Escore de risco terapêutico na seleção de pacientes para acompanhamento e análise farmacoterapêutica em unidade de terapia intensiva

Abstract

The therapeutic risk score is an instrument that aims to select patients for pharmacotherapeutic follow-up. It stratifies the patient at 'low', 'medium' or 'high' risk through the sum of criteria that influence the therapeutics. Pharmacotherapeutic monitoring is an inherent activity for the pharmacist, requiring time and dedication to correctly identify the problems related to therapy and documentation of this activity. Pharmaceutical interventions should be effective and contribute to a positive clinical outcome and rationalization of available resources. Patients in an intensive care unit require more pharmaceutical attention because of clinical criticity. The study was quantitative, descriptive and prospective, carried out the stratification of the therapeutic risk and the pharmacotherapeutic follow-up of patients in an intensive care unit. Drug-related problems and negative outcomes associated with medications have been identified and classified. Interventions were classified as significance, acceptance and purpose, and clinical outcomes were defined. The statistical relation between the risk score and the number of drug-related problems and mortality was established. The prediction of mortality by the therapeutic risk score was compared with that of a system already used for this purpose. Sixty patients were followed, 83.3% were older than 45 years and 60% were males. The mean length of hospital stay was 11 days. The most prevalent diagnosis at the time of admission involved the respiratory system (41.7%) and the class of medication most involved in problems related to identified drugs was that of general anti-infectives for systemic use (32.5%). An average of 5.38 drug-related problems per patient and a total of 323 drug-related negative outcomes were identified. The most frequent involved need (52.3%) of the drug, followed by safety (30.4%) and effectiveness (15.5%). The outcomes were mostly positive for pharmaceutical care and the majority (72.4%) were classified as prevented. Pharmaceutical interventions were mostly related to prescription (77.8%), were accepted (96.9%) and considered significant (97%), and still revealed more than ten thousand brasilian real in economics. Most patients had a therapeutic risk classified as 'medium' (65%). In the 'high' therapeutic group, all patients were older than 45 years, use of a higher number of medications, use of alternative oral feeding, presence of one or more previous clinical complications and use of potentially dangerous drugs. The study statistically demonstrated that patients categorized as 'medium' and 'high' at therapeutic risk are more likely to suffer drug-related problems and to evolve to death when compared to patients categorized at 'low' therapeutic risk.