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

Lee, Heeyoung PharmD, PhD1; Ryu, Kyungwoo RPharm2; Sohn, Youmin MS, BCPS, BCCCP3; Kim, Jungmi PhD4; Suh, Gee Young MD, PhD, FCCM5; Kim, EunYoung PharmD, PhD, BCPS2,6,7

doi: 10.1097/CCM.0000000000003830
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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.

1Department of Clinical Pharmacy, College of Pharmacy, Gachon University, Incheon, Republic of Korea.

2Evidence-Based and Clinical Research Laboratory, Division of Clinical Pharmacotherapy, Department of Health, Social and Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea.

3Department of Pharmacy, ICU Supportive Pharmacy Team, Samsung Medical Center, Seoul, Republic of Korea.

4Department of Pharmacy, Samsung Medical Center, Seoul, Republic of Korea.

5Division of Pulmonary and Critical Care Medicine, Department of Critical Care Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.

6Division of Clinical Pharmacy & Pharmacoepidemiology, Graduate School of Food and Drug Administration, Chung-Ang University, Seoul, Republic of Korea.

7Division of Licensing of Medicines and Regulatory Science, Graduate School of Pharmaceutical Industry Management, Chung-Ang University, Seoul, Republic of Korea.

*See also p. 1276.

Drs. Lee and Ryu contributed equally to this work as co-first authors.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by the Korean Hospital Pharmaceutical Education & Research Center (No. KSHPERC-18-01).

The authors have disclosed that they have no potential conflicts of interest.

For information regarding this article, E-mail: eykimjcb777@cau.ac.kr

Copyright © 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.