Clinical and economic outcomes of involving pharmacists in the direct care of critically ill patients with infections*

MacLaren, Robert; Bond, Christopher; Martin, Steven J.; Fike, David S.

doi:10.1097/ccm.0b013e31818f2269

Cited by 198 publications

(140 citation statements)

References 22 publications

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“…A prospective observational study was undertaken in 21 UK CCUs from [5][6][7][8][9][10][11][12][13][14][15][16][17][18] th Nov 2012. A data collection web portal was designed where the specialist critical care pharmacist (SCCP) reported all interventions at their site.…”

Section: Methodsmentioning

confidence: 99%

“…Since the first reports of clinical pharmacist interventions in critical care in the mid-1980s [4], there has been a gradual progression from those focused on financial savings in medicine use, to reducing medication errors and more recently to the optimisation of medication therapy [5]. Clinical pharmacists have been reported to improve medicines-related patient outcomes in the use of sedation [6], antimicrobial therapy [7], therapeutic drug monitoring [8] and management of thromboembolism/ infarction [9]. Medicines optimisations by addition or adjustment of pharmacotherapy are becoming more dominant practices [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Pharmacist’s review and outcomes: Treatment-enhancing contributions tallied, evaluated, and documented (PROTECTED-UK)

Shulman

McKenzie

Landa

et al. 2015

Journal of Critical Care

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PURPOSE.To describe clinical pharmacist interventions across a range of critical care units (CCUs) throughout the United Kingdom (UK). To identify CCU medication error rate, prescription optimisation and to identify the type and impact of each intervention in the prevention of harm and improvement of patient therapy. MATERIALS AND METHODS.A prospective observational study was undertaken in 21 UK CCUs from [5][6][7][8][9][10][11][12][13][14][15][16][17][18] th Nov 2012. A data collection web portal was designed where the specialist critical care pharmacist (SCCP) reported all interventions at their site. Each intervention was classified as either: medication error, optimisation or consult. In addition, a clinical impact scale was used to code the interventions. Interventions were scored as low, moderate, high impact and life saving. The final coding was moderated by blinded independent multidisciplinary trialists. RESULTS. 20,517 prescriptions were reviewed with 3,294 interventions recorded during the weekdays. This resulted in an overall intervention rate of 16.1%: 6.8% were classified as medication errors, 8.3 % optimisations and 1.0% consults. The interventions were classified as: low impact (34.0%), moderate impact (46.7%) high impact (19.3%) and one case was life saving. Almost three-quarters of interventions were to optimise the effectiveness of and improve safety of pharmacotherapy. CONCLUSIONS. This observational study demonstrated that both medication error resolution and pharmacist led optimisation rates were substantial. Almost 1 in 6 prescriptions required an intervention from the clinical pharmacist. The error rate was slightly lower than an earlier UK prescribing error study (EQUIP). Two thirds of the interventions were of moderate to high impact. Key wordsCritical care, interventions, specialist critical care pharmacist, medication errors, optimisations, impact coding IntroductionThe critically ill patient is at risk of medicines-related adverse events [1], drug interactions and on some occasions inadequate therapy [2]. This risk can be exacerbated by the presence of organ failure or by supportive therapies such as renal replacement therapy. Consequently, interventions to reduce medication errors and optimise therapy are an essential component of patient care. These include electronic prescribing, smart infusion pumps, medicines reconciliation, clinical guidelines and services normally led by a specialist critical care pharmacist (SCCP) [3]. Improving the safety and efficacy of medication therapy in critical care patients is the cornerstone of SCCP activity. Since the first reports of clinical pharmacist interventions in critical care in the mid-1980s [4], there has been a gradual progression from those focused on financial savings in medicine use, to reducing medication errors and more recently to the optimisation of medication therapy [5]. Clinical pharmacists have been reported to improve medicines-related patient outcomes in the use of sedation [6], antimicrobial therapy [7], therapeutic drug m...

