Impact on Patient Outcomes of Pharmacist Participation in Multidisciplinary Critical Care Teams: A Systematic Review and Meta-Analysis*

Abstract

Objectives: The objective of this systematic review and meta-analysis was to assess the effects of including critical care pharmacists in multidisciplinary ICU teams on clinical outcomes including mortality, ICU length of stay, and adverse drug events. Data Sources: PubMed, EMBASE, and references from previous relevant systematic studies. Study Selection: We included randomized controlled trials and nonrandomized studies that reported clinical outcomes such as mortality, ICU length of stay, and adverse drug events in groups with and without critical care pharmacist interventions. Data Extraction: We extracted study details, patient characteristics, and clinical outcomes. Data Synthesis: From the 4,725 articles identified as potentially eligible, 14 were included in the analysis. Intervention of critical care pharmacists as part of the multidisciplinary ICU team care was significantly associated with the reduced likelihood of mortality (odds ratio, 0.78; 95% CI, 0.73–0.83; p < 0.00001) compared with no intervention. The mean difference in ICU length of stay was –1.33 days (95% CI, –1.75 to –0.90 d; p < 0.00001) for mixed ICUs. The reduction of adverse drug event prevalence was also significantly associated with multidisciplinary team care involving pharmacist intervention (odds ratio for preventable and nonpreventable adverse drug events, 0.26; 95% CI, 0.15–0.44; p < 0.00001 and odds ratio, 0.47; 95% CI, 0.28–0.77; p = 0.003, respectively). Conclusions: Including critical care pharmacists in the multidisciplinary ICU team improved patient outcomes including mortality, ICU length of stay in mixed ICUs, and preventable/nonpreventable adverse drug events.

Drug-Related Problems Identified During Pharmacy Intervention and Consultation: Implementation of an Intensive Care Unit Pharmaceutical Care Model

“…Patients admitted to the intensive care unit (ICU) are at higher risk for developing DRPs, from 2.1/1,000 to 804.5/1,000 patients days (Garrouste-Orgeas et al, 2010;Garrouste-Orgeas et al, 2015;Garrouste-Orgeas et al, 2016), primarily cause by their critical diseases status or complications, the use of various high alert medications, and the rapid changing pharmacotherapies (Kari et al, 2018). Previous studies have shown that critical care pharmacists can play an essential role in promoting the delivery of pharmaceutical care (PC) and improve the overall quality of health care by offering individualized recommendations in complicated drug regimens, reducing the incidence rate of DRPs, and decreasing preventable ADEs (Tasaka et al, 2018;Lee et al, 2019;Reinau et al, 2019). However, the development of PC in the ICU is currently facing three major challenges worldwide.…”

National Survey of Clinical Pharmacy Practice in Saudi Arabia-2017-2018: Administration and Management

“…The positive impact of clinical pharmacists, specifically in critical care and in medical and emergency services has been clearly documented; their impact is reflected in reducing drug costs, provides vital educational function and provides continuous and individualized pharmacotherapeutic care. 32,33 The majority of the participants agreed that the services of clinical pharmacy influence the safety and effectiveness of patient care alongside decreasing morbidity and mortality. 33,34 The clinical pharmacy services should be extended to cover all various specialties and medical departments in the KSA.…”

“…32,33 The majority of the participants agreed that the services of clinical pharmacy influence the safety and effectiveness of patient care alongside decreasing morbidity and mortality. 33,34 The clinical pharmacy services should be extended to cover all various specialties and medical departments in the KSA. Unfortunately, most of Alomi YA, et al: Clinical Pharmacy Practice Administration and Management in Saudi Arabia the hospitals had no assistant at their satellite services in clinical pharmacy services.…”

Effect of critical care pharmacist on antibiotic medication optimizations, reduce drug costs but not increase mortality: A retrospective cohort study in the real world research

“…The roles of the pharmacists on patient care had been proved by many studies [10,[18][19][20][21]. Lee et al reported that including critical care pharmacists in the multidisciplinary ICU team improved patient outcomes including mortality, ICU length of stay in mixed ICUs, and preventable/non-preventable adverse drug events [22]. In our study, after pharmacist attendance, the rate of antimicrobial agent utilizations in the discharged patients decreased and patient antibiotic charges including the total drug costs were saving per stay.…”