Cost implications of and potential adverse events prevented by interventions of a critical care pharmacist

Kopp, Brian J.; Mrsan, Melinda; Erstad, Brian L.; Duby, Jeremiah J.

doi:10.2146/ajhp060674

Cited by 172 publications

(152 citation statements)

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“…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].…”

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confidence: 91%

“…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].…”

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confidence: 99%

“…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.…”

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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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Do we need a pharmacist in the ICU?

2015

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“…Potential ADEs are medication errors that have the potential to cause harm, but were intercepted by pharmacist's intervention or before reaching the patient [16,17]. Our events were assigned probability of harm scores which were adapted from other studies [3,7,[18][19][20] with few modifications and ranged from 0.1 to 1. A probability of harm score of 1 was given to an actual ADE identified and intercepted by the clinical pharmacist [3,7].…”

Section: Discussionmentioning

confidence: 99%

“…Our events were assigned probability of harm scores which were adapted from other studies [3,7,[18][19][20] with few modifications and ranged from 0.1 to 1. A probability of harm score of 1 was given to an actual ADE identified and intercepted by the clinical pharmacist [3,7]. For potential ADEs, the probability of harm score was set at 0.1 (for low probability), 0.5 (intermediate) and 0.9 (high) (Appendix A).…”

Section: Discussionmentioning

confidence: 99%

Clinical Pharmacist and Physician Team Collaboration to Improve Medication Safety and Cost Savings in an Inpatient Medicine Unit: A Prospective Cohort Study

Alex¹,

Kerns²,

Adenew³

et al. 2014

JPP

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Background: To prevent adverse drug events and promote patient safety, medication reconciliation is critical in all patient care settings. The purpose of this study was to identify medication discrepancies occurring in an inpatient medicine unit and to analyze the clinical and economic benefit of clinical pharmacist and physician team collaboration. Methods: A prospective cohort study in which pharmacist attended daily team rounds and assisted with medication management and medication reconciliation on admission and discharge in an academic hospital with internal medicine residents. All interventions related to medication management were categorized based on error type, severity of harm, preventable, non-preventable and potential adverse drug events. The economic outcome associated with these medication errors was analyzed. Results: There were 160 admissions and 179 pharmacist recommendations with a 91% acceptance rate from physicians. There were 145 discharges during the study period of which 104 medication discrepancies were identified. Eighty nine of the medication discrepancies were corrected by the pharmacist within 72 hours of discharge. Pharmacist identified 11 actual adverse drug events. Cost savings from pharmacist interventions during the study period was $11,652 and cost avoidance from intercepting potential and actual adverse drug events was $256,806. Conclusion: Collaboration of pharmacist with a physician team improved medication safety and led to significant cost savings and cost avoidance.

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Cost avoidance associated with clinical pharmacist presence in a medical intensive care unit

Hammond

Flowers

Meena

et al. 2019

J Am Coll Clin Pharm

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Objective: To determine the clinical pharmacist-generated cost avoidance and benefit-cost ratio in a medical intensive care unit (MICU).Methods: All accepted clinical pharmacist recommendations on a multidisciplinary, rounding service at an academic medical center over a 12-month period were evaluated. Cost avoidance values from each intervention were determined using a systematic framework. Total cost avoidance was calculated by summing the cost avoidance for each general category. Average rates of cost avoidance per day and hour were calculated by dividing total cost avoidance by number of days and hours the clinical pharmacist provided care. Average interventions and cost avoidance per day and hour were calculated for weekday and call status. Differences between months, day of the week, and call status were evaluated using chi-square goodness of fit tests. Results: Over 12 months, 8866 clinical pharmacist-recommended interventions were implemented, averaging 38.9 interventions per workday. The four most commonly accepted interventions were minor adverse drug event prevention (n = 4023, 45%), dosage adjustment: no continuous renal replacement therapy (n = 1162, 13%), antimicrobial therapy initiation and streamlining (n = 966, 11%), and antimicrobial pharmacokinetic evaluation (n = 777, 9%). All interventions resulted in a total cost avoidance of $3 270 178, averaging $14 731 per workday. Interventions per hour (P < 0.001) and average cost avoidance per hour (P < 0.001) differed significantly across workdays. For on-call days compared with postcall days, there were a similar average number of interventions per hour (10.2 vs 9.8, P = 0.28) and average cost avoidance per hour ($3741 vs $3622, P = 0.47); the benefit-cost ratio was 24.5:1. Conclusions: The clinical pharmacist-generated cost avoidance over a 12-month period in the MICU was $3 270 178 and the benefit-cost ratio was 24.5:1. Day of the week but no call status affected average cost avoidance. Employing a clinical pharmacist to be part of the multidisciplinary MICU team can reduce health care expenditures through cost avoidance. K E Y W O R D S cost, critical care, intensive care, pharmacist, pharmacy

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Cost implications of and potential adverse events prevented by interventions of a critical care pharmacist

Abstract: Among the interventions performed and documented by a clinical pharmacist in an ICU, patient care rounds and chart-review activities were associated with the greatest number of interventions and the greatest potential cost avoidance.

Cited by 172 publications

References 16 publications

Do we need a pharmacist in the ICU?

Do we need a pharmacist in the ICU?

Clinical Pharmacist and Physician Team Collaboration to Improve Medication Safety and Cost Savings in an Inpatient Medicine Unit: A Prospective Cohort Study

Cost avoidance associated with clinical pharmacist presence in a medical intensive care unit

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