aldrich JM, Gross AK, Barchas DM, Thornton KC, Schell-Chaple HM, et al. University of California, San Francisco Critical Care Innovations Group. Interprofessional Care and Teamwork in the ICU. Crit Care Med. 2018;46(6):980-90. doi: 10.1097/CCM.0000000000003067.

Cardinal LS, Matos VT, Resende GM, Toffoli-Kadri MC. Characterization of drug prescriptions in an adult intensive care unit. Rev Bras Ter. intensiva. 2012; 24(2):151-6.

MacLaren R, Devlin JW. The Bedside Critical Care Pharmacist: A Mandatory ICU Team Member Essential for Patient Care. Crit Care Med. 2019;47(9):1276-8. doi: 10.1097/CCM.0000000000003888.

Rudis MI, Brandl KM. Position paper on critical care pharmacy services. Society of Critical Care Medicine and American College of Clinical Pharmacy. Pharmacotherapy. 2000;20:1400–6.

Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Resolução RDC Nº 7, de 24 de fevereiro de 2010. Dispõe sobre os requisitos mínimos para funcionamento de Unidades de Terapia Intensiva e dá outras providências. Diário Oficial da União, 2010; Secção 01, nº37.

Lee H, Ryu K, Sohn Y, Kim J, Suh GY, Kim E. Impact on Patient Outcomes of Pharmacist Participation in Multidisciplinary Critical Care Teams: A Systematic Review and Meta-Analysis. Crit Care Med. 2019; 47:1243–50. doi: 10.1097/CCM.0000000000003830.

MacLaren R, Bond CA, Martin SJ, Fike D. Clinical and economic outcomes of involving pharmacists in the direct care of critically ill patients with infections. Crit Care Med. 2008; 36:3184–9. doi: 10.1097/CCM.0b013e31818f2269.

Marshall J, Finn CA, Theodore AC. Impact of a clinical pharmacist-enforced intensive care unit sedation protocol on duration of mechanical ventilation and hospital stay. Crit Care Med. 2008;36:427–33. doi: 10.1097/01.CCM.0000300275.63811.B3.

Wang T, Benedict N, Olsen KM, Luan R, Zhu X, Zhou N, et al. Effect of critical care pharmacist’s intervention on medication errors: a systematic review and meta-analysis of observational studies. J Crit Care. 2015;30:1101-6. doi: 10.1016/j.jcrc.2015.06.018.

Fideles GMA, Neto JMA, Peixoto Júnior AA, Neto PJS, Tonete TL, Silva JEG, et al. Recomendações farmacêuticas em unidade de terapia intensiva: três anos de atividades clínicas. Rev. bras. ter. intensiva. 2015;27(2):149-54. doi: 10.5935/0103-507X.20150026.

Lat I, Paciullo C, Daley MJ, MacLaren R, Bolesta S, McCann J, et al. Position Paper on Critical Care Pharmacy Services: 2020 Update. Crit Care Med. 2020 ;48(9):e813-e834. doi: 10.1097/CCM.0000000000004437.

Conselho Federal de Farmácia (CFF). Resolução CFF Nº 585 de 29 de agosto de 2013. Regulamenta as atribuições clínicas do farmacêutico e dá outras providências [Internet]. Brasília: CFF; 2013.

Shulman R, McKenzie CA, Landa J, Bourne RS, Jones A, Borthwick M, et al. PROTECTED-UK Group: Pharmacist’s review and outcomes: Treatment-enhancing contributions tallied, evaluated, and documented (PROTECTED-UK). J Crit Care 2015; 30:808–13. doi: 10.1016/j.jcrc.2015.04.008.

Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999; 282:267–270. doi: 10.1001/jama.282.3.267. 39.

Sabater D, Fernandez-Llimos F, Parras M, Faus MJ. Tipos de intervenciones farmacéuticas en seguimiento farmacoterapéutico. Seguimiento Farmacoterapéutico. 2005;3(2):90-7.

