Evaluation of a clinical pharmacist dosage-adjustment intervention in a teaching hospital medical intensive care unit

Most intensive care unit (ICU) patients often suffer from multi-organ failure and use multiple medications, creating a high potential for dosage errors. We aimed to analyse patterns of dosage errors requiring pharmacist intervention before and after an ICU pharmacist was assigned as a multidisciplinary team member. We compared dosage appropriateness for patients in January 2009 and in January 2013 (before and after the ICU pharmacist system was implemented, respectively) in the medical ICU at a large academic tertiary care medical center. We categorised the reasons for incorrect doses when they occurred. If the drug was a candidate for therapeutic drug monitoring, then we examined whether therapeutic drug monitoring consultations were issued and whether optimal drug levels were maintained with or without an ICU pharmacist on the treatment team. The time taken to correct an incorrect dosage was estimated for all eligible patients. We found 156 prescriptions in 2009 and 204 in 2013 that fit the parameters of this study. Orders required dosage adjustments for 45 patients in 2009 and 42 patients in 2013. Dosage adjustment due to the potential effects of renal function was the most frequent reason for pharmacist intervention. Five cases (11.1%) of therapeutic drug monitoring omission occurred in 2009, but only one occurred in 2013 (2.4%). The time between erroneous dosage orders and the first correction of those orders was significantly shorter in 2013 compared with 2009 (p < 0.001). When clinical pharmacists were added to multidisciplinary intensive care unit care teams, patients received appropriate dosage modifications in less time.