신생아중환자실 전담약사의 임상적 중재에 의한 회피비용 및 절감비용 분석
Pharmacist Interventions in Neonatal Intensive Care Unit and Associated Cost Avoidance and Cost Savings
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Background : In neonates, frequent changes in dosing intervals and dosage can increase the risk of medication errors. In addition, patients in Neonatal Intensive Care Unit (NICU) are highly dependent on total parenteral nutrition (TPN) which is one of the most important interventions made by pharmacists. Although the role of ICU pharmacists in improving clinical outcomes has been documented, there is little report on economic impact of such interventions in Korea. The purpose of this study was to evaluate interventions made by NICU pharmacists and describe cost avoidance and cost savings. Methods : From March 1 to August 31, 2016, a retrospective evaluation was conducted by analyzing clinical intervention records from prescription review, TPN consults, and Clinical Pharmacokinetic Consultation Service (CPCS) reports delivered by pharmacist at Seoul National University Bundang Hospital. The level of intervention outcome severity was graded by three independent pharmacist evaluators and the economic impact was determined by calculating cost avoidance and cost saving. Results : During the study period, a total of 608 clinical interventions were performed, TPN was involved in 482 (79.3%) interventions and the number of intervention activities related to prescription review was 81 (13.3%). The most frequent interventions related to prescription review were‘ incorrect dose and interval (46.1%)’, followed by ‘incorrect administration schedule’and ‘consult for medication information and treatment plan’. Antibiotics were the most frequently associated with medication errors (52%). The prescriber’s acceptance rate of pharmacist recommendations was 95.2%. Total cost avoidance for 6 months was 175,863,624 won and total cost saving for 6 months was 75,033 won. Conclusions : This study showed reduction of medication errors and medical expenses in a Korean hospital. However, further study is needed to demonstrate the contribution of clinical pharmacists to improvement of clinical and economic outcomes more comprehensively.
Abstract
Background : In neonates, frequent changes in dosing intervals and dosage can increase the risk of medication errors. In addition, patients in Neonatal Intensive Care Unit (NICU) are highly dependent on total parenteral nutrition (TPN) which is one of the most important interventions made by pharmacists. Although the role of ICU pharmacists in improving clinical outcomes has been documented, there is little report on economic impact of such interventions in Korea. The purpose of this study was to evaluate interventions made by NICU pharmacists and describe cost avoidance and cost savings. Methods : From March 1 to August 31, 2016, a retrospective evaluation was conducted by analyzing clinical intervention records from prescription review, TPN consults, and Clinical Pharmacokinetic Consultation Service (CPCS) reports delivered by pharmacist at Seoul National University Bundang Hospital. The level of intervention outcome severity was graded by three independent pharmacist evaluators and the economic impact was determined by calculating cost avoidance and cost saving. Results : During the study period, a total of 608 clinical interventions were performed, TPN was involved in 482 (79.3%) interventions and the number of intervention activities related to prescription review was 81 (13.3%). The most frequent interventions related to prescription review were‘ incorrect dose and interval (46.1%)’, followed by ‘incorrect administration schedule’and ‘consult for medication information and treatment plan’. Antibiotics were the most frequently associated with medication errors (52%). The prescriber’s acceptance rate of pharmacist recommendations was 95.2%. Total cost avoidance for 6 months was 175,863,624 won and total cost saving for 6 months was 75,033 won. Conclusions : This study showed reduction of medication errors and medical expenses in a Korean hospital. However, further study is needed to demonstrate the contribution of clinical pharmacists to improvement of clinical and economic outcomes more comprehensively.
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