To identify drug-related problems (DRPs) in liver transplant recipients in the intensive care unit (ICU) and determine the potential impact of pharmacist interventions.

A retrospective study was conducted to review the DRPs, interventions, and acceptance identified by pharmacists during pharmaceutical care and consultations in the liver surgery ICU at Zhongshan Hospital, Fudan University, from January 2020 to December 2021. Two pharmacists classified DRPs using the Pharmaceutical Care Network Europe V9.1. Pharmacist interventions were independently assessed using a six-point scale based on the potential impact on the treatment of liver transplant recipients in resolving DRPs. Gephi 0.9.2 network analysis software was used to analyze the relationships between DRPs and causes.

During pharmaceutical care, pharmacists identified 97 DRPs, with the most common "adverse drug event (possibly) occurring" (51.5%). Among the types of causes for DRPs, "drug selection" accounted for the highest proportion (61.9%). Pharmacists proposed 220 interventions for the identified DRPs, with 122 interventions at the prescriber level, predominantly involving "intervention proposed to prescriber" . There were 98 interventions at drug level, with "drug paused or stopped" being the most common. The vast majority of interventions were rated as "very significant" (10.3%), "significant" (64.0%), and "somewhat significant" (24.7%). Following pharmacist interventions, 88.7% (86/97) of the DRPs were resolved. In terms of consultations, pharmacists identified 114 DRPs, with 64.0% related to anti-infective drugs. Physicians were more concerned about "treatment effectiveness and safety, " and among the causes for DRPs, "drug selection" had the highest proportion (40.4%). In addition to prescriber-level (n=202) and drug-level (n=83) interventions, pharmacists proposed other interventions or behaviors (n=10) for the DRPs identified during consultations. Except for 17 DRPs where interventions could not be directly evaluated due to the lack of target patients, among the remaining 97 DRPs, the proportions of interventions by pharmacists with "very significant" , "significant" , and "somewhat significant" potential impact were 19.6%, 52.6%, and 26.8%, respectively. Comparing the causes of DRPs identified during pharmaceutical care and consultations, both physicians and pharmacists were concerned about drug combination issues, including drug interactions. Physicians were more prone to seek pharmacist assistance when encountering "dose adjustment of renal or liver insufficiency" , "needing supplementary drug information" , or facing "unavailable prescribed drugs" . Network analysis of the relationships between DRPs and causes revealed that the most diverse causes in pharmaceutical care were "adverse drug event" and "effect of drug treatment not optimal" , with 10 and 8 causes, respectively. In consultations, the most diverse causes were related to "treatment effectiveness and safety" , with 7 causes.

Pharmacists can identify and resolve DRPs in liver transplant recipients in the ICU, and targeted pharmaceutical interventions positively impact their treatment. The complementary knowledge systems of physicians and pharmacists within the liver transplant team are conducive to ensuring the safety and reliability of medication.