FEATURE
Targeting drug safety in the ICU An interview with Clinical Pharmacist Dr. Lisa Burry
By Natalie Osborne
I
n the intensive care unit (ICU), a multidisciplinary team of health care professionals must work in tandem to treat critically ill patients. This includes prescribing high-risk medications to severely ill patients while balancing efficacy, minimizing side effects and avoiding harmful drug interactions. Enter the Clinical Pharmacist; professionals trained in pharmacology and clinical medicine who make the rounds in the ICU everyday to ensure patients are receiving safe and efficacious drugs.
It was this bedside interaction that drew Dr. Lisa Burry to the PharmD program at the University of Toronto (UofT). She had already completed a BSc in pharmacy and worked for four years as a hospital pharmacist in a small community hospital when her mentors encouraged her to pursue advanced clinical care training. She was accepted into one of just six spots in the post-doc PharmD program and hired in the Critical Care Clinical Pharmacy Specialist position at Mount Sinai Hospital even before graduation. Now, years later, Dr. Burry has decided to go back to school for yet another doctorate—this time a PhD at the Institute of Medical Science. As a Clinician-Scientist at Mount Sinai and Assistant Professor in the Leslie 14 |
Dan Faculty of Pharmacy at UofT, Dr. Burry is already an accomplished researcher. She fully credits the clinical research-centric ICU she works in for involving her in as many projects as possible from the very start of her career, and eventually encouraging her to lead her own studies. Dr. Burry is particularly interested in sedation, delirium, and pain relief in critically ill patients. Due to their serious illness as well as invasive life-saving procedures, many ICU patients experience agitation, anxiety, sleep deprivation, and pain. “My research has focussed on patient and drug safety, and symptom management. For example, if we’re giving a patient a drug to relieve their agitation, I want to determine; what’s the best option? How long do we need to give it? And how can we wean them off it once they leave the ICU?” Dr. Burry further explains, “As patients’ symptoms evolve over time, the treatment plan is also going to evolve. We need a clear plan for when some of these drugs are going to stop, because there are consequences to many of these drugs in terms of prolonged hospitalization and longterm addiction potential.” Delirium, associated with medications or severe acute infections, is a common symptom in the ICU. Dr. Burry and colleagues wanted to understand
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which common ICU drugs increased the risk of delirium, so they followed 550 ICU patients, quantifying every psychoactive drug they received and assessing them for delirium daily. Then, they ran models to assess if any of the drugs were independently associated with delirium, accounting for other potentially confounding predictors such as age and sex (e.g., older men are more likely to have delirium). They identified two classes of drugs— benzodiazepines and anti-cholinergic drugs—that were independently associated with delirium. They also determined the dose exposure of these drugs also increased delirium risk.
Lisa Burry, BSc Pharm, PharmD Clinician Scientist & Clinical Pharmacy Specialist, Dept. of Pharmacy, Mount Sinai Hospital Assistant Professor, Leslie Dan Faculty of Pharmacy, University of Toronto Graphics by Janell Lin with icons from Wanicons
