Evolution of Adverse Drug Event Avoidance Interventions by Telecritical Care Pharmacists

Introduction: Telecritical care (TCC) pharmacists may improve medication safety and cost avoidance (CA) through adverse drug event (ADE) prevention, with proactive review often associated with more interventions per patient than alert-based review. This quality improvement (QI) project compared ADE avoidance interventions between first shift, proactive patient review and second shift, alert-based review.


Methods: This was a retrospective, multicenter, observational QI project comparing ADE avoidance interventions performed by TCC pharmacists using alert-based review on second shift in 2016 to those performed using proactive patient review on first shift in 2024. The primary outcomes were the quantity and types of interventions performed between time frames. Secondary outcomes included the percentages of interventions per facility, percentage of medications by drug class, frequency of high alert medications and estimated CA. Descriptive statistics were reported.


Results: One hundred and seventy-two ADE avoidance interventions were documented with alert-based review (109 major), as compared to 443 (214 major) with proactive review, a 258% increase. In 2016, 41.9% of interventions were associated with high alert medications per the Institute for Safe Medication Practices, similar to rates of 49.4% in 2024. In 2016, the most common drug classes were antimicrobials (19.8%), glycemic control (14.5%), anticoagulants (AC) (13.4%), and pain/agitation/delirium (PAD) (12.2%). In 2024, AC (30.2%), PAD (13.1%), glycemic control (5.9%), antiseizure medications (5.9%), and antimicrobials (4.7%) were most common. Interventions were made at 10 facilities in 2016, with a rural 18-bed ICU accounting for the largest proportion of interventions (25.6%). In 2024, 7 facilities were represented, with the same 18-bed ICU accounting for 36.1% of interventions.

Total CA in 2016 was $475,671 and $983,852 in 2024. Assuming 25to 75% of interventions may have been identified without TCC pharmacist presence, adjusted CA for 2016 was $118,918 to $356,753 and $245,963 to $737,889 in 2024.


Conclusions: Proactive review resulted in more than 2.5 times the ADE avoidance interventions identified and nearly double CA estimates than alert-based review. This adds to the current literature supporting the TCC pharmacists in ADE prevention.