Pharmacist-Led Comprehensive Medication Management and Patient Outcomes in Pediatric Intensive Care Unit Patients: A Multicenter Cohort Study
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Objective
Clinical pharmacists improve medication management and safety in intensive care units, yet their role in neonatal and pediatric intensive care remains highly variable across institutions. Evidence supporting standardized clinical pharmacy practice models in these settings is limited. This study evaluated the association between pharmacist service coverage and clinical outcomes in critically ill pediatric patients.
Design
Multicenter, observational study with prospective and retrospective data collection.
Setting
ICUs at participating institutions in the United States and internationally.
Patients
Patients <18 years of age
Intervention
None
Measurements
The primary exposure was pharmacist-led comprehensive medication management (CMM) with daily participation in multidisciplinary rounds. The secondary exposure was the pharmacist-to-ICU-patient ratio. The primary outcome was hazard of discharge alive (HDA) from the ICU. Secondary outcomes included in-hospital mortality, hospital HDA, and hazard of extubation alive (HEA). Fine-Gray competing risks models and multivariable Firth logistic regression were used for adjusted analyses.
Main results
A total of 1,459 patients cared for by 69 clinical pharmacists across 31 institutions were included. Daily CMM with rounding was associated with a higher HDA from the ICU (HR 2.60, 95% CI 2.17-3.10; p<0.001), higher HDA from the hospital (HR 2.25, 95% CI 1.83-2.75; p<0.001), and a higher HEA (HR 1.21, 95% CI 1.10-1.33; p<0.001), but not with in-hospital mortality (OR 0.44, 95% CI 0.14-1.36; p=0.154). The pharmacist-to-ICU-patient ratio was not significantly associated with ICU HDA (HR 1.00, 95% CI 0.99-1.01; p=0.88) or any secondary outcome.
Conclusions
Daily pharmacist-provided CMM with multidisciplinary ICU rounding was associated with improved discharge outcomes among critically ill pediatric and neonatal patients, whereas pharmacist-to-ICU-patient ratio alone was not. These findings support standardized integration of clinical pharmacists into daily multidisciplinary rounds in this setting.
