Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score*

Abstract

OBJECTIVES: Despite the established role of the critical care pharmacist on the ICU multiprofessional team, critical care pharmacist workloads are likely not optimized in the ICU. Medication regimen complexity (as measured by the Medication Regimen Complexity-ICU [MRC-ICU] scoring tool) has been proposed as a potential metric to optimize critical care pharmacist workload but has lacked robust external validation. The purpose of this study was to test the hypothesis that MRC-ICU is related to both patient outcomes and pharmacist interventions in a diverse ICU population. DESIGN: This was a multicenter, observational cohort study. SETTING: Twenty-eight ICUs in the United States. PATIENTS: Adult ICU patients. INTERVENTIONS: Critical care pharmacist interventions (quantity and type) on the medication regimens of critically ill patients over a 4-week period were prospectively captured. MRC-ICU and patient outcomes (i.e., mortality and length of stay [LOS]) were recorded retrospectively. MEASUREMENTS AND MAIN RESULTS:A total of 3,908 patients at 28 centers were included. Following analysis of variance, MRC-ICU was significantly associated with mortality (odds ratio, 1.09; 95% CI, 1.08-1.11; p < 0.01), ICU LOS (β coefficient, 0.41; 95% CI, 00.37-0.45; p < 0.01), total pharmacist interventions (β coefficient, 0.07; 95% CI, 0.04-0.09; p < 0.01), and a composite intensity score of pharmacist interventions (β coefficient, 0.19; 95% CI, 0.11-0.28; p < 0.01). In multivariable regression analysis, increased patient: pharmacist ratio (indicating more patients per clinician) was significantly associated with increased ICU LOS (β coefficient, 0.02; 0.00-0.04; p = 0.02) and reduced quantity (β coefficient, -0.03; 95% CI, -0.04 to -0.02; p < 0.01) and intensity of interventions (β coefficient, -0.05; 95% CI, -0.09 to -0.01). CONCLUSIONS:Increased medication regimen complexity, defined by the MRC-ICU, is associated with increased mortality, LOS, intervention quantity, and intervention intensity. Further, these results suggest that increased pharmacist workload is associated with decreased care provided and worsened patient outcomes, which warrants further exploration into staffing models and patient outcomes.

Optimizing Pharmacist Impact in Critically Ill Patients: Is Medication Regimen Complexity the Answer?*

“…This study represent a key step in what has been a thoughtful development of the MRC-ICU score by Sikora et al (10). Their findings support the validity of the score as a tool to objectively quantify pharmacotherapeutic complexity in critically ill patients.…”

“…In this issue of Critical Care Medicine , Sikora et al (10) present a multicenter validation of the medication regimen complexity-ICU (MRC-ICU) score, a tool that could address the challenge of patient prioritization. The MRC-ICU is designed to quantify pharmacotherapeutic complexity in critically ill patients (11).…”

“…To address this issue, the investigators conducted a multicenter cohort study in 28 ICUs at academic and community hospitals in the United States (10). The study aims were to examine associations between the MRC-ICU score and patient outcomes (mortality, LOS) and pharmacist activities (intervention quantity and complexity).…”

Critical Care Pharmacists: Improving Care by Increasing Access to Medication Expertise

“…Even with this compelling evidence and endorsement by multiprofessional guidelines that pharmacists are essential members of the ICU team, a pharmacist attending rounds occurs in only 70% of ICUs ( 1 ). This is especially notable, given that higher workload of pharmacists has been associated with reduced quality of care and longer lengths of stay in the ICU ( 7 ).…”

“…Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics with the Medication Regimen Complexity–ICU (MRC-ICU) Score. Crit Care Med 2022;50(9):1318–1328 ( 7 ). Evaluation of critical care pharmacist interventions, length of stay, mortality, and a novel prediction metric observed increased pharmacist workload, which was significantly associated with reduced quantity and intensity of interventions and increased ICU length of stay.…”