gms | German Medical Science

Background: Drug-drug interactions (DDIs) may compromise patient safety by leading to toxicity or a diminishing therapeutic benefit. 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.

The purpose of this investigation was to evaluate pharmaceutical interventions in the intensive care unit (ICU) to concentrate DDIs.

Materials and Methods: The participation of a clinical pharmacist during ward rounds in four intensive care units (75 beds) at the University hospital Jena was started in September 2010. Pharmaceutical interventions documented and classified in the database ADKA DokuPIK were analysed over 18 month from January 1st 2011 to June 30th 2013.

Results: Altogether 2968 pharmaceutical interventions were documented between January 2011 and June 2013. In 2017 patients 2519 pharmaceutical interventions were managed during ward rounds. Of 2968 pharmaceutical interventions evaluated, 121 (4.1%) clinically relevant DDIs were identified. The most frequently encountered drug classes that caused potential drug-drug interactions were cardiovascular medications (35% ATC-Code C) and antibacterials for systemic use (30% ATC-Code J). Change of medication or dosage was in 37.2% caused by the pharmacist recommendations. The rate of physicans’ acceptance was 92.4%. On the basis of the documented interventions a handout was developed to prevent drug-drug interactions by focusing on pharmacokinetic interactions caused by the cytochrome P450 (CYP) enzyme system.

Conclusion: There was a high acceptance rate by the physicians for medication-related recommendations made by the pharmacist. The handout for prevention of drug-drug interactions was implemented in the ICU. A clinical pharmacy service is helpful for optimizing pharmacotherapy in a multidisciplinary team in the ICU.