THE EFFECT OF ICU SEDATION GUIDELINES AND PHARMACIST INTERVENTIONS ONCLINICAL OUTCOMES AND DRUG COST

OBJECTIVE: To measure the effect of evidence-based intensive care unit (ICU) sedation guidelines and interventions by a pharmacist to promot e these guidelines on the weaning time from mechanical ventilation and sedation drug cost. DESIGN: Before-after study. SETTING: A 15-bed med ical-surgical ICU at a tertiary-care teaching hospital. PATIENTS: 100 patients (2 groups of 50 consecutive patients) on mechanical ventilati on (assist or pressure control mode for greater than or equal to 6 h) who were successfully discharged from the ICU. METHODS: ICU sedation g uidelines were developed through physician, nursing, and pharmacy cons ensus using a physician survey and literature overview as points of re ference and were implemented into practice. Prospectively, data on the time required to wean patients from mechanical ventilation (successfu l trial of T-piece, pressure support, or intermittent mandatory ventil ation leading to extubation) and total drug costs for sedation were me asured and compared between groups, All prospective ICU pharmacist int erventions pertaining to sedation were documented. RESULTS: New sedati on guidelines promoted lorazepam use in preference to midazolam and su ggested propofol for patients not successfully sedated with high-dose lorazepam, haloperidol, or morphine. Over the 2-month collection perio ds, there was no difference in the median weaning time between the pre - (16 h, range 2-607) and post- (18 h, range 1-284) guideline groups. Total sedation drug costs decreased from $4515 to $1152 ($US) (p = 0.0 81), Median sedation drug costs decreased from $11.27 (range $0-1340) to $3.55 (range $0-250), with the amount (mg) of midazolam and propofo l used decreasing by 86% and 100%, respectively, The ICU pharmacist su ccessfully recommended a change from midazolam to lorazepam in 12 of 5 0 patients, 5 of whom had received midazolam for more than 24 hours. C ONCLUSIONS: High compliance with ICU sedation guidelines promoting lor azepam rather than midazolam or propofol in mechanically ventilated pa tients led to a 75% decrease in sedation drug costs and did not advers ely affect the clinicians' ability to wean patients from mechanical ve ntilation.