Page 242 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology ICU pharmacists and clinical outcomes

the pharmacist’s impact on preventing preventable ADEs (i) Medication error prevention: CCPs review and
(4 vs. 14 events, p=0.006) and reducing drug costs, reconcile medications daily, preventing errors in
reinforcing their value in multidisciplinary ICU teams. dosing, duplications, and omissions, especially during
The study by Hammond et al. evaluated the impact care transitions.
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of pharmacist-led educational interventions on the (ii) Therapeutic optimization: Pharmacists tailor
treatments based on patient-specific variables,
appropriateness of stress ulcer prophylaxis (SUP) in including renal/hepatic function, weight, drug levels,
critically ill patients. The intervention, which included and drug interactions.
guideline-based education and pocket cards for physicians, (iii) Antimicrobial stewardship: Several studies (e.g.,
significantly reduced inappropriate initiation of acid Jiang et al. 27,28,38 and Li et al. ) in this meta-analysis
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suppression therapy (AST) from 23% to 11% (p=0.012). demonstrated that CCP-led antimicrobial programs
While no differences were observed in mortality or adverse reduced inappropriate antibiotic use and potentially
events (e.g., pneumonia, Clostridium difficile infection), minimized resistance patterns, leading to improved
the study demonstrated that pharmacist involvement in infection-related outcomes.
education improved adherence to evidence-based SUP (iv) Education and protocol development: CCPs contribute
practices. This highlights the role of CCPs in optimizing to policy and protocol development and offer bedside
medication safety and reducing unnecessary therapy, education, increasing adherence to evidence-based
though broader interventions may be needed to address guidelines.
inappropriate continuation of AST beyond the ICU. (v) Interdisciplinary synergy: Pharmacists free up
In a study performed by Pronovost et al., apposite physician time by managing medication-related tasks,
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pharmacist recommendations for antibiotic treatment contributing to more efficient workflows and reducing
in critically ill patients were associated with a decline in clinician burnout, a factor indirectly tied to fewer
ventilator-related pneumonia, which is often linked to clinical errors.
higher mortality. Furthermore, a study by Kim et al. 47 A notable strength of this meta-analysis is its inclusion
showed that, compared to patients who did not receive of studies from diverse regions, such as North America,
team-based care with CCP, mortality was lower among Asia, Europe, and Africa. This diversity supports the
those managed by an ICU team that incorporated CCPs. global applicability of the findings. Even in middle-
An earlier meta-analysis focusing on the influence of income countries, such as Egypt and India, where resource
ICU CCPs’ interventions on medication errors and ADEs constraints may be more prominent, CCPs demonstrated
showed a decrease in ADEs when a CCP was added to measurable improvements in patient safety and outcomes.
the team. However, the data were derived from subjects This suggests that pharmacist integration is not only a
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admitted to general medical or surgical units rather than high-income health system luxury but also a universally
ICU settings, and the definition of medication errors was impactful intervention when appropriately implemented.
unclear. In resource-limited settings, CCPs may have even
A previous study by Leape et al. demonstrated the greater importance, given the scarcity of intensivists,
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significant impact of integrating pharmacists into ICU suboptimal nurse-to-patient ratios, and high patient
rounds, showing a 66% reduction in preventable ADEs, turnover. The pharmacist’s vigilance and expertise can
from 10.4 to 3.5/1,000 patient-days, after implementing serve as a vital safety net in such environments.
pharmacist participation. The study, conducted in a medical This study demonstrated a significant association
ICU, highlighted that nearly all (99%) of the pharmacists’ between the inclusion of CCPs in ICU teams and reductions
recommendations were accepted by physicians, with in both mortality and ADEs. However, further high-quality
interventions ranging from dose corrections to identifying trials are needed to clarify the specific clinical contexts
drug interactions and allergies. The authors estimated and mechanisms through which these benefits occur. In
annual cost savings of approximately $270,000 due to addition, our meta-analysis did not identify any significant
prevented ADEs, underscoring the pharmacist’s role in associations between outcomes and patient characteristics
error prevention, interception, and systems improvement. such as age, ethnicity, or gender. This finding is consistent
These findings support the value of pharmacists as active with previous meta-analyses, which also reported no clear
members of the ICU team in enhancing medication safety influence of these demographic factors on the observed
and reducing harm. outcomes. 3,48
Several mechanisms likely explain the observed Incorporating CCPs should be considered a standard
outcomes: component of ICU staffing models, especially given

Volume 9 Issue 3 (2025) 234 doi: 10.36922/EJMO025150116