Position paper on critical care pharmacy services (executive summary): 2020 update

Abstract

ObjectivesTo provide a multiorganizational statement to update the statement from a paper in 2000 about critical care pharmacy practice and makes recommendations for future practice.DesignThe Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health‐Systems Pharmacists convened a joint task force of 15 pharmacists representing a broad cross‐section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (>66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting, and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development.Main resultsThere are 82 recommendation statements: forty‐four original recommendations and 38 new recommendation statements. Thirty‐four recommendations were made for patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations are in the domain of training and education and eight recommendations regarding professional development.ConclusionsThe statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.

Critical care pharmacists have a rich history and evolving roles

“…While no bibliography can ever be complete, there are influential citations provided in Table 1. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] As understanding of medications and therapeutics evolves and grows, so does the role of the pharmacist. Routine clinical integration of personalized medicine knowledge with consistent application remains a challenge, despite a growing body of resources.…”

“…Leadership and project management skills are needed to maximize opportunities for programmatic expansion T A B L E 1 Selected Landmark Publications in the Evolution of Critical Care Pharmacy. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] and assessment of economic and patient care outcomes. Knowledge of optimal resource utilization is needed along with the ability to influence quality measures used internally and externally (e.g.…”

“…In time, specialty pharmacy interest groups emerged. Validation of CC pharmacy as a specialty occurred at or near the beginning of the new millennium in several landmark publications listed in Table 1 1–20 . Other notable articles defined the scope of pharmacy practice within ICUs, and provided documentation of the added value of pharmacists as members of the multidisciplinary ICU team (i.e., reduced mortality, shorter length of ICU stay, reduced adverse drug events (ADE), lower costs, etc.).…”

“…Progress in pharmacist roles has been documented and can be categorized under the domains of practice, research, administration, and education. While no bibliography can ever be complete, there are influential citations provided in Table 1 1–20 . As understanding of medications and therapeutics evolves and grows, so does the role of the pharmacist.…”

“…Validation of CC pharmacy as a specialty occurred at or near the beginning of the new millennium in several landmark publications listed in Table 1. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Other notable articles defined the scope of pharmacy practice within ICUs, and provided documentation of the added value of pharmacists as members of the multidisciplinary ICU team (i.e., reduced mortality, shorter length of ICU stay, reduced adverse drug events (ADE), lower costs, etc.). Pharmacists are also widely recognized within the CC specialty as evidenced by the awarding of fellow and/or master status within ACCM, ACCP, and NCS and the receipt of numerous prestigious awards from these organizations.…”