Response to Haas et al

Smith, Susan E.; Murray, Brian; Sikora, Andrea

doi:10.1093/ajhp/zxac067

Cited by 2 publications

(3 citation statements)

References 25 publications

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“…While intervention counting captures many direct patient care activities (e.g., renal dose adjustments), it does not capture the myriad of indirect activities critical care pharmacists perform (e.g., developing treatment protocols) (4, 28). Further, tying “value” to these interventions is prone to significant limitations and debate among experts (29–33). Thus, intervention counting not only does not entirely capture what a pharmacist does but also does so relatively poorly, and for these reasons, pure intervention counting is colloquially termed “widget counting,“ to denote its somewhat ineffective nature (5).…”

Section: Discussionmentioning

confidence: 99%

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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*

Sikora

Ayyala

Rech

et al. 2022

Critical Care Medicine

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OBJECTIVES: Despite the established role of the critical care pharmacist on the ICU multiprofessional team, critical care pharmacist workloads are likely not optimized in the ICU. Medication regimen complexity (as measured by the Medication Regimen Complexity-ICU [MRC-ICU] scoring tool) has been proposed as a potential metric to optimize critical care pharmacist workload but has lacked robust external validation. The purpose of this study was to test the hypothesis that MRC-ICU is related to both patient outcomes and pharmacist interventions in a diverse ICU population. DESIGN: This was a multicenter, observational cohort study. SETTING: Twenty-eight ICUs in the United States. PATIENTS: Adult ICU patients. INTERVENTIONS: Critical care pharmacist interventions (quantity and type) on the medication regimens of critically ill patients over a 4-week period were prospectively captured. MRC-ICU and patient outcomes (i.e., mortality and length of stay [LOS]) were recorded retrospectively. MEASUREMENTS AND MAIN RESULTS:A total of 3,908 patients at 28 centers were included. Following analysis of variance, MRC-ICU was significantly associated with mortality (odds ratio, 1.09; 95% CI, 1.08-1.11; p < 0.01), ICU LOS (β coefficient, 0.41; 95% CI, 00.37-0.45; p < 0.01), total pharmacist interventions (β coefficient, 0.07; 95% CI, 0.04-0.09; p < 0.01), and a composite intensity score of pharmacist interventions (β coefficient, 0.19; 95% CI, 0.11-0.28; p < 0.01). In multivariable regression analysis, increased patient: pharmacist ratio (indicating more patients per clinician) was significantly associated with increased ICU LOS (β coefficient, 0.02; 0.00-0.04; p = 0.02) and reduced quantity (β coefficient, -0.03; 95% CI, -0.04 to -0.02; p < 0.01) and intensity of interventions (β coefficient, -0.05; 95% CI, -0.09 to -0.01). CONCLUSIONS:Increased medication regimen complexity, defined by the MRC-ICU, is associated with increased mortality, LOS, intervention quantity, and intervention intensity. Further, these results suggest that increased pharmacist workload is associated with decreased care provided and worsened patient outcomes, which warrants further exploration into staffing models and patient outcomes.

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Section: Discussionmentioning

confidence: 99%

“…To date, robust analysis of critical care pharmacist practice has been limited by the "before-after" design of studies (34)(35)(36)(37)(38). Indeed, most every study evaluating the value a pharmacist brings compares one pharmacist to zero pharmacists and observes improvement in outcomes.…”

Section: Discussionmentioning

confidence: 99%

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*

Sikora

Ayyala

Rech

et al. 2022

Critical Care Medicine

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show abstract

“…These metrics must bridge the administrator‐clinician chasm. As such, they must be objective, reproducible, and related to hard outcomes (e.g., mortality, length of stay), but they also must reflect what the clinician truly does at the bedside to improve care (i.e., “A pharmacist is an agent of patient care, not a productivity unit”) 6,38 . Clinician‐oriented dashboards that include metrics reflective of the Triple Domain may set a foundation for future meaningful evaluation of models 39 …”

Section: Elements Of the Ideal Critical Care Pharmacist Practice Modelmentioning

confidence: 99%

Critical care pharmacy: Our next 30 years

Newsome

2023

J Am Coll Clin Pharm

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Response to Haas et al

Cited by 2 publications

References 25 publications

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*

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*

Critical care pharmacy: Our next 30 years

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