(1010) Effect of Emergency Medicine Pharmacist Interventions on Sedation in the Emergency Department

Introduction: Sedation has been identified as a modifiable factor that independently contributes to clinical outcomes, such as mortality and lengths of stay. The Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility and Sleep Disruption in Adult Patients in the ICU (PADIS) recommend targeting light sedation in mechanically ventilated patients with nonbenzodiazepine sedatives. Pharmacist presence for intubation in the ED has been associated with decreased time to sedation initiation, but the effect on agents used is unknown. This study aimed to assess emergency medicine (EM) pharmacist interventions on light sedation in the ED and their impact on guideline compliance and clinical outcomes. We hypothesized that EM pharmacist intervention would be associated with an increased incidence of guideline compliant sedation.

Methods: This retrospective cohort study reviewed adult patients who required intubation in the ED between May 1, 2021, and April 30, 2022, with a documented target goal of light sedation. Patients with a neurologic injury, post-cardiac arrest, or post cardiovascular injury were excluded, as well as patients who experienced death, discontinuation of mechanical ventilation, or withdrawal of care within 24 hours of presentation. The primary outcomes of this study were prevalence of EM pharmacist intervention and sedation regimen guideline compliance. Secondary outcomes included ICU length of stay, hospital length of stay, duration of mechanical ventilation, and 30-day or discharge disposition (whichever came first).

Results: Of the 293 patients screened, 62 were included for final analysis. EM pharmacist intervention relating to post-intubation sedation occurred in 20 patients (32%), while 42 did not receive EM pharmacist intervention. Patients with EM pharmacist intervention had an increased incidence of guideline-compliant post-intubation sedation orders (70% vs 54.8%; p = 0.253) and an increased incidence of analgesia use (65% vs 38.1%; p = 0.047). There were no statistically significant differences in secondary outcomes.

Conclusions: EM pharmacist intervention on sedation in the ED was associated with an increase in guideline-compliant sedation regimens and a significant increase in the use of sedatives that also provide analgesia.