Exploring granular pharmaceutical data, clinical activity and impact on evidence-implementation in the intensive care unit (ICU)

Abstract

Introduction: research with high certainty should improve patient outcomes. Yet implementation is challenging. We proposed that longitudinal granular analysis of medication usage indexed against outcomes would give data to improve implementation. The project aim was to explore clinical utility of a 5-year analysis of pharmaceutical activity indexed against ICU practice.

Methods: this project was registered as a service evaluation without ethics approval and conducted in a UK ICU. A report template was developed and revised over 25 years by clinical pharmacists. Utilising the pharmacy-based electronic finance system, cumulative totals for critical care were stratified by therapeutic group including pain, delirium and IV fluids and indexed against clinical activity with a review of benefit and harm, including opioid consumption, and antimicrobial stewardship1,2. To deliver meaningful findings an annual report with highlighted areas for consideration was created.

Results: core clinical activity, including ICU admissions and bed occupancy, increased over time. Mean length of stay remained static. Overall pharmaceutical expenditure decreased in 2023/24 from £2.3 to £2.2 million. Over the 5 years there was a below inflation increase: £1.9 to £2.2 million. This was enhanced during the COVID-19 pandemic. IV fentanyl use increased from £10k to £41k (300% increase) during COVID-19. Since 2019/20, antimicrobial consumption has remained consistent, despite COVID-19 and introduction of newer agents.

Conclusion: our 5-year analysis gave vital information for evidence implementation. Satisfyingly, expenditure reduced despite increase in clinical activity. Areas of concern include the rise in IV opioids during COVID-19. Future interventions will include targeting medication with limited benefit including parenteral olanzapine and Gelofusine.

2019/202020/212021/222022/232023/24
Total pharmaceutical expenditure£1,873,925
£2,376,755
£2,282,199

£2,303,502
£2,180,961

Occupied bed days OBD2256622568224492369723779
Cost per OBD£83£105£102£97£92


References
1.Young D et al. Pathogen 13(11): 961,2024
2.McKenzie C et al. Intensive Care Medicine 49(12):1544-1545,2023

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ORCID for Cathrine McKenzie: orcid.org/0000-0002-5190-9711

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