title: Pharmacist Remote Review of Medication Prescriptions for Appropriateness in Pediatric Intensive Care Unit.
abstract: BACKGROUND
  One aspect of ordering and prescribing medication is the requirement for a trained professional to review medication orders or prescriptions for appropriateness. In practice, this review process is usually performed by a clinical pharmacist. However, in many medical centers there is a shortage of staff and a pharmacist is not always available.
  
  
  OBJECTIVE
  To determine whether remote review of medication orders by a pharmacist is a plausible method in a pediatric intensive care unit (PICU).
  
  
  METHODS
  A pharmacist from the pharmacy department reviewed medication orders of patients admitted to our PICU over a 7-month period for appropriateness. A special form for medical orders was filled in and sent to the physician in the PICU, who replied informing whether the recommendation had been accepted. The time spent by the pharmacist for this activity was recorded.
  
  
  RESULTS
  The review time for one medical record was 8.9 (95% CI, 6.9-10.9) min. Every additional drug prescribed increased the total review time by 0.8 (95% CI, 0.45-1.11) min. The pharmacist filled in 186 forms on 117 admissions for 109 children. The median review time was 15 (12.8-18.8) and 12 (9-15) min, respectively, for patients with psychiatric-neurologic disorders compared to those without (p = 0.032). Usually, a daily workload of 240 min was needed for the pharmacist accompanying the round in contrast to 108 min per day needed to review all the medical records in 95% of the cases. The physician accepted 51.2%, rejected 11.9%, and made no comment on 36.9% of the recommendations.
  
  
  CONCLUSIONS
  Hospitals facing budget shortages can carry out focused remote reviews of prescriptions by the pharmacist.
authors.affiliation: Pharmacy Department, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel-Aviv University Tel-Aviv, Israel.
authors.forename: Moran
authors.initials: M
authors.lastname: Lazaryan
authors.affiliation: Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel-Aviv University Tel-Aviv, Israel.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abu-Kishk
authors.affiliation: Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel-Aviv University Tel-Aviv, Israel.
authors.forename: Noa
authors.initials: N
authors.lastname: Rosenfeld-Yehoshua
authors.affiliation: Pharmacy Department, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel-Aviv University Tel-Aviv, Israel.
authors.forename: Sofia
authors.initials: S
authors.lastname: Berkovitch
authors.affiliation: Pharmacy Department, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel-Aviv University Tel-Aviv, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Toledano
authors.affiliation: Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel-Aviv University Tel-Aviv, Israel.
authors.forename: Iris
authors.initials: I
authors.lastname: Reshef
authors.affiliation: Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel-Aviv University Tel-Aviv, Israel.
authors.forename: Tal
authors.initials: T
authors.lastname: Kanari
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel-Aviv University Tel-Aviv, Israel.
authors.forename: Tomer
authors.initials: T
authors.lastname: Ziv-Baran
authors.affiliation: Clinical Pharmacology Unit, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel-Aviv University Tel-Aviv, Israel.
authors.forename: Matitiahu
authors.initials: M
authors.lastname: Berkovitch
keywords: clinical pharmacist; joint commission international; medication review; pediatric intensive care