Prevention of adverse drug events and cost savings associated with PharmD interventions in an academic Level I trauma center: an evidence-based approach.
BACKGROUND
The financial benefit of an established clinical pharmacy service in the trauma intensive care unit has not been well-described. This study was conducted to identify adverse drug events prevented by the clinical pharmacy team and to determine the net cost savings associated with their input on a multidisciplinary trauma service.


METHODS
Between July 2010 and June 2011, we conducted a retrospective analysis of clinical pharmacy activities and interventions on our 31-bed trauma unit managed by a multidisciplinary team. At the initiation of the study, a Web-based pharmacy documentation system was officially integrated into the trauma pharmacy work process. Based on this system, the type of intervention and a value of cost savings ($0-$6,000) were assigned to each activity. Cost-saving values for interventions were calculated from the literature describing the costs of adverse drug events and average drug costs.


RESULTS
Over the year, a total of 2,574 pharmacy activity entries were documented in the Quantifi system. The total conservative estimate of cost savings associated with clinical pharmacy interventions amounted to $565,664. Considering the mean US hospital pharmacist salary and the highest quoted cost associated with the Quantifi program, the net cost savings associated with our clinical pharmacist interventions on the trauma service was $428,327. Most of the interventions (53%) fell under the category of pharmacotherapy improvement, with 21% in the category of quality/safety improvement and 18% as antibiotic stewardship. Prevention of 34 serious adverse drug events was documented. Antibiotic changes and discontinuing medications were other common interventions. Antimicrobial medications (668), anticoagulants (270), and gastrointestinal medications (231) were the most common medication classes involved in pharmacy interventions.


CONCLUSIONS
Using a Web-based pharmacy documentation system, we were able to demonstrate prevention of serious adverse drug events and a significant cost savings by including clinical pharmacy in a multidisciplinary approach to caring for the seriously injured.


METHODS
Economic analysis, level III; therapeutic study, level IV.
Division of Trauma and Surgical Critical Care, Department of Pharmaceutical Sciences,Vanderbilt University Medical Center, Nashville, Tennessee. susan.hamblin@vanderbilt.edu
Susan
S
Hamblin
Kelli
K
Rumbaugh
Richard
R
Miller
D000046:Academic Medical Centers / Q000191:economics* / Q000458:organization & administration; D017046:Cost Savings / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D016527:Drug Costs / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics / Q000517:prevention & control*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D010595:Pharmacists / Q000191:economics / Q000458:organization & administration; D010607:Pharmacy Service, Hospital / Q000191:economics / Q000458:organization & administration; D024382:Professional Role; D012189:Retrospective Studies; D013714:Tennessee; D014193:Trauma Centers / Q000191:economics* / Q000458:organization & administration