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Published on: August 30, 2018
Pharmacy intervention on antimicrobial management of critically ill patients
Immanuel Ijo1, Jeffrey Feyerharm1
1Asante Health System. Medford, OR ( United States ).
Unlabelled:
Frequent, suboptimal use of antimicrobial drugs has resulted in the emergence of microbial resistance, compromised clinical outcomes and increased costs, particularly in the intensive care unit (ICU). Mounting on these challenges is the paucity of new antimicrobial agents.
Objective:
The study aims to determine the impact of prospective pharmacy-driven antimicrobial stewardship in the ICU on clinical and potential financial outcomes. The primary objectives were to determine the mean length of stay (LOS) and mortality rate in the ICU resulting from prospective pharmacy interventions on antimicrobial therapy. The secondary objective was to calculate the difference in total drug acquisition costs resulting from pharmacy infectious diseases (ID)-related interventions.
Methods:
In collaboration with an infectious disease physician, the ICU pharmacy team provided prospective audit with feedback to physicians on antimicrobial therapies of 70 patients over a 4-month period in a 31-bed ICU. In comparison with published data, LOS and mortality of pharmacy-monitored ICU patients were recorded. Daily cost savings on antimicrobial drugs and charges for medication therapy management (MTM) services were added to calculate potential total cost savings. Pharmacy interventions focused on streamlining, dose optimization, intravenous-to-oral conversion, antimicrobial discontinuation, new recommendation and drug information consult. Antimicrobial education was featured in oral presentations and electronic newsletters for pharmacists and clinicians.
Results:
The mean LOS in the ICU was 6 days, which was lower than the published reports of LOS ranging from 11 to 36 days. The morality rate of 14% was comparable to the reported range of 6 to 20% in published literature. The total drug cost difference was a negative financial outcome or loss of USD192 associated with ID-related interventions.
Conclusions:
In collaboration with the infectious disease physician, prospective pharmacy intervention on antimicrobial therapy in the ICU led to positive clinical outcomes and an additional drug cost expense of USD192.
Insights
Prospective pharmacy stewardship in the ICU improved clinical outcomes, reducing length of stay. While antimicrobial interventions showed a small drug cost increase, they demonstrated effective antimicrobial stewardship.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacy Practice
Background:
- Suboptimal antimicrobial use in ICUs drives resistance, poor outcomes, and increased costs.
- A lack of new antimicrobial agents exacerbates these challenges.
Purpose of the Study:
- To assess the impact of prospective, pharmacy-driven antimicrobial stewardship on clinical and financial outcomes in the ICU.
- To determine the effect on intensive care unit (ICU) length of stay (LOS) and mortality.
- To calculate the financial impact of infectious disease (ID)-related pharmacy interventions on drug acquisition costs.
Main Methods:
- A 4-month prospective audit with feedback on antimicrobial therapies for 70 ICU patients by a pharmacy team and infectious disease physician.
- Comparison of recorded ICU LOS and mortality against published data.
- Calculation of potential total cost savings by summing daily drug cost savings and medication therapy management (MTM) charges.
- Interventions included streamlining, dose optimization, IV-to-oral conversion, discontinuation, and new recommendations.
Main Results:
- Mean ICU LOS was 6 days, significantly lower than published ranges (11–36 days).
- Mortality rate was 14%, comparable to reported literature (6–20%).
- ID-related interventions resulted in a net drug cost difference of -USD192 (a loss).
Conclusions:
- Prospective pharmacy interventions in antimicrobial therapy within the ICU achieved positive clinical outcomes.
- These interventions led to a modest increase in drug costs (USD192).
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