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
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
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.