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Abstract

Introduction: Few studies have assessed the impact of clinical pharmacy services on patient outcomes in the Intensive Care Unit (ICU). At Royal Columbian Hospital, pharmacy interventions are documented in patient charts and electronic health records, providing a unique opportunity to evaluate pharmacist interventions in the ICU. Hypothesis: Clinical pharmacist prioritize their workload based on the patients complexity. Pharmacy interventions can decrease mortality rates in the ICU. Methods: Inpatient records of patients admitted between January 1st, 2004 and March 31st, 2007 were analyzed to identify the presence of clinical pharmacy notes (CPNs), an indicator of pharmacist interventions. Characteristics of patients in the CPN and No CPN groups were compared. In the primary analysis of the association between patient CPlx level and CPN, logistic regression modeling was performed to adjust for potential confounding. Logistic regression was used to explore the possible association between CPN and mortality. The mortality analysis was also carried out in CPN and No CPN groups of patients matched by CPlx level, a predictor of mortality. Results: The main study cohort comprised 1561 patients, 21.3% of which were in the CPN group and 78.7% in the No CPN group. In the CPN group, 88.6% of patients had CPlx level 4 (highest complexity), compared to 53.7% in the No CPN group. After controlling for age and gender, the odds ratio for having a CPN among patients with CPlx 4 (compared to patients at lower complexity levels) was 8.2 (95%CI: 5.4-12.4). The mortality rate was 26.7% and 27.9% in the CPN and No CPN groups, respectively (p = ns). After adjusting for age, gender, CPlx level, and ICU length of stay (LOS), CPN was not significantly associated with mortality. The mortality rate in the matched cohort (n = 1078) was 26.7% and 30.3% in the CPN and No CPN groups, respectively (p = ns), and CPN was not significantly associated with mortality after adjustments. Conclusions: Our data suggest that ICU pharmacists prioritize clinical activities to care for the sickest patients. Further investigations are needed to quantify the clinical impact of pharmacist services and identify the types of interventions most beneficial to ICU patients.