소아중환자실 담당약사의 병동상주 전후 임상적·경제적 효과 비교
Clinical and Economic Outcomes of on-Ward Participation of Pharmacists in a Pediatric Intensive Care Unit
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Background : It is known that the involvement of pharmacists in critical care can lead to positive clinical and economic outcomes based on previous studies. However, most of these studies enrolled adult patients. Few studies were performed on pediatric patients. Since September 2016, ward-based pharmacists have been assigned to pediatric intensive care unit (PICU) of Seoul National University Hospital. The aim of this study was to investigate effects of a ward-based pharmacist in PICU on clinical and economic outcomes. Methods : A retrospective review of medical records from March 2016 to February 2017 was conducted to assess clinical interventions, question and answer (Q&A), and report of adverse drug reactions (ADR) by pharmacists. The potential significance of pharmacist interventions affecting clinical outcomes was evaluated by two pharmacists and one medical doctor (fellow). For antibiotics, a therapeutic class showing the most frequent usage with the highest increase in intervention, cost avoidance for preventing ADR was calculated. Results : At six months after introducing ward-based pharmacists into PICU, the number of interventions was increased from 72 cases initially to 201. To determine the potential significance on clinical outcome, the number of Level 3 cases was evaluated. It was 9 (12.5%) cases out of 72 interventions in prior six months. After the assignment of a ward-based pharmacist, it was increased to 79 (39.3%) cases out of 201 interventions (p<0.05). The estimated cost avoidance was increased to ₩46,876,403 after assigning ward-based pharmacists compared to that in the past (₩10,239,991). Conclusion : Assigning a ward-based pharmacists in PICU could contribute to efficient and safe pharmacotherapy with economic benefits for patients as a meaningful intervention. It could quantitatively and qualitatively increase ADR report and Q&A support for other healthcare professionals.
Abstract
Background : It is known that the involvement of pharmacists in critical care can lead to positive clinical and economic outcomes based on previous studies. However, most of these studies enrolled adult patients. Few studies were performed on pediatric patients. Since September 2016, ward-based pharmacists have been assigned to pediatric intensive care unit (PICU) of Seoul National University Hospital. The aim of this study was to investigate effects of a ward-based pharmacist in PICU on clinical and economic outcomes. Methods : A retrospective review of medical records from March 2016 to February 2017 was conducted to assess clinical interventions, question and answer (Q&A), and report of adverse drug reactions (ADR) by pharmacists. The potential significance of pharmacist interventions affecting clinical outcomes was evaluated by two pharmacists and one medical doctor (fellow). For antibiotics, a therapeutic class showing the most frequent usage with the highest increase in intervention, cost avoidance for preventing ADR was calculated. Results : At six months after introducing ward-based pharmacists into PICU, the number of interventions was increased from 72 cases initially to 201. To determine the potential significance on clinical outcome, the number of Level 3 cases was evaluated. It was 9 (12.5%) cases out of 72 interventions in prior six months. After the assignment of a ward-based pharmacist, it was increased to 79 (39.3%) cases out of 201 interventions (p<0.05). The estimated cost avoidance was increased to ₩46,876,403 after assigning ward-based pharmacists compared to that in the past (₩10,239,991). Conclusion : Assigning a ward-based pharmacists in PICU could contribute to efficient and safe pharmacotherapy with economic benefits for patients as a meaningful intervention. It could quantitatively and qualitatively increase ADR report and Q&A support for other healthcare professionals.
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