Position Paper on Critical Care Pharmacy Services: 2020 Update

Abstract

Objectives: To provide a multiorganizational statement to update recommendations for critical care pharmacy practice and make recommendations for future practice. A position paper outlining critical care pharmacist activities was last published in 2000. Since that time, significant changes in healthcare and critical care have occurred. 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: 44 original recommendations and 38 new recommendation statements. Thirty-four recommendations represent the domain of 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 were made in the domain of training and education and eight recommendations regarding professional development. Conclusions: Critical care pharmacists are essential members of the multiprofessional critical care team. 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.

Examination of critical care pharmacist work activities and burnout

“…In contrast, desirable critical care pharmacist activities include documenting interventions, rounding with a multidisciplinary team, and reviewing medication histories. These activities may require less creativity and receive less recognition and may become mundane and/or tedious, leading to feelings of burnout; however, these activities are absolutely essential for the delivery of high‐quality patient care 6,27 . As such, evaluation of pharmacist‐to‐patient ratio, which multiplies the percentage of time doing these tasks, and strategies to offload these tasks (eg, pharmacist extenders) is necessary.…”

“…Lastly, the ACCP/SCCM position paper on critical care pharmacist services was updated in 2020, shortly after the present survey was distributed, by SCCM, the ACCP Critical Care PRN, and the American Society of Health‐Systems Pharmacists 6 . Statements from the original position statement were voted on to retain, revise, or retire, and recommendations were then categorized by level of ICU and were grouped into five domains comprising patient care, quality improvement, research and scholarship, training and education, and professional development.…”

“…In 2000, the Society of Critical Care Medicine (SCCM) and the American College of Clinical Pharmacy (ACCP) published a joint position statement defining fundamental (eg, evaluates drug therapy for safety and effectiveness), desirable (eg, rounds as a member of the multidisciplinary critical care team), and optimal (eg, teaches advanced cardiovascular life support) activities for critical care pharmacists 5 . This statement was updated in 2020 6 …”

Clinicians' experiences and reflections from a health system cyberattack

“…They have defined roles endorsed by pharmacy and medical associations and are supported by documented improvements in clinical and economic outcomes. 11 Patient care rounds, interprofessional care collaboration, and comprehensive medication management are outlined as foundational activities. Participation in these daily activities positioned the pharmacist ideally for communication and interaction with the team to recognize and resolve issues during the cyberattack.…”

Prescribing and documentation by critical care clinical pharmacy specialists with around‐the‐clock staffing: A single‐center evaluation

“…Although many benefits of critical care pharmacists are known, limited data are available regarding pharmacist prescribing and documentation, ideal pharmacist staffing, or timing of clinical pharmacy activities in the ICU. Based on the level of care provided in an ICU, comprehensive medication management (CMM) and around‐the‐clock availability are considered essential or desirable activities of critical care pharmacists 6 . While prescribing may be considered a component of CMM, specific recommendations for critical care pharmacist prescribing are lacking.…”