Costs of pharmaceutical interventions in the intensive care unit of a public urgency and emergency hospital

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DOI:

https://doi.org/10.30968/rbfhss.2024.151.0951

Abstract

Objective: Describe the costs of pharmaceutical interventions in the ICU of a public urgent and emergency hospital and evaluate the impact on the length of hospital stay of diseases that required additional medication after pharmaceutical intervention. Method: Pharmacotherapeutic follow-up data were collected from May to July 2022 and the prices of medications, diluents and materials were used to calculate three types of costs: maximum intervention, accepted intervention and rejected intervention costs. For the evaluation of the impact on the length of hospital stay of diseases that required additional medication, a panel of specialists was carried out. Results: A total of 163 patients were monitored, and 5,770 medications were evaluated. The most frequent pharmaceutical intervention was the suggestion of changing pharmacotherapy (93.37%). The estimated saving of resources was US$ 2,092.91, a mean of US$ 1.83/patient-day. The maximum intervention and rejected intervention costs were US$ 2,462.56 and US$ 3.85, respectively. Infectious conditions required more interventions, resulting in more than 85% of total savings. Items A on the ABC curve corresponded to 77.00% of interventions, with savings of US$ 2,408.47. The expert panel agreed that the absence of medication for stress ulcer prophylaxis, combination therapy for ventilator-associated pneumonia, and septic shock could increase the patient’s ICU stay at five, seven, and seven days, respectively. Conclusion: The clinical pharmacist, in the care of critical patients, provided savings in the use of medications. Infectious conditions and medications A of ABC curve are strategic points for professional action. Improving communication and building clinical protocols are important for greater clinical and financial return.

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References

Storpirtis S, Mori ALPM, Yochiy A, et al. Farmácia Clínica e Atenção Farmacêutica. 1st ed. Rio de Janeiro: Guanabara Koogan; 2009.

Conselho Federal de Farmácia. Resolução No 585 de 29 de agosto de 2013. Brasil; 2013.

Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: The Patient-Centered Approach to Medication Management. 3rd ed. New York: The McGraw-Hill Companies, Inc; 2012.

Sabater D, Fernandez-llimos F, Parras M, et al. Types of pharmacist intervention in pharmacotherapy follow-up. Seguim Farmacoter [Internet]. 2005;3(2):90–7.

Conselho Federal de Farmácia. Resolução No 675 de 31 de outubro de 2019. Brasil; 2019.

Barros ME, Araújo IG. Avaliação das intervenções farmacêuticas em unidade de terapia intensiva de um hospital de ensino. Rev Bras Farmácia Hosp e Serviços Saúde. 2021;12(3). DOI: 10.30968/rbfhss.2021.123.0561.

Reis WCT, Scopel CT, Correr CJ, et al. Análise das intervenções de farmacêuticos clínicos em um hospital de ensino terciário do Brasil. Einstein (São Paulo). 2013;11(2):190–6. DOI: 10.1590/S1679-45082013000200010.

Tiguman GB, Junior RM. Impacto econômico da intervenção farmacêutica em serviços de saúde do Brasil: uma revisão sistemática. Rev Bras Farmácia Hosp e Serviços Saúde. 2020;11(4):5–12. DOI: 10.30968/rbfhss.2020.114.0512.

Aguiar KS, Santos JM, Cambrussi MC, et al. Patient safety and the value of pharmaceutical intervention in a cancer hospital. Einstein (São Paulo). 2018;16(1):1–7. DOI: 10.1590/S1679-45082018AO4122.

Malfará M, Pernassi M, Aragon D, et al. Impact of the clinical pharmacist interventions on prevention of pharmacotherapy related problems in the paediatric intensive care unit. Int J Clin Pharm. 2018;40:513–9. DOI: 10.1007/s11096-018-0632-x.

Silva MAP. Aplicação do método Curva ABC de Pareto e sua contribuição para gestão das farmácias hospitalares [Trabalho de conclusão de especialização em Gestão de Sistemas e Serviços de Saúde]. Centro de Pesquisas Aggeu Magalhães, Recife, 2011.

McMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques. Int J Clin Pharm. 2016;38:655–62. DOI: 10.1007/s11096-016-0257-x.

Vergara SC. Métodos de Pesquisa em Administração. São Paulo: Atlas S.A.; 2005.

World health Organization. ATC/DDD Index 2022 [Internet]. 2022. Available from: https://www.whocc.no/atc_ddd_index/. Accessed on December 9, 2022.

