Doubling Pharmacist Coverage in the Intensive Care Unit: Impact on the Pharmacists’ Clinical Activities and Team Members’ Satisfaction

Abstract

National professional organizations have recognized pharmacists as essential members of the intensive care unit (ICU) team. Critical care pharmacists' clinical activities have been categorized as fundamental, desirable, and optimal, providing a structure for gauging ICU pharmacy services being provided. To determine the impact the addition of a second ICU pharmacist covering 30 adult ICU beds at a large regional medical center has on the complexity of pharmacists' interventions, the types of clinical activities performed by the pharmacists, and the ICU team members' satisfaction. A prospective mixed-method descriptive study was conducted. Pharmacists recorded their interventions and clinical activities performed. A focus group composed of randomly selected ICU team members was held to qualitatively describe the impact of the additional pharmacist coverage on patient care, team dynamics, and pharmacy services provided. The baseline period consisted of 33 days, and the intervention period consisted of 20 days. The average complexity of interventions was 1.72 during the baseline period (mode = 2) versus 1.69 (mode = 2) during the intervention period. The number of desirable and optimal clinical activities performed daily increased during the intervention from 8.4 (n = 279) to 16.4 (n = 328) and 2.3 (n = 75) to 8.6 (n = 171) compared with the baseline, respectively. Focus group members qualitatively described additional pharmacist coverage as beneficial. The additional critical care pharmacist did not increase pharmacy intervention complexity; however, more interventions were performed per day. Additional pharmacist coverage increased the daily number of desirable and optimal clinical activities performed and positively impacted ICU team members' satisfaction.

Perceptions and expectations of health professionals regarding hospital pharmacy services and the roles of hospital pharmacists: A qualitative systematic review and meta-synthesis

“… Outpatient/ambulatory Doctor/physician: 4 4 Interviews Mixed-methods Serious concern Lloyd, Watmough, and O'Brien 2015 41 United Kingdom To ascertain the views of doctors toward receiving formalized prescribing error feedback, specifically to explore what the impact has been on them as prescribers and their views on pharmacists as facilitators of prescribing error feedback. Medical Doctor/physician: 10 10 Interviews Thematic analysis Minor concern McDaniel et al 2017 42 United States of America Overall: to determine the impact the addition of a second ICU pharmacist covering 30 adult ICU beds at a large regional medical centre has on the complexity of pharmacists' interventions, the types of clinical activities performed by the pharmacists, and the ICU team members' satisfaction Focus group component: to qualitatively describe the additional pharmacists' impact on patient care, team dynamics, and the quality of pharmacy services provided. Adult Intensive Care Unit (ICU) Doctors/physician: 1 Nurse: 1 Respiratory therapist: 1 3 Focus group Mixed-methods Serious concern Mekonnen et al 2013 43 Ethiopia To explore key informants' perspectives in the implementation of clinical pharmacy practice with the multidisciplinary team at Jimma University Specialized Hospital, Ethiopia.…”

“… Australia 20 , 40 , 45 , 46 , 50 Canada 53 Indonesia 6 Ireland 44 South Korea 39 USA 5 Malta 21 Portugal 45 Unknown 48 Medication reviews and/or prescribing feedback Activities that involved reviewing the medications prescribed during admission, aimed at identifying any potential medication-related problems and promoting the quality use of medicines. Australia 26 , 45 , 50 Canada 27 Ethiopia 43 , 49 Indonesia 6 Ireland 44 Malta 21 Mexico 29 Pakistan 23 , 37 Qatar 35 Sweden 31 , 33 , 52 Switzerland 25 UK 41 USA 5 , 28 , 34 , 42 Unknown 24 , 48 Proactive roles in medication-related therapy decisions Collaborative activities or discussions between pharmacists and other members of the multidisciplinary team that occurred before prescribing any medications or making therapeutic decisions. Australia 20 , 38 , 45 , …”

“… Australia 26 , 45 , 50 Canada 27 Ethiopia 43 , 49 Indonesia 6 Ireland 44 Malta 21 Mexico 29 Pakistan 23 , 37 Qatar 35 Sweden 31 , 33 , 52 Switzerland 25 UK 41 USA 5 , 28 , 34 , 42 Unknown 24 , 48 Proactive roles in medication-related therapy decisions Collaborative activities or discussions between pharmacists and other members of the multidisciplinary team that occurred before prescribing any medications or making therapeutic decisions. Australia 20 , 38 , 45 , 50 , 51 Ethiopia 49 India 32 Indonesia 6 Malaysia 19 Malta 21 Pakistan 22 South Korea 39 Qatar 35 Sweden 31 , 33 Switzerland 25 USA 28 , 34 , 42 Unknown 48 Drug information and...…”

“… Australia 20 , 38 , 45 , 50 , 51 Ethiopia 49 India 32 Indonesia 6 Malaysia 19 Malta 21 Pakistan 22 South Korea 39 Qatar 35 Sweden 31 , 33 Switzerland 25 USA 28 , 34 , 42 Unknown 48 Drug information and education for other health professionals Activities that were designed to assist health professionals in obtaining information regarding medications in general or to aid in prescribing e.g., continuing education sessions. Australia 20 , 38 , 45 , 46 Brazil 30 Canada 27 Ethiopia 49 France 36 India 32 Indonesia 6 Malaysia 19 Malta 21 Mexico 29 Pakistan 23 , 37 Portugal 45 , 46 South Korea 39 Qatar 35 Sweden 31 , 33 Switzerland 25 UK 41 USA 28 , ...…”

“… 30 , 32 , 36 , 39 , 43 Health professionals are not convinced that hospital pharmacists are clinically competent enough to solve therapeutic problems (Low Confidence). 21 , 22 , 24 , 25 , 27 , 29 , 38 , 39 , 42 , 43 , 45 , 52 Hospital pharmacists must not be too demanding and should refrain from intervening unnecessarily in patient care (Very Low Confidence). 52 …”