Interventions of a clinical pharmacist in a medical intensive care unit – A retrospective analysis (original) (raw)
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Clinical Impact of Pharmacist Presence in ICU Medical Team on Mortality Rate
Studies indicate alarmingly high number of death, by medical errors, especially in the US 23. This review article aims to use studies around the world in order to examine the role clinical pharmacists can play, as proactive health team members in an Intensive Care Unit (ICU), in preventing health risks, particularly those ending in life losses. It also examines clinical pharmacist interventionist role by focusing on optimizing the quality of pharmacotherapy and patient safety. The goal of creating an advanced medical treatment integrated team is already a trend in western countries and pharmacist roles in clinical decisions is expanding, in a very specialized fashion. This therefore although puts pharmacists under a greater burden of responsibility than ever before, but it is well justified, since it prevents a considerable number of health risks, by achieving a relevant reduction in mortality rates, and at the same time cuts down unnecessary expenses. According to ASHP Guidelines 20 : " pharmacist should function as a liaison between pharmacy and other clinical staff in different departments such as anesthesiology, surgery and antibiotic use. " The paper examines the role of the clinical pharmacists as experts of excellence in drug use and its impact in ICU that will eventually reflect in not only reducing mortality rates and improving clinical outcomes but also lowering considerably the costs of drugs, medical devices, consequential costs caused by medical errors, number of recovery days in the hospital and more. This can be obtained by using clinical pharmacist to guard, oversee, both adjust/correct therapies and take a task of using a management tool, in every day ICU's activities. Based on biomedical literature, we can observe a general improvement in different clinical outcomes and as a result a noticeable reduction in mortality rates, when a clinical pharmacist is a permanent member of the medical team. In brief words, we are here to help not only in increasing life quality of the patients in need of a functional healthcare system, but also in removing unnecessary cost burdens, which eventually prevents economy turmoil.
Role of Clinical Pharmacists in Intensive Care Units
Cureus, 2021
The cost of health care has been rising in the United States and globally and will continue to increase. Intensive care unit (ICU) care carries a significant portion of the cost for the hospitals. The Institute of Medicine and subsequent studies have suggested that medication errors account for significant morbidity, mortality, and cost, frequently encountered in the ICU. Over the past three decades, clinical pharmacists have emerged from dispensing medication to getting involved in direct patient care and have become an integral part of the multidisciplinary critical care team. Clinical pharmacists play a significant role in reducing medication errors and costs, medication reconciliation, antibiotic stewardship, and patient and health care provider education. This review will discuss the health care and ICU cost, the evolving role of clinical pharmacists in managing critically ill patients, and their contributions in the ICU to mitigate the risks, improve patient outcomes, and decrease health care costs.
Open Forum Infectious Diseases, 2015
Background: Infectious disease (ID) clinicians and multidisciplinary teams may have a beneficial impact on patient outcomes. This study was conducted to determine the impact of dedicated ID team rounding in an adult noncardiac intensive care unit (ICU) on antimicrobial costs, length of stay and mortality. Methods: The authors instituted dedicated ICU ID team rounds at a large tertiary care hospital ICU ("intervention"), with the ID team conducting rounds in the ICU every weekday. The authors compared the cost of antimicrobial agents, total hospital and ICU length of stay and inpatient mortality for the 6-month period before and after institution of these rounds between those seen versus those not seen by the ID team. Results: Among 386 patients analyzed, 206 were admitted in the preintervention and 180 in the postintervention period. Among those seen by the ID team, there was an 18% decrease in total antimicrobial cost (P , 0.0001), 40% decrease in ICU length of stay (P 5 0.1), 33% decrease in overall hospital length of stay (P 5 0.03) and 34% decrease in mortality (0.04) from preintervention to postintervention period. Among those not seen by ID, there was a 39% decrease in cost among those not seen by ID (P , 0.0001), but length of ICU or hospital stay and mortality were not significantly different. Conclusions: Institution of dedicated ID team rounding in the ICU leads to substantial decreases in antimicrobial costs, hospital length of stay and inpatient mortality among those patients seen by the team.
