W. Anthony Hawkins, BCCCP, PharmD, FCCM
Clinical Associate Professor
UGA College of Pharmacy
Albany, Georgia
Disclosure information not submitted.
Ryan Bok, PharmD(c)
PharmD candidate
University of Georgia, United States
Disclosure information not submitted.
Diana Dang, PharmD(c)
PharmD candidate
University of Georgia, United States
Disclosure information not submitted.
Rachel Rikard, PharmD
PharmD
Bristol Regional Medical Center, United States
Disclosure information not submitted.
Michael Long, Jr., PharmD
PGY2 Emergency Medicine Pharmacy Resident
Indiana University Health
Hawkinsville, Georgia
Disclosure information not submitted.
Susan Smith, BCCCP, BCPS, PharmD
Clinical Associate Professor
University of Georgia
Athens, Georgia
Disclosure information not submitted.
Title: Comparison of fluid stewardship practice in patients with and without COVID
Introduction: Fluid stewardship is a practice that enables clinicians to better individualize fluid therapy. Two constructs can be used, which include the Four Rights (patient, drug, dose, route) and ROSE (Rescue, Optimization, Stabilization, Evacuation) model to implement this practice. Some data exist related to pharmacy practice of fluid stewardship, but none exist for adults with COVID. This study aims to compare pharmacist-driven fluid stewardship recommendations in patients with and without COVID.
Methods: This was a single-center, retrospective study conducted at a large community hospital including all critically ill adults followed by the academic pharmacy team between 2018 and 2020. Notes for each patient day were reviewed and recommendations were classified according to Four Rights and ROSE. The primary outcome was the mean number of fluid stewardship recommendations per patient day. Secondary outcomes included the number of recommendations related to each Right.
Results: Over 3,900 total recommendations were reviewed for 79 COVID and 350 non-COVID patients, accounting for 420 and 895 patient days, respectively. There were an average of 0.421 and 0.556 fluid stewardship recommendations per patient day (p=0.003). There were significantly fewer recommendations in COVID patients under the right patient and drug, but similar in dose or route. There were significantly more recommendations in the Rescue and Optimization phases, but fewer in the Stabilization and Evacuation phases for COVID patients.
Conclusions: Pharmacist-driven fluid stewardship recommendations were more common in non-COVID patients. The type and distribution of recommendations varied between both groups across both fluid stewardship constructs of Four Rights and ROSE model.