title: Outcomes of expanded use of clinical pharmacist practitioners in addition to team-based care in a community health system intensive care unit.
abstract: OBJECTIVE
  Clinical and cost benefits achieved through expanded use of state-licensed clinical pharmacist practitioners (CPPs) with prescribing authority on a critical care team are reported.
  
  
  METHODS
  A retrospective pre-post analysis was conducted to evaluate patient care outcomes and cost savings during one-year periods before and after the number of CPPs on a North Carolina community health system's neurotrauma intensive care unit (NTICU) team was increased from one to three. Outcomes assessed included the number and types of medication management encounters, estimated cost savings, and the rate of preventable adverse drug events (ADEs) with expanded use of CPPs.
  
  
  RESULTS
  During the two-year study period, CPPs conducted 13,386 documented medication encounters involving 2,198 patients; associated cost savings totaled an estimated $2,118,426. During the 12 months after CPP involvement on the NTICU team was increased, there was a 182% increase in encounters for therapeutic optimization (p = 0.01), with an associated 29% increase in cost savings and an improved return on investment. The CPP service expansion was also associated with a reduction in preventable ADEs, including a 75% reduction in prescribing-related ADEs (risk ratio [RR], 0.25; 95% confidence interval [CI], 0.05-1.2; p = 0.09) and a 37% reduction in higher-severity ADEs (RR, 0.63; 95% CI, 0.25-1.57; p = 0.36).
  
  
  CONCLUSIONS
  With expanded CPP involvement on the NTICU team, there was a substantial increase in therapeutic optimization interventions and a clinically notable reduction in preventable ADEs, as well as an estimated 30% increase in associated cost savings.
authors.affiliation: Elizabeth Michalets, Pharm.D., BCPS, CPP, FCPP, is Regional Assistant Dean of Clinical Affairs and Associate Professor of Clinical Education; and Julie Creger, Pharm.D., BCPS, CPP, is Clinical Pharmacist, Neurotrauma Intensive Care Unit, Mission Health System Department of Pharmacy, University of North Carolina Eshelman School of Pharmacy, Asheville. William R. Shillinglaw, D.O., M.H.A., is Director of Trauma Surgery and Critical Care, Mission Health System Department of Trauma Surgery and Critical Care, Asheville. elizabeth.michalets@msj.org.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Michalets
authors.affiliation: Elizabeth Michalets, Pharm.D., BCPS, CPP, FCPP, is Regional Assistant Dean of Clinical Affairs and Associate Professor of Clinical Education; and Julie Creger, Pharm.D., BCPS, CPP, is Clinical Pharmacist, Neurotrauma Intensive Care Unit, Mission Health System Department of Pharmacy, University of North Carolina Eshelman School of Pharmacy, Asheville. William R. Shillinglaw, D.O., M.H.A., is Director of Trauma Surgery and Critical Care, Mission Health System Department of Trauma Surgery and Critical Care, Asheville.
authors.forename: Julie
authors.initials: J
authors.lastname: Creger
authors.affiliation: Elizabeth Michalets, Pharm.D., BCPS, CPP, FCPP, is Regional Assistant Dean of Clinical Affairs and Associate Professor of Clinical Education; and Julie Creger, Pharm.D., BCPS, CPP, is Clinical Pharmacist, Neurotrauma Intensive Care Unit, Mission Health System Department of Pharmacy, University of North Carolina Eshelman School of Pharmacy, Asheville. William R. Shillinglaw, D.O., M.H.A., is Director of Trauma Surgery and Critical Care, Mission Health System Department of Trauma Surgery and Critical Care, Asheville.
authors.forename: William R
authors.initials: WR
authors.lastname: Shillinglaw
mesh_terms: D000328:Adult; D000368:Aged; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration*; D010593:Pharmaceutical Services / Q000191:economics / Q000458:organization & administration*; D010595:Pharmacists / Q000191:economics / Q000458:organization & administration*; D024382:Professional Role; D012189:Retrospective Studies