Page 240 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology ICU pharmacists and clinical outcomes

This study revealed that ICU team care involving CCPs
decreased the occurrence of ADEs. The incidence of ADEs
is influenced by the clinical setting and the nature of
interventions. ADEs contribute significantly to healthcare
costs, particularly through insurance claims; therefore,
reducing their occurrence represents a major advantage
for ICU patients. The observed 61% reduction in ADEs
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supports the role of CCPs in improving medication safety.
In the ICU, ADEs are frequently linked to polypharmacy,
organ dysfunction, drug–drug interactions (DDIs), and
medications with narrow therapeutic indices. CCPs bring
specialized expertise to address these challenges, ensuring
appropriate dosing and monitoring of medications. Their
interventions range from preventing nephrotoxic drug
combinations to adjusting antibiotic regimens based on
pharmacokinetic parameters, actions that directly mitigate
the risk of ADEs.
Figure 5. Funnel plot examining potential publication bias associated These findings align with earlier meta-analyses.
with adverse drug event outcomes 14
Abbreviations: Or: Odds ratio; SE: Standard error For example, Wang et al. demonstrated that CCP
interventions were effective in reducing ADEs in general
hospital settings. However, their analysis did not show a
support previous literature and underscore the clinical significant effect on mortality and did not focus specifically
and operational value of pharmacist-led interventions on ICU populations. Our results not only reaffirm the
in high-acuity environments. Clinicians in the ICU face benefit of CCPs in reducing ADEs but also extend prior
difficult-to-manage situations and complex patients daily, research by demonstrating a clear mortality advantage
and without appropriate pharmacological oversight, these specific to ICU settings, which represent the most complex
challenges can lead to fatal complications. CCPs with and high-risk environment for medication management.
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particular experiences can help decrease complex MRPs
when integrated into ICU teams. 42 In a more recent systematic review, Lee et al.
3
highlighted improvements in ICU outcomes when
The inclusion of CCPs may also decrease the workload
of other ICU staff by redistributing responsibilities. pharmacists participated in multidisciplinary care.
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However, their analysis did not quantify ADEs, and the
Reduced workloads have been associated with lower mortality data were more limited. Our work thus provides
ICU mortality by minimizing medical errors and a more comprehensive synthesis of both safety and
improving access to critical equipment. By contributing survival endpoints and fills an important evidence gap in
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to an interdisciplinary team, CCPs can play a vital role in the literature on ICU pharmacotherapy.
reducing mortality, which is a key indicator of ICU care
26
quality. Moreover, ADEs are often fatal in critically ill The study by Rivkin and Yin demonstrated that CCPs
44
patients, reinforcing the importance of medication safety significantly reduce clinically important DDIs in medical
45
interventions. ICU patients. Prospective pharmacist review during rounds
led to a 65% reduction in severe DDIs requiring therapy
The 28% reduction in mortality observed in ICUs with
CCP involvement is particularly noteworthy. Mortality in modification or avoidance (classified as categories D and
X; p<0.01), with an 82% acceptance rate of pharmacist
critical care is influenced by multiple intersecting variables, recommendations. Notably, fewer DDIs were associated
including disease severity, timeliness and appropriateness with shorter ICU length of stay (p<0.01), though the direct
of treatment, comorbidities, and care coordination.
Pharmacists help optimize several of these factors, impact on mortality was not statistically significant (p=0.09).
especially through the identification and prevention of The intervention group had a lower mortality rate (13.9% vs.
drug-related problems, timely therapeutic adjustments, 29.5%, p=0.01), suggesting broader benefits of pharmacist
and reduction of iatrogenesis harm. The mortality benefit involvement beyond DDI management. This highlights the
observed in this analysis likely reflects CCPs’ proactive pharmacist’s role in mitigating MRPs and optimizing ICU
role in early pharmacotherapy optimization in the clinical outcomes through proactive, team-based interventions.
trajectory, which is essential in conditions such as sepsis, Aghili and Kasturirangan investigated the role
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acute respiratory distress syndrome, or multi-organ failure. of clinical pharmacists in managing DDIs among

Volume 9 Issue 3 (2025) 232 doi: 10.36922/EJMO025150116