Evaluation of the Impact of a tele-ICU Pharmacist on the Management of Sedation in Critically III Mechanically Ventilated Patients

Forni, Allison; Skehan, Nancy; Hartman, Christian; Yogaratnam, Dinesh; Njoroge, Milka; Schifferdecker, Christopher; Lilly, Craig M.

doi:10.1345/aph.1m576

Cited by 57 publications

(47 citation statements)

References 15 publications

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“…For example, a recent cluster-randomized trial showed that a multifaceted knowledge-translation intervention that included education via telemedicine increased the adoption of targeted best practices in community hospitals with few resources dedicated to quality improvement [34]. Similarly, a before/after study found a significant increase in the percentage of patients who received a daily sedative interruption with tele-ICU pharmacy support [35]. Last, one study reported improved nursing-staff satisfaction after the implementation of robotic tele-ICU [36].…”

Section: Discussionmentioning

confidence: 99%

The effect of telemedicine in critically ill patients: systematic review and meta-analysis

2012

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IntroductionTelemedicine extends intensivists' reach to critically ill patients cared for by other physicians. Our objective was to evaluate the impact of telemedicine on patients' outcomes.MethodsWe searched electronic databases through April 2012, bibliographies of included trials, and indexes and conference proceedings in two journals (2001 to 2012). We selected controlled trials or observational studies of critically ill adults or children, examining the effects of telemedicine on mortality. Two authors independently selected studies and extracted data on outcomes (mortality and length of stay in the intensive care unit (ICU) and hospital) and methodologic quality. We used random-effects meta-analytic models unadjusted for case mix or cluster effects and quantified between-study heterogeneity by using I2 (the percentage of total variability across studies attributable to heterogeneity rather than to chance).ResultsOf 865 citations, 11 observational studies met selection criteria. Overall quality was moderate (mean score on Newcastle-Ottawa scale, 5.1/9; range, 3 to 9). Meta-analyses showed that telemedicine, compared with standard care, is associated with lower ICU mortality (risk ratio (RR) 0.79; 95% confidence interval (CI), 0.65 to 0.96; nine studies, n = 23,526; I2 = 70%) and hospital mortality (RR, 0.83; 95% CI, 0.73 to 0.94; nine studies, n = 47,943; I2 = 72%). Interventions with continuous patient-data monitoring, with or without alerts, reduced ICU mortality (RR, 0.78; 95% CI, 0.64 to 0.95; six studies, n = 21,384; I2 = 74%) versus those with remote intensivist consultation only (RR, 0.64; 95% CI, 0.20 to 2.07; three studies, n = 2,142; I2 = 71%), but effects were statistically similar (interaction P = 0.74). Effects were also similar in higher (RR, 0.83; 95% CI, 0.68 to 1.02) versus lower (RR, 0.69; 95% CI, 0.40 to 1.19; interaction, P = 0.53) quality studies. Reductions in ICU and hospital length of stay were statistically significant (weighted mean difference (telemedicine-control), -0.62 days; 95% CI, -1.21 to -0.04 days and -1.26 days; 95% CI, -2.49 to -0.03 days, respectively; I2 > 90% for both).ConclusionsTelemedicine was associated with lower ICU and hospital mortality among critically ill patients, although effects varied among studies and may be overestimated in nonrandomized designs. The optimal telemedicine technology configuration and dose tailored to ICU organization and case mix remain unclear.

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Section: Discussionmentioning

confidence: 99%

The effect of telemedicine in critically ill patients: systematic review and meta-analysis

2012

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“…[23][24][25][26] This definition covers a variety of tele-ICU models ranging from exclusively reactive systems, where tele-ICU staff was available via telephone on an as-needed consultative basis, 27 to the more commonly used proactive systems, where patients were continuously monitored in real time via videoconferencing, telemetry, and access to the electronic medical record. 28,29 …”

Section: Study Inclusion Criteria and Outcome Measuresmentioning

confidence: 99%

Impact of Telemedicine Intensive Care Unit Coverage on Patient Outcomes

Young¹,

Chan²,

Lü³

et al. 2011

Arch Intern Med

234

120

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“…Current examples of telehealth programs with clinical pharmacist involvement include cardiology, diabetes, and anticoagulation in the VA and HIV and hepatitis C in the Department of Corrections . Table provides information on settings where clinical pharmacists have successfully implemented and used telehealth care practices . With the continued expansion of telehealth, development of postgraduate training programs will likely follow.…”

Section: Methodsmentioning

confidence: 99%

“…53,54 Table 3 provides information on settings where clinical pharmacists have successfully implemented and used telehealth care practices. [51][52][53][55][56][57][58][59][60] With the continued expansion of telehealth, development of postgraduate training programs will likely follow.…”

Section: Methodsmentioning

confidence: 99%

Providing Comprehensive Medication Management in Telehealth

et al. 2018

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The goal of this white paper is to provide direction for clinical pharmacists providing telehealth. Telehealth care is rapidly emerging to improve patient access to health care and optimize patient health outcomes. With the increasing ability to access electronic health record portals, as many as 75 million telehealth encounters are expected in North America annually. Although electronic "point of access" undoubtedly increases the use of medical and pharmacy services, the real value of telehealth lies in improved access to patients in remote areas lacking adequate medical and pharmacy services and to high-risk patients requiring frequent monitoring. This document is intended to serve as a guide for those interested in or already using telehealth to provide direct patient care. Specifically, it focuses on general concepts of telehealth and demonstrates how the delivery of comprehensive medication management (CMM) by telehealth aligns with the Standards of Practice for Clinical Pharmacists set forth by the American College of Clinical Pharmacy. Although clinical pharmacists must be appropriately credentialed and privileged to provide CMM, their process of care must also be adapted to suit the remote patient. Patient assessment, evaluation of medication therapy, development and implementation of a plan of care, follow-up, monitoring, and documentation of all processes of care are influenced by the technology available, the collaborations established, and the applicable regulations and requirements for telehealth practice.

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Evaluation of the Impact of a tele-ICU Pharmacist on the Management of Sedation in Critically III Mechanically Ventilated Patients

Abstract: 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.

Cited by 57 publications

References 15 publications

The effect of telemedicine in critically ill patients: systematic review and meta-analysis

The effect of telemedicine in critically ill patients: systematic review and meta-analysis

Impact of Telemedicine Intensive Care Unit Coverage on Patient Outcomes

Providing Comprehensive Medication Management in Telehealth

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