Multicenter validation of a novel medication-regimen complexity scoring tool

Abstract

Background The MRC-ICU, a novel regimen complexity scoring tool, provides an objective measure of medication regimen complexity in critically ill patients. The MRC-ICU may have the ability to evaluate the impact of critical care pharmacists on patient outcomes but requires further validation. The objective of this study was to confirm the external validity of the MRC-ICU scoring tool at multiple institutions and intensive care unit (ICU) settings. Methods This was a multicenter, prospective, observational study. The electronic medical record was reviewed to collect patient demographics and patient outcomes, and the medication administration record was reviewed to collect MRC-ICU scores at 24 hours, 48 hours, and ICU discharge. Validation was performed by assessing convergent and divergent validity of the score. Spearman rank-order correlation was used to determine correlation. Results A total of 230 patients were evaluated across both centers in both medical ICUs and surgical ICUs. Differences between the original center and the new site included that total number of orders (29 vs 126; P < 0.001) and total number of medication orders (17 vs 36; P < 0.001) were higher at the new site, whereas the original site had higher overall MRC-ICU scores (14 vs 11; P = 0.004). The MRC-ICU showed appropriate convergent validity with number of orders and medication orders (all P < 0.001) and appropriate divergent validity with no significant correlation found between age, weight, or gender (all P > 0.05). Conclusions External validity of the MRC-ICU has been confirmed through evaluation at an external site and in the surgical ICU population. The MRC-ICU scoring tool requires prospective evaluation to provide objective data regarding optimal pharmacist use.

Evaluating the Medication Regimen Complexity Score as a Predictor of Clinical Outcomes in the Critically Ill

“…The MRC for the intensive care unit (ICU) scoring tool has been developed and intended for use in critically ill patients [ 25 , 26 ]. MRC-ICU is the first validated quantitative weighted scoring tool intended to predict clinical events such as mortality [ 27 , 28 ]. A recent study demonstrates that the prediction of patient outcomes can be improved by incorporating the MRC-ICU score into the previously established severity-of-disease classification system Acute Physiology and Chronic Health Evaluation (APACHE II) scoring tool [ 29 ].…”

Evaluating the Association and Predictability of Complex Medication Regimen Scores with Clinical Outcomes Among the Critically Ill

“…In the intensive care unit (ICU) population, the MRC in ICU (MRCICU) scoring tool was developed and revised (modified MRCICU) in 2019 [22,23]. The modified MRCICU is the first validated quantitative weighted scoring tool intended to predict clinical outcomes (i.e., ICU mortality, length of stay (LOS), and need for mechanical ventilation (MV)) [24,25]. In a previous study, we have developed a novel proof-ofconcept method demonstrating improvement in the prediction of patient outcomes by incorporating the MRCICU score into the previously established Acute Physiology and Chronic Health Evaluation (APACHE II) scoring tool [26].…”

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*

“…The studies that chronicle the development and evaluation of the MRC-ICU are summarized in Supplemental Digital Content -Table 2 (http://links.lww.com/CCM/H141). The primary limitation of all MRC-ICU evaluations to date has been the small sample and one (or two) center designs that inherently lack the robust external validity necessary for widespread use (6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

“…The Medication Regimen Complexity-ICU (MRC-ICU) scoring tool is the first metric proposed with the specific intention of describing relevant relationships in the optimal critical care pharmacy practice model and has shown early promise at overcoming historical limitations in pilot studies (6)(7)(8)(9)(10)(11)(12)(13). This 37-line item score has been provided in Supplemental Digital Content -Table 1 (http://links.lww.com/CCM/H141).…”

“…For example, a patient receiving cefepime (2 points), vancomycin (3 points), norepinephrine (1 point), and vasopressin (1 point) on ICU day 2 would have a day 2 MRC-ICU score of 7. To date, this metric has been successfully correlated to patient acuity (as measured by the Acute Physiology and Chronic Health Evaluation [APACHE III]), patient-centered outcomes including mortality and length of stay (LOS), ICU-related complications including fluid overload and drug-drug interactions, and pharmacist workload, as measured by documented pharmacist interventions (6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Furthermore, it has been successfully built into the electronic health record in one academic medical center (12).…”