Effect of comprehensive medication management on mortality in critically ill patients

Background Medication management in the intensive care unit (ICU) is causally linked to both treatment success and potential adverse drug events (ADEs), often associated with deleterious consequences. Patients with higher severity of illness tend to require more management. The purpose of this evaluation was to explore the effect of comprehensive medication management (CMM) on mortality in critically ill patients. Methods In this retrospective cohort study of adult ICU patients, CMM was measured by critical care pharmacist (CCP) medication interventions. Propensity score matching was performed to generate a balanced 1:1 matched cohort, and logistic regression was applied for estimating propensity scores. The primary outcome was the odds of hospital mortality. Hospital and ICU length of stay were also assessed. Results In a cohort of 10,441 ICU patients, the unadjusted mortality rate was 11% with a mean APACHE II score of 9.54 ± 4.18 and Medication Regimen Complexity-Intensive Care Unit (MRC-ICU) score of 5.78 ± 4.09. Compared with CCP interventions less than 3, more CCP interventions was associated with a significantly reduced risk of mortality (estimate -0.04, 95% confidence interval -0.06 - -0.03, p < 0.01) and shorter length of ICU stay (estimate -2.77, 95% CI -2.98 - - 2.56, p < 0.01). Conclusions The degree by which CCPs deliver CMM in the ICU is directly associated with reduced hospital mortality independent of patient characteristics and medication regimen complexity.