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Evolution & Validation of Practice Standards

Eric W. Mueller ~3 min read Module 1 of 20

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Evolution and Validation 0f Practice Standards, Training, and Professional Development

D.Improvement in Thromboembolic and Infarction-Related Event (TIE) Clinical and Economic Outcomes

(Pharmacotherapy 2009;29:761-8)

Mortality increased in ICU patients with TIE without clinical pharmacy services compared with ICU

patients with clinical pharmacy services: 37%, (p<0.0001).

2Bleeding complications increased by 49% (p<0.001), with 39% more patients receiving transfusions

(p=0.006) in ICUs without clinical pharmacy services.

Length of ICU stays and costs were significantly higher in patients with TIE in ICUs without clinical

pharmacy services.

E.Meta-Analysis of 14 Studies of Critical Care Pharmacists as Member of Multidisciplinary Team (Crit Care

Med 2019;1243-50)

Reduced mortality: OR 0.78, 95% CI (0.73-0.83, p<0.00001)

2LOS reduction: mean -1.33 days, 95% CI (-1.75, -0.90), p<0.00001)

Impact of ICU Protocols on Patient Outcomes

Significant improvement in sedation and analgesia monitoring targets with the use of protocol versus

empiric therapy (p≤0.01); no difference in length of ICU stay (Pharmacotherapy 2000;20:662-72)

2Pharmacist-enforced ICU sedation protocol reduced mechanical ventilator duration as well as ICU and

hospital length of stay (p<0.001) (Crit Care Med 2008;36:427-33)

Improvement in mortality with inclusion of clinical pharmacist after multicomponent intervention in

tertiary care in a medical ICU (also included increase in ICU beds, larger rooms, 24-hour critical care

specialist coverage, decrease in respiratory therapist/patient ratio) (Crit Care Med 2011;39:284-93)

ICU mortality decrease from 18.4% to 14.9% (p=0.006), hospital mortality decrease 25.8% to 21.7%

(p=0.005)

Increase in median ICU length of stay; no difference in hospital length of stay

Increase in median 28-day ventilator-free days in mechanically ventilated patients

d.	Mean decrease in daily dosing of fentanyl and lorazepam

Pharmacist management of pain, agitation, and delirium in ICU through multidisciplinary bundle; 46%

reduction in continuous sedation, reduction in ICU and hospital length of stay (Am J Health-Syst Pharm

2017;74:253-62); systematic review of pharmacist-led interventions on pain, agitation, and delirium in

mechanically ventilated adults (J Am Coll Clin Pharm 2023;6:1041-52).

Pharmacist involvement in multidisciplinary initiative to reduce sepsis-related mortality in ICU (i.e.,

“Code Sepsis”); reduction in mean time from sepsis screen to antibiotic administration from 427 minutes

to 31 minutes (Am J Health-Syste Pharm 2016;73(3):143-9)

Leadership role in developing clinical practice guidelines for preventing and managing pain, agitation/

sedation, delirium, immobility, and sleep disruption in adult critically ill patients (PADIS Guidelines)

(Crit Care Med 2002;30:119-41; Crit Care Med 2018;46:e825-73) and clinical practice guidelines for

sustained neuromuscular blockade in critically ill adults (Crit Care Med 2016;44:2079-103).

Before and after study of critical care pharmacist interventions on drug therapy and clinical strategies:

Reduction in hospital length of stay (3.7 days, p<0.001), ICU length of stay (1.4 days, p<0.01), duration

of mechanical ventilation (1.2 days, p<0.01), hospital costs per stay (2560 euros, p<0.001); no impact on

mortality. (Crit Care Med 2018;46:199-207)

Retrospective cohort study of albumin use in critically ill patients at single academic medical center:

Reduction in inappropriate albumin use (50.9%, p<0.001), total annual cost savings greater than

$355,000. (Ann Pharmacotherapy 2020;54:105-112).

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