Prevention of adverse drug events and cost savings associated with PharmD interventions in an academic Level I trauma center

Hamblin, Susan; Rumbaugh, Kelli; Miller, R Eric

doi:10.1097/ta.0b013e318267cd80

Cited by 58 publications

(56 citation statements)

References 28 publications

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“…Future studies are needed in this direction, as ADRs could also happen with DDIs. [14] There was no incidence of failure to receive therapy; this can be attributed to the fact that especially for the ICU patients, the drugs were not charged as it was a charity hospital (which eliminates the financial aspect) and all the medicines are administered by the nurses (which eliminates the patient adherence problems).…”

Section: Discussionmentioning

confidence: 99%

An interventional study on intensive care unit drug therapy assessment in a rural district hospital in India

Pichala¹,

Kumar²,

Zachariah³

et al. 2013

J Basic Clin Pharma

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Background:Intensive care unit is a potential area for drug-related problems. As many of the patients treated are complex patients, clinical pharmacy intervention could find drug therapy problems.Materials and Methods:Drug information liaisons daily attended ward rounds with intensivists and screened the patient for drug therapy assessment using the American Society for Health-System Pharmacists clinical skills competition DTA format. This was a prospective study done for 6 months from August 2012 to January 2013. Simple statistics were used to tabulate the drug-related problems assessed.Results:A total of 72 patients were screened for drug therapy problems, for which 947 drug doses were prescribed in the study period. The total number of prescriptions was 148. The average number of drugs per prescription was 6.39 and the average number of drugs per patient was 13.15. A total of 243 problems were identified; on an average, 1.67 problems were present per prescription. The total number of drug interactions identified was N = 192 (78.2%); majority of them (61.4%) were of type C (not serious). So, 55.73% of them were monitored and not stopped or substituted. The second type of problem was a correlation between drug therapy and medical problem (7.4%). Appropriate drug selection and drug regimen was the third problem, and the adverse drug reactions and therapeutic duplications accounted for approximately 2% of the drug-related problems identified.Conclusion:Drug interactions constituted the major problem of ICUs, but not many were serious or significant. Consensus in assessment of drug-related problems and convincing intensivists with good quality evidences are required for better acceptance of interventions.

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Section: Discussionmentioning

confidence: 99%

An interventional study on intensive care unit drug therapy assessment in a rural district hospital in India

Pichala¹,

Kumar²,

Zachariah³

et al. 2013

J Basic Clin Pharma

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“…Additional input comes from ICU-based pharmacy support [92] . Pharmacists are significant drivers in ASPs, with roughly one-fifth of pharmacist intervention in an American trauma centre being ASP related [93] . The MDT approach itself seems to be more effective than purely its components.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

Zhang

Singh

2015

WJCCM

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Antibiotic usage and increasing antimicrobial resistance (AMR) mount significant challenges to patient safety and management of the critically ill on intensive care units (ICU). Antibiotic stewardship programmes (ASPs) aim to optimise appropriate antibiotic treatment whilst minimising antibiotic resistance. Different models of ASP in intensive care setting, include "standard" control of antibiotic prescribing such as "de-escalation strategies" through to interventional approaches utilising biomarkerguided antibiotic prescribing. A systematic review of outcomes related studies for ASPs in an ICU setting was conducted. Forty three studies were identified from MEDLINE between 1996 and 2014. Of 34 nonprotocolised studies, [1 randomised control trial (RCT), 22 observational and 11 case series], 29 (85%) were positive with respect to one or more outcome: These were the key outcome of reduced antibiotic use, or ICU length of stay, antibiotic resistance, or prescribing cost burden. Limitations of non-standard antibiotic initiation triggers, patient and antibiotic selection bias or baseline demographic variance were identified. All 9 protocolised studies were RCTs, of which 8 were procalcitonin (PCT) guided antibiotic stop/start interventions. Five studies addressed antibiotic escalation, 3 de-escalation and 1 addressed both. Six studies reported positive outcomes for reduced antibiotic use, ICU length of stay or antibiotic resistance. PCT based ASPs are effective as antibiotic-stop (de-escalation) triggers, but not as an escalation trigger alone. PCT has also been effective in reducing antibiotic usage without worsening morbidity or mortality in ventilator associated pulmonary infection. No study has demonstrated survival benefit of ASP. Ongoing challenges to infectious disease management, reported by the World Health Organisation global report 2014, are high AMR to newer antibiotics, and regional knowledge gaps in AMR surveillance. Improved AMR surveillance data, identifying core aspects of successful ASPs that are transferable, and further well-conducted trials will be necessary if ASPs are to be an effective platform for delivering desired patient outcomes and safety through best antibiotic policy.

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“…Similarly, a study at a trauma centre found that clinical pharmacy activities and interventions, including discontinuation of medications, changes to antibiotic therapy, and changes from IV to oral formulations, resulted in significant cost savings, either directly or by preventing adverse drug events. 8 The current study assessed only direct and immediate medication cost savings; long-term costs were not considered. Increased health care costs due to changes to medications that might have resulted in increased costs, such as therapeutic substitutions and increases in doses, were not considered as an outcome, nor was there any attempt to associate cost savings with a particular dollar value.…”

Section: Discussionmentioning

confidence: 99%

Assessing the Impact of an Expanded Scope of Practice for Pharmacists at a Community Hospital

Hwang

Koleba

Mabasa

2013

CJHP

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Prevention of adverse drug events and cost savings associated with PharmD interventions in an academic Level I trauma center

Abstract: Economic analysis, level III; therapeutic study, level IV.

Cited by 58 publications

References 28 publications

An interventional study on intensive care unit drug therapy assessment in a rural district hospital in India

An interventional study on intensive care unit drug therapy assessment in a rural district hospital in India

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

Assessing the Impact of an Expanded Scope of Practice for Pharmacists at a Community Hospital

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