Pharmacist participation on physician rounds and adverse drug events in the intensive care unit

Context Pharmacist review of medication orders in the intensive care unit ( ICU) has been shown to prevent errors, and pharmacist consultation has redu ced drug costs. However, whether pharmacist participation in the ICU at the time of drug prescribing reduces adverse events has not been studied. Objective To measure the effect bf pharmacist participation on medical roun ds in the ICU on the rate of preventable adverse drug events (ADEs) caused by ordering errors. Design Before-after comparison between phase 1 (baseline) and phase 2 (afte r intervention implemented) and phase 2 comparison with a control unit that did not receive the intervention. Setting A medical ICU (study unit) and a coronary care unit (control unit) in a large urban teaching hospital. Patients Seventy-five patients randomly selected from each of 3 groups: all admissions to the study unit from February 1, 1993, through July 31, 1993 (baseline) and all admissions to the study unit (postintervention) and cont rol unit from October 1, 1994, through July 7, 1995. In addition, 50 patien ts were selected at random from the control unit during the baseline period . Intervention A senior pharmacist made rounds with the ICU team and remained in the ICU for consultation in the morning, and was available on call thro ughout the day. Main Outcome Measures Preventable ADEs due to ordering (prescribing) errors and the number, type, and acceptance of interventions made by the pharmaci st. Preventable ADEs were identified by review of medical records of the ra ndomly selected patients during both preintervention and postintervention p hases. Pharmacists recorded all recommendations, which were then analyzed b y type and acceptance. Results The rate of preventable ordering ADEs decreased by 66% from 10.4 pe r 1000 patient-days (95% confidence interval [CI], 7-14) before the interve ntion to 3.5 (95% CI, 1-5, P<.001) after the Intervention. In the control u nit, the rate was essentially unchanged during the same time periods: 10.9 (95% CI, 6-16) and 12.4 (95% CI, 8-17) per 1000 patient-days. The pharmacis t made 366 recommendations related to drug ordering, of which 362 (99%) wer e accepted by physicians. Conclusions The presence of a. pharmacist on rounds as a full member of the patient care team in a medical ICU was associated with a substantially low er rate of ADEs caused by prescribing errors. Nearly all the changes were r eadily accepted by physicians.