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pharmacist’s review and outcomes: Treatment-enhancing contributions tallied, evaluated, and documented (PROTECTED-UK)

Shulman

McKenzie

Landa

et al. 2015

Journal of Critical Care

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“…In fact, within the SCCM guidelines for best practice model and ICU staffing [2], pharmacist presence was considered as best practice supported by grade C evidence, the highest level of all recommendations in that document. A summary of the studies evaluating the impact of having a dedicated pharmacist in the ICU is shown in Table 1 [3][4][5][6][7][8][9][10][11][12][13][14][15]. In general, these studies show reductions in drug prescribing errors, adverse drug events, and costs, with no worsening and typically improvement in clinical outcomes such as ICU length of stay and mortality.…”

mentioning

confidence: 99%

“…A large survey of US hospitals conducted in 2004 compared costs and clinical outcomes in ICUs with at least a part-time dedicated pharmacist to those without this resource. It showed improved costs and clinical outcomes (shorter ICU lengths of stay and lower hospital mortality) particularly in patients with infections [5] and thromboembolic diseases [6]. In a landmark paper, Leape and colleagues [3] clearly demonstrated that presence of pharmacists in a medical ICU reduced medication errors and cost.…”

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confidence: 99%

Do we need a pharmacist in the ICU?

2015

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On the surface, the answer to the question of the title of this editorial seemed to be a rhetorical and obvious yes. This is not because two pharmacists are involved in authoring this editorial, but because there is a substantial amount of literature-arguably more than which exists for any other clinical team member in the ICU and likely more than some of the standard-of-care interventions (such as mechanical ventilation)-which linked the presence of a pharmacist in an ICU to improved patient outcomes.Since the beginning of ICU clinical pharmacy services in the 1960s [1], the practice has matured along with the subspecialty of critical care medicine into one that has been considered by the Society of Critical Care Medicine (SCCM) as essential [2]. In fact, within the SCCM guidelines for best practice model and ICU staffing [2], pharmacist presence was considered as best practice supported by grade C evidence, the highest level of all recommendations in that document. A summary of the studies evaluating the impact of having a dedicated pharmacist in the ICU is shown in [3] clearly demonstrated that presence of pharmacists in a medical ICU reduced medication errors and cost. These benefits appear generalizable since the studies have been conducted in a variety of ICUs (e.g., medical, surgical, neurosurgical, cardiac, and pediatric) using different physician staffing models (e.g., open vs closed ICU), and date back to the early 1990s [13]. The majority of the studies have been conducted in North America, but similar beneficial results have been published from studies conducted in Asia [4,8,9], the Middle East [10], and Europe [11]. Provision of drug information, clarifying and correcting medication orders, identifying drug interactions as well as actual or potential adverse drug events, and recommending alternative therapies account for greater than 90 % of ICU pharmacists' activities [3,4,8,13,14]. The studies indicate that a large majority, and in most studies almost all, of pharmacists' recommendations are accepted by the physicians [3,4,[13][14][15]. These significant improvements in patient care afforded by the presence of dedicated pharmacists are clearly viewed as important by medical colleagues, as shown by a recent survey [16].In addition to the clear benefits for the patients, ICU pharmacists can play a multitude of other roles [17] such as education of other team members, leadership or administrative roles in critical care committees, and in Intensive Care Med (2015) 41:1314-1320

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“…beneficiaries is economically beneficial from both beneficiaries' and plan sponsors' perspectives, as it is shown to reduce Medicare billings by as much as 12%. 16 Due to convenient hours of operation and a high level of trust in the profession, 17,18 many beneficiaries may seek assistance from pharmacists during Medicare open enrollment to determine which plan is most appropriate. However, previous research has shown that over 50% of pharmacists are unable to correctly use the Medicare Plan Finder Tool.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a Medicare Plan Selection Assistance Program Through a Community Partnership

Hohmann

Hastings

McFarland

et al. 2018

American Journal of Pharmaceutical Education

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Clinical and economic outcomes of involving pharmacists in the direct care of critically ill patients with infections*

Abstract: The involvement of clinical pharmacists in the care of critically ill Medicare patients with infections is associated with improved clinical and economic outcomes. Hospitals should consider employing clinical ICU pharmacists.

Cited by 198 publications

References 22 publications

Pharmacist’s review and outcomes: Treatment-enhancing contributions tallied, evaluated, and documented (PROTECTED-UK)

Pharmacist’s review and outcomes: Treatment-enhancing contributions tallied, evaluated, and documented (PROTECTED-UK)

Do we need a pharmacist in the ICU?

Implementation of a Medicare Plan Selection Assistance Program Through a Community Partnership

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