J Clin Outcomes Manage
Cost-effective medication use in critical care: Capital Health System's experience in VHA's MUSIC program
Barbarello-Andrews L, Susla G, Ng V, St. John D, Lau C
Abstract Objective: To describe a team-based approach to optimizing medication use in the critical care setting. Methods: Ten hospitals participated in a collaborative program developed and supported by VHA, Inc. and VHA East Coast called “Medication Usage Strategies in Critical Care” (MUSIC). Hospital MUSIC teams worked to identify therapeutic target areas for improvement, assess usage patterns of target agents, develop strategies to influence prescribing habits, evaluate outcomes, and implement plans to sustain success. Capital Health System (Trenton, NJ) focused on agents used in stress ulcer prophylaxis, continuous sedation, anemia of critical illness, and hypoalbuminemia of critical illness. They implemented a variety of methods, including educational communication forms, pharmacist-physician discussions, and policy revisions, to influence prescribing practices. A VHA Web-based platform allowed teams to share strategies and knowledge during the program. Results: Policy changes and educational tools initiated by the MUSIC program positively influenced prescribing habits, resulting in refinement of use of the target agents. Dollar savings were realized through reduced inappropriate use of select targeted agents and reduced rates of ventilator-associated pneumonia and hospital length of stay that were attributed to changes in the sedation protocol. Conclusion: Pharmacist involvement and implementation of efficient and evidence-based medication use policies in critical care units can improve outcomes and reduce costs
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