(1272) Pharmacist Productivity in Transitions of Care out of the Intensive Care Unit

Introduction: Within the intensive care unit (ICU), critically ill patients are initiated on medications with the intent of short-term use for temporary indications. Although these medications are started for a temporary indication during ICU admission, they are often inadvertently continued upon transfer from the ICU, and potentially upon discharge from the hospital. The continuation of these medications may lead to adverse patient outcomes. Pharmacist intervention at the time of transition out of the ICU has previously demonstrated reductions in inappropriate continuation of therapy, medication errors, and hospital costs. The purpose of this study was to characterize the impact of pharmacist interventions at the time of transition out of the ICU before and after the implementation of a standardized documentation workflow in a community teaching hospital.

Methods: A retrospective review of patients who had documentation of pharmacist review upon transfer out of ICU before and after the institution of a standardized ICU transitions of care documentation checklist workflow was conducted. The primary outcome was the number of interventions per patient. Additional outcomes included number of missed interventions, medication class intervened upon, benefit from intervention made, and cost-avoidance per patient.

Results: A total of 105 patients were included (pre-cohort=35; post-cohort=70). The mean number of interventions per patient was significantly higher in the post-cohort compared to the pre-cohort (0.6 vs 1.44; p=0.002). The mean number of missed interventions per patient was significantly reduced in the post-cohort (1.37 vs 0.49; p< 0.001). The majority of interventions in both cohorts were pertaining to antimicrobial initiation and streamlining and discontinuation of unwarranted therapy. Median cost avoidance per patient was significantly increased in the post-cohort as well ($0.00 vs $262.67; p=0.01).

Conclusions: Implementation of a standardized ICU transitions of care documentation checklist within the electronic health record (EHR) significantly increased the number of interventions made by the pharmacist at the time of ICU transfer, reduced the number of missed interventions per patient, and increased cost-avoidance per patient.