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

2. 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

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

4. Results: Classification of Interventions

5. 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:

6. Results: Significance of Interventions

7. 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.

8. 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

9. Med Rec Form

10. Med Rec Form

11. 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

12. 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

13. 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.