Pharmacotherapy
-
To determine the prevalence of postsurgical opioid use in the inpatient setting, to ascertain the frequency of and risk factors for opioid-related adverse drug events (ORADEs) among patients who received opioids, and to evaluate the impact of ORADEs on clinical and economic outcomes. ⋯ Opioid use was ubiquitous among hospitalized patients who underwent common surgical procedures. The observed negative outcomes of ORADEs and their impact on patients and the health care system should be considered when evaluating the balance between effectively managing postsurgical pain while minimizing the risk of ORADEs.
-
To determine if a higher serum vancomycin (Vt) target trough concentration of 15-20 μg/ml or greater is associated with an increased rate of vancomycin-induced nephrotoxicity in children admitted to a pediatric intensive care unit (PICU), and to determine risk factors for developing vancomycin-induced nephrotoxicity. ⋯ Our observations suggest that maintaining Vt concentrations 15 µg/ml or greater is not associated with an increased rate of nephrotoxicity in a PICU population.
-
Comparative Study
Clinical and financial impact of pharmacy services in the intensive care unit: pharmacist and prescriber perceptions.
To compare pharmacist and prescriber perceptions of the clinical and financial outcomes of pharmacy services in the intensive care unit (ICU). ⋯ Critical care pharmacy activities were associated with perceptions of beneficial clinical and financial outcomes. Prescribers valued most services more than pharmacists. Fundamental services were viewed more favorably than desirable or optimal services, possibly because they occurred more frequently or were required for safe patient care. Substantial inefficiencies may occur if pharmacy services disappeared. Considerable support existed for funding and reimbursement of critical care pharmacy services.
-
To determine whether pharmacologic prophylaxis for venous thromboembolism (VTE) was associated with a decrease in the incidence of VTE or an increased incidence of bleeding in patients with chronic liver disease (CLD). ⋯ Pharmacologic VTE prophylaxis was associated with a decreased incidence of VTE in patients with CLD without an increased rate of bleeding and should be routinely considered on admission to the hospital. Patients with CLD and active malignancy, trauma or surgery during hospitalization, or history of VTE appear to be at highest risk of VTE and thus warrant pharmacologic prophylaxis. Prospective studies must validate these findings.