(348) Implementation of Critical Care Clinical Pharmacy Services in an Electronic Intensive Care Unit

Introduction: In traditional intensive care units (ICU), residency trained critical care pharmacists have contributed to improved patient outcomes including decreased ICU length of stay, medication-related adverse events, cost, and mortality. Integrating specialized pharmacists into the electronic ICU (eICU) allows for greater accessibility of pharmacy clinical services where critical care pharmacists are needed. Literature regarding eICU pharmacy focuses on responsibilities such as remote order entry, medication reconciliations, allergy clarifications, and pharmacokinetic consults. The purpose of this study is to assess the impact of critical care pharmacists from an eICU on patient outcomes compared to outcomes before integration of a critical care eICU pharmacist.

Methods: A prospective chart review of ICU patients at a multi-site hospital system over a 10-month period was conducted. Inclusion criteria were adult patients admitted to ICUs across six community hospitals that were reviewed by critical care clinical pharmacists in the eICU setting. The primary outcome was the percent improvement in glycemic control and APACHE IVa severity adjusted ventilator days. Secondary outcomes included the number and type of ICU pharmacist interventions.

Results: Over a 10-month period, 4,341 interventions for 808 patients were provided by the eICU specialist with a 98.9% acceptance rate. The percentage of patients with an average daily glucose less than 180 mg/dL improved by 4.5% (83% to 87.5%) following implementation of critical care pharmacy services. Of the 4,341 interventions provided, 537 focused on recommendations for spontaneous awakening trials (SATs) with a 19% reduction in APACHE IVa severity adjusted ventilator days (adjusted ratio, 1.12 to 0.93). Additional interventions focused on new drug therapy, medication discontinuations, and adjustments of medication dose, route, and frequency.

Conclusions: Integrating critical care pharmacy services can optimize patient care and allow specialized interventions to reach ICUs where critical care pharmacists have not been incorporated. Overall, the collaboration between critical care pharmacists and the eICU multidisciplinary team has shown opportunity to expand eICU pharmacist consultative services.