Evaluation of clinical pharmacist's contribution to sepsis and septic shock management

The effect of the pathophysiology of sepsis and septic shock on pharmacokinetics, the number of drug usage and the variable physiology of patients may lead to drug-related problems, therefore an individualized treatment plan is required in this patient group. It is stated in "Sepsis Survival Campaign" that the inclusion of the multidisciplinary team in the management of sepsis and septic shock might decrease the mortality rates. In this thesis, it was aimed to evaluate the contribution of the clinical pharmacist to the drug therapy management with the recommendations made for the drug related problems detected in all treatment steps of patients diagnosed with sepsis and septic shock. Total of 65 patients were included in the study group prospectively in which the intervention of clinical pharmacist provided for the drug treatments and retrospectively 65 patients in the control group without any intervention. In the study group, 670 recommendations were made for 753 problems related to their drug therapy. It was found that these recommendations were made most frequently for doses of antimicrobials (n=168, 25.81%). Between study and control groups, improvement in appropriateness of antimicrobials in terms of dose (p<0.001), antimicrobial transition time (p<0.001), daily antibiotic costs in all patients (p<0.005) and antibiotic costs in patients with impaired renal function (p<0.05) significant difference were found statistically. In this thesis, as a result of the clinical pharmacist's daily follow-up interventions and informations about septic patients' drug therapy management it has been shown to contribute to the prevention and management of drug interactions, to start antimicrobial therapies more quickly, to select the appropriate drug and dose for the patient, especially antimicrobials, to follow the treatment with therapeutic drug and to save the costs of antimicrobial drugs.