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Evaluation of the Impact of a tele-ICU Pharmacist

02/19/2010

Here is a fantastic pharmacist practice model for the future that is here and now at UMass Memorial Medical Center.  I have the honor and privilege of knowing these folks. Their impact goes way beyond ventilator management. Nice job!

Clipped from: http://www.theannals.com/cgi/content/abstract/aph.1M576v1?papetoc

Evaluation of the Impact of a tele-ICU Pharmacist on the Management of Sedation in Critically Ill Mechanically Ventilated Patients (March)

Allison Forni PharmD BCPS1*, Nancy Skehan MD2, Christian A Hartman PharmD MBA3, Dinesh Yogaratnam PharmD BCPS4, Milka Njoroge PharmD BCPS5, Christopher Schifferdecker BSPharm MBA5, Craig M Lilly MD6

  Abstract

BACKGROUND: An organized and uniform approach to managing sedation in critically ill patients has been associated with improved outcomes, but the most effective means of optimizing sedative medication use in clinical practice has not been fully determined. Pharmacist interventions directed at improving sedation guideline compliance have been shown to reduce the duration of mechanical ventilation.

OBJECTIVE: To determine the impact that pharmacy staffing configurations that include a tele-ICU pharmacist have on compliance with an intensive care unit (ICU) sedation guideline in critically ill mechanically ventilated patients requiring continuous-infusion sedative medications.

METHODS: Compliance with an established ICU sedation guideline, the performance of daily sedative interruptions, and the number of sedative medication-related interventionswere evaluated before and after expansion of the ICU pharmacist staffing model to include comprehensive off-hours pharmacist coverage supported with established tele-ICU resources. In both groups, sedation was managed by the primary ICU team. In theintervention group, a pharmacist working in the tele-ICU center performed electronic record audits and made sedative medication recommendations to the primary team.

RESULTS: The addition of third shift tele-ICU pharmacist support was associated with a significant increase in the percentage of patients who received a daily sedative interruption (45% vs 54%; p < 0.0001). This occurred in the context of significant increases in the total number of ICU pharmacist interventions (36 vs 49.4 per 100 patient days, p < 0.0001), the number of therapeutic interventions (20.4 vs 26.1 per 100 patient days, p < 0.001), and the number of sedative-related interventions (0.9 vs 4.4 per 100 patient days, p < 0.0001).

CONCLUSIONS: Tele-ICU resources can be utilized to increase compliance with an established ICU sedation guideline and extend the benefits that daytime ICU clinical pharmacy services provide. Increased ICU pharmacist availability may have additional benefits not measured in this study.

 

1 at time of study, Critical Care Pharmacy Resident, UMass Memorial Medical Center, Worcester, MA; now, Clinical Pharmacy Specialist, Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA
2 Internal Medicine Chief Resident, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester
3 Medication Safety Officer, Department of Pharmacy, UMass Memorial Medical Center; Assistant Professor of Medicine, University of Massachusetts Medical School
4 Clinical Pharmacy Specialist, Critical Care, Department of Pharmacy, UMass Memorial Medical Center
5 Tele ICU Clinical Pharmacist, Department of Pharmacy, UMass Memorial Medical Center
6 Director eICU, Professor of Medicine, Anesthesia, and Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center

* To whom correspondence should be addressed. E-mail: AForni@partners.org.

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