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Impact of pharmacist management of pain, agitation, and delirium in the intensive care unit through participation in multidisciplinary bundle rounds.

PURPOSE: A two-phase program to increase pharmacist involvement in management of pain, agitation and delirium (PAD) at a large community teaching hospital is described.

SUMMARY: 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.

CONCLUSION: The provision of proactive critical care pharmacist services directed at PAD management is an innovative approach to fostering interprofessional collaboration and optimizing clinical outcomes.

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