Impact of pharmacist management of pain, agitation, and delirium in the intensive care unit through participation in multidisciplinary bundle rounds.
A two-phase program to increase pharmacist involvement in management of pain, agitation and delirium (PAD) at a large community teaching hospital is described.



Florida Orlando Hospital implemented a two-phase initiative to decrease intensive care unit (ICU) length of stay (LOS), ventilator use, sedative use, and hospital expenditures while advancing pharmacists' scope of practice. Phase 1 of the initiative involved a pilot project to evaluate pharmacist management of sedative therapy for mechanically ventilated patients. Using a newly developed PAD order set, a pharmacist performed daily sedation management in a cohort of patients; relative to physician-managed standard care, pharmacist-directed sedation management resulted in fewer hours of patient exposure to continuous sedation, with an overall 46% reduction in continuous infusions of sedatives and reductions in both ICU and total hospital LOS, resulting in estimated savings of $1.2 million in direct hospital costs and $183,216 in drug costs. In phase 2 of the project, an expanded group of pharmacists collaborated with interprofessional teams to manage PAD using an integrated "ABCDE bundle" to promote early mobility and weaning from sedatives and analgesics. A retrospective comparison of data on a cohort of medical ICU patients managed using the ABCDE bundle approach (n= 436) and a standard-care cohort (n= 499) demonstrated improvements in several outcomes, including mean ventilator days per patient, ICU LOS, and mortality.



The provision of proactive critical care pharmacist services directed at PAD management is an innovative approach to fostering interprofessional collaboration and optimizing clinical outcomes.
Critical Care and ED Pharmacy Division, Florida Hospital Orlando, Orlando, FL patricia.louzon@flhosp.org.|University of Florida College of Pharmacy, Gainesville, FL patricia.louzon@flhosp.org.
Patricia
P
Louzon
Florida Hospital Orlando, Orlando, FL.
Heath
H
Jennings
Medical Intensive Care Unit, Florida Hospital Orlando, Orlando, FL.|Central Florida Pulmonary Group, Orlando, FL.
Mahmood
M
Ali
Florida Hospital Orlando, Orlando, FL.
Marijo
M
Kraisinger
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017109:Akathisia, Drug-Induced / Q000175:diagnosis / Q000517:prevention & control*; D016638:Critical Illness / Q000628:therapy; D003693:Delirium / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007362:Intensive Care Units / Q000639:trends*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods / Q000639:trends*; D010348:Patient Care Team / Q000639:trends*; D010595:Pharmacists / Q000639:trends*; D010865:Pilot Projects; D024382:Professional Role; D012189:Retrospective Studies
D006993:Hypnotics and Sedatives
ABCDE bundle; delirium; multidisciplinary; pharmacist management; pharmacy ROI