Position Paper on Critical Care Pharmacy Services (Executive Summary): 2020 Update

Abstract

Objectives: Provide a multiorganizational statement to update the statement from a paper in 2000 about critical care pharmacy practice and makes recommendations for future practice. Design: The 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 Results: There 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. Conclusions: The 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.

Development and application of quality measures of clinical pharmacist services provided in inpatient/acute care settings

“…25,26 Examples provided in Table 3 are not all-encompassing, are not implied as the most critical or important, and are not intended to supplant previously created collections of activities and measures within specialty areas of practice. 3,4,23,27 For context, the term medication therapy problem (MTP) is defined as an event or circumstance involving pharmacotherapy that interferes with optimal patient care. 28 Further classifications and subclassifications of MTPs are presented in Figure 2.…”

“…22 Reasons for this vari- with the goal of achieving standardization. 3,4,23,38,41,42 However, much work still needs to be done to implement clinical pharmacy practice standardization within and between institutions and organizations.…”

“…Although a reduction in indirect costs or cost avoidance may result from the prevention of adverse drug events in some cases, cost was only mapped to the core quality measure if it was associated with a reduction in direct costs 25,26 . Examples provided in Table 3 are not all‐encompassing, are not implied as the most critical or important, and are not intended to supplant previously created collections of activities and measures within specialty areas of practice 3,4,23,27 …”

“…In recent years, health care has been evolving from a fee‐for‐service to a value‐based care model, with large payers like the Centers for Medicare & Medicaid Services (CMS) placing greater emphasis on quality of care 1 . In this evolution, a focus has emerged on interprofessional team‐based care with clinical pharmacists increasingly integrated as essential members of the health care team in a variety of clinical disciplines 2‐6 . Similarly, within interprofessional teams and health systems, stakeholders increasingly expect pharmacists to be accountable for medication‐related outcomes and the medication use system through the provision of clinical pharmacy services, including comprehensive medication management (CMM).…”

Usefulness of the Biomarker TIMP-2•IGFBP7 for Acute Kidney Injury Assessment in Critically Ill Patients: A Narrative Review

“…Additionally, the weekly assessment of medications by a pharmacist is not considered standard of care, regardless of setting, according to a position paper promulgated by the Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Pharmacy and Research Network, and the American Society of Health-Systems Pharmacists. 29 An additional follow-up investigation of SAPPHIRE and TOPAZ evaluated the effects of common comorbid disease states on the predictive ability of the biomarker. 30 Of the various disease states investigated, including coronary artery disease, chronic obstructive pulmonary disease, hypertension, and diabetes, the only significant differences seen in patients with or without the disease states were noted for congestive heart failure (AUC = 0.89 vs AUC = 0.79, respectively; P = 0.026) and CKD (AUC = 0.91 vs AUC = 0.80; P = 0.024).…”