LAUSR

Learning Objectives: Dexmedetomidine (DEX) is an attractive short-term sedative option for patients in the intensive care (ICU) setting due to its ability to achieve light sedation without an effect on respiratory drive. However due to the cost of DEX, a focus has been placed on the appropriate use of DEX through careful patient selection and duration of therapy. The benefit of a pharmacy-driven DEX guideline and restriction have demonstrated benefit in a community hospital setting, so we sought to implement similar stewardship at a large academic medical center Methods: This was a retrospective study of adult patients receiving DEX for ICU sedation during mechanical ventilation across all ICU settings. Patients were identified from DEX pharmacy charge data and needed to receive at least 3 hours of uninterrupted therapy for inclusion. The PRE-group was comprised of randomly selected patients from September 2014 to September 2015, and the POST-group consisted of all patients meeting inclusion criteria from September 2017 to March 2018. The appropriate use guideline consisted of a list of contraindications for DEX use, and a 48-hour stop was placed on all DEX orders by the pharmacy department. Results: A total of 188 patients met inclusion criteria, with 88 in the PRE-group and 100 in the POST-group. Adherence to the restrictions was quite high at 73.3%. There was a significant difference in the duration of DEX therapy after the restrictions were in place (1.7 vs. 0.9 days, P = 0.042). The POST-group also used less total mcg than the PRE-group, but did not reach statistical significance (1330 vs. 1018 mcg, P = 0.084). Based on year-long cost projections using the percentage of included patients, there would be a total 318 patients in the PRE-group and 200 patients in the POST-group. This would project to a total cost of $102,777.60 in the PRE-group and $48,489.00 in the POST-group, representing 71.8% difference between the two groups based on average wholesale price. Conclusions: DEX appropriate use guidelines and pharmacybased restrictions resulted in a decrease in DEX utilization and cost savings at a large academic medical center. 907