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Impact of a clinical pharmacist-enforced intensive care unit sedation protocol on duration of mechanical ventilation and hospital stay*

Marshall, John PharmD; Finn, Christine A. PharmD; Theodore, Arthur C. MD

doi: 10.1097/01.CCM.0000300275.63811.B3
Clinical Investigations

Objective: While the use of a protocol to guide sedation and analgesia therapy in the intensive care unit has been shown to improve patient outcomes, compliance is often poor. We hypothesized that a formal, consistent intervention by pharmacists to promote adherence to our institution's sedation guidelines would improve clinical outcomes. The purpose of this study was to document the impact of daily pharmacist interventions on clinical outcomes of intensive care unit patients prescribed continuous sedative therapy.

Design: Before-after study.

Setting: Two medical intensive care units (total of 18 beds) at a university medical center.

Patients: Patients were 156 mechanically ventilated patients prescribed a continuous infusion of sedative medication while in the medical intensive care unit.

Interventions: In the retrospective group, data were collected on all mechanically ventilated patients receiving continuous sedative infusions over a 3-month period. In the prospective group, a pharmacist evaluated all mechanically ventilated patients on continuous sedation daily and made recommendations to adhere to the institution's previously approved sedation guidelines.

Measurements and Main Results: Data were collected for 78 control and 78 intervention patients. The groups were well matched in terms of baseline demographics. The mean duration of mechanical ventilation was reduced from 338 ± 348 hrs (14 days) in the pre-intervention group to 178 ± 178 hrs (7.4 days) in the postintervention group (p < .001). Durations of both intensive care unit stay (380 ± 325 hrs vs. 238 ± 206 hrs, p = .001) and hospital stay (537 ± 350 hrs vs. 369 ± 274 hrs, p = .001) were also significantly reduced in the post intervention group.

Conclusions: The institution of a daily pharmacist-enforced intervention directed at improving sedation guideline adherence resulted in a significant decrease in the duration of mechanical ventilation in patients receiving continuous sedation.

From the Department of Pharmacy (JM, CAF) and Department of Pulmonary and Critical Care Medicine (ACF), Boston Medical Center, Boston, MA.

There was no financial support for this study. The authors have not disclosed any potential conflicts of interest.

Address requests for reprints to: John Marshall, PharmD, Department of Pharmacy, Boston Medical Center, Atrium H2606, 88 East Newton Street, Boston, MA 02118-2393. E-mail: john.marshall@bmc.org

© 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins