OBJECTIVES: To comprehensively classify interventions performed by ICU clinical pharmacists and quantify cost avoidance generated through their accepted interventions. DESIGN: A multicenter, prospective, observational study was performed between August 2018 and January 2019. SETTING: Community hospitals and academic medical centers in the United States. PARTICIPANTS: ICU clinical pharmacists. INTERVENTIONS: Recommendations classified into one of 38 intervention categories (divided into six unique sections) associated with cost avoidance. MEASUREMENTS AND MAIN RESULTS: Two-hundred fifteen ICU pharmacists at 85 centers performed 55,926 interventions during 3,148 shifts that were accepted on 27,681 adult patient days and generated $23,404,089 of cost avoidance. The quantity of accepted interventions and cost avoidance generated in six established sections was adverse drug event prevention (5,777 interventions; $5,822,539 CA), resource utilization (12,630 interventions; $4,491,318), individualization of patient care (29,284 interventions; $9,680,036 cost avoidance), prophylaxis (1,639 interventions; $1,414,465 cost avoidance), hands-on care (1,828 interventions; $1,339,621 cost avoidance), and administrative/supportive tasks (4,768 interventions; $656,110 cost avoidance). Mean cost avoidance was $418 per intervention, $845 per patient day, and $7,435 per ICU pharmacist shift. The annualized cost avoidance from an ICU pharmacist is $1,784,302. The potential monetary cost avoidance to pharmacist salary ratio was between $3.3:1 and $9.6:1. CONCLUSIONS: Pharmacist involvement in the care of critically ill patients results in significant avoidance of healthcare costs, particularly in the areas of individualization of patient care, adverse drug event prevention, and resource utilization. The potential monetary cost avoidance to pharmacist salary ratio employing an ICU clinical pharmacist is between $3.3:1 and $9.6:1.
The aim of the present study was to determine the effectiveness of entry screening for tuberculosis and biannual follow-up screening among new immigrants in the Netherlands.To achieve this, the present authors analysed screening, prevalence and incidence data of 68,122 immigrants, who were followed for 29 months. Patients diagnosed within 5 months and 6-29 months after entry screening were considered to be detected at entry and during the follow-up period, respectively.
The potential benefits of acetazolamide include ventilator weaning for chronic obstructive pulmonary disease patients, avoidance of invasive procedures in patients with a CSF leak or elevated ICP, and prevention of high-dose methotrexate toxicity and contrast-induced nephropathy. Uncertainty remains regarding the selection of patients who would best benefit from acetazolamide use.
Introduction Pharmacists are widely recognized members of the critical care health care team. However, unlike other health care professions, critical care pharmacists do not have standardized pharmacist to patient ratios that establish maximal cost‐efficiency while maintaining optimal patient safety. Though many prior recommendations claim a ratio of 1:15 for safe pharmacy practice, recommendations have ranged as low as 1:8 to as high as 1:30. Objectives To determine critical care pharmacists' perceptions of pharmacist to patient ratios within the intensive care unit (ICU) and qualitatively and quantitatively describe critical care pharmacist work environments. Methods A cross‐sectional survey of pharmacists was conducted to identify current pharmacist to patient ratios and identify pharmacist perceptions of the safety of these ratios. Responses were presented using descriptive statistics. Multiple linear regression was conducted to determine factors associated with perceptions of workload and patient safety. Results The response rate was 11% (n = 185). The majority of respondents reported participating in activities beyond patient care. The majority of pharmacists cared for more than 15 patients daily (n = 155, 84%), and 16% took care of 15 or fewer patients. About 30% of pharmacists did not feel the pharmacist to patient ratio optimized patient safety, and over half reported perceptions overwork. A majority of participants (n = 130, 76%) expressed a need for additional critical care pharmacists at their institutions. Higher pharmacist to patient ratios were associated with increased perception of unsafe patient care −.343 (−.507 to −.180, P < .001). Conclusions Heterogeneity exists among critical care pharmacy activities that may influence pharmacists' perceptions of workload and patient safety. Critical care pharmacists report that their institutions should have more critical care pharmacists. Pharmacists' perceptions of workload vary based on differences in their activities outside of patient care.
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