Optimizing pharmacist-driven protocols and documentation of interventions using clinical decision support systems

Heck, Cory; Tichy, Eric M.; Vonderheyde, Robyn; Jaszczur, Gregory R.; McManus, Dayna; Topal, Jeffrey; Rogers, Mark E.; Rouse, Ginger

doi:10.1093/ajhp/zxaa061

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…The EHR has been used in a number of innovative ways to measure and quantify clinical pharmacist activity, but workload measurement generally revolves around discrete, predefined activities that are easily documented in the EHR. This may include electronic task lists for pharmacist-driven protocol to-do items, 21 documenting the depth of daily patient chart review, 22 or the development of institution-specific scoring tools for complex medication regimens. 23 These tools allow for institutional tracking of pharmacist activities, but often, they do not correlate with pharmacist workload or patient severity of illness.…”

Section: Discussionmentioning

confidence: 99%

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The use of electronic health record embedded MRC-ICU as a metric for critical care pharmacist workload

Webb,

Carver,

Rowe

et al. 2023

JAMIA Open

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Objectives A lack of pharmacist-specific risk-stratification scores in the electronic health record (EHR) may limit resource optimization. The medication regimen complexity-intensive care unit (MRC-ICU) score was implemented into our center’s EHR for use by clinical pharmacists. The purpose of this evaluation was to evaluate MRC-ICU as a predictor of pharmacist workload and to assess its potential as an additional dimension to traditional workload measures. Materials and methods Data were abstracted from the EHR on adult ICU patients, including MRC-ICU scores and 2 traditional measures of pharmacist workload: numbers of medication orders verified and interventions logged. This was a single-center study of an EHR-integrated MRC-ICU tool. The primary outcome was the association of MRC-ICU with institutional metrics of pharmacist workload. Associations were assessed using the initial 24-h maximum MRC-ICU score’s Pearson’s correlation with overall admission workload and the day-to-day association using generalized linear mixed-effects modeling. Results A total of 1205 patients over 5083 patient-days were evaluated. Baseline MRC-ICU was correlated with both cumulative order volume (Spearman’s rho 0.41, P < .001) and cumulative interventions placed (Spearman’s rho 0.27, P < .001). A 1-point increase in maximum daily MRC-ICU was associated with a 31% increase in order volume (95% CI, 24%-38%) and 4% increase in interventions (95% CI, 2%-5%). Discussion and conclusion The MRC-ICU is a validated score that has been previously correlated with important patient-centered outcomes. Here, MRC-ICU was modestly associated with 2 traditional objective measures of pharmacist workload, including orders verified and interventions placed, which is an important step for its use as a tool for resource utilization needs.

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Section: Discussionmentioning

confidence: 99%

“…Further, the critical care pharmacist’s value to the team goes well beyond verifying medication orders. 21 Yet, both medication orders verified and interventions documented are readily quantifiable metrics that have historical importance in characterizing pharmacist activity and moreover are institutionally relevant.…”

Section: Discussionmentioning

confidence: 99%

The use of electronic health record embedded MRC-ICU as a metric for critical care pharmacist workload

Webb,

Carver,

Rowe

et al. 2023

JAMIA Open

View full text Add to dashboard Cite

show abstract

“…[19,20] The EHR has been used in a number of innovative ways to measure and quantify clinical pharmacist activity, but workload measurement generally revolves around discrete, pre-defined activities that are easily documented in the EHR. This may include electronic task lists for pharmacist-driven protocol to-do items, [21] documenting the depth of daily patient chart review, [22] or development of institution-specific scoring tools for complex medication regimens. [23] These tools allow for institutional tracking of pharmacist activities, but often, they do not correlate with pharmacist workload or patient severity of illness.…”

Section: Mrc-icu Demonstrated Modest Correlation With Interventions M...mentioning

confidence: 99%

The Use of Electronic Health Record Embedded MRC-ICU as a Metric for Critical Care Pharmacist Workload

