Critical care pharmacy workforce: a 2020 re-evaluation of the UK deployment and characteristics

Abstract

Introduction Critical care pharmacists improve the quality and efficiency of medication therapy whilst reducing treatment costs where they are available. UK critical care pharmacist deployment was described in 2015, highlighting a deficit in numbers, experience level, and critical care access to pharmacy services over the 7-day week. Since then, national workforce standards have been emphasised, quality indicators published, and service commissioning documents produced, reinforced by care quality assessments. Whether these initiatives have resulted in further development of the UK critical care pharmacy workforce is unknown. This evaluation provides a 2020 status update. Methods The 2015 electronic data entry tool was updated and circulated for completion by UK critical care pharmacists. The tool captured workforce data disposition as it was just prior to the COVID-19 pandemic, at critical care unit level. Main findings Data were received for 334 critical care units from 203 organisations (96% of UK critical care units). Overall, 98.2% of UK critical care units had specific clinical pharmacist time dedicated to the unit. The median weekday pharmacist input to each level 3 equivalent bed was 0.066 (0.043–0.088) whole time equivalents, a significant increase from the median position in 2015 (+ 0.021, p < 0.0001). Despite this progress, pharmacist availability remains below national minimum standards (0.1/level 3 equivalent bed). Most units (71.9%) had access to prescribing pharmacists. Geographical variation in pharmacist staffing levels were evident, and weekend services remain extremely limited. Conclusions Availability of clinical pharmacists in UK adult critical care units is improving. However, national standards are not routinely met despite widely publicised quality indicators, commissioning specifications, and assessments. Additional measures are needed to address persistent deficits and realise gains in organisational and patient-level outcomes. These measures must include promotion of cross-professional collaborative working, adjusted funding models, and a nationally recognised training pathway for critical care pharmacists.

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

“…The majority of respondents (9 out of 10, 90.0%) reported sta ng levels fell below the minimum standards for 5-day services for clinical pharmacy staff according to GPICS II guidelines [6], this concurs with the workforce studies by Borthwick and colleagues [18,19]. Respondents reported several posts split between specialities, that limits time spent on ECMO-speci c clinical activities or places multiple competing demands on the clinical pharmacy workforce.…”

“…Furthermore, the NHS England critical care service speci cation states that commissioned CCUs must align to GPICS guidelines [17]. In the UK, there is a good evidence base describing the CC pharmacy workforce and activities, especially clinical pharmacists, although there remains great variation in the delivery of the clinical pharmacy service, MDT ward round participation and 7-day clinical pharmacy services, despite evidence of bene t [18][19][20]. This is not the case for commissioned ECMO services, where no data exists for the clinical pharmacy workforce.…”