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- Title
Implementation of a diuretic stewardship program in a pediatric cardiovascular intensive care unit to reduce medication expenditures.
- Authors
THOMAS, CHRISTOPHER A.; MORRIS, JENNIFER L.; SINCLAIR, ELIZABETH A.; SPEICHER, RICHARD H.; AHMED, SHEIKH S.; ROTTA, ALEXANDRE T.
- Abstract
Purpose. The implementation of a diuretic stewardship program in a pediatric cardiovascular intensive care unit (ICU) is described. Methods. This retrospective study compared the use of i.v. chlorothiazide and i.v. ethacrynic acid in pediatric cardiovascular surgery patients before and after implementation of a diuretic stewardship program. All pediatric patients admitted to the pediatric cardiovascular service were included. The cardiovascular surgery service was educated on formal indications for specific diuretic agents, and the diuretic stewardship program was implemented on January 1, 2013. Under the stewardship program, i.v. ethacrynic acid was indicated in patients with a sulfonamide allergy, and i.v. chlorothiazide was considered appropriate in patients receiving maximized i.v. loop diuretic doses. A detailed review of the pharmacy database and medical records was performed for each patient to determine i.v. chlorothiazide and i.v. ethacrynic acid use and expenditures, appropriateness of use, days using a ventilator, and cardiovascular ICU length of stay. Results. After implementation of diuretic stewardship, the use of i.v. chlorothiazide decreased by 74% (531 fewer doses) while i.v. ethacrynic acid use decreased by 92% (47 fewer doses), resulting in a total reduction of $91,398 in expenditures on these diuretics over the six-month study period and an estimated annual saving of over $182,000. The median number of days using a ventilator and the length of ICU stay did not differ significantly during the study period. Conclusion. Implementation of a diuretic stewardship program reduced the use of i.v. chlorothiazide and i.v. ethacrynic acid without adversely affecting clinical outcomes such as ventilator days and length of stay in a pediatric cardiovascular ICU.
- Subjects
DIURETICS; HOSPITAL pharmacies; INTENSIVE care units; MEDICAL care costs; PHARMACEUTICAL arithmetic; HUMAN services programs; RETROSPECTIVE studies; DATA analysis software; DESCRIPTIVE statistics
- Publication
American Journal of Health-System Pharmacy, 2015, Vol 72, Issue 12, p1047
- ISSN
1079-2082
- Publication type
Article
- DOI
10.2146/ajhp140532