The role of the critical care pharmacist during the COVID-19 pandemic

Clinical pharmacy as a guarantee of safety in times of crisis: evolution and relevance of the continued presence of clinical pharmacists in frontline medical units during the first wave of COVID-19

BackgroundThe COVID-19 pandemic has had a major impact on the organisation of health services worldwide. In the first wave, many therapeutic options were explored, exposing patients to significant iatrogenic risk. In a context in which patient management was not well defined by clear recommendations and in which healthcare professionals were under great stress, was it still relevant to maintain pharmaceutical care or did it bring an additional factor of disorganisation?

OBJECTIVE

The aim of our study was to compare the relevance of pharmaceutical care practices before and during the COVID-19 crisis.

METHODS

A retrospective, comparative, observational analysis was conducted in two medical units in a French university hospital that were receiving patients with COVID-19 and benefiting from pharmaceutical care prior to the crisis. This study compared clinical pharmacy performance between two 1.5-month periods before and during the COVID-19 crisis. Performance was assessed according to the CLEO scale, rating the clinical, economic and organisational impacts of the accepted pharmaceutical interventions (PIs) performed in these units.

RESULTS

Of the 675 accepted PIs carried out in the two medical units over the entire study period, PIs performed during the COVID-19 period had a greater significant clinical impact (72% vs 56%, p˂0.0001), a more positive economic impact (38% vs 23%, p˂0.0001) and a more favourable organisational impact (52% vs 20%, p˂0.0001) than those performed prior to the COVID-19 period.

CONCLUSIONS

The health crisis generated important changes in care practices. Our study demonstrates the sustained relevance of pharmaceutical care during a health crisis. This local experience confirms the major interest in improving the integration of pharmaceutical expertise within French healthcare teams.

Assessing the impact of critical care training on pharmacy students in Egypt: a pre-post study

BACKGROUND

Transition to independent pharmacy practice is challenging. Undergraduate and postgraduate pharmacy students in low-to-middle-income countries (LMICs) currently receive minimal experiential learning in critical care.

OBJECTIVE

To assess the critical care training course's impact on pharmacy students' knowledge, self-efficacy, and self-esteem, as well as their satisfaction with the course.

METHOD

In a pre-post interventional study, pharmacy students took a 10-day critical care training course with experiential learning. They completed a knowledge questionnaire covering various critical care topics, the 18 questions Pharmacy Self-efficacy and Self-esteem Study Questionnaire, and a satisfaction questionnaire. Data was analyzed using IBM SPSS version 20.0.

RESULTS

A total of 72 trainees participated in the study. The average score for pre-course self-efficacy and self-esteem significantly increased post-course, with a median (IQR) of 3.75 (3.50-3.94) compared to 3.56 (3.28-3.78) pre-course, with a p-value of less than 0.05. Furthermore, their overall knowledge score significantly increased from baseline to post-course, with the median (IQR) rising from 0.53 (0.50-0.61) to 0.98 (0.97-1.0), with a p-value of less than 0.05. Their course satisfaction average total score was 45.08 (SD ± 5.41) (on a scale of 10-50).

CONCLUSION

The present study provides clear evidence that integrating this critical care training course into a structured curriculum for pharmacy students using experiential learning can act as a facilitator of knowledge enrichment, increase their self-esteem and self-efficacy, and make them satisfied with learning. Larger long duration studies are needed to support this evidence.

Hospital pharmacy response to the COVID-19 pandemic: experience from a regional referral center in the United Arab Emirates

BACKGROUND

The recent SARS-CoV-2 pandemic has resulted in significant morbidity and mortality worldwide. The healthcare systems, including pharmacies, faced unique challenges, such as managing  an overwhelming patient influx, clinical workforce management, transitioning to remote or online work, medication procurement and several others. The purpose of this study is to describe our hospital pharmacy's experience dealing with the COVID-19 pandemic and to present solutions to the challenges that arose.

