REVIEW ARTICLE
Year : 2020 | Volume
: 4 | Issue : 5 | Page : 18--20
Clinical Pharmacy Service in the Intensive Care Unit during COVID-19 Pandemic
Jawaher Abdullah Gramish1, Maram Maher Abuzaid2, Moteb Abdu Khobrani3,
1 Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences; Clinical Pharmacy, Pharmaceutical Care Services, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
2 Clinical Pharmacy, Pharmaceutical Care Services, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
3 Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
Correspondence Address:
Jawaher Abdullah Gramish
College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences; Pharmaceutical Care Services, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh
Saudi Arabia
Abstract
Critical care pharmacist is essential member of the intensive care unit (ICU) multidisciplinary team. ?During COVID-19 pandemic, ICU pharmacists showed their vital role in conceptualizing, appraising, and drafting prevention and treatment protocols, as well as evaluating the available evidence and providing the best references to develop national and institutional guidelines in COVID-19 management. In addition, their responsibilities include ensuring that the patient is receiving the safe and effective treatment. In addition, during this pandemic, clinical pharmacists around the Kingdom played a crucial role in mitigation of drug shortages.
How to cite this article:
Gramish JA, Abuzaid MM, Khobrani MA. Clinical Pharmacy Service in the Intensive Care Unit during COVID-19 Pandemic.Saudi Crit Care J 2020;4:18-20
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How to cite this URL:
Gramish JA, Abuzaid MM, Khobrani MA. Clinical Pharmacy Service in the Intensive Care Unit during COVID-19 Pandemic. Saudi Crit Care J [serial online] 2020 [cited 2023 Jun 4 ];4:18-20
Available from: https://www.sccj-sa.org/text.asp?2020/4/5/18/302583 |
Full Text
Introduction
The most recent COVID-19 pandemic put enormous pressure on the health-care system causing many health-care organizations all over the world to change the normal course of clinical practice in response to this crisis. Health-care workers from different professions are involved in caring for patients with this highly transmittable pathogen. It is recommended by many international organizations to include pharmacists in the management of COVID-19 pandemics as they have long been an integral part of health-care professionals in handling public health emergencies.[1] Many studies have shown that pharmacists can play an essential role in conceptualizing, appraising, and drafting prevention and treatment protocols, as well as analyzing national and international therapeutic options for the management of any emerging outbreak.[2] Many organizations reinforce the importance of pharmacists’ participation and role in decision-making during these circumstances. The Saudi Society of Clinical Pharmacy released an extensive document for pharmacy professionals related to COVID-19 measures in the pharmacy workforce to provide guidance and several insights regarding the pharmacist’s roles and responsibilities in the community, supply chain, and health-care settings in the Kingdom.[3] In this brief review, we will describe a general overview of the role of clinical pharmacists in managing COIVD-19 critically ill patients.
Clinical pharmacists were heavily involved in evaluating the available evidence and providing the best references to develop national and institutional management guidelines. Their role as a part of the multidisciplinary team is to create an evidence-based treatment protocol for the COVID-19-related medications.[4],[5] After establishment of these protocols, pharmacist responsibilities are extended to monitor critically ill patients for drug efficacy and to evaluate the critical pathway for patient safety.
With the limited data on the treatment of COVID-19, there has been a great interest in utilizing a number of drugs that are approved for other indications and available in the market as a potential treatment for COVID-19 patients. Critical care pharmacists play an essential role in reviewing and interpreting information regarding these agents to assist physicians and other health-care professional colleagues who may have limited time to evaluate new data and make appropriate decisions during the time of increased patient volume.
Giving that there are no randomized controlled trials demonstrating the efficacy of most agents that are used for the treatment of COVID-19 patients, and the fact that some clinicians may get excited about newly published data for COVID-19 treatment, it is crucial that pharmacists take a critical approach in evaluating risks and harms.[6] For example, while hydroxychloroquine, lopinavir/ritonavir, and tocilizumab have been considered to have good promise in treating COVID19 cases, recent randomized trials failed to show a clinical benefit when compared to the standard of care.[7],[8]
It is the intensive care unit (ICU) clinical pharmacist’s responsibilities to ensure that COVID-19 patient is receiving the appropriate treatment in term of indication, dosing, duration, interactions, adverse effects, preparations, and administration precautions, in addition to monitoring the therapy for efficacy and safety,[9] for example, monitoring the use of lopinavir/ritonavir and tocilizumab to avoid inappropriate prescribing or to reduce unnecessary cost. Another example is monitoring the QT-interval in the echocardiogram for patients on hydroxychloroquine to prevent potential cardiac adverse effects.
Drug shortages were one of the major challenges that faced the clinicians during this pandemic at the national and global levels, especially for those medications that are commonly used in ICU patients as analgesics, sedatives, and neuromuscular blocking agents. COVID19 drug-related shortages are mainly because of slowdowns in manufacturing and importation on top of the unpredictable and significant surge in use. Clinical pharmacists in the Kingdom played a crucial role in mitigation of drug shortages during the pandemic including analysis of drugs with high demands to design an alternative treatment guidelines, algorithms, policies and/or protocols, advocating evidence-based medication use, secure medications on compassionate use, and share the experience from other countries in overcoming drug shortages. [Table 1] illustrates critical care pharmacist actions in mitigation of drug shortages during this pandemic. These are examples to name a few. Moreover, communicating with the supply chain and working with policymakers at the national and institutional levels were part of the helpful role of clinical pharmacists during this pandemic.[10]{Table 1}
Different clinical pharmacy staffing modules were implemented in various hospitals around the Kingdom to ensure the continuity of the provided services at the highest standards of patient care during this pandemic. Some institutions continued with the physical attendance of the ICU pharmacist as a part of the medical team and have trained other non-ICU pharmacists to participate in the patient care to meet the huge expansions in the ICU beds. Few pharmacy departments in different institutions around the Kingdom developed a contingency plan for staffing adjustments based on pharmacist availability. In addition, remote clinical pharmacy services were implemented in many hospitals to limit the staff exposure and to reduce the risk of staff shortages. While some pharmacy administration decided to have the ICU pharmacists work remotely from home using devices that are equipped with a secure-access virtual private network application to ensure patient information protection, others worked on-site but remotely from the ICUs. In general, these services include remote participation in daily rounds, reviewing patient information, and providing recommendations, medication reconciliation, counseling, and consultations. Although the remote access model assists with reviewing a greater number of ICU patients, many ICU pharmacists found it difficult to perform daily patient care duties with effective communication with ICU medical and nursing staff whom they have a long-term collegial relationship with. In addition, reactive rather than proactive clinical pharmacy interventions were provided on many occasions.
Conclusion
Clinical pharmacists in Saudi Arabia play a vital role in facing COVID-19 pandemic. This is clearly illustrated through sharing their professional expertise, analyzing the situation rationally, and formulating different and appropriate strategies to provide patient care. Critical care pharmacists work effectively in a united and efficient manner to provide innovative pharmacy services during this pandemic.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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