Suzan N Kucukarslan1, Kim Corpus2, Nisha Mehta3, Mark Mlynarek4, Mike Peters5, Lisa Stagner6, Chris Zimmerman7. 1. Assistant Professor, University of Michigan, College of Pharmacy, Ann Arbor, Michigan; 2. Medical Intensive Care Unit Clinical Pharmacy Specialist. 3. Pharmacist, Jesse Brown VA Medical Center, Chicago, Illinois; 4. Surgical Intensive Care Unit Clinical Pharmacy Specialist. 5. Critical Care Clinical Pharmacy Specialist. 6. Critical Care Medicine Physician, Henry Ford Health System, Detroit, Michigan; 7. Clinical Pharmacist Specialist Informatics, University of Michigan Health System, Ann Arbor, Michigan. [Dr. Kucukarslan is now Medication Safety Officer at McLaren Hospital and CompleteRx, Inc, Flint, Michigan.] Corresponding author: Suzan N. Kucukarslan, PhD, McLaren Hospital-Flint, 401 S Ballenger Highway, Flint, MI 48532; phone: 810-342-2426; e-mail: skucukar@gmail.com.
Abstract
PURPOSE: Published studies have shown that pharmacists on medical rounds reduce the incidence of preventable adverse drug events (ADEs). However, the impact of a dedicated pharmacist who provides consistent patient care in a critical care unit remains to be evaluated. OBJECTIVE: To determine the impact of a pharmacist who is permanently assigned to the medical intensive care unit (MICU) on the incidence of preventable ADEs, drug charges, and length of stay (LOS) in the MICU. DESIGN: A randomized, experimental versus historical control group design was used. Preventable ADEs were identified and validated by 2 pharmacists and a critical care physician. Information about MICU drug charges and LOS were obtained from the hospital administrative database. RESULTS: The intervention group had fewer occurrences of ADEs (10 ADEs/1,000 patient days) when compared to the control group (28 ADEs/1,000 patient days) at a significance level of .03. No significant differences were found between the 2 groups in MICU drug charges and LOS. The vast majority of the 596 documented recommended interventions (99%) were accepted by the medical team. Nutrition monitoring, medication indicated but not prescribed, and dosage modification were the top 3 problems identified by the pharmacist. CONCLUSION: The addition of a dedicated critical care pharmacist to the MICU medical team improves the safe use of medication. The services of a dedicated critical care pharmacist should be expanded to include weekend hours to ensure the benefits of improved medication safety.
RCT Entities:
PURPOSE: Published studies have shown that pharmacists on medical rounds reduce the incidence of preventable adverse drug events (ADEs). However, the impact of a dedicated pharmacist who provides consistent patient care in a critical care unit remains to be evaluated. OBJECTIVE: To determine the impact of a pharmacist who is permanently assigned to the medical intensive care unit (MICU) on the incidence of preventable ADEs, drug charges, and length of stay (LOS) in the MICU. DESIGN: A randomized, experimental versus historical control group design was used. Preventable ADEs were identified and validated by 2 pharmacists and a critical care physician. Information about MICU drug charges and LOS were obtained from the hospital administrative database. RESULTS: The intervention group had fewer occurrences of ADEs (10 ADEs/1,000 patient days) when compared to the control group (28 ADEs/1,000 patient days) at a significance level of .03. No significant differences were found between the 2 groups in MICU drug charges and LOS. The vast majority of the 596 documented recommended interventions (99%) were accepted by the medical team. Nutrition monitoring, medication indicated but not prescribed, and dosage modification were the top 3 problems identified by the pharmacist. CONCLUSION: The addition of a dedicated critical care pharmacist to the MICU medical team improves the safe use of medication. The services of a dedicated critical care pharmacist should be expanded to include weekend hours to ensure the benefits of improved medication safety.
Entities:
Keywords:
adverse drug events; medication safety; pharmacist; staffing model
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