METHODOLOGY

We retrospectively reviewed and consolidated strategies, interventions, and solutions that were implemented by our pharmaceutical institute in response to the challenges that arose during the COVID-19 pandemic. The study period was from March 1 to September 30, 2020.

RESULTS

We reviewed and organized our hospital pharmacy response to the COVID-19 pandemic into different categories. In inpatient and outpatient satisfaction surveys, physicians and patients expressed a high level of satisfaction with pharmacy services. The close collaboration between the pharmacy team and other clinicians was demonstrated through the number of pharmacist interventions, participation in the COVID-19 guidelines reviews, involvement in local and international research, and innovative solutions to inpatient and outpatient pharmacy medication management challenges.

CONCLUSIONS

This study highlights the crucial role that our pharmacists and pharmaceutical institute played in ensuring continuity of care during the COVID-19 pandemic. We implemented several key initiatives, innovations, and collaborations with other clinical disciplines to successfully overcome the challenges faced.

A bibliometric analysis of global trends in the research field of pharmaceutical care over the past 20 years

Pharmaceutical care is essential in building up the basics of public health and clinical care. A comprehensive understanding of global status in the field of pharmaceutical care is necessary for directing its research frontiers and future trends. Therefore, this study aims to make a bibliometric analysis to track the development of pharmaceutical care research worldwide during the past two decades. The publications regarding pharmaceutical care were culled from the Web of Science Core Collection (WoSCC). Countries, institutions, authors, journals, references, and keywords in this field were visually analyzed by using VOSviewer (version 1.6.17) and CiteSpace (Version 5.8.R3). As a result, 3,597 publications (3,177 articles and 420 reviews) were obtained. The annual yields grew more than three times in the past two decades, from 54 records in 2002 to 379 papers in 2021. The United States played the leading role in this research from multiple aspects, including publication (n = 1,208), citations (n = 28,759), funding agencies, and collaboration worldwide. The University of Sydney in Australia was the most contributed institution with the greatest number of publications (n = 112) in pharmaceutical care research. Hersberger KE from the University of Basel was the most productive author (n = 40). Chen TF from the University of Sydney was the author who owed the highest H-index of 19 and most citations (n = 1,501). They both significantly impacted this field. American Journal of Health System Pharmacy produced the most publications, while Pharmacotherapy had the highest IF (IF2020 = 4.705) in this field. Clusters networks of co-cited references and keywords suggested that clinical pharmacy is an essential theme in pharmaceutical care. Terms of medication safety and critical care recognized by burst analysis of keywords also hint at the recent attention on clinical pharmacy. The present bibliometrics analysis may provide a comprehensive overview and valuable reference for future researchers and practitioners in the research field of pharmaceutical care.

Redistribution of critical drugs in shortage during the first wave of COVID-19 in France: from operating theaters to intensive care units

Background

Tension in the supply of highly consumed drugs for patients with COVID-19 (propofol, midazolam, curares) led the French government to set up a centralized supply of hospitals with distribution based on the number of resuscitation beds in March 2020. The French Societies of Clinical Pharmacy and of Anesthesia and Critical Care aimed to evaluate the changes in total needs and the distribution between anesthesia and critical care activities (CCU), to prepare resumed surgical activity.

Methods

National declarative survey among pharmacists, via an online form (SurveyMonkey®), was conducted in April and May 2020. The analysis focused on quantities dispensed during the whole year 2019, and March and April of year 2019 and 2020 for the drugs subject to quota, and on their distribution in CCU and operating theaters.

Results

For the 358 establishments (47% public, 53% private), dispensations in CCU in March 2020 compared to March 2019 increased, respectively: propofol (+81%), midazolam (+125%), cisatracurium (+311%), atracurium (+138%), rocuronium (+119%); and decreased for anaesthesia: propofol (−27%), midazolam (-10%), cisatracurium (−19%), atracurium (−27%), rocuronium (+16%).

