Comparative analysis of clinical pharmacy interventions in a pediatric intensive care unit
Objective: The objectives of this study were 1) to describe and characterize interventions performed by a clinical pharmacist and 2) provide a comparative analysis of length of stay, mortality, and drug charges in control and intervention groups.
Design: This was a retrospective analysis of clinical pharmacy interventions performed in a Pediatric Intensive Care Unit (PICU) over two years. The clinical pharmacy faculty member was a dual-residency trained specialist in pediatric critical care, and was on-site in the PICU for approximately 0.5 full time equivalents.
Setting and patients: The interventions occurred in an 18-bed medical-surgical PICU in a tertiary care children’s hospital. All patients admitted to the PICU during the study period were included.
Interventions: The intervention group was comprised of patients admitted to the PICU during the study period for which the clinical pharmacist suggested changes in medication therapy. All other PICU patients were included in the control group. Interventions suggested were varied, including drug dosing adjustments, antibiotic recommendations, sedation recommendations, and discontinuation of drug therapy.
Measurements and main results: On average, there were 4.4 interventions per patient (0.35 interventions per patient-day). Dosing recommendations, pharmacokinetic recommendations, and discontinuation of medications were the most common types of interventions performed. Antibiotics and sedation/analgesia were the most common drug classes for intervention. There were statistically significant differences in the length of stay and mortality of groups, with both higher in the intervention group. Notably, the intervention group also had higher Pediatric Risk of Mortality (PRISM) scores and drug charges, signifying increased severity of illness compared to the control group. Estimated annual cost savings in the intervention group was $ 86,000.
Conclusions: Antibiotics and sedation/analgesia dosing were the most common areas for pharmacy interventions. Patients with higher PRISM scores had increased interventions. Cost savings were considerable even with a part time pharmacist.