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Implementation of a diuretic stewardship program in a pediatric cardiovascular intensive care unit to reduce

Christopher A Thomas1, Jennifer L Morris2, Elizabeth A Sinclair2

  • 1Christopher A. Thomas, Pharm.D., is Clinical Pharmacy Specialist-Pediatric Cardiovascular Intensive Care Unit (ICU), Department of Pharmacy, Riley Hospital for Children at Indiana University Health (IUH), Indianapolis; at the time of writing he was Clinical Pharmacy Specialist-Pediatric Cardiovascular ICU, Department of Pharmacy Services, Phoenix Children's Hospital, Phoenix, AZ. Jennifer L. Morris, Pharm.D., is Clinical Pharmacy Specialist-Pediatric ICU, Department of Pharmacy Services, Texas Children's Hospital, Houston; at the time of writing she was Clinical Pharmacy Specialist-Pediatric ICU, Department of Pharmacy Services, Riley Hospital for Children at IUH. Elizabeth A. Sinclair, Pharm.D., is Clinical Pharmacy Specialist-Pediatric ICU, Department of Pharmacy Services, Texas Children's Hospital, Houston. Richard H. Speicher, M.D., is Medical Director, Pediatric ICU, Division of Pediatric Critical Care, Rainbow Babies and Children's Hospital, Cleveland, OH, and Assistant Professor, Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland. Sheikh S. Ahmed, M.D., is Assistant Professor of Clinical Pediatrics, Section of Pediatric Pulmonology, Critical Care and Allergy, Riley Hospital for Children at IUH. Alexandre T. Rotta, M.D., is Chief, Division of Pediatric Critical Care, Rainbow Babies and Children's Hospital, and Professor, Department of Pediatrics, School of Medicine, Case Western Reserve University. cthomas15@iuhealth.org.

American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
|May 31, 2015
PubMed

Insights

A diuretic stewardship program in a pediatric cardiovascular intensive care unit (ICU) successfully reduced the use of specific intravenous diuretics. This initiative achieved significant cost savings without negatively impacting patient outcomes like ventilator days or ICU length of stay.

Area of Science:

  • Pediatric critical care medicine
  • Cardiovascular surgery
  • Pharmacology and therapeutics

Background:

  • Diuretic use in pediatric cardiovascular intensive care units (ICUs) can be extensive.
  • Optimizing diuretic selection and utilization is crucial for cost-effectiveness and patient care.
  • Specific intravenous diuretics like chlorothiazide and ethacrynic acid have distinct indications and cost profiles.

Purpose of the Study:

  • To describe the implementation of a diuretic stewardship program in a pediatric cardiovascular ICU.
  • To evaluate the impact of this program on the utilization and expenditure of intravenous chlorothiazide and ethacrynic acid.
  • To assess the effect of the stewardship program on clinical outcomes.

Main Methods:

  • A retrospective study comparing diuretic use before and after program implementation.
  • Inclusion of all pediatric patients admitted to the cardiovascular service.
  • Education of the cardiovascular surgery service on formal indications for specific diuretic agents.
  • Review of pharmacy and medical records to determine drug use, expenditures, appropriateness, ventilator days, and ICU length of stay.

Main Results:

  • Intravenous chlorothiazide use decreased by 74% and intravenous ethacrynic acid use decreased by 92% post-implementation.
  • Total expenditures on these diuretics were reduced by $91,398 over six months, with an estimated annual saving of over $182,000.
  • No significant differences were observed in median ventilator days or ICU length of stay.

Conclusions:

  • The implemented diuretic stewardship program effectively reduced the use of intravenous chlorothiazide and ethacrynic acid.
  • The program achieved substantial cost savings.
  • Clinical outcomes, including ventilator days and length of stay, were not adversely affected by the changes in diuretic utilization.
Abstract

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