Webb,

Carver,

Rowe

et al. 2023

Preprint

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ObjectiveA lack of pharmacist-specific risk-stratification scores in the electronic health record (EHR) may limit resource optimization. The medication regimen complexity-intensive care unit (MRC-ICU) score was implemented into our center’s EHR for use by clinical pharmacists. The purpose of this evaluation was to evaluate MRC-ICU as a predictor of pharmacist workload and to assess its potential as an additional dimension to traditional workload measures.MaterialsData were abstracted from the EHR on adult ICU patients, including MRC-ICU scores and two traditional measures of pharmacist workload: numbers of medication orders verified and interventions logged.MethodsThis was a single-center study of an EHR-integrated MRC-ICU tool. The primary outcome was the association of MRC-ICU with institutional metrics of pharmacist workload. Associations were assessed using the initial 24-hour maximum MRC-ICU score’s Pearson’s correlation with overall admission workload and the day-to-day association using generalized linear mixed-effects modeling.ResultsA total of 1,205 patients over 5,083 patient-days were evaluated. Baseline MRC-ICU was correlated with both cumulative order volume (Spearman’s rho 0.41, p < 0.001) and cumulative interventions placed (Spearman’s rho 0.27, p < 0.001). A one-point increase in maximum daily MRC-ICU was associated with 31% increase in order volume (95% CI 24-38%) and 4% increase in interventions (95% CI 2-5%).DiscussionThe MRC-ICU is a validated score that has been previously correlated with important patient-centered outcomes. Here, MRC-ICU was modestly associated with two traditional objective measures of pharmacist workload, including orders verified and interventions placed, which is an important step for its use as a tool for resource utilization needs.Lay SummaryMeasuring critical care clinical pharmacist workload is challenging because currently available metrics, including number of medication orders verified or medication interventions logged, do not capture the full breadth of work critical care pharmacists do. The medication regimen complexity-intensive care unit (MRC-ICU) score is a tool designed to quantify the complexity of an ICU patient’s medication regimen and may serve as an alternative measure of overall critical care pharmacist workload. In this study, we assessed whether MRC-ICU scores from 1,205 ICU patients admitted to a single academic medical center were correlated with traditional metrics used to assess pharmacist workload, including medication orders and documented interventions. MRC-ICU was correlated with both workflow measures and traditional measures of patient acuity and also was predictive of the next day’s workload, suggesting MRC-ICU could be explored as an additional tool to optimize critical care pharmacist resource utilization. Further studies should assess how MRC-ICU can be utilized to optimize critical care pharmacist workload.

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A descriptive report of the rapid implementation of automated MRC-ICU calculations in the EMR of an academic medical center

Webb

Rowe

Newsome

2022

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Numerous clinical scoring tools exist for a variety of patient populations and disease states, but few tools provide information specifically designed for use by critical care pharmacists. The medication regimen complexity intensive care unit (MRC-ICU) score was designed to provide high-level information about the complexity of critically ill patient’s medication regimens for use by critical care pharmacists. To date, implementation of this score in the electronic medical record (EMR) has not been reported. Summary Using an agile project management framework, the MRC-ICU score was rapidly implemented into an academic medical center’s EMR. The score automatically calculates on all critically ill patients and is available for critical care pharmacists to triage patient review in their individual workflow. Reporting capabilities of the score also allow for granular complexity trending over time and between units, supplementing other objective measures of pharmacist workload. Conclusion The MRC-ICU score can be quickly implemented into the EMR for pharmacist use in real time. Future investigations into how pharmacists utilize this information and how to harness reporting capabilities for pharmacist workload assessment are warranted.

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Optimizing pharmacist-driven protocols and documentation of interventions using clinical decision support systems

Cited by 3 publications

References 7 publications

The use of electronic health record embedded MRC-ICU as a metric for critical care pharmacist workload

The use of electronic health record embedded MRC-ICU as a metric for critical care pharmacist workload

The Use of Electronic Health Record Embedded MRC-ICU as a Metric for Critical Care Pharmacist Workload

A descriptive report of the rapid implementation of automated MRC-ICU calculations in the EMR of an academic medical center

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