Rethinking justifications for critical care pharmacist positions: Translating bedside evidence to the C-suite

Forehand, Christy; Keats, Kelli; Amerine, Lindsey B.; Newsome, Andrea Sikora

doi:10.1093/ajhp/zxad122

American Journal of Health-System Pharmacy

2023

DOI: 10.1093/ajhp/zxad122

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Rethinking justifications for critical care pharmacist positions: Translating bedside evidence to the C-suite

Christy Forehand

Kelli Keats

Lindsey B. Amerine³

et al.

Abstract: 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.

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Cited by 3 publications

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“…Pediatric pharmacists have been reported to perform 21 interventions per day, preventing nearly all medication order errors from reaching patients ( 9 , 23 ). Given pharmacists are typically not revenue-generating, cost-to-benefit ratios may be useful in describing potential benefits ( 24 ). Although recent data in the adult critical care and emergency medicine setting have noted an annualized monetary benefit-to-cost ratio to be upward of 10.6:1, data specific to pediatric pharmacists in the ICU and ED settings are lacking ( 13 – 16 ).…”

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confidence: 99%

Pharmacist Avoidance or Reductions in Medical Costs in Critically and Emergently Ill Pediatrics: PHARM-PEDS Study

Kiskaddon,

Smith,

Gilliland

et al. 2023

Critical Care Explorations

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OBJECTIVES: To comprehensively classify interventions performed by pediatric critical care clinical pharmacists and quantify cost avoidance (CA) generated through their accepted interventions. DESIGN: A multicenter, prospective, observational study performed between August 2018 and January 2019. SETTING: Academic and community hospitals in the United States with pediatric critical care units. SUBJECTS: Pediatric clinical pharmacists. INTERVENTIONS: Pharmacist recommendations were classified into one of 38 total intervention categories associated with CA. MEASUREMENTS AND MAIN RESULTS: Nineteen pediatric pharmacists at five centers documented 1,458 accepted interventions during 112 shifts on 861 critically ill pediatric patients. This calculated to an associated CA of $450,590. The accepted interventions and associated CA in the six established categories included as follows: adverse drug event prevention (155 interventions, $118,901 CA), resource utilization (267 interventions; $59,020), individualization of patient care (898 interventions, $217,949 CA), prophylaxis (8 interventions, $453 CA), hands-on care (30 interventions, $35,509 CA), and administrative/supportive tasks (108 interventions, $18,758 CA). The average associated CA was $309 per accepted intervention, $523 per patient day, and $4,023.13 per pediatric clinical pharmacist shift. The calculated potential annualized CA of accepted interventions from a pediatric pharmacist was $965,550, resulting in a potential monetary-associated CA-to-pharmacist salary ratio between $1.5:1 and $5.2:1. CONCLUSIONS: There is potential for significant avoidance of healthcare costs when pediatric pharmacists are involved in the care of critically and emergently ill pediatric patients, with a monetary potential CA-to-pediatric pharmacist salary ratio to be between $1.5:1 and $5.2:1.

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confidence: 99%

Pharmacist Avoidance or Reductions in Medical Costs in Critically and Emergently Ill Pediatrics: PHARM-PEDS Study

Kiskaddon,

Smith,

Gilliland

et al. 2023

Critical Care Explorations

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Defining the “ideal state”: A primer on critical care pharmacy practice models

Smith,

Nei

2024

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 Critical care pharmacists (CCPs) have been clearly established as value-added members of the interprofessional team, and their contributions positively impact patient outcomes in the intensive care unit (ICU). Despite this, not every critically ill patient in the US receives care from a CCP and the model through which CCPs practice is variable, which has important implications. The purpose of this primer is to review current CCP models and discuss elements of the optimal CCP practice model. Summary Current CCP practice models are defined, including the drug processing and dispensing model, clinical pharmacy specialist model, integrated pharmacy generalist model, and hybrid model, as well as unit-based vs service-based models. The optimal CCP practice model considers the Triple Domain of CCP workload, which includes direct patient care, indirect patient care, and professional service. Elements of the ideal CCP practice model including 24/7/365 CCP services, unit- vs service-based models, prescriptive authority, operational support, and CCP-to-patient ratio are discussed. Other vital elements include protected offline time, use of appropriate workload metrics, development of career ladders, opportunities for professional development, and providing wellness resources. The ideal CCP practice model must also be considered through the lens of the patient and medical team, the CCP, the institution, and professional organizations. Strategies for optimizing current CCP practice models are provided, and application of optimal CCP practice model elements is explored through 5 case studies. Conclusion The optimal CCP practice model includes multiple elements and incorporates the viewpoints of patients, providers, CCPs, institutions, and professional organizations; this model will increase access of all ICU patients to CCPs, enhance the scope of CCP cognitive services, and ensure the economic sustainability of CCP practice while establishing CCP involvement in activities outside of patient care and in professional service.

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From symptoms to solutions: A structured approach to alleviating burnout among critical care pharmacists

Reed

2024

American Journal of Health-System Pharmacy

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Rethinking justifications for critical care pharmacist positions: Translating bedside evidence to the C-suite

Cited by 3 publications

References 17 publications

Pharmacist Avoidance or Reductions in Medical Costs in Critically and Emergently Ill Pediatrics: PHARM-PEDS Study

Pharmacist Avoidance or Reductions in Medical Costs in Critically and Emergently Ill Pediatrics: PHARM-PEDS Study

Defining the “ideal state”: A primer on critical care pharmacy practice models

From symptoms to solutions: A structured approach to alleviating burnout among critical care pharmacists

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