Clinical Pharmacist–Led Impact on Inappropriate Albumin Use and Costs in the Critically Ill

Abstract

Background:Optimal albumin use in the intensive care unit (ICU) remains challenging with inappropriate use approaching 50%. No published reports have described clinical pharmacist impact aimed at mitigating inappropriate albumin use in the ICU. Objective: To evaluate the clinical and economic impact of a clinical pharmacist–led intervention strategy targeting inappropriate albumin in the ICU. Methods: A retrospective cohort study evaluated all adult (≥18 years) ICU patients administered albumin at an academic medical center over a 2-year period. Institutional guidelines were developed with clinical pharmacists targeting inappropriate albumin use. The primary end point was to compare inappropriate use of albumin administered before and after pharmacist intervention implementation. Secondary analyses compared the overall albumin use between study periods. In-hospital mortality, length of stay, and albumin-related costs between study periods were also compared. Results: A total of 4419 patients were identified, with 2448 (55.4%) critically ill patients included. The pharmacist-led strategy resulted in a 50.9% reduction of inappropriate albumin use ( P < 0.001). The rate of inappropriate albumin use was 44.3 ± 10.5 and 5.5 ± 2.9 g per patient-day in the preimplementation and postimplementation periods, respectively ( P < 0.001). Costs associated with overall and inappropriate albumin use in the ICU decreased by 34.8% and 87.1%, respectively. Total annual cost-savings was $355 393 in the ICUs. No differences in clinical outcomes were found. Conclusion and Relevance: Clinical pharmacist–led interventions reduced overall and inappropriate albumin use and costs without negatively affecting clinical outcomes.

Application of FASTHUG-MAIDENS mnemonic and evaluation of its impact in pharmaceutical intervention in an adult intensive care unit

“…These data reinforce that health institutions must use clinical pharmacists as a vital component in a process improvement strategy and in promoting an ideal pharmacotherapy. 18 In twenty-two patients, 32 serious drug interactions were identified, of which 59.3% were related to the risk of QT prolongation. The main conduct related to this interaction was the intensification of cardiological monitoring, in addition to assessing the risk-benefit of maintaining the related medications.…”

Albumin for cirrhosis‐related complications

“…The appropriate uses of albumin have been the subject of debate for decades, primarily because of its high cost and periodic shortages. This has led to a variety of measures such as prescribing protocols and formulary restrictions to limit albumin use in the clinical setting 1,2 . The use of albumin for cirrhosis‐related complications is one area of scrutiny and controversy because of its theoretical appeal based on synthesis in the liver and diverse mechanisms of action.…”

Clinical Pharmacist–Led Impact on Inappropriate Albumin Utilization and Associated Costs in General Ward Patients

“…The discounting approach is similar to that in other previously published reports. 22,23,26 Costs associated with albumin were calculated by multiplying the discounted AWP by the total grams administered for the preimplementation and postimplementation period.…”

“…We recently reported our evaluation on the impact of a clinical pharmacist–led intevention strategy targeting inappropraite albumin in the intensive care unit (ICU). 26 The clinical pharmacist–led strategy signficantly reduced inappropriate albumin use in the ICU by 50.9% ( P < 0.001), resulting in total annual cost savings of $355 393 in the adult ICUs. A clinical pharmacist–led intervention strategy has not been evaluated in the non-ICU patient population.…”