Scientific Online Resource System

Annual for Hospital Pharmacy

Effects Of Implementing A Clinical Pharmacist Service In A Mixed Norwegian Icu

Elisabeth T Johansen, Stine M Haustreis, Ann S Mowinckel, Lars M Ytrebø


Objectives: An unacceptably high proportion of patients admitted to intensive care units (ICUs) develop drug-related problems (DRPs). DRPs might cause harm and increase costs and length of stay. The implementation of a clinical pharmacist service has been shown to detect a high number of DRPs and contributes effectively to solving these across different healthcare systems. However, this has not been prospectively studied in a mixed tertiary Norwegian ICU.

Methods: During a 12-month period from October 2012, a clinical pharmacist was dedicated to review medications 3 h daily (Monday to Friday). DRPs were reported at the ICU conference and included advice by the pharmacist for each case. All DRPs were categorized and the clinical impact was documented for later analysis. Drug-related questions from the staff were categorised and answered.

Results: 363 of 549 patients admitted to the ICU received medication reviews. 641 DRPs were detected in 194 of these patients (mean 1.8 DRPs per patient, range 0–25). Too high a dose, significant drug interactions and unnecessary or inappropriate drugs were among the most frequently detected DRPs. 87% of advice given by the pharmacist was accepted or taken into consideration. Typical questions from the nursing staff were related to drug preparation, generic equivalents and drug administration. Questions from doctors were most frequently related to drug dosage, efficiency and adverse effects.

Conclusions: The addition of a dedicated clinical pharmacist to the ICU team improves the quality and safety of medication in a mixed Norwegian ICU.

Full Text


Rothschild JM, Landrigan CP, Cronin JW, et al. The Critical Care Safety Study: the incidence and nature of adverse events and serious medical errors in intensive care. Crit Care Med 2005;33:1694–700.

Pharmaceutical Care Network Europe (PCNE). Drug-related problems classifications. Secondary Pharmaceutical Care Network Europe (PCNE). 2010.

Gillespie U, Alassaad A, Henrohn D, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med 2009;169:894–900.

MacLaren R, Bond CA. Effects of pharmacist participation in intensive care units on clinical and economic outcomes of critically ill patients with thromboembolic or infarction-related events. Pharmacotherapy 2009;29:761–8.

Klopotowska JE, Kuiper R, van Kan HJ, et al. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study. Crit Care 2010;14:R174.

Leape LL, Cullen DJ, Clapp MD, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA 1999;282:267–70.

Kucukarslan SN, Corpus K, Mehta N, et al. Evaluation of a dedicated pharmacist staffing model in the medical intensive care unit. Hosp Pharm 2013;48:922–30.

Bourne RS, Choo CL, Dorward BJ. Proactive clinical pharmacist interventions in critical care: effect of unit speciality and other factors. Int J Pharm Pract 2014;22:146–54.

Kaushal R, Bates DW, Abramson EL, et al. Unit-based clinical pharmacists’ prevention of serious medication errors in pediatric inpatients. Am J Health Syst Pharm 2008;65:1254–60.

Blix HS, Viktil KK, Moger TA, et al. Characteristics of drug-related problems discussed by hospital pharmacists in multidisciplinary teams. Pharm World Sci 2006;28:152–8.

Halvorsen KH, Ruths S, Granas AG, et al. Multidisciplinary intervention to identify and resolve drug-related problems in Norwegian nursing homes. Scand J Prim Health Care 2010;28:82–8.

Lundereng K, Sund J, Sporsem H, et al. Prevalence and management of drug-related problems in an intensive care unit. Eur J Hosp Pharm 2013;20(Suppl 1):A206.

Ashley C, Curry A. The renal drug handbook. 3rd rev edn. Oxford: Radcliffe Publishing Ltd, 2008.

Paw H, Shulman R. Handbook of drugs in intensive care. 4th edn. Cambridge: Cambridge University Press, 2010.

Ruths S, Viktil KK, Blix HS. [Classification of drug-related problems]. Tidsskr Nor Laegeforen 2007;127:3073–6.

Cram P, Hillis SL, Barnett M, et al. Effects of weekend admission and hospital teaching status on in-hospital mortality. Am J Med 2004;117:151–7.

Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med 2001;345:663–8.

Valentin A, Capuzzo M, Guidet B, et al. Errors in administration of parenteral drugs in intensive care units: multinational prospective study. BMJ 2009; 338:b814.



Article Tools
Email this article (Login required)