The Role of Critical Care Pharmacists Beyond Intensive Care Units: A Narrative Review on Medication Management for ICU Survivors

Abstract There is a global improvement in critical care services that leads to prolonged survival after ICU stay. This improvement has increased the demand for multidisciplinary critical care services beyond the ICU. Recently, efforts focused on the patient’s quality of life after ICU discharge and family involvement in their care. Most older adults who survive an ICU stay are challenged by complex medication changes following discharge, as are their caregivers. Limited literature addresses the standard of practice for medication management and critical care pharmacists’ involvement in post-ICU services. This narrative review describes the available literature that addresses medication management in post-ICU settings by critical care pharmacists and potential axes for future research. The included articles were articles published in English related to adult ICU survivors and addressed pharmacist involvement or medication management. The main findings summarize the most performed pharmacist services following ICU discharge, including medication reconciliation, full medication review, and adverse drug event preventative measures. This review concluded a lack of consensus about the standard model of post-ICU pharmacy services and the relationship of these services with long-term outcomes.

摘要 全球范围内，重症监护病房（Intensive Care Unit, ICU）相关医疗服务的优化使得ICU住院患者的生存期得以延长。此类服务的升级亦推动了ICU以外多学科重症监护服务的需求增长。近年来，研究焦点逐渐转向ICU出院患者的生活质量，以及家属参与患者照护的相关议题。多数经ICU救治存活的老年患者在出院后会面临复杂的用药方案调整难题，其照护者亦面临相同困境。目前针对ICU出院后用药管理的实践标准，以及重症监护药师参与ICU后医疗服务的相关研究仍较为匮乏。本叙述性综述系统梳理了当前有关重症监护药师参与ICU后场景用药管理的现有文献，并提出了未来研究的潜在方向。本次综述纳入的文献均为以英文发表、针对成人ICU幸存者且涉及药师参与或用药管理的研究。主要研究结果总结了ICU出院后药师开展的核心服务，包括用药重整（medication reconciliation）、全面用药审查以及药品不良反应（Adverse Drug Event, ADE）预防措施。本综述同时指出，当前尚未就ICU后药学服务的标准模式，以及此类服务与患者长期预后之间的关联达成共识。