Effect of Comprehensive Medication Management on Mortality in Critically Ill Patients

Objectives: Medication management in the ICU is causally linked to both treatment success and adverse drug events. The purpose of this evaluation was to explore the effect of comprehensive medication management (CMM) on mortality in critically ill patients. Design: Retrospective, observational, propensity-matched cohort study. Setting: Adult ICUs at the Oregon Health Sciences University. Patients: Consecutive adults admitted to an ICU greater than or equal to 24 hours between June 1, 2020, and June 7, 2023, with available pharmacist intervention data. Interventions: None. Measurements and Main Results: CMM was measured by documented 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. In a cohort of 10,441 ICU patients, the unadjusted mortality rate was 11% with a mean Acute Physiology and Chronic Health Evaluation II score of 9.54 ± 4.18 and Medication Regimen Complexity-ICU (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% CI, –0.06 to –0.03; p < 0.01) and shorter length of ICU stay (estimate, –2.77; 95% CI, –2.98 to –2.56; p < 0.01). Conclusions: The quantity of CCP-delivered CMM in the ICU is directly associated with reduced hospital mortality independent of patient characteristics and MRC.