title: Impact of pharmaceutical care on pain and agitation in a medical intensive care unit in Thailand.
abstract: Background Currently, a lack of pharmaceutical care exists concerning pain and agitation in medical intensive care units (MICU) in Thailand. Pharmaceutical care focusing on analgesics/sedatives would improve clinical outcomes. Objective To investigate the impact of pharmaceutical care of pain and agitation on ICU length of stay (LOS), hospital LOS, ventilator days and mortality. Setting The MICU of a university hospital. Method A before/after study was conducted on mechanically ventilated patients receiving analgesics/sedatives. Medical chart reviews and data collection were conducted in the retrospective group (no pharmacists involved). In the prospective group, pharmacists involved with the critical care team helped select analgesics/sedatives for individual patients. Main outcome measure ICU LOS Results In total, 90 and 66 patients were enrolled in retrospective and prospective groups, respectively. The median duration of ICU LOS was reduced from 10.00 (2.00-72.00) in the retrospective group to 6.50 days (2.00-30.00) in the prospective group (p = 0.002). The median hospital stay was reduced from 30.50 days (2.00-119.00) in the retrospective group to 17.50 days (2.00-110.00) in the prospective group (p < 0.001). Also, the median ventilator days was reduced from 14.00 days (2.00-90.00) to 8.50 days (1.00-45.00), p = 0.008. Mortality was 53.03% in the prospective group and 46.67% in the retrospective group (p = 0.432). Conclusion Pharmacist participation in a critical care team resulted in a significant reduction in the duration of ICU LOS, hospital LOS and ventilator days, but not mortality.
authors.affiliation: Division of Clinical Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand.
authors.forename: Pitchaya
authors.initials: P
authors.lastname: Dilokpattanamongkol
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
authors.forename: Viratch
authors.initials: V
authors.lastname: Tangsujaritvijit
authors.affiliation: Division of Clinical Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand.
authors.forename: Thanarat
authors.initials: T
authors.lastname: Suansanae
authors.affiliation: Department of Pharmacology, Faculty of Pharmacy, Mahidol University, 447 Sri Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand. chuthamanee.sut@mahidol.ac.th.
authors.forename: Chuthamanee
authors.initials: C
authors.lastname: Suthisisang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy; D010348:Patient Care Team / Q000458:organization & administration*; D010593:Pharmaceutical Services / Q000458:organization & administration*; D010595:Pharmacists / Q000458:organization & administration*; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000188:drug therapy; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013785:Thailand
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives
keywords: Agitation; Analgesics; Critically ill patients; Medical intensive care unit; Pain; Pharmaceutical care; Sedatives; Thailand