Clinical Outcomes Associated with the Implementation of a Dedicated Clinical Pharmacy Service in a Resource-Limited Neurocritical Intensive Care Unit.

Abstract

Background: Patients in neurocritical care units are particularly vulnerable to medication errors and adverse drug events, necessitating specialized care and comprehensive pharmacological management. Despite this need, the scarcity of clinical pharmacist specialists in South Korean hospitals results in limited direct patient care within multidisciplinary teams. Objective: This study aimed to evaluate the impact of a dedicated pharmacy service program in the neurocritical care intensive care unit (neuro-ICU) on patient outcomes and to propose a clinical pharmacy service model tailored for resource-limited settings. Methods: We conducted a retrospective cohort study comparing neuro-ICU mortality rates and length of stay between periods with and without the presence of a dedicated neurocritical care pharmacist (d-NCP) from May 1, 2016, to December 31, 2017. The study also assessed the frequency and nature of pharmacy interventions alongside factors associated with patient outcomes. Results: The analysis included 769 patients in the group with d-NCP and 676 patients in the group without d-NCP. The presence of a d-NCP was associated with significantly shorter neuro-ICU stays (3.4 ± 8 days vs 3.5 ± 6.4 days, P = .012). Multivariate analysis indicated that the involvement of a d-NCP correlated with reduced length of neuro-ICU stay (β coefficient -0.077, 95% CI: -0.148 to -0.006, P = .033), whereas the number of prescribed medications was linked to longer stays (β coefficient 0.004, 95% CI: 0.014 to 0.005, P < .001). Conclusion: The implementation of a dedicated pharmacy service program in the neuro-ICU leads to improved patient outcomes and mitigates drug-related complications. This model offers a feasible and effective approach for enhancing care in hospitals with limited resources.