Analysis of pharmaceutical interventions in a COVID-19 intensive care unit of a university hospital in Rio de Janeiro

Abstract

Objectives. To evaluate data from pharmaceutical interventions performed in an intensive care unit (ICU) dedicated to COVID-19. Methods. A retrospective cross-sectional study was carried out in an ICU dedicated to COVID-19 of a university hospital in Rio de Janeiro, during the period from january to june of 2021. Data was obtained from pharmaceutical interventions recorded in pharmacotherapeutic follow-up forms, carried out by a team of clinical and resident pharmacists, based on on-site work with the multidisciplinary team. The daily review of pharmacotherapy and clinical assessment of patients was based on an adaptation of the FASTHUG-MAIDENS mnemonic, and the interventions performed were compiled in an online Google Drive spreadsheet. The identified drug-related problems were categorized according to the types of medication errors involved, and the cited drugs were classified according to the Anatomical Therapeutic Chemical Code (ATC). Forms that did not contain registered interventions were excluded from the analysis. Results. A total of 223 patients were followed, and 1,140 pharmaceutical interventions were performed, with an average of 5.1 interventions per patient and an acceptance rate of 85.2%. Among the medication-related problems, categorized as medication errors, those with the highest frequency of interventions were omissions of doses or medications (357), inadequate prescriptions (169), and incorrect doses (168). Among the drug classes most involved in interventions, digestive system and metabolism (243) and nervous system (221) had the highest number of recorded recommendations. Regarding the other types of medication errors recorded (161), 91 interventions were related to stockouts and variability in stock, as a reflection of drug shortages caused by COVID-19. Conclusion. The pharmacist, as part of the multidisciplinary team, optimizes the pharmacotherapeutic follow-up and helps in the identification and prevention of drug-related problems. The data obtained point out specific pharmacotherapeutic issues that need more attention during the monitoring carried out in the observed scenario and can guide the formulation of actions aimed at patient safety and protocols aimed at the use of medicines.