Patients in intensive care units who don't receive care from a pharmacist for even one day of their stay are 20% more likely to die, according to new research led by the University of Georgia.
The study also found ICU patients were 10% more likely to die when pharmacists were responsible for more than 15 patients. For every one patient increase in a pharmacist's workload, the odds of a patient dying increased by 1%.
"Critically ill patients experience an average of 1.7 medical errors per day, and nearly 80% of serious errors are caused by medications," said Susan Smith, lead author of the study and an associate professor in UGA's College of Pharmacy. Smith also practices critical care pharmacy in a local ICU. "The comprehensive medication management provided by pharmacists is essential for ensuring medication safety."
The researchers analyzed data from 213 pharmacists across 64 hospitals. The pharmacists provided information on their workload and every patient they cared for each day for 100 consecutive days, resulting in data from more than 28,000 patients. The researchers then compiled information on those patients' severity of illness, health outcomes and more.
"Previous research has shown that having pharmacists present in ICUs is good and that it improves outcomes," Smith said. "But this is the first publication to show that we need pharmacists in the ICU every day, seven days a week, 365 days a year."
Pharmacists guard against adverse drug events
Critical care pharmacists are an integral part of the medical team in hospital ICUs. They review medications for potential drug interactions, optimize dosing and determine if a different medication would be a better fit.
Critical care pharmacists act as a key safeguard against adverse drug events, which kill an estimated 250,000 hospital patients each year.
"These findings could directly influence ICU care by reinforcing the importance of having critical care pharmacists involved in medication management every day of a patient's ICU stay," said Andrea Sikora, a senior author on the study and associate professor at the University of Colorado Anschutz. Sikora is also an adjunct associate professor in UGA's College of Pharmacy. "The study also highlights the importance of evidence-based team design and the power of large-scale collaboration across institutions."
Hospital staffing, budgets may pose obstacle to patient care
Most hospitals have critical care pharmacists in their ICUs. But about a third don't, according to recent studies. And those that do are often limited to pharmacist presence on weekdays and day shift alone.
As hospital budgets shrink, having a critical care pharmacist on call 24/7 isn't always a priority. But adding pharmacists to the team would likely save money in the long term through shorter patient stays and less reliance on costly life-sustaining measures, the researchers said.
"I've seen firsthand the consequences of both having and not having dedicated critical care pharmacists at the bedside," said Mojdeh Heavner, a member of the study's leadership team and a professor at the University of Maryland School of Pharmacy. Heavner is also an adjunct associate professor in the UGA College of Pharmacy. "These findings reinforce that pharmacist coverage in the ICU is not simply a staffing decision. It's a patient safety and survival issue.
"We found a clear association between pharmacist workload and patient mortality. We hope these data will help hospital leaders advocate for the resources needed to ensure patients have access to critical care pharmacy expertise every day of their ICU stay."
Published by CHEST Journal, the study was co-authored by Zhetao Chen and Xianyan Chen of the UGA College of Public Health. Additional co-authors include researchers from Wellstar MCG Health, Northeastern University, Brigham and Women's Hospital, Emory University and the University of Colorado.
