Optimization of Comprehensive Medication Management by Pharmacists Reduces Mortality in the Intensive Care Unit

BackgroundMedication-related morbidity due to inappropriate prescribing, delays in appropriate treatment, and adverse drug events are major contributors to mortality in acutely hospitalized adults. Comprehensive medication management (CMM) is a standard for medication therapy care provided by pharmacists in collaboration with the interprofessional rounding team. Optimization of CMM via appropriate pharmacist staffing practices may reduce mortality. MethodsAdults admitted to an intensive care unit (ICU) without restrictions to care for at least 24 hours from 64 centers were enrolled in a prospective, observational trial that collected patient-level and healthcare team staffing data from August 2023 - August 2024. The primary exposure was patient-level, pharmacist staffing measured by the pharmacist-to-patient ratio averaged over each patients ICU stay. The primary outcome was hospital mortality assessed by multi-level logistic regression that accounted for 15 variables. ResultsA total of 213 pharmacists provided ICU-based CMM care to 28,795 patients at a median (interquartile range) pharmacist-to-patient ratio of 1:17 (13-23). The hospital mortality rate was 14.7%. Patients without pharmacist CMM for 1 day had an increased risk of mortality of 17.9% (95% Confidence Interval (CI) 1.061-1.311, p=0.002). For every one patient increase in the pharmacist-to-patient ratio, the odds of mortality increased by 0.8% (Odds Ratio (OR) 1.008, 95% CI 1.003-1.012, p<0.001). Approximately 42 patients need to receive daily CMM at a pharmacist-to-patient ratio [&le;]1:15 to prevent one additional hospital death. ConclusionsCMM delivered by pharmacists in collaboration with the interprofessional team is associated with improved hospital survival, particularly when pharmacists care for 15 or fewer ICU patients.