The Effect of ICU Sedation Guidelines and Pharmacist Interventions on Clinical Outcomes and Drug Cost

Devlin, John W.; Holbrook, Anne; Fuller, Hugh D.

doi:10.1177/106002809703100604

Cited by 144 publications

(69 citation statements)

References 28 publications

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“…Guidelines for pharmacotherapeutic management of stress ulcer prophylaxis, and sedation have been developed by pharmacists in cooperation with physicians [7,29] and the clinical outcomes of the guidelines have been measured. Sedation guidelines were developed by a multidisciplinary team and implemented by a critical care pharmacist [7].…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…Sedation guidelines were developed by a multidisciplinary team and implemented by a critical care pharmacist [7]. A pre-and post-guideline period was compared.…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…The intensivist-led team reduces unnecessary resource use and improves patient outcomes [2, 3, 4,5,6,7]. This paper will review the influence of the pharmacist as part of the multidisciplinary ICU team and the effects on patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The impact of critical care pharmacists on enhancing patient outcomes

2003

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The highly specialized knowledge and skills needed to care for critically ill patients requires a multidisciplinary team approach. Pharmacists are integral members of this team. They make valuable contributions to improve clinical, economic, and humanistic outcomes of patients. The purpose of this article is to review the literature pertaining to pharmacists' contributions within a multidisciplinary intensivist-led intensive care unit (ICU) team. Pharmacist interventions include correcting/clarifying orders, providing drug information, suggesting alternative therapies, identifying drug interactions, and therapeutic drug monitoring. Pharmacist involvement in improving clinical outcomes of critically ill patients is associated with optimal fluid management and substantial reductions in the rates of adverse drug events, medication administration errors, and ventilator-associated pneumonia. Furthermore, economic evaluations of clinical pharmacy services in the ICU consistently reveal the potential for considerable cost savings.

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Section: Clinical Outcomesmentioning

confidence: 99%

“…Sedation guidelines were developed by a multidisciplinary team and implemented by a critical care pharmacist [7]. A pre-and post-guideline period was compared.…”

Section: Clinical Outcomesmentioning

confidence: 99%

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The impact of critical care pharmacists on enhancing patient outcomes

2003

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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%

“…The extent to which these are seen in individual ICUs is variable, as outlined by a recent survey [18]. As an example, in one of the studies listed in Table 1 [ 12], the development and implementation of sedation guidelines were initiated and led by the ICU pharmacist. However, the bulk of the activities still involve provision of pharmaceutical care where a patient's drug-related issues (e.g., wrong dose, wrong drug, interactions, and adverse reactions) are identified, prevented, and resolved with pharmacists making recommendations that are accepted by the physicians a majority of the times.…”

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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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