Evaluation of the impact of a tele-ICU pharmacist on the management of sedation in critically ill mechanically ventilated patients.
BACKGROUND
An organized and uniform approach to managing sedation in critically ill patients has been associated with improved outcomes, but the most effective means of optimizing sedative medication use in clinical practice has not been fully determined. Pharmacist interventions directed at improving sedation guideline compliance have been shown to reduce the duration of mechanical ventilation.


OBJECTIVE
To determine the impact that pharmacy staffing configurations that include a tele-ICU pharmacist have on compliance with an intensive care unit (ICU) sedation guideline in critically ill mechanically ventilated patients requiring continuous-infusion sedative medications.


METHODS
Compliance with an established ICU sedation guideline, the performance of daily sedative interruptions, and the number of sedative medication-related interventions were evaluated before and after expansion of the ICU pharmacist staffing model to include comprehensive off-hours pharmacist coverage supported with established tele-ICU resources. In both groups, sedation was managed by the primary ICU team. In the intervention group, a pharmacist working in the tele-ICU center performed electronic record audits and made sedative medication recommendations to the primary team.


RESULTS
The addition of third shift tele-ICU pharmacist support was associated with a significant increase in the percentage of patients who received a daily sedative interruption (45% vs 54%; p < 0.0001). This occurred in the context of significant increases in the total number of ICU pharmacist interventions (36 vs 49.4 per 100 patient days, p < 0.0001), the number of therapeutic interventions (20.4 vs 26.1 per 100 patient days, p < 0.001), and the number of sedative-related interventions (0.9 vs 4.4 per 100 patient days, p < 0.0001).


CONCLUSIONS
Tele-ICU resources can be utilized to increase compliance with an established ICU sedation guideline and extend the benefits that daytime ICU clinical pharmacy services provide. Increased ICU pharmacist availability may have additional benefits not measured in this study.
Forni
Allison
A
UMass Memorial Medical Center, Worcester, MA Brigham and Women's Hospital, Boston, MA 02115, USA. AForni@partners.org
Skehan
Nancy
N
Hartman
Christian A
CA
Yogaratnam
Dinesh
D
Njoroge
Milka
M
Schifferdecker
Christopher
C
Lilly
Craig M
CM
D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D010595:Pharmacists / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000379:methods; D017216:Telemedicine / Q000458:organization & administration*
D006993:Hypnotics and Sedatives