Impact of pharmacist's interventions on cost of drug therapy in intensive care unit
Pharmacy Practice (internet), 2009
Pharmacist participation in patient care team has been shown to reduce incidence of adverse drug events, and overall drug costs. However, impact of pharmacist participation in the multidisciplinary intensive care team on cost saving and cost avoidance has little been studied in Thailand. Objective: To describe the characteristics of the interventions and to determine pharmacist's interventions led to change in cost saving and cost avoidance in intensive care unit (ICU). Methods: A Prospective, standard care-controlled study design was used to compare cost saving and cost avoidance of patients receiving care from patient care team (including a clinical pharmacist) versus standard care (no pharmacist on team). All patients admitted to the medical intensive care unit 1 and 2 during the same period were included in the study. The outcome measures were overall drug cost and length of ICU stay. Interventions made by the pharmacist in the study group were documented. The analyses of acceptance and cost saving and/or cost avoidance were also performed. Results: A total of 65 patients were admitted to either ICU 1 or 2 during the 5 week-study period. The pharmacist participated in patient care and made total of 127 interventions for the ICU-1 team. Ninety-eight percent of the interventions were accepted and implemented by physicians. The difference of overall drug cost per patient between two groups was 182.01 USD (1,076.37 USD in study group and 1,258.38 USD in control group, p=0.138). The average length of ICU stay for the intervention group and the control group was not significantly different (7.16 days vs. 6.18 days, p=0.995). The 125 accepted interventions were evaluated for cost saving and cost avoidance. Pharmacist's interventions yielded a total of 1,971.43 USD from drug cost saving and 294.62 USD from adverse drug event cost avoidance. The net cost saved and avoided from pharmacist interventions was 2,266.05 USD. Interventions involving antibiotic use accounted for the largest economic impact (1,958.61 USD). Conclusions: Although the statistical was not significant, having a pharmacist participated in ICU patient care team tend to reduced overall drug cost,
Interdisciplinary Patient Care in the Intensive Care Unit: Focus on the Pharmacist
Pharmacotherapy, 2011
The field of critical care medicine began to flourish only within the last 40 years, yet it provides some of the best examples of collaborative pharmacy practice models and evidence for the value of pharmacist involvement in interdisciplinary practice. This collaborative approach is fostered by critical care organizations that have elected pharmacists into leadership positions and recognized pharmacists through various honors. There is substantial literature to support the value of the critical care pharmacist as a member of an interdisciplinary intensive care unit (ICU) team, particularly in terms of patient safety. Furthermore, a number of economic investigations have demonstrated cost savings or cost avoidance with pharmacist involvement. As the published evidence supporting pharmacist involvement in patient care activities in the ICU setting has increased, surveys have demonstrated an increase in the percentage of pharmacists performing clinical activities. In addition, substantial support of pharmacists has been provided by other clinicians, safety officers, and administrative personnel who have been involved with the initiation and expansion of critical care pharmacy services in their own institutions. Although there is still room for improvement in the range of pharmacist involvement, particularly with respect to interdisciplinary activities related to education and scholarship, pharmacists have become essential members of interdisciplinary care teams in ICU settings.
Annals of Intensive Care
Background Severe infections and multidrug-resistant pathogens are common in critically ill patients. Antimicrobial stewardship (AMS) and therapeutic drug monitoring (TDM) are contemporary tools to optimize the use of antimicrobials. The A-TEAMICU survey was initiated to gain contemporary insights into dissemination and structure of AMS programs and TDM practices in intensive care units. Methods This study involved online survey of members of ESICM and six national professional intensive care societies. Results Data of 812 respondents from mostly European high- and middle-income countries were available for analysis. 63% had AMS rounds available in their ICU, where 78% performed rounds weekly or more often. While 82% had local guidelines for treatment of infections, only 70% had cumulative antimicrobial susceptibility reports and 56% monitored the quantity of antimicrobials administered. A restriction of antimicrobials was reported by 62%. TDM of antimicrobial agents was used in 61%...