Background: Intensive care unit (ICU) patients regularly require the use of continuous sedation to decrease stress associated with mechanical ventilation, agitation, and overall discomfort. Due to the increased risk of complications associated with prolonged mechanical ventilation & sedation such as oversedation, ventilator-induced lung injury, and extended ICU length of stay, protocols have been developed to ensure spontaneous awakening (SATs) are routinely performed. Despite guideline recommendations, these are often not conducted at the recommended frequency and may not be appropriately conducted across multidisciplinary teams. Literature has demonstrated the clinical benefit of pharmacist involvement in SAT performance including a trend towards shorter weaning times, reduced rates of ventilator-related infections and other medication-related adverse events. The goal of this project is to determine the impact of pharmacist involvement on adherence to a nursing-driven protocol for performance of SATs.

Methods: This is a multi-center, IRB-reviewed bi-phasic study of mechanically ventilated patients requiring continuous intravenous (IV) sedation or analgesia with midazolam, propofol, or fentanyl. A random sample of patients on continuous IV sedation was reviewed retrospectively. The prospective phase of this study consisted of ICU pharmacists providing recommendations for performance of SATs on qualifying patients over a 6-month period. The primary outcome was SAT compliance and the number and type of pharmacist interventions. Secondary outcomes included total days of mechanical ventilation and ICU length of stay.

Results: A retrospective analysis of 37 patients showed 57% (21/37) of those who met criteria had a SAT conducted. Prospectively, pharmacists provided a total of 86 interventions in a 6-month period. Fifty-nine interventions were recommendations to perform a SAT and 27 interventions focused on providing education on how to properly conduct SATs. The overall acceptance rate of pharmacist interventions was 73.3%. Of the 59 patients who met criteria for a SAT, 69% (41/59) had a SAT conducted following pharmacist intervention (p=0.2). Median duration of ICU length of stay decreased from 11.42 days to 11.1 days (p=0.17) and median duration of mechanical ventilation increased from 8 days to 9 days (p=0.53).

Conclusion: Pharmacist intervention through a multidisciplinary approach resulted in a greater percentage of daily spontaneous awakening trials performed in qualifying patients.

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Florida Residency Conference

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