Colin SL, Nutti C. Intervenção Farmacêutica: descrição do papel do farmacêutico clínico em unidades de terapia intensiva. Rev Bras Farmácia Hosp e Serviços Saúde. 2022;13(2). DOI: 10.30968/rbfhss.2022.132.0766.

Santos OS, Takashi MH. Atuação do farmacêutico clínico na unidade de terapia intensiva. Revisa. 2021;10(2):833–8. DOI: 10.36239/revisa.v10.nEsp2.p833a838.

Rosa TP, Magnago TSBS, Tavares JP, et al. Perfil dos pacientes atendidos na sala de emergência do pronto socorro de um hospital universitário. Rev Enferm da UFSM. 2011;1(1):51–60. DOI: 10.5902/217976922090.

Cardinal LSM, Matos VTG, Resende GMS, et al. Caracterização das prescrições medicamentosas em unidade de terapia intensiva adulto. Rev Bras Ter Intensiva. 2012;24(2):151–6. DOI: 10.1590/S0103-507X2012000200009.

Associação de Medicina Intensiva Brasileira. Manual de Medicina Intensiva. Guimarães HP, Assunção MSC de, Carvalho FB de, Japiassú AM, Veras KN, Nácul FE, et al., editors. São Paulo: Atheneu; 2014.

Magalhães ACAF, Cantanhede AMFC, Drummond BM, et al. Avaliação da implantação do serviço de farmácia clínica na Unidade de Terapia Intensiva para contribuir na segurança do paciente. Rev Med Minas Gerais. 2016;26(5):16–22.

Arantes T, Durval CC, Pinto VB. Avaliação da economia gerada por meio das intervenções farmacêuticas realizadas em um hospital universitário terciário de grande porte. Clin Biomed Res. 2020;40(2):96–104. DOI: 10.22491/2357-9730.95646.

Hayat K, Mustafa ZU, Godman B, et al. Perceptions, Expectations, and Experience of Physicians About Pharmacists and Pharmaceutical Care Services in Pakistan: Findings and Implications. Front Pharmacol. 2021;12. DOI: 10.3389/fphar.2021.650137.

Magedanz L, Silliprandi EM, Santos RP. Impact of the pharmacist on a multidisciplinary team in an antimicrobial stewardship program: A quasi-experimental study. Int J Clin Pharm. 2012;34(2):290–4. DOI: 10.1007/s11096-012-9621-7.

Melo FS, Azevedo SL, Porto IS, et al. Uso racional de antimicrobianos na unidade de terapia intensiva. Rev Enferm UFPE online. 2019;13(5):1475–84. DOI: 10.5205/1981-8963-v13i5a238666.

Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. Integr Pharm Res Pract. 2017;6:37–46. DOI: 10.2147/IPRP.S108047.

Souza AA, Raimundini SL, Souza NC, et al. Modelagem do custeio baseado em atividades para farmácias hospitalares. Rev Informação Contábil. 2009;3(1):149–72.

Motta JPOF. Sistemas de Classificação de Materiais Aplicados à Gestão de Medicamentos [Dissertação de mestrado]. Universidade Federal Fluminense, Niterói, 2015.

Revorêdo LS, Maia RS, Torres GV, et al. O uso da Técnica Delphi em saúde: uma revisão integrativa de estudos brasileiros. Arq ciênc saúde. 2015;22(2):16–21. DOI:10.17696/2318-3691.

Cook DJ, Griffith LE, Walter SD, et al. The attribute mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care. 2001;5(6):368–75. DOI: 10.1186/cc1071.

Abdelsalam MFA, Abdalla MS, El-Abhar HSED. Prospective, comparative clinical study between high-dose colistin monotherapy and colistin–meropenem combination therapy for treatment of hospital-acquired pneumonia and ventilator-associated pneumonia caused by multidrug-resistant Klebsiella pneumoniae. J Glob Antimicrob Resist. 2018;15:127–35. DOI: 10.1016/j.jgar.2018.07.003.

Liang H, Song H, Zhai R, et al. Corticosteroids for Treating Sepsis in Adult Patients: A Systematic Review and Meta-Analysis. Front Immunol. 2021;12:1–17. DOI: 10.3389/fimmu.2021.709155.

Published

2024-03-28

How to Cite

1.
SANTOS LM, VIMIEIRO AS, RUAS CM. Costs of pharmaceutical interventions in the intensive care unit of a public urgency and emergency hospital. Rev Bras Farm Hosp Serv Saude [Internet]. 2024Mar.28 [cited 2024Apr.25];15(1):951. Available from: https://rbfhss.org.br/sbrafh/article/view/951

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ORIGINAL ARTICLES