Pharmacist Impact on Patient Mortality and Advanced Cardiac Life Support Guideline Compliance During In-Hospital Cardiac Arrest Joseph Cavanaugh, PharmD PGY1 Resident Community Medical Center, Toms River, NJ

Background The advanced cardiac life support (ACLS) guidelines Authored by American Heart Association (AHA) Provide specific algorithms for the treatment of cardiac arrest1 In-hospital cardiac arrests (IHCA)2 1.6 arrests per 1000 admissions 18.4% survival rate

Background Pharmacists have been integrated into response teams in hospitals throughout the United States3 Offer a different perspective Optimize drug dosing, selection, timing, and administration Physician compliance with ACLS guidelines is less than 65%4

Purpose Primary Objective Secondary Objective To evaluate the impact of pharmacist participation during IHCA on patient mortality Secondary Objective Determine impact of pharmacist participation on ACLS guideline compliance Identify the total number of guideline deviations

Methods Approved by Institutional Review Board Retrospective chart review September 1, 2013 to February 29, 2016 Inclusion Criteria In-hospital cardiac arrest > 18 years old Exclusion Criteria Cardiac arrests in progress upon arrival Incomplete code sheet documentation No medications administered

Methods Mortality Compliance Statistics At the end of cardiac arrest Correct medication Correct dose Correct timing of doses Statistics Continuous Data: Student’s t-test Nominal: Fisher’s exact test

Data Collection All data was recorded without identifiers and kept confidential Data was collected from cardiac arrest code sheets and the electronic medical record (EMR) Patient demographics Location of cardiac arrest Length of cardiac arrest Health professionals present Presenting rhythm/cause of arrest Medication doses and timing

Results Table 1. Demographics Pharmacist Participation n = 64 No Pharmacist Participation n = 493 P-value Male (%) 41 (64.1%) 290 (58.8%) 0.499 Age (years) ( ± SD) 73 ( ± 15.7) 74 ( ± 13.5) 0.616 Average Length of Code (minutes) ( ± SD) 18.1 ( ± 13.6) 17.4 ( ± 10.3) 0.698

Results Table 1. Demographics Pharmacist Participation n = 64 No Pharmacist Participation n = 493 P-value General Medicine Floors (%) 11 (17.2%) 186 (37.7%) 0.001 ICU (%) 17 (26.5%) 218 (44.2%) 0.002 Emergency Department (%) 36 (56.3%) 89 (18.1%) < 0.001

Source of Deviation No Pharmacist Pharmacist

p = 0.001 p = 0.083 p = 0.445

Results Table 2. Results Pharmacist Participation n = 64 No Pharmacist Participation n = 493 P-value Patient Mortality (%) 29 (45.3%) 245 (49.7%) 0.595 Compliance (%) 46 (71.9%) 209 (42.4%) < 0.001 Total Deviations (per cardiac arrest) 37 (0.58) 476 (0.97) 0.008

Discussion Pharmacist participation Limitations Similar mortality 1.7 fold increase in compliance 1.7 fold decrease in deviations Limitations Retrospective Charting errors Small sample size

Conclusion Pharmacist participation significantly increased compliance with the ACLS guidelines

Future Steps Expand ACLS Pharmacist Training Increase Response Rate Staff/Decentralized Pharmacist Increase Response Rate Nursing Education Involvement Cardiac Arrest Simulations

References Neumar RW, Otto CW, Link MS, et al. Part 8: Adult Advanced Cardiovascular Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 suppl 3):S729-S767. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics 2016 update: a report from the American Heart Association. Circulation. 2016 Jan 26;133(4):e38-e360. Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration—2014. Am J Health Syst Pharm. 2015;72(13):1119-1137. Cline DM, Welch KJ, Cline LS, Brown CK. Physician Compliance With Advanced Cardiac Life Support Guidelines. Ann Emerg Med. 1995;25(1):52-57.

Assessment Question? What is the role of a pharmacist during in-hospital cardiac arrest? Calculate medication dosages Manage medication preparation Provide drug information expertise All of the above

QUESTIONS? Joseph Cavanaugh, PharmD PGY1 Resident Community Medical Center, Toms River, NJ jcavanaugh@barnabashealth.org