Characterization of changes in medication complexity using a modified scoring tool

Abstract

Purpose The purpose of this study was to characterize dynamic changes in medication regimen complexity over time in critically ill adults and to validate a modified version of the medication regimen complexity–intensive care unit (MRC-ICU) scoring tool. Summary A single-center, retrospective, observational chart review was conducted with a primary aim of assessing changes in medication regimen complexity over time, as measured by both the 39-item MRC-ICU scoring tool and a modified version (the mMRC-ICU) containing just 17 items. Secondary aims included validation of the mMRC-ICU and exploration of relationships between medication regimen complexity and ICU length of stay (LOS), inpatient mortality, and patient acuity. Adults admitted to a medical ICU from November 2016 through June 2017 were included. The medication regimens of a total of 130 patients were scored in order to test, modify, and validate the MRC-ICU and mMRC-ICU tools. The modified tool was validated by evaluating correlation of mMRC-ICU scores with MRC-ICU scores and with patient outcomes including patient acuity, ICU LOS, and inpatient mortality. mMRC-ICU scores were collected at 24 and 48 hours after admission and at ICU discharge to evaluate changes over time. Significant changes in medication regimen complexity over time were observed, with the highest scores observed at 24 hours after admission. Conclusion Medication regimen complexity may provide valuable insights into pharmacist activity and resource allocation. Further validation of the MRC-ICU and mMRC-ICU scoring tools in other critically ill populations and at external sites is required.

A survey of critical care pharmacists to patient ratios and practice characteristics in intensive care units

“…Justification of pharmacy services is limited by this lack of supporting evidence in addition to limited ways to measure either predicted pharmacy resources or efficiency of the available pharmacy resources . A novel medication regimen complexity scoring tool, the medication regimen complexity‐ICU MRC‐ICU has been proposed to objectively predict pharmacist interventions and optimize pharmacy practice models, but prospective studies are presently lacking . Likely, institutions should have standardized practices that delineate acceptable pharmacist to patient ratios, cross‐coverage expectations, and minimum number of in‐house pharmacists.…”

Medication regimen complexity is associated with pharmacist interventions and drug‐drug interactions: A use of the novel MRC‐ICU scoring tool

“…The MRC-ICU score at 24 hours was found to correlate with interventions at all three time points (24,48 Table 3.…”

“…This tool was shortened to 17 vs the original 39 line-items but remained significantly correlated with MRC-ICU, hospital mortality, and patient acuity. 24 Both the MRC-ICU and the mMRC-ICU have been shown to dynamically change over time from a patient's admission, to 48 hours, and discharge indicating that real-time assessment may be beneficial. 24 The purpose of this study was to evaluate the relationship of medication regimen complexity, as measured by the MRC-ICU and the mMRC-ICU, and pharmacist activity, as measured by pharmacist interventions, and the number of DDIs in multiple ICU settings and institutions.…”

“…24 Both the MRC-ICU and the mMRC-ICU have been shown to dynamically change over time from a patient's admission, to 48 hours, and discharge indicating that real-time assessment may be beneficial. 24 The purpose of this study was to evaluate the relationship of medication regimen complexity, as measured by the MRC-ICU and the mMRC-ICU, and pharmacist activity, as measured by pharmacist interventions, and the number of DDIs in multiple ICU settings and institutions. The central hypothesis was that MRC is associated with both patient outcomes in the critically ill patient population and pharmacist activity.…”

Maintaining comprehensive pharmacy services during a pandemic: Recommendations from a designated COVID-19 facility

“…1 Previous events have highlighted pharmacists' endeavors to fulfill needs of their patients, institutions, and communities as part of the disaster medicine response. [2][3][4][5][6][7] The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID- 19) is no exception, and it was declared a pandemic by the World Health Organization in March 2020.…”