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Pharmacist participation on physician rounds and adverse drug events in the intensive care unit.
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- Author(s): Leape, Lucian L.; Cullen, David J.; Clapp, Margaret Dempsey; Burdick, Elisabeth; Demonaco, Harold J.; Erickson, Jeanette Ives; Bates, David W.; Leape, L L (AUTHOR); Cullen, D J (AUTHOR); Clapp, M D (AUTHOR); Burdick, E (AUTHOR); Demonaco, H J (AUTHOR); Erickson, J I (AUTHOR); Bates, D W (AUTHOR)
- Source:
JAMA: Journal of the American Medical Association. 7/21/99, Vol. 282 Issue 3, p267-270. 4p. 2 Charts. - Source:
- Additional Information
- Subject Terms: MEDICATION errors; INTENSIVE care units; DRUG side effects; PHARMACIST malpractice; MEDICATION error prevention; ACADEMIC medical centers; CLINICAL trials; COMPARATIVE studies; DRUG utilization; HEALTH care teams; HOSPITAL medical staff; INTERPROFESSIONAL relations; RESEARCH methodology; MEDICAL cooperation; PHARMACISTS; RESEARCH; URBAN hospitals; EVALUATION research; RANDOMIZED controlled trials
- Subject Terms:
- Abstract:
Context: Pharmacist review of medication orders in the intensive care unit (ICU) has been shown to prevent errors, and pharmacist consultation has reduced drug costs. However, whether pharmacist participation in the ICU at the time of drug prescribing reduces adverse events has not been studied.Objective: To measure the effect of pharmacist participation on medical rounds in the ICU on the rate of preventable adverse drug events (ADEs) caused by ordering errors.Design: Before-after comparison between phase 1 (baseline) and phase 2 (after intervention implemented) and phase 2 comparison with a control unit that did not receive the intervention.Setting: A medical ICU (study unit) and a coronary care unit (control unit) in a large urban teaching hospital.Patients: Seventy-five patients randomly selected from each of 3 groups: all admissions to the study unit from February 1, 1993, through July 31, 1993 (baseline) and all admissions to the study unit (postintervention) and control unit from October 1, 1994, through July 7, 1995. In addition, 50 patients were selected at random from the control unit during the baseline period.Intervention: A senior pharmacist made rounds with the ICU team and remained in the ICU for consultation in the morning, and was available on call throughout the day.Main Outcome Measures: Preventable ADEs due to ordering (prescribing) errors and the number, type, and acceptance of interventions made by the pharmacist. Preventable ADEs were identified by review of medical records of the randomly selected patients during both preintervention and postintervention phases. Pharmacists recorded all recommendations, which were then analyzed by type and acceptance.Results: The rate of preventable ordering ADEs decreased by 66% from 10.4 per 1000 patient-days (95% confidence interval [CI], 7-14) before the intervention to 3.5 (95% CI, 1-5; P<.001) after the intervention. In the control unit, the rate was essentially unchanged during the same time periods: 10.9 (95% CI, 6-16) and 12.4 (95% CI, 8-17) per 1000 patient-days. The pharmacist made 366 recommendations related to drug ordering, of which 362 (99%) were accepted by physicians.Conclusions: The presence of a pharmacist on rounds as a full member of the patient care team in a medical ICU was associated with a substantially lower rate of ADEs caused by prescribing errors. Nearly all the changes were readily accepted by physicians. [ABSTRACT FROM AUTHOR] - Abstract: Copyright of JAMA: Journal of the American Medical Association is the property of American Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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