title: PROTECTED-UK - Clinical pharmacist interventions in the UK critical care unit: exploration of relationship between intervention, service characteristics and experience level.
abstract: OBJECTIVE
  Clinical pharmacist (CP) interventions from the PROTECTED-UK cohort, a multi-site critical care interventions study, were further analysed to assess effects of: time on critical care, number of interventions, CP expertise and days of week, on impact of intervention and ultimately contribution to patient care.
  
  
  METHODS
  Intervention data were collected from 21 adult critical care units over 14 days. Interventions could be error, optimisation or consults, and were blind-coded to ensure consistency, prior to bivariate analysis. Pharmacy service demographics were further collated by investigator survey.
  
  
  RESULTS
  Of the 20 758 prescriptions reviewed, 3375 interventions were made (intervention rate 16.1%). CPs spent 3.5 h per day (mean, ±SD 1.7) on direct patient care, reviewed 10.3 patients per day (±SD 4.2) and required 22.5 min (±SD 9.5) per review. Intervention rate had a moderate inverse correlation with the time the pharmacist spent on critical care (P = 0.05; r = 0.4). Optimisation rate had a strong inverse association with total number of prescriptions reviewed per day (P = 0.001; r = 0.7). A consultant CP had a moderate inverse correlation with number of errors identified (P = 0.008; r = 0.6). No correlation existed between the presence of electronic prescribing in critical care and any intervention rate. Few centres provided weekend services, although the intervention rate was significantly higher on weekends than weekdays.
  
  
  CONCLUSIONS
  A CP is essential for safe and optimised patient medication therapy; an extended and developed pharmacy service is expected to reduce errors. CP services should be adequately staffed to enable adequate time for prescription review and maximal therapy optimisation.
authors.affiliation: Pharmacy Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne.
authors.forename: Nicola
authors.initials: N
authors.lastname: Rudall
authors.affiliation: Institute of Pharmaceutical Sciences, Kings College London, London.|Pharmacy and Critical Care, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London.
authors.forename: Catherine
authors.initials: C
authors.lastname: McKenzie
authors.affiliation: Pharmacy and Critical Care, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London.
authors.forename: June
authors.initials: J
authors.lastname: Landa
authors.affiliation: Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield.
authors.forename: Richard S
authors.identifier: http://orcid.org/0000-0003-0893-525X
authors.initials: RS
authors.lastname: Bourne
authors.affiliation: School of Pharmacy, University College London, London.
authors.forename: Ian
authors.initials: I
authors.lastname: Bates
authors.affiliation: Pharmacy and Critical Care, University College Hospital NHS Foundation Trust, London.
authors.forename: Rob
authors.initials: R
authors.lastname: Shulman
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003422:Critical Care / Q000379:methods* / Q000458:organization & administration / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D055695:Electronic Prescribing / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008508:Medication Errors / Q000706:statistics & numerical data; D010595:Pharmacists / Q000458:organization & administration / Q000706:statistics & numerical data*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D024382:Professional Role; D011446:Prospective Studies; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom; D000078329:Workforce
keywords: clinical interventions; clinical pharmacist; intensive care; patient safety; prescribing errors