Pharmacoeconomic impact of rational use guidelines on the provision of analgesia, sedation, and neuromuscular blockade in critical care.
OBJECTIVE
To determine the cost-effectiveness and safety of a set of rational use guidelines for analgesia, sedation, and neuromuscular blockade in critically ill ventilated patients when compared with similar factors in standard prescribing.


METHODS
Prospective cost-benefit analysis.


METHODS
Medical and surgical intensive care units (ICU) of a 350-bed tertiary care university hospital.


METHODS
Patients admitted to our ICUs who required mechanical ventilation and continuous analgesics, sedatives, and/or neuromuscular junction blockers (NMJBs). There were 72 patients in the baseline and 84 patients in the follow-up groups.


METHODS
Prospective tracking of eligible baseline patients was followed by the development and introduction of guidelines and an academic detailing process to promote the use of guidelines. Several months after the introduction of guidelines, a second group of eligible follow-up patients was tracked. The use and effectiveness of analgesics, sedatives, and NMJBs, as well as cost and outcomes, were followed in both groups. Data were subsequently reviewed and analyzed.


RESULTS
We recorded data by means of Paradox and Excel databases and included demographics, costs, outcomes (including adverse drug reactions, functional status, ventilator time in hours, lengths of stay), and mortality rates. Data were subsequently analyzed via the Winks statistical data analysis program. Both groups were similar with regard to demographics. There was a statistically significant increase in severity of illness in the follow-up group without a statistically significant increase in mortality. Direct drug costs, ventilator time, and lengths of stay were reduced in the follow-up group. In addition, the use of NMJBs was reduced from 30% in the baseline group to 5% in the follow-up group.


CONCLUSIONS
Rational use guidelines resulted in safe, cost-effective improvements in the provision of continuous analgesia, sedation, and neuromuscular blockade to critically ill patients requiring ventilator management when compared with similar factors in baseline prescribing strategies.
Department of Anesthesiology, State University of New York, Upstate Medical University, Syracuse, USA. Masciam@aol.com
M F
MF
Mascia
M
M
Koch
J J
JJ
Medicis
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000698:Analgesia / Q000191:economics*; D002648:Child; D016292:Procedural Sedation / Q000191:economics*; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics* / Q000379:methods*; D017850:Economics, Pharmaceutical; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade; D011446:Prospective Studies; D012121:Respiration, Artificial