Critical care pharmacy service provision and workforce in adult extracorporeal membrane oxygenation centres: a multicentre cross-sectional survey

Abstract

BackgroundThere is good evidence describing pharmacy workforce and service provision in general critical care units. However, no data exists from adult extracorporeal membrane oxygenation (ECMO) centres. AimTo describe workforce characteristics, pharmacy service provision, and pharmaceutical care activities in critical care units providing an adult ECMO service in the United Kingdom (UK), and compare to national sta ng standards for critical care units. MethodWe conducted a multicentre, cross-sectional electronic survey inviting one pharmacy professional response per UK ECMO centre. ResultsThe survey response rate was 90.9%: representatives of 10/11 tertiary hospitals providing ECMO services responded. The median ratio of critical care pharmacists per critical care bed was 1:12.1 (interquartile range (IQR) -1:9.4 -1:14.9). Most centres (90.0%) did not meet national standards for pharmacy professionals to critical care bed sta ng ratios for weekday services. Total critical care beds covered by the critical care pharmacy team varied across the UK: median (IQR) -45 (37-80) beds. Two centres funded pharmacist time for ECMO activity, and one centre funded a pharmacy technician post. Median peak ECMO activity was 4 ECMO patients in a single day (IQR: 3-5). Most respondents reported reduced pharmacy service at weekends compared to weekday, with limited on-site support. ConclusionMost responding ECMO centres reported pharmacy sta ng ratios below nationally agreed critical care standards. There was high variability in clinical pharmacy services to ECMO patients over 7 days. Future work should address the gap in clinical pharmacy services, the 7-day service and ensure adequate technician provision across each ECMO centre. Impact Statements• Extracorporeal membrane oxygenation (ECMO) provides advanced respiratory and/or cardiac support to patients when conventional therapies on the critical care unit have failed.• ECMO patients have a high disease severity and pharmaceutical complexity.• Most responding ECMO centres reported pharmacy sta ng ratios below nationally agreed standards.