Pharmacist initiative to improve appropriate prophylactic medications in an intensive care unit

Document Type

Conference Proceeding

Publication Date

1-1-2022

Publication Title

Crit Care Med

Abstract

INTRODUCTION: Mechanically ventilated (MV) intensive care unit (ICU) patients are at risk for complications. The use of ventilator bundles, including stress ulcer prophylaxis (SUP), chlorhexidine (CHX) oral solution, and venous thromboembolism (VTE) prophylaxis, reduce complications in ICU patients. Although ventilator bundles are standard of care, evidence suggests low compliance. This study compared the appropriate use of ventilator bundles in MV patients in a medical ICU (MICU) before and after a pharmacist-initiated intervention. METHODS: This was an IRB approved, retrospective, quasiexperimental study evaluating ventilator bundle compliance in MICU patients at a large academic medical center. The pre- and post-intervention groups consisted of patients who had ventilator bundles initiated through standard practice or pharmacist driven protocol, respectively. Adult patients were included if they were admitted to the MICU and on MV for ≥ 24 hours from 11/18-2/19 for the pre-intervention group and 11/19-2/20 for the post-intervention group. The primary outcome was the percentage of days patients were on all appropriate ventilator bundle medications. Ventilator bundle medications assessed included evidence-based indications for SUP, CHX oral solution, and VTE prophylaxis. Secondary endpoints included individual components of the primary endpoint, choice of SUP, ventilator days, ICU and hospital length of stay. Descriptive statistics, chi-squared, and Mann Whitney U test were used, as appropriate. RESULTS: A total of 130 patients were included, 65 in both the pre- and post-group. Baseline characteristics were similar between groups. There was a significant increase in the percentage of days patients were on all appropriate ventilator bundle medications in the pharmacist driven protocol group (60.1% vs 88.8%; p< 0.001). The percentage of days on SUP and VTE prophylaxis increased between the pre- and post-intervention groups (84.4% vs 95.4%; p=0.009 and 67.4% vs 94.5%; p< 0.001, respectively). SUP was more likely to be started at the appropriate dose in the pharmacist driven protocol group (81.7% vs 95.3%; p=0.024). There were no differences noted in other secondary endpoints. CONCLUSIONS: Implementation of a pharmacist-initiated ventilator bundle protocol in MV MICU patients increased days of complete compliance.

Volume

50

Issue

1 SUPPL

First Page

481

Last Page

481

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