Evaluation of the role of the critical care pharmacist in identifying and avoiding or minimizing significant drug-drug interactions in medical intensive care patients.

ABSTRACT

STUDY OBJECTIVE: The aim of the study was to evaluate the impact of prospective review of significant drug-drug interactions (DDIs) occurring in medical intensive care unit (MICU) patients by the critical care pharmacist participating in patient care rounds on improvement of safer and more efficacious medication use. STUDY DESIGN: A prospective consecutive 10-week study was conducted in the MICU, St Luke's/Roosevelt Hospital Center (St Luke's site), New York, NY. This study compared baseline period when clinical pharmacist services were not provided with the period when each patient's profile was reviewed daily during MICU rounds and interactions were minimized. The study examined whether the presence of critical care pharmacist would decrease the number of significant DDIs in the MICU. Impact of decreasing presence of severe DDIs on length of stay (LOS) and discharge status was also evaluated. RESULTS: Having a pharmacist on rounds resulted in statistically significant decrease in number of clinically important interactions requiring therapy modification, rated D-X (Poisson regression B = -1.036; 95% confidence interval, -1.318 to -0.753; P < .01). The coefficient (-1.036) indicates the incidence rate ratio of 0.35, meaning that the presence of clinical pharmacist in MICU rounds decreased DDI rate by 65%. According to the multiple linear regression, lower number of DDIs was associated with shorter LOS (P < .01). Inpatient mortality rate was lower in the intervention group compared with the preintervention group. Number of DDIs was not significantly associated with mortality based on simple regression (P = .45) or multiple regression analysis (P = .09). CONCLUSION: Implementing a DDI screening procedure results in significantly lower number of important DDI in the MICU and shortens LOS.