ASIAN CORNER
Neurointensive Care Unit at the TMG Asaka Medical
Center and the Pharmacists’ Roles
By Satoshi Egawa1), Nobuhiro Narabu2), Satomi Yamagata2), Ryosuke Okada2), Minoru Fukuda2), Hidetoshi Nakamoto3), and Yuichi Kubota3)
Satoshi Egawa1 Nobuhiro Narabu2 Satomi Yamagata2 Ryosuke Okada2 Minoru Fukuda2 Hidetoshi Yuichi Kubota3
1. Neurointensive Care Unit, TMG Asaka Medical Center
2. Pharmacy, TMG Asaka Medical Center
3. Stroke and Epilepsy Center, TMG Asaka Medical Center
Excellent activity of any hospital demands effective teamwork of
its medical staff, especially in the intensive care unit (ICU). Since
Jan. 1, 2018, TMG Asaka Medical Center has been operating the
neuro ICU in complete collaboration with pharmacists. Every
day, one pharmacist works as a team member managing the
operation of the neuro ICU. This article aims to report the role of
pharmacists in our neuro ICU at the TMG Asaka Medical Center.
Typically, neuro ICUs host patients whose diseases and prescribed
drugs are often uncommon for general intensivists. Thus, the
safe, timely and evidence-based appropriate administration of
medications warrants advice and supervision of pharmacists.
Because of its proximity to the Epilepsy Center, the neuro ICU at
TMG Asaka Medical Center receives many status epilepticus (SE)
patients. The adherence of AEDs and drug interactions presents
several pitfalls. Physicians might find it hard to understand all
drugs completely in the early stage of their hospitalization. In
such scenarios, the pharmacists obtain relevant information of
patients, starting from their history to medical conditions such as
allergy and adherence. In addition, in the neuro ICU, there are not
only SE but also a lot of refractory and superrefractory SE patients
who must be monitored by continuous EEG monitoring. In those
cases, they monitor drug interactions and side effects, especially
skin rashes, every day. Using the expertise of pharmacists in the
neuro ICU enhances and facilitates determining the effective drug
combination promptly.
In addition, pharmacists help in the compliance of safety guidelines
of DOAC (direct oral anticoagulants) usage, which warrants
extraordinary attention because of its dosage dependence on
patients’ body weight and age. Hence, pharmacists’ support might
decrease hemorrhagic complications. For other drugs, they monitor
the renal function and suggest alternate drug regimen as applicable.
On morning neuro ICU rounds, a pharmacist shares those
findings with the medical team to assess whether any change
in management is required. In addition, during these rounds,
pharmacists routinely deliver a short lecture about the patients’
drugs to educate the neurocritical care team. Routine lectures
are planned, too. For instance, sedation and analgesia for
patients in the neuro ICU, shivering management during
targeted temperature management and proper use of AEDs and
hyperosmotic agents. The information provided by pharmacists is
beneficial for residents, neurosurgeons and nurses.
Nakamoto3
Pharmacists have a lot of opportunity to learn clinical knowledge,
which is imperative to clinical works in the neuro ICU. Both
intensivists and neurointensivists teach them the pathophysiology
of patients to acquire an understanding of clinical medicine, thus
enabling them to discuss the drug dosage depending on patients’
condition. Furthermore, every pharmacist is advised to undertake
an ENLS course. In Japan, reportedly, half of the ICUs have at least
one full-time pharmacist; however, the neuro ICU itself is rarely
established. In Japan, establishing the position of pharmacists
with an expertise in neurocritical care is important too for the
smooth functioning of the neuro ICU.
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