ABSTRACT
BACKGROUND: Critical care services have expanded over the last decade to include tele-ICU. In 2015, Atrium Health's pharmacy services began covering tele-ICU patients from 3-11 PM. In 2017, dayshift tele-ICU pharmacy services were added on Monday, Wednesday and Friday from 8 AM to 12 PM. Cutting-edge technology and software integration allow alerts to be generated in areas of abnormal glucose, electrolyte and lactate levels. This analysis was conducted to describe the interventions recommended during dayshift hours. METHODS: Data collected from 1 August 2017 to 30 June 2018, the first 11 months of dayshift pharmacist coverage, include number of charts reviewed per shift, interventions and specific types logged, if the intervention was tied to an alert and if it was accepted or rejected. Interventions can originate from alerts or from proactive assessment by the pharmacist. Descriptive statistics were reported. RESULTS: On average, 41 charts were reviewed per shift. Over an 11-month period, 1024 interventions were made for 634 patient chart reviews. Some 89% of all interventions were accepted or accepted with modifications. Of the total interventions, 37 (3.6%) were adverse drug events avoided and 658 (64.4%) were interventions unrelated to alert data. Medication management accounted for 44.3% of all interventions. DISCUSSION: Proactive assessment rather than alert review resulted in the majority of interventions, demonstrating that reviewing every ICU patient is vital for improving patient care. Determining optimal avenues for intervention delivery and integration with the bedside multidisciplinary teams remains one of the biggest challenges. Dayshift innovations included weekly virtual rounds and providing drug information for the bedside teams.
Subject(s)
Drug-Related Side Effects and Adverse Reactions , Pharmacists , Critical Care , Humans , Intensive Care UnitsABSTRACT
Purpose: A review of the implementation and development of telepharmacy services that ensure access to a critical care-trained pharmacist across a healthcare system. Summary: Teleintensive care unit (tele-ICU) services use audio, video, and electronic databases to assist bedside caregivers. Telepharmacy, as defined by the American Society of Health-System Pharmacists, is a method in which a pharmacist uses telecommunication technology to oversee aspects of pharmacy operations or provide patient care services. Telepharmacists can ensure accurate and timely order verification, recommend interventions to improve patient care, provide drug information to clinicians, assist in standardization of care, and promote medication safety. This tele-ICU pharmacy team is one of the only entirely clinical-based tele-ICU pharmacy models among the tele-ICU programs across the United States. The use of technology for customized alert generation and intervention proposal with medication orders and chart notation are unique. In a 34-month period from September 2015 to July 2018, more than 110 000 alerts were generated and 13 000 interventions were performed by telepharmacists. Conclusions: Tele-ICU pharmacists employ limited resources to provide critical care pharmacy expertise to multiple sites within a healthcare system during nontraditional hours with documented clinical and financial benefits. Further study is needed to determine the impact of tele-ICU pharmacists on ICU and hospital length of stay, morbidity, and mortality.
ABSTRACT
BACKGROUND: Sedation of mechanically ventilated patients should optimize comfort and safety while avoiding over-sedation and adverse outcomes. To our knowledge, characteristics associated with attaining target sedation are unknown. OBJECTIVES: Evaluate current sedation practice at a single center and explore which patient characteristics are associated with attaining target sedation. METHODS: This is a single-center, retrospective chart review of sedated, ventilated patients in a medical/surgical ICU. Demographic and clinical data were collected. Univariate and multivariate logistic regression analyses were used with attaining target sedation as the dependent variable. RESULTS: Of the 100 patients included (median 60.5 years), 50 attained target sedation. Univariate analyses (a = 0.10) revealed factors associated with target sedation were age (P = 0.08), history of alcohol abuse (P = 0.08), multiple comorbidities (P = 0.09), and delirium monitoring (P = 0.002). Multivariate analysis revealed an association between delirium monitoring/documentation and attaining target sedation (P = 0.005; OR 9.2; 95% CI 2.3-36.8). CONCLUSIONS: Patients without appropriate delirium monitoring/documentation had significantly reduced likelihood of achieving target sedation.
