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Analysis of Clinical Pharmacist Interventions in the Cardio-Surgical Intensive Care Unit
J. Kor. Soc. Health-syst. Pharm. 2021;38:185-194
Published online May 31, 2021;
© 2021 Korean Society of Health-System Pharmacists

You Min Sohna, Min Ji Koa, Hyo Jung Parka, Jae Hyun Leea, Yong Seok Leea, Hu Kyung Leea, Jeong Mee Kima, Yang Hyun Chob and Myung Sook Mina†

Department of Pharmaceutical Services, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Koreaa Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Koreab
Correspondence to: 민명숙 Tel:02-3410-3370
*손유민과 고민지는 공동 제1저자로서 본 논문에 동등하게 기여함
Received March 23, 2021; Revised April 13, 2021; Accepted April 23, 2021.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background : It has been reported that clinical pharmacists’ participation in the multidisciplinary intensive care unit (ICU) team reduces the number of medication errors and improves the clinical outcome. However, studies assessing the role of pharmacists in a cardio-surgical ICU (CSICU) are limited. The aim of this study was to analyze pharmacologic interventions and identify pharmacologic problems that require pharmacist intervention in a CSICU.
Methods : The research was conducted by retrospectively reviewing the electronic medical records of patients aged 18 years or older who were admitted to the CSICU of Samsung Medical Center from April 1 2019 to June 30 2019.
Results : During the study, the clinical pharmacist monitored 12,021 drug prescriptions for 205 patients and conducted 379 pharmacologic interventions. The most common pharmacologic intervention recommended by the pharmacist was nutritional support (19.0%), followed by therapeutic drug monitoring (TDM) (18.5%) and provision of drug information (14.8%). The most frequently mediated group of drugs was antibiotics (31.1%), and the causes for pharmacologic intervention of antibiotics were mostly TDM (51.7%) and inappropriate dosage (20.3%). The intervention rate of ‘pain, sedation and delirium-related drugs’ was 17.2%, while the intervention rate of ‘antiarrhythmics, anticoagulant, and antiplatelet agents’ was 13.2%. The most common reason for intervention in both groups was missed prescriptions, followed by adverse drug events and inappropriate dosages. The acceptance rate of intervention was 92.2%.
Conclusion : Clinical pharmacists’ participation in the ICU has enabled active drug prescription monitoring, proper nutrition support, and TDM. The acceptance rate of intervention is high. The CSICU requires pharmacologic intervention of pain, sedation and delirium-related drugs specific to critically ill patients, as well as drugs indicated for cardio-surgery.
Keywords : Clinical pharmacist, Intervention, Cardio-surgical intensive care unit