Conclusions

Variation of dispensations between CCU and others was directly related to the increase of COVID patients in CCU and the decrease in surgical activity. Each establishment could receive up to five or six different presentations and concentrations, leading to a major risk of medication error. This collaborative national survey provided accurate data on the drugs’ usual consumption. This work emphasized the need for a strong collaboration between pharmacists and anesthesiologists and intensive care physicians. It was further used by the Health Ministry to adjust the drug distribution.

Role of Clinical Pharmacists in Intensive Care Units

The cost of health care has been rising in the United States and globally and will continue to increase. Intensive care unit (ICU) care carries a significant portion of the cost for the hospitals. The Institute of Medicine and subsequent studies have suggested that medication errors account for significant morbidity, mortality, and cost, frequently encountered in the ICU. Over the past three decades, clinical pharmacists have emerged from dispensing medication to getting involved in direct patient care and have become an integral part of the multidisciplinary critical care team. Clinical pharmacists play a significant role in reducing medication errors and costs, medication reconciliation, antibiotic stewardship, and patient and health care provider education. This review will discuss the health care and ICU cost, the evolving role of clinical pharmacists in managing critically ill patients, and their contributions in the ICU to mitigate the risks, improve patient outcomes, and decrease health care costs.

COVID the Catalyst for Evolving Professional Role Identity? A Scoping Review of Global Pharmacists' Roles and Services as a Response to the COVID-19 Pandemic

The COVID-19 pandemic requires a range of healthcare services to meet the needs of society. The objective was to explore what is known about the roles and services performed by frontline pharmacists during the first year of the COVID-19 pandemic. A scoping review was conducted of frontline pharmacists' roles and services during the first year of the COVID-19 pandemic. A medical librarian conducted comprehensive searches in five bibliographic databases-MEDLINE (via Ovid), Embase (Ovid), CINAHL, Scopus, and Web of Science Core Collection for articles published between December 2019 and December 2020. The initial search retrieved 3269 articles. After removing duplicates, 1196 articles titles and abstracts were screened, 281 full texts were reviewed for eligibility, and 63 articles were included. This scoping review presents a conceptual framework model of the different layers made visible by COVID-19 of pharmacist roles in public health, information, and medication management. It is theorized that there is an invisible layer of change representing evolving professional role identity that may influence permanent role change following the pandemic. Thus, the pharmacy profession needs to build upon the lessons and experiences of this global pandemic and not let the momentum of the visible and invisible changes go to waste.

Effect of pharmaceutical care on the treatment of COVID-19: A protocol for systematic review and meta analysis

BACKGROUND

We aimed to conduct a meta-analysis to assess the effect of pharmaceutical care on the treatment of coronavirus disease 2019 (COVID-19).

METHODS

All case-controlled studies related to pharmaceutical care on the treatment of COVID-19 will be included in this review. We will use index words related to pharmaceutical care and COVID-19 to perform literature searches in PubMed, Embase, MEDLINE, CNKI, and Wanfang databases, to include articles indexed as of October 20, 2020 in English and Chinese language. Two reviewers will select trials independently for inclusion and assess trial quality. Two pairs of review authors will independently extract information for each included trials. Primary outcomes are clinical outcomes, average hospital stays, costs, patient satisfaction, and incidence of adverse drug reactions. We will evaluate the risk of bias of the included studies based on Cochrane assessment tool. Revman 5.3 (the Cochrane collaboration, Oxford, UK) will be used for heterogeneity assessment, generating funnel-plots, data synthesis, subgroup analysis, and sensitivity analysis.

RESULTS

We will provide targeted and practical results assessing the effect of pharmaceutical care on the treatment of COVID-19.

CONCLUSION

The stronger evidence about the effect of pharmaceutical care on the treatment of COVID-19 will be provided for clinicians.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020214223 ETHICS AND DISSEMINATION:: There is no need for ethical approval, and the review will be reported in a peer-reviewed journal.