Impact of Clinical Pharmacist Educational Intervention on The Potential Drug-Drug Interactions in Surgical Intensive Care Unit

Abstract

The Institute of Medicine’s report ‘‘To Err is Human, Building a Safer Health System,’’ has heightened the awareness of preventable medical errors. Drug-drug interactions, a subclass of preventable medical errors, are particularly concerning because they are associated with an increase in patient morbidity and mortality. The most current guidelines have recommended combination of medications for the management of diseases such as hypertension. A drug interaction takes place when the effects and/or toxicity of a drug are affected by another drug. Although results may be positive (increased efficacy) or negative (decrease of efficacy, toxicity or idiosyncrasy), in pharmacotherapy they are usually unforeseen and undesirable. With the continued development of new drugs and subsequent prescriptions with increasingly more complex combinations it has become difficult for physicians and pharmaceutics to be familiar with all potential interactions. Drug–drug interactions (DDIs) in the intensive care unit (ICU) are associated with longer ICU stays, adverse drug events and end-organ damage. Critically ill patients are at an increased risk of adverse drug events related to DDIs because of the large number of medications that they receive and pharmacokinetic characteristics of the administered medications. DDI software and clinical decision support software is recommended in the literature to aid prescribers and pharmacists in DDI identification. This study aimed to explore the pattern and frequency of potential drug-drug interactions as well as their risk rating, and perform an educational intervention for proper management of them. The main objective is to highlight the impact of clinical pharmacist educational intervention to minimize the frequency of drug-drug interactions of significant clinical impotance (class × and D). This three phases study was conducted at Ain Shams University hospitals, (Surgey unit, surgical intensive care unit) Cairo, Egypt through a period of 12 months. The study phases were phase 1 (pre-intervention phase), phase 2 (intervention phase), and phase 3 (post-intervention phase). During the study, all patients who were admitted to the surgical ICU were included. Lexi-Comp database (Lexi-Comp, Inc, Hudson, Ohio) was used to identify and