Pharmacy Intervention Intensive Care Syndrome : Promoting Independence and Return to Employment Pamela MacTavish

Pharmacy Intervention Medicine Reconciliation On admission, in ICU, on discharge and at clinic GP letter Highlight any medication issues Ask me Three Questions National Patient Safety Foundation

Pharmacy Intervention Education Medication changes New medications Medication Passport What they are on and why ICE tag

Results: Classification of Interventions

Results: Classification of Interventions Drug omissions mainly involved medicines for chronic disease states which had been omitted during the patient’s hospital stay but should now have been restarted. New drug treatment recommendations were mostly for symptoms of pain. The pharmacist identified pharmaceutical care issues with 18.3% of the prescribed medications. This was slightly higher than the rate identified by pharmacists working within an ICU unit.[1]. 1. Shulman R et al.: J Critical Care 2015; 30:808-813

Results: Significance of Interventions

Results: Classification of Interventions High Impact Patient with NSTEMI during ICU admission – commenced on Aspirin, Bisoprolol and Atorvastatin. GP had not continued these after discharge, patient had no cardiology follow-up. Patient admitted with Valproate overdose. Restarted and discharged on a lower dose. Readmitted with seizures-dose had still not been increased. Low Impact…… Reduce Lactulose dose in an ALD patient. - However simple interventions can also make a huge difference to a patient – we had a patient who’s goal was to be able to leave his house. It transpired he couldn’t leave his house because his bowels were moving 8-10 times a day he know it was because he was on lactulose but he had been told he needed to take it because of his liver disease therefore he had not questioned the effect it was having on him. A simple change in dose should help him achieve his goal.

Impact on the service Med Rec on admission was already part of our QIP Driver for improving Med Reconciliation on discharge. Improved Medicines Reconciliation form 8

Med Rec Form

Med Rec Form

Impact on the service SPSP data shows that we have improved Medicines Reconciliation in our unit. Last 2 cohorts less medication related problems Speak to patients and relatives about changes to medication during admission 11

Further Work Build a model to see if we can predict which patients will have the highest number/ most significant issues with their medication after discharge. Age, no of meds prior to admission, length of stay. Target patients prior to discharge. Refer patients to Primary Care Pharmacists

What Have I Learned ? Recovery from an ICU stay is a long process. Realisation that medicines are not always the answer ! Many other factors are important. Multidisciplinary approach essential.