Background Clinical pharmacists are established members of the interprofessional patient care team, but limited guidance for the optimal utilization of pharmacy resources is available. Objective measurement of medication regimen complexity offers a novel process for evaluating pharmacist activity. The purpose of this study was to evaluate the relationship between medication regimen complexity, as measured by a novel medication regimen complexity scoring tool (MRC‐ICU), and both pharmacist interventions and drug‐drug interactions (DDIs). Methods This was a multi‐center, prospective, observational study. The electronic medical record was reviewed to collect patient demographics, patient outcomes, and MRC‐ICU and modified MRC‐ICU (mMRC‐ICU) score at 24, 48 hours, and at discharge. Pharmacist interventions were recorded during the patients' intensive care unit (ICU) stay. DDIs were also evaluated at 24, 48 hours, and at discharge. Spearman's rank‐order correlation was used to determine any correlation between the MRC‐ICU score at each time point and the number of pharmacist interventions and DDIs. Results A total of 153 patients were evaluated from both centers. The median MRC‐ICU at 24 hours was 11 (interquartile range [IQR] 7‐15). MRC‐ICU at 24 hours was correlated with interventions at 24 hours (rs .439, P <.001). Furthermore, MRC‐ICU was correlated with total DDIs (rs .4, P < .001). A modified version of the MRC‐ICU was also correlated with number of pharmacist interventions (P < .001) and DDIs (P < .001). Conclusions Medication regimen complexity showed a relationship with number of pharmacist interventions and number of DDIs.
Stroke is a devastating disease associated with high morbidity and mortality. Despite the approved indication of systemic thrombolytic therapy in the United States for the acute management of ischemic stroke, its use is limited given a strict eligibility criteria and a risk for hemorrhagic transformation as a feared adverse effect. Many agents have been studied without success for neuroprotection in patients with stroke to reduce vascular injury and improve long-term functional outcomes. Minocycline is a tetracycline antibiotic that shows promise for its neuroprotective effects in multiple animal models and three human trials. It affects multiple pathways to reduce apoptosis, neuroinflammation, infarct size, and vascular injury. The aim of this review is to discuss current evidence for minocycline from pre-clinical and early clinical trials and its potential role in neuroprotection in patients with acute ischemic stroke.
Introduction: The position paper on critical care pharmacy services describes two tiers of responsibilities: essential and desirable activities. Activities are categorized into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. Documentation of these activities can be important for justifying pharmacist positions, comparing pharmacy practice models, conducting performance evaluations, and tracking individual workload; however, limited recommendations are provided for standardized productivity tracking, and national practices remain largely uncharacterized. Objectives: The purpose of this survey was to describe documentation practices of critical care pharmacist activities. Methods: A cross-sectional survey was distributed via email to 1694 members of the ACCP critical care practice research network. The survey asked respondents to describe the methods used to document productivity as it relates to the 5 domains. Results: Seventy-nine (4.7%) critical care pharmacists from 63 institutions completed the survey. Intervention documentation was used for position justification and annual reviews among 54.4% and 44.1% of pharmacists, respectively. Pharmacists were routinely expected to perform additional responsibilities beyond patient care that contribute to overall productivity, but the percentage of institutions that track these activities as a measure of pharmacist productivity was relatively low: quality improvement (46%), research/scholarship (29%), training/education (38%), and professional development (27%). Documentation of these additional responsibilities and activities was primarily used for annual evaluations, but the majority of respondents answered that no standardized method for tracking activities existed. In multivariate regression, dedicated ICU pharmacists was a significant predictor for increased satisfaction (Exp(ß) 4.498, 95% CI 1.054-19.187, P = .042). Conclusion: Practice variation exists in how and for what intent critical care pharmacists track productivity. Further evaluation and standardization of productivity tracking may aid in position justification and practice model evaluation for dedicated ICU pharmacists in today’s value-based era.
Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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