Megan Rech, BCCCP, MS, PharmD
Clinical Pharmacist, Emergency Medicine
Loyola University Medical Center
Chicago, Illinois, United States
Disclosure information not submitted.
Cara Joyce, PhD
Dr
Loyola University Chicago
Maywood, Illinois, United States
Disclosure information not submitted.
Alexander Flannery, PharmD, PhD, BCCCP
Assistant Professor
University of Kentucky College of Pharmacy
Lexington, Kentucky
Disclosure information not submitted.
Title: Impact of Service on Pharmacist Avoidance or Reductions in Medical costs: PHARM-CRIT-SERVICE
Introduction: Inclusion of an intensive care unit (ICU) pharmacist as a member of the interdisciplinary health care team is associated with a number of benefits, including significant cost avoidance. It is presently unknown how ICU pharmacists covering multiple services compared to one service impacts patient care in critically ill patients. We hypothesize that ICU pharmacists covering only one service will be more likely to perform interventions.
Methods: Secondary analysis of a multicenter, prospective, observational study performed from August 2018 to January 2019 in academic medical centers and community hospitals throughout the United States. ICU pharmacists documented accepted recommendations and interventions. Pharmacists who covered only one service were compared to those who covered two or more services. Generalized linear mixed models were used to present comparisons based on number of rounding services accounting for within-pharmacist correlation and adjusting for pharmacist practice area and shift length.
Results: 215 ICU pharmacists participated across 85 centers, with data collected on 1766 shifts with one rounding service and 822 shifts with two or more rounding services. ICU pharmacists most commonly worked in medical (57.8%), surgical (52.3%) or cardiac ICUs (surgical: 39.9%, medical: 36.2%). The adjusted mean patient-to-pharmacist ratio was higher for pharmacists covering two or more services for both medical (15.7±1.7 vs. 24.6±1.7) and surgical (13.7±1.5 vs. 19.9±1.6) populations. Overall, the odds of performing accepted interventions in each category were higher for ICU pharmacists covering one service compared to two or more services: adverse drug event prevention (odds ratio [OR] 1.91 [95% confidence interval (CI) 1.71-2.13]), resource utilization (OR 1.33 [95% CI 1.20-1.46]), individualization of patient care (OR 1.47 [95% CI 1.35-1.59]), prophylaxis (OR 1.5 [95% CI 1.22-1.86]), hands-on care (OR 1.7 [95% CI 1.35 – 2.13]), and administrative and supportive tasks (OR 1.64 [95% CI 1.45-1.87]).
Conclusion: ICU pharmacists covering one service as compared to multiple services provided care for fewer patients and, correspondingly, were more likely to document interventions associated with cost avoidance.