Evaluation of a pharmacist-driven medication discontinuation protocol in an intensive care unit.
Martz C, Peters M, Swiderek J, and Smith Z. Evaluation of a pharmacist-driven medication discontinuation protocol in an intensive care unit. Crit Care Med 2018; 46:464.
Critical Care Medicine
Learning Objectives: Many temporary medications are initiated in the intensive care unit (ICU) for treatment and prevention of complications. A growing body of literature has described these medications continued inappropriately at hospital discharge. This study aimed to establish a process for pharmacists to discontinue temporary medications in the ICU. Methods: This was retrospective quasi-experimental study with randomized sampling conducted in a medical ICU during the same three month period in consecutive years. The primary objective was to compare the proportion of patients with inappropriate continuation of temporary medications at ICU discharge. The control and intervention groups had medications discontinued through standard practice and pharmacist driven protocol, respectively. Patients were included if admitted to the medical ICU, at least 18 years of age and were initiated on a temporary medication for one or more of the following: stress ulcer prophylaxis (SUP), ICU delirium and/or weaning of continuously infused narcotics. Descriptive statistics, Mann-Whitney U, chi square and student t-test were performed. Results: There were 132 patients included with 66 in both the control and intervention group. There was no difference in the use of SUP, antipsychotics and or/methadone in the control and intervention groups at 93.9% vs 86.4%, 13.6% vs 25.8%, and 4.5% vs 0%, respectively. The inappropriate continuation of temporary medications was 45.5% vs 33.3% in the control and intervention groups, respectively (p = 0.154). An a priori sub-group analysis of medication class by indication showed a reduction in continuation of SUP at ICU discharge (45.2% vs 24.6%; p = 0.019). The median number of unindicated temporary medication doses was reduced by 50% (4 doses [1-9] vs 2 doses [1-5]; p = 0.028). This reduction led to decreased inpatient medication costs ($1,898.57 vs $760.76; p = 0.006). Conclusions: A pharmacist discontinuation protocol does not seem to reduce the inappropriate continuation of all therapies on ICU discharge however it may reduce the inappropriate continuation of SUP.