Pharmacist Avoidance or Reductions in Medical Costs in Critically and Emergently Ill Pediatrics: PHARM-PEDS Study

Amy L Kiskaddon; Michelle M Smith; Frankie Gilliland; Megan A Rech

doi:10.1097/CCE.0000000000000980

Pharmacist Avoidance or Reductions in Medical Costs in Critically and Emergently Ill Pediatrics: PHARM-PEDS Study

Crit Care Explor. 2023 Oct 5;5(10):e0980. doi: 10.1097/CCE.0000000000000980. eCollection 2023 Oct.

Authors

Amy L Kiskaddon^{1

2}, Michelle M Smith³, Frankie Gilliland³, Megan A Rech^{4

5}

Affiliations

¹ Department of Pharmacy, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
² Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
³ Division of Critical Care Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
⁴ Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL.
⁵ Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL.

Abstract

Objectives: To comprehensively classify interventions performed by pediatric critical care clinical pharmacists and quantify cost avoidance (CA) generated through their accepted interventions.

Design: A multicenter, prospective, observational study performed between August 2018 and January 2019.

Setting: Academic and community hospitals in the United States with pediatric critical care units.

Subjects: Pediatric clinical pharmacists.

Interventions: Pharmacist recommendations were classified into one of 38 total intervention categories associated with CA.

Measurements and main results: Nineteen pediatric pharmacists at five centers documented 1,458 accepted interventions during 112 shifts on 861 critically ill pediatric patients. This calculated to an associated CA of $450,590. The accepted interventions and associated CA in the six established categories included as follows: adverse drug event prevention (155 interventions, $118,901 CA), resource utilization (267 interventions; $59,020), individualization of patient care (898 interventions, $217,949 CA), prophylaxis (8 interventions, $453 CA), hands-on care (30 interventions, $35,509 CA), and administrative/supportive tasks (108 interventions, $18,758 CA). The average associated CA was $309 per accepted intervention, $523 per patient day, and $4,023.13 per pediatric clinical pharmacist shift. The calculated potential annualized CA of accepted interventions from a pediatric pharmacist was $965,550, resulting in a potential monetary-associated CA-to-pharmacist salary ratio between $1.5:1 and $5.2:1.

Conclusions: There is potential for significant avoidance of healthcare costs when pediatric pharmacists are involved in the care of critically and emergently ill pediatric patients, with a monetary potential CA-to-pediatric pharmacist salary ratio to be between $1.5:1 and $5.2:1.

Keywords: cost; medication; pediatric critical care; pharmacist; safety.