Critical care pharmacists have a rich history and evolving roles

Abstract

Critical care (CC) pharmacists have been contributing to patient outcomes, team effectiveness, education, research and quality improvement for approximately 50 years. Current CC specialists are evolving the practice, science and scholarship into new and exciting areas as described in the series of articles collected for a special series in this journal. To summarize past accomplishments and contemplate how next level achievements may develop, brainstorming by experienced CC specialists, researchers, educators, and scholars was done to establish a foundation for this paper and three of that group summarized it into an overview of the challenges of the past and opportunities that are shaping the future. A small group of CC pharmacists identified need and opportunity to improve patient care in a limited number of settings but subsequent CC pharmacists have expanded into numerous specialties and subspecialties. Comprehensive medication management of CC patients and survivors of their critical illness is now a standard, but delivery may be influenced by new technology and equipment. Improved quality of care and outcome measures are being developed and measured. The imperative to move practice forward and adopt new practices while maintaining a core set of guideline‐based practices may be facilitated by technology such as wearable devices, personalized medicine, machine learning or artificial intelligence. However, these new tools may create new obstacles. Similar changes in education and expansion into administrative roles afford new opportunities and challenges. CC pharmacists have created a solid foundation, but continued growth in number and expansion of roles requires the next generation to continue to push ahead and continue to demonstrate value in key areas.

Continuing excellence in critical care pharmacy practice, education, and advocacy

“…However, justification of pharmacy service expansion continues to be difficult as a cost savings model is not as persuasive to administration as a revenue‐generating healthcare team member. As we look forward toward revised payment models, it will be important for critical care pharmacy to position itself as an undeniably essential provider of medication management in the ICU, which has clearly been further illustrated by the impact on outcomes by the manuscripts published in this themed issue and the many others published before 1,3 …”

“…In this issue, Dr. Jacobi and colleagues describe the rich history of critical care pharmacists and their evolving roles as an essential member on intensive care unit (ICU) patient care teams. 3 The complexity of medication therapy and the interplay of critical illness and medication effects require pharmacists to provide critical insight regarding the appropriate selection, dosage, and monitoring of all medications. In many ICUs, the pharmacists act as a direct patient care provider under collaborative practice agreements to fully manage medications in an ever-changing clinical status.…”

“…Inclusion of a critical care pharmacist consistently reduces adverse medication events, morbidity, mortality, and costs 1 . Over several decades since the inception of the critical care pharmacist in the 1960s, 2,3 roles have expanded to encompass research and scholarly activities, education, and involvement in leadership roles 4 . As such, this themed issue of the Journal of the American College of Clinical Pharmacy includes manuscripts focused on the continuing excellence in critical care pharmacy practice, education, and advocacy.…”

“…1,3 Essential components for the critical care pharmacist when advancing education, practice, and advocacy to ensure excellence in critical care pharmacy.…”

Evolution of critical care pharmacy practice: A study to remember

“…There are many important events that are central to critical care pharmacists' acceptance and recognition as noted in a recent paper by Jacobi et al, which listed some of the major publications supportive of critical care pharmacy as a specialty. 2 The listing includes consensus papers developed by interprofessional critical care organizations and a few papers involving original research. One of the latter publications cited but not discussed in detail (likely precluded by space limitations) concerns a study by Leape et al involving a pharmacist rounding in a medical intensive care unit (ICU).…”