World Health Organization. The anatomical therapeutic chemical classification system with defined daily doses (ATC/DDD). Norway: WHO. 2006. Available in . Accessed 01 Jan 2018.

Instituto para Práticas Seguras no Uso de Medicamentos. Medicamentos Potencialmente Perigosos de Uso Hospitalar e Ambulatorial - Listas Atualizadas 2015. Boletim ISMP Brasil. 2015; 4(3). Available in<http://www.ismp-brasil.org/site/wp-content/uploads/2015/12/V4N3.pdf>. Accessed 12 jun 2022.

Brasil. Lei n° 10.741, de 1º de outubro de 2003. Dispõe sobre o Estatuto do Idoso e dá outras providências. Diário Oficial da União, 3 out. 2003. Available in < http://www.planalto.gov.br/ccivil_03/leis/2003/l10.741.htm> Accessed 25 May 2022.

Maciel EC, Borges RP, Portela AS. Pharmaceutical actuation in intensive care units: contributions to rational use of drugs. Rev Bras Farm Hosp Serv Saude. 2019;10(4):0429. doi: 10.30968/rbfhss.2019.104.0429.

Klopotowska JE, Kuiper R, van Kan HJ, de Pont AC, Dijkgraaf MG, Lie-A-Huen L, et al. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study. Critical Care. 2010;14(5):174. doi: 10.1186/cc9278.

Reis WC, Scopel CT, Correr CJ, Andrzejevski VM. Analysis of clinical pharma- cist interventions in a tertiary teaching hospital in Brazil. Einstein. 2013;11(2):190-6. doi: 10.1590/S1679-45082013000200010.

Dias D, Wiese LPL, Pereira EM, Fernandes FM. Evaluation of pharmaceutical clinical interventions in the ICU of a public hospital of Santa Catarina. Rev Bras Farm Hosp Serv Saude. 2019;9(3)1-5. doi: 10.30968/rbfhss.2018.093.005.

Bourne RS, Choo CL. Pharmacist proactive medication recommendations using electronic documentation in a UK general critical care unit. Int J Clin Pharm. 2012;34:351-7. doi: 10.1007/s11096-012-9613-7.

Sereno MTF, Serrano RP, Díaz-Miguel RO, González MCE, Álvarez HAH, Checa AA, et al. Pharmacist adscription to intensive care: Generating synergies. Med Intensiva. 2018;42(9):534-40. doi: 10.1016/j.medin.2018.02.006.

Al-Dorzi HM, Eissa AT, Khan RM, Harbi SAA, Aldabbagh T, Arabi YM. Dosing errors of empirical antibiotics in critically ill patients with severe sepsis or septic shock: A prospective observational study. Int j healthc sci. 2019;13(4):48-55.

Silva CDR, Silva Júnior M. Strategies for appropriate antibiotic use in intensive care unit. Einstein. 2015;13(3):448-53. doi: 10.1590/S1679-45082015RW3145.

Parente DM, Morton J. Role of the Pharmacist in Antimicrobial Stewardship. Med Clin North Am. 2018;102(5):929-36. doi: 10.1016/j.mcna.2018.05.009.

Miarons M, Marín S, Amenós I, Campins L, Rovira M, Daza M. Pharmaceutical interventions in the emergency department: cost-effectiveness and cost-benefit analysis. Eur J Hosp Pharm. 2021;28(3):133-8. doi: 10.1136/ejhpharm-2019-002067.

Pearson DJ, Sharma A, Lospinoso JA, Morris MJ, McCann ET. Effects of Electrolyte Replacement Protocol Implementation in a Medical Intensive Care Unit. J Intensive Care Med. 2018;33(10):574-81. doi: 10.1177/0885066616679593.

Cajanding JMR. Administering and monitoring high-alert medications in acute care. Nurs Stand. 2017;31(47)42–52.doi: 10.7748/ns.2017.e10849.