Cuidado farmacêutico em terapia intensiva: avaliação de dez anos de recomendações farmacêuticas

Abstract

Clinical Pharmacy is the area of ​ ​ pharmacy where pharmacists provide patient care in order to optimize pharmacotherapy and promote the rational use of medications through the provision of pharmaceutical services (PS), which are essential in a hospital unit, especially in Intensive Care Units (ICU) where clinical and therapeutic complexity increases the risk of medication-related problems (MRP). MRP can be solved through pharmaceutical recommendations (PR) made during the provision of PS. A crosssectional, descriptive, retrospective, single-center study was conducted to evaluate the PR performed in the clinical ICU of a teaching hospital in the state of Ceará. Information regarding PR performed from January 2015 to December 2024 was collected from the service's database.Study approved by the ethics committee under number: 7.994.509. A total of 18.017 PR were performed on 1.439 patients, with an average of 12.5 PR per patient and an overall acceptance rate of 90.1%. The most frequent MRP were "necessary medication not prescribed" (21.1%), followed by "unnecessary medication prescribed" (15.5%). The most frequently performed PR were "medication inclusion" (21.1%) and "dose (adequacy)" (19.4%). Regarding the most involved drug class (ATC level 1), antiinfectives for systemic use received (33,3%), followed by alimentary tract and metabolism (18,8%), with vancomycin being the main drug (8.5%), followed by potassium chloride (4.5%) and meropenem (4.3%). During the COVID-19 period, the main MRP found for patients admitted to beds exclusively designated for patients with this disease were "necessary medication not prescribed" 19.9% and "dilution/reconstitution" 11.6%, and the PR were "inclusion of medication" 19.9% and "dose (adequacy)" 19.0%. The most frequently involved drug class (ATC level 1) was antiinfectives for systemic use (41.3%), with vancomycin (10.4%) and hypromellose/dextran (8.2%) being the most involved medications. These results demonstrate the fundamental role of the pharmacist in the ICU in resolving MRP, contributing significantly to patient safety and the optimization of pharmacotherapy. The high number of PR and the high acceptance rate demonstrate the consolidation and relevance of pharmacy services, even in challenging scenarios such as during the COVID-19 pandemic, reinforcing their essential role in the multidisciplinary team.