• Users Online: 145
  • Print this page
  • Email this page


 
 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 4  |  Issue : 5  |  Page : 18-20

Clinical Pharmacy Service in the Intensive Care Unit during COVID-19 Pandemic


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

Date of Submission06-Sep-2020
Date of Decision31-Oct-2020
Date of Acceptance29-Sep-2020
Date of Web Publication7-Dec-2020

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
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sccj.sccj_46_20

Rights and Permissions
  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.

Keywords: Clinical pharmacist, COVID-19, intensive care unit


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, Suppl S1:18-20

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 Feb 3];4, Suppl S1:18-20. Available from: https://www.sccj-sa.org/text.asp?2020/4/5/18/302583




  Introduction Top


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: Role of clinical pharmacists in mitigation of drug shortages during COVID-19 pandemic

Click here to view


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 Top


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.



 
  References Top

1.
Aruru M, Truong HA, Clark S. Pharmacy Emergency Preparedness and Response (PEPR): a proposed framework for expanding pharmacy professionals’ roles and contributions to emergency preparedness and response during the COVID-19 pandemic and beyond [published online ahead of print, 2020 Apr 10]. Res Social Adm Pharm. 2020;S1551-7411(20)30323-5. doi:10.1016/j.sapharm.2020.04.002.  Back to cited text no. 1
    
2.
Visacri MB, Figueiredo IV, Lima T. Role of pharmacist during the COVID-19 pandemic: A scoping review. Research in Social & Administrative Pharmacy, Advance online publication 2020. Available from: https://doi.org/10.1016/j.sapharm.2020.07.003  Back to cited text no. 2
    
3.
Badreldin HA, Raslan S, Almudaiheem H, Alomari B, Almowaina S, Joharji H, et al. Pharmacists roles and responsibilities during epidemics and pandemics in Saudi Arabia: An opinion paper from the Saudi Society of Clinical Pharmacy. Saudi Pharm J 2020;28:1030-4.  Back to cited text no. 3
    
4.
Meng L, Huang J, Qiu F, Sun S. Roles of the Chinese clinical pharmacist during the COVID-19 pandemic. Journal of the American College of Clinical Pharmacy: JACCP, 2020. Advance online publication. Available from: https://doi.org/10.1002/jac5.1274.  Back to cited text no. 4
    
5.
Alhazzani W, Al-Suwaidan FA, Al Aseri ZA, Al Mutair A, Alghamdi G, Rabaan AA, et al. The Saudi Critical Care Society Clinical Practice Guidelines on the management of COVID-19 patients in the intensive care unit. Saudi Crit Care J 2020;4:27-44.  Back to cited text no. 5
  [Full text]  
6.
Liu J, Zheng X, Tong Q, Li W, Wang B, Sutter K, et al. Overlapping and discrete aspects of the pathology and pathogenesis of the emerging human pathogenic coronaviruses SARS-CoV, MERS-CoV, and 2019-nCoV. J Med Virol 2020;92:491-4.  Back to cited text no. 6
    
7.
RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. Dexamethasone in Hospitalized Patients with Covid-19 - Preliminary Report. The New England journal of medicine, NEJMoa2021436. 2020, Advance online publication. Available from: https://doi.org/10.1056/NEJMoa2021436.  Back to cited text no. 7
    
8.
Behera S, Jha SK, Singh NK, Khilnani GC, Mahajan A, Kumar S, et al. COVID-19: What we all intensivists should know. Saudi Crit Care J 2020;4:45-57.  Back to cited text no. 8
  [Full text]  
9.
Aljuhani OA. Critical care pharmacy services in the Western region of Saudi Arabia. Saudi Crit Care J 2020;4:66-72.  Back to cited text no. 9
  [Full text]  
10.
ASHP guidelines on the pharmacist’s role in the development, implementation, and assessment of critical pathways. Am J Health Sys Pharm 2004;61:939-45.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed2296    
    Printed114    
    Emailed0    
    PDF Downloaded167    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]