Impact of a clinical pharmacist-enforced intensive care unit sedation protocol on duration of mechanical ventilation and hospital stay.
OBJECTIVE
While the use of a protocol to guide sedation and analgesia therapy in the intensive care unit has been shown to improve patient outcomes, compliance is often poor. We hypothesized that a formal, consistent intervention by pharmacists to promote adherence to our institution's sedation guidelines would improve clinical outcomes. The purpose of this study was to document the impact of daily pharmacist interventions on clinical outcomes of intensive care unit patients prescribed continuous sedative therapy.


METHODS
Before-after study.


METHODS
Two medical intensive care units (total of 18 beds) at a university medical center.


METHODS
Patients were 156 mechanically ventilated patients prescribed a continuous infusion of sedative medication while in the medical intensive care unit.


METHODS
In the retrospective group, data were collected on all mechanically ventilated patients receiving continuous sedative infusions over a 3-month period. In the prospective group, a pharmacist evaluated all mechanically ventilated patients on continuous sedation daily and made recommendations to adhere to the institution's previously approved sedation guidelines.


RESULTS
Data were collected for 78 control and 78 intervention patients. The groups were well matched in terms of baseline demographics. The mean duration of mechanical ventilation was reduced from 338 +/- 348 hrs (14 days) in the pre-intervention group to 178 +/- 178 hrs (7.4 days) in the postintervention group (p < .001). Durations of both intensive care unit stay (380 +/- 325 hrs vs. 238 +/- 206 hrs, p = .001) and hospital stay (537 +/- 350 hrs vs. 369 +/- 274 hrs, p = .001) were also significantly reduced in the post intervention group.


CONCLUSIONS
The institution of a daily pharmacist-enforced intervention directed at improving sedation guideline adherence resulted in a significant decrease in the duration of mechanical ventilation in patients receiving continuous sedation.
Marshall
John
J
Department of Pharmacy, Boston Medical Center, Boston, MA, USA. john.marshall@bmc.org
Finn
Christine A
CA
Theodore
Arthur C
AC
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016292:Procedural Sedation / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives