초록

Background : Clinical pharmacists have participated in a multidisciplinary team of doctors, pharmacists, nurses, and nutritionists at the Trauma Intensive Care Unit (TICU) of the National Medical Center since June 2019. This study was conducted to analyze drug interventions and drug information provided by the pharmacist, and evaluate the appropriateness of antibiotic prescriptions and nutritional support. Methods : We reviewed TICU daily rounds reports from July to September 2019. To evaluate the appropriateness of antibiotics and nutritional support, we retrospectively investigated and compared the medical records before their participation (from March to May 2019) and after (from July to September 2019). We reviewed the bacterial susceptibility testing results, antibiotic dosages, and nutritional support for the daily requirements of calories and protein, then considered them appropriate if all criteria were met. Results : Sixty-two daily rounds were conducted on 48 patients with the pharmacists. There were 89 drug interventions and 72 cases of drug information services. Seventy (78.7%) interventions were accepted, which included 21 (23.6%) cases of therapeutic drug monitoring, 15 (16.9%) cases of nutritional support, and 13 (14.6%) cases of renal dosage adjustment. Of the drug information services conducted, 18 (25.0%) cases concerned the names of available drugs with the correct ingredients, 11 (15.3%) cases were related to the drug dosing regimen, and eight (11.1%) cases pertained to adverse drug events. There were 12 patients over the 3-month period from March to May and 39 from July to September 2019. There were 164 appropriate cases of antibiotic prescriptions out of 197 (83.2%) from March to May and 406 out of 474 (85.7%) from July to September 2019. There were 175 appropriate cases of nutritional support out of 265 (66.0%) from March to May and 394 out of 491 (80.2%) from July to September. Conclusion : The appropriateness of antibiotic prescriptions and nutritional support was increased after pharmacists’ participation in the TICU multidisciplinary team. This study had a limitation in assessing exceptional clinical conditions given the nature of the retrospective review.

키워드

Antimicrobial stewardship, Pharmacist-driven, Nutrition support

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