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Davis