• Implementation of an ICU Antibiotic Formulary Improves Patient Outcome

      Nix, David; Van Hassel, Tom; Stahl, John; College of Pharmacy, The University of Arizona (The University of Arizona., 2007)
      Objectives: The purpose of this study is to determine if an antibiotic formulary is beneficial in an inpatient ICU setting. The main goal, of course, is to ensure patients receive the most appropriate antimicrobial therapy resulting in the least amount of resistance, by using an antibiotic formulary and ICU antibiotic intervention. Methods: This project will use a retrospective design in which one-year post-intervention antibiotic resistant trends will be compared with pre-intervention trends at Yuma Regional Medical Center (YRMC). As is common at YRMC, patients started on antibiotic therapy had susceptibility testing performed to determine the best treatment for the patient. This susceptibility data will be the data used for comparison. Comparison of patient charges and hospital costs associated with these patients will also be performed. YRMC employed an ICU antibiotic intervention documentation form that was used to monitor and extrapolate intervention data. Hospital lab percent susceptibility data will be looked at to determine isolate susceptibility data to determine if any trends are present in antibiotic resistance between the time period when the antibiotic formulary was implemented and the previous corresponding period of time before the formulary. This data will also be compared with the hospital trends in resistant isolates as a whole. The data is desensitized, as individual patient data is not being reviewed. In looking at patient charges and hospital costs, charts will be reviewed. These charts will be de-identified to the investigators of this study. Of further note, YRMC placed the intervention in action in February 2006 and began collecting post-intervention data at that time. This study will be using post intervention data collected from February 2006 thru February 2007. Results: Conclusions:
    • Prioritization of Pharmacist Activities in the ICU: An Analysis of the Costs and Consequences of Interventions

      Erstad, Brian; Kopp, Brian; Mrsan, Melinda; College of Pharmacy, The University of Arizona (The University of Arizona., 2005)
      Objectives: The purpose of this retrospective investigation is to compare the quantity, importance, and associated cost implications of drug-related problems identified (and ultimately resolved) through order entry/verification versus other clinical activities of a decentralized critical care pharmacist. Methods: The data from this study was collected by one decentralized pharmacist assigned to a surgical intensive care unit. A standard form was used to document all interventions during the period of this observation. For the purposes of this retrospective evaluation the following data will be extracted from the existing database: amount of time spent performing various clinical activities, how drug-related problems were identified (e.g., order entry verification versus chart reviews), the time it took to identify and resolve drug-related problems, a general description of interventions, the importance of the intervention, and the estimated economic impact associated with interventions. Results: In only a 41⁄2 month period, 111 patients would have likely experienced an adverse drug event had the ICU pharmacist not intervened. This equals a cost avoidance to the institution of anywhere from $200,000 to $280,000 for as little on average of 15-30 minutes of the pharmacist time. Implications: As previous studies have shown, the presence of a pharmacist in an ICU is crucial to lowering the incidence of adverse drug events. Our results have proven the interventions pharmacist make during team rounding and chart review are not only cost effective, but substantially improve patient care.