Role of a Clinical Pharmacist on Drotrecogin Alfa (Activated) Outcomes in a Large Community Teaching Hospital

摘要

Drotrecogin alfa (activated), a recombinant form of Human Activated Protein C (APC), is indicated for the treatment of adults with severe sepsis and appears to have the greatest mortality benefit in those patients with a high-risk of death (APACHE II >= 25). Due to this observation and its high acquisition cost, a multidisciplinary team was assembled to develop a strict protocol for the use of APC at our institution. This protocol required a clinical pharmacist to evaluate all candidates for appropriateness before receiving APC therapy. Herein, we report the role of a clinical pharmacist in determining appropriate candidates to receive APC and the subsequent effects on clinical and economic outcomes. Patients receiving APC consults between 01/2002 and 01/2003 were divided into two groups, those who met protocol criteria (Group I) and those who did not (Group II). Data were collected for patient demographics, APACHE II score, type of ICU, site of infection, 28-day mortality, and bleeding incidence. Cost analysis was done using the Average Wholesale Price (AWP) of APC and the national average hourly salary for a full time clinical pharmacist. Costs saved were estimated by the cost of APC that would have been administered to patients who did not meet criteria and were alive at 28-days. Thirty-four patients were consulted (Group I: 20, Group II: 14). There was no statistically significant difference between Group I and II regarding demographics, type of ICU, site of infection, and bleeding incidence. APACHE II scores were high and similar for both groups (Group I: 31 + 6; Group II: 29 ± 6, p = 0.394). Despite not meeting protocol criteria as determined by the clinical pharmacist, 8 patients in Group II received APC therapy. Twenty-eight day mortality was lower in patients determined to be appropriate candidates for APC therapy by the clinical pharmacist (Group 1:30% vs. Group II: 64%, p = 0.08). Cost analysis demonstrated that a total of