title: Improving antimicrobial dosing in critically ill patients receiving continuous venovenous hemofiltration and the effect of pharmacist dosing adjustment.
abstract: BACKGROUND
  Appropriate antimicrobial dosing for patients receiving continuous venovenous hemofiltration (CVVH) is complex. Pharmacist participation in antimicrobial dosing adjustment for patients receiving CVVH may be advantageous.
  
  
  METHODS
  A comparative study was performed in a China hospital intensive care unit (ICU).Patients receiving CVVH in the intervention group received antimicrobial dosing adjustment service by pharmacists from January 2012 to June 2012, whereas patients in the control group received routine medical care between July 2012 and December 2012. The primary outcomes including patients' length of ICU stay, mortality in ICU, ICU hospitalization costs, and the occurrence of adverse drug events (ADEs) were then compared.
  
  
  RESULTS
  87 and 93 patients were included in the control and intervention groups. During the intervention period, pharmacists made 256 antimicrobial dosing adjustment recommendations for 93 enrolled patients receiving CVVH, of which 224 (87.5%) recommendations were accepted by physicians. Changing in CVVH-related variables (175, 68.4%) were the most common risk factors for dosing errors, whereas β-lactams (131, 51.2%) were the most frequency of antimicrobials associated with dosing errors. Compared with the control group, pharmacist dosing adjustment resulted in £1637.7 cost savings per patient, and 2.36 times reduction of antimicrobial-related adverse drug events (ADEs) (11 vs 26, P=0.002), while length of ICU stay and mortality in ICU showed no significant difference (P>0.05).
  
  
  CONCLUSIONS
  The involvement of pharmacist to participate in the ICU team rounds for patients receiving CVVH is associated with cost savings and reduction of ADEs. Hospital may consider employing ICU pharmacists.
authors.affiliation: Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, P.R. China.
authors.forename: Sai-Ping
authors.initials: SP
authors.lastname: Jiang
authors.affiliation: Department of Pharmacy, Lishui central Hospital, 289 Kuocang Road, Lishui 323000, P.R. China.
authors.forename: Yan-Yan
authors.initials: YY
authors.lastname: Xu
authors.affiliation: Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, P.R. China.
authors.lastname: Ping-Yang
authors.affiliation: Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, P.R. China.
authors.forename: Wei-Fang
authors.initials: WF
authors.lastname: Wu
authors.affiliation: Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, P.R. China.
authors.forename: Xing-Guo
authors.initials: XG
authors.lastname: Zhang
authors.affiliation: Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, P.R. China.
authors.forename: Xiao-Yang
authors.initials: XY
authors.lastname: Lu
authors.affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China.
authors.forename: Yong-Hong
authors.initials: YH
authors.lastname: Xiao
authors.affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China.
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Liang
authors.affiliation: Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, P.R. China. Electronic address: cjicu88@126.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Chen
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D003422:Critical Care / Q000379:methods*; D005260:Female; D006440:Hemofiltration; D006801:Humans; D007362:Intensive Care Units; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010595:Pharmacists; D058996:Quality Improvement; D012017:Referral and Consultation
chemical_list: D000890:Anti-Infective Agents
keywords: Adverse drug events; Antimicrobial dosing adjustment; Continuous venovenous hemofiltration; Cost savings; Pharmacist