News Corner: How Pharmacists Improve Patient Outcomes in the ICU

A new study shows that as pharmacists’ roles expand in the hospital, it may be appropriate to take advantage of their clinical expertise in the ICU.  Pharmacists can help improve patient outcomes by knowing when to reduce drugs that cause delirium and lead to deep sedation, while effectively managing pain.  With pharmacists’ help, patients can become mobile earlier, which may lead to better outcomes and less time spent in the ICU.

Involving pharmacists in the ICU care teams is just one aspect of a “comprehensive, multidisciplinary approach to increasing the survival and post-ICU functionality of ICU patients,” according to an article in Pharmacy Practice News.

The ABCDEF Bundle

This comprehensive approach to improving recovery rates for patients in the ICU is now known as the ABCDEF bundle, which is an acronym for the evidence-based steps that facilitate this process.

Table. ICU Liberation: ABCDEF Bundles
Symptoms  Monitoring Tools  ABCDEF Bundle
Pain Critical-Care Pain Observation Tool

Numeric Rating Scale

Behavioral Pain Scale

Assess, Prevent, Manage Pain

Both Spontaneous Awakening Trials and Spontaneous breathing Trials

Choice of Analgesia and Sedation

Delirium: Assess, Prevent and Manage

Early Mobility and Exercise

Family Engagement and Empowerment

Agitation Richmond Agitation-Sedation Scale

Riker Sedation-Agitation Scale

Delirium Confusion Assessment Method for the ICU

Intensive Care Delirium Screening Checklist

The “F” was recently added, but the efficacy of the bundle was first proven following a multicenter study conducted in 2014. The goal of this bundle is to improve patient comfort and reduce pain, while facilitating liberation from the ICU and reducing the length of the ICU stay.

Pharmacists’ Role

The main role that pharmacists play is to help assist in patient-waking each day and avoid use of sedation, which is an independent risk factor for mortality.

On one interdisciplinary team at the University of Nebraska Medical Center, critical care pharmacists actively participate in ICU rounds with attending physicians and nurses. Armed with tools that allow them to measure patient pain and delirium, the pharmacists make recommendations for adjusting medications, and interruptions in sedation to help keep patients moving.

Patient safety is always paramount – some patients with limited mobility or who may require ongoing sedation for healing are exempt from this practice – and researchers advise that all patients who are physically able should be mobile as early as possible. By designating a pharmacist to help monitor patient pain or delirium, early mobilization can be done in a safe and deliberate manner without putting patients at increased risk.

Related Articles:

The Wall Street Journal

Pharmacy Practice News

Pharmacy Times

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