Clinical and financial impact of pharmacist interventions during patient rounds in intensive care units

Clinical and financial impact of pharmacist interventions during patient rounds in intensive care units: an intervention study, comparing a university hospital with a general teaching hospital in the Netherlands

Status

Active, not recruiting

Phases

Unknown

Study type

Interventional

Source

ISRCTN

Registry ID

ISRCTN39231922

Enrollment

334

Registered

2016-10-21

Start date

2008-07-01

Completion date

Unknown

Last updated

2017-10-09

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Intensive care Not Applicable

Interventions

A proactive ICU pharmacist intervention method was developed. This intervention method consisted of two elements, namely preparation of the patient rounds by collecting and assessing patient’s informa

Eligibility

Sex/Gender

All

Inclusion criteria

Inclusion criteria: 1. Patients aged at least 18 2. Staying in the ICU during the patient round in which the pharmacist participates

Exclusion criteria

Exclusion criteria: Participants not fulfilling inclusion criteria

Design outcomes

Primary

Measure	Time frame
The proportion of pharmacist recommendation interventions on prescribing that were accepted and implemented by the prescriber. Calculated via the number of recommendation interventions that lead to an actual change in prescribing (nominator) divided by the total number of the recommendation interventions made by the pharmacist (denominator). i.e. if the pharmacist intervened on the prescription by recommending that the doctor stop the drug, and the doctor followed the recommendation and actually stopped the prescription, than the intervention was scored as being accepted by the doctor. This outcome was real time/immediately measured. After the patient round, the prescribing system was checked on actual changes in prescribing. After data collection a cross check was done to verify all collected data.	—

Measure

Time frame

The proportion of pharmacist recommendation interventions on prescribing that were accepted and implemented by the prescriber. Calculated via the number of recommendation interventions that lead to an actual change in prescribing (nominator) divided by the total number of the recommendation interventions made by the pharmacist (denominator). i.e. if the pharmacist intervened on the prescription by recommending that the doctor stop the drug, and the doctor followed the recommendation and actually stopped the prescription, than the intervention was scored as being accepted by the doctor. This outcome was real time/immediately measured. After the patient round, the prescribing system was checked on actual changes in prescribing. After data collection a cross check was done to verify all collected data.

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Secondary

Measure	Time frame
1. Intervention severity, assessed according to inappropriateness of the prescription order or its deviation from the standard of practice (according to scale: A =Potentially lethal, B=Serious, C=Significant ,D=Minor, E=No error) 2. Value of service, assessed as the potential impact of the pharmacist’s recommendation on patient care (according to scale 1= Extremely significant, 2= Very significant, 3= Significant, 4= Somewhat significant, 5= No significance, 6= Adverse significance) 3. Probability of prevention of an adverse event occurring, assessed using the following score: 0.6 = high (harm is expected, life threatening), 0.4 = medium (harm is expected, clinically relevant), 0.1 = low (some harm is expected, but poorly clinically relevant) , 0.01 = very low (problem orders, clarifications, missing information etc), 0 = zero 4. Cost effectiveness, measured via a preliminary cost benefit analysis using the following variables: costs of service (labour costs), cost savings (through recommendation interventions that directly reduced drug costs) and cost avoidance, (based on ADE probability estimates and ADE unit cost) All secondary outcomes were created/scored retrospectively (in 2015 -2016). 1, 2 and 3 were scored separately by an intensive care doctor (specialized in internal medicine ) and a ICU trained hospital pharmacist, consensus was reached in a consensus meeting. Cost effectiveness was retrospectively measured in 2016.	—

Measure

Time frame

1. Intervention severity, assessed according to inappropriateness of the prescription order or its deviation from the standard of practice (according to scale: A =Potentially lethal, B=Serious, C=Significant ,D=Minor, E=No error) 2. Value of service, assessed as the potential impact of the pharmacist’s recommendation on patient care (according to scale 1= Extremely significant, 2= Very significant, 3= Significant, 4= Somewhat significant, 5= No significance, 6= Adverse significance) 3. Probability of prevention of an adverse event occurring, assessed using the following score: 0.6 = high (harm is expected, life threatening), 0.4 = medium (harm is expected, clinically relevant), 0.1 = low (some harm is expected, but poorly clinically relevant) , 0.01 = very low (problem orders, clarifications, missing information etc), 0 = zero 4. Cost effectiveness, measured via a preliminary cost benefit analysis using the following variables: costs of service (labour costs), cost savings (through recommendation interventions that directly reduced drug costs) and cost avoidance, (based on ADE probability estimates and ADE unit cost) All secondary outcomes were created/scored retrospectively (in 2015 -2016). 1, 2 and 3 were scored separately by an intensive care doctor (specialized in internal medicine ) and a ICU trained hospital pharmacist, consensus was reached in a consensus meeting. Cost effectiveness was retrospectively measured in 2016.

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Countries

Netherlands

Outcome results

None listed

Source: ISRCTN (via WHO ICTRP) · Data processed: Feb 4, 2026