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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 of Practice Standards, Training, and Professional Development

IV.STUDIES DOCUMENTING THE ASSOCIATION OF CRITICAL CARE PHARMACY SERVICES

WITH FAVORABLE HEALTH CARE OUTCOMES

A.Reduction in Drug Costs in ICU with the Inclusion of a Pharmacist as a Member of the Multidisciplinary

Team

Medical-surgical ICU: Annual savings of $67,664 in 1994 (Crit Care Med 1994;22:1044-8)

2Several other studies in a wide range of ICU settings (see Intensive Care Med 2003;29:691-8)

Burn ICU: Annual savings of $22,162 in 2003 (J Burn Care Res 2006;310-13)

Neurosurgical ICU: Reduction in pharmacy acquisition costs from $4833 to $3239 per patient after

the addition of a pharmacist to the neurosurgery team; reduction in ICU days from 8.56 to 7.24 days

(p=0.003) (Neurosurgery 2009;65:946-50; discussion 950-1)

Scoping review conducted for cost avoidance generated by clinical pharmacists on interventions

performed in an ICU or emergency department identified 38 distinctive categories (Pharmacotherapy

2019;39:215-31). Across 55,926 interventions, estimated cost avoidance was $418.48 per intervention

and $845.49 per patient. Overall ratio of cost avoidance/pharmacist salary was between $3.3:1 and $9.6:1

(Crit Care Explor 2021;3:e0594).

Multicenter, observational cohort study in critically ill adult patients across a 25-hospital integrated

health care system evaluating telehealth critical care pharmacist services in 8-hour shifts, 7 days a week,

found that pharmacists documented 2838 interventions associated with $1,664,254 gross cost avoidance

over 2 years. Expense:cost avoidance ratio was 4.5:1 (Crit Care Explor 2023;5:e0839).

B.Reduction in Adverse Drug Effects/Drug-Drug Interactions

Decrease in preventable adverse drug effects after the inclusion of a pharmacist on interdisciplinary

medical ICU rounds: 66%, (p<0.001) (JAMA 1999;282:267-70); supported by meta-analysis of three

studies (odds ratio (OR) 0.23, 95% confidence interval (0.11, 0.48) (J Crit Care 2015;30:1101-06).

Reduced; preventable and nonpreventable adverse drug events (OR 0.26, 95% CI (0.15, 0.44), p<0.0001

and OR 0.47, 95% CI (0.28, 0.77, p=0.003, respectively) (Crit Care Med 2019;47:1243-50).

2Decreased incidence of QTc-interval prolongation with ICU monitoring by a pharmacist using a standard

algorithm: 19% versus 39% (p=0.006) (Ann Pharmacother 2008;42:475-82)

Reduction in drug-drug interactions by 65% (p<0.01) in medical ICUs with a pharmacist (J Crit Care

2011;26:104.e101-106)

C.Improvement in Infectious Diseases Morbidity, Mortality, and Costs (Crit Care Med 2008;36:3184-9)

Mortality in ICUs without clinical pharmacists than in ICUs with clinical pharmacists: 23.6% higher

for nosocomial-acquired infections in ICUs without clinical pharmacists (p<0.001), 16.2% higher for

community-acquired infections in ICUs without clinical pharmacists (p=0.008), 4.8% higher for sepsis

in ICUs without clinical pharmacists (p≤0.008)

2Longer length of stay for ICUs without clinical pharmacists than for ICUs with clinical pharmacists:

7.9% for nosocomial-acquired infections in ICUs without clinical pharmacists (p<0.001), 5.9% for

community-acquired infections in ICUs without clinical pharmacists (p=0.03), 8.1% for sepsis in ICUs

without clinical pharmacists (p<0.001)

Increased Medicare billing in ICUs without clinical pharmacists compared with ICUs with clinical

pharmacists: 12% for nosocomial-acquired infections in ICUs without clinical pharmacists, 11.9% for

community-acquired infections in ICUs without clinical pharmacists, 12.9% for sepsis in ICUs without

clinical pharmacists (p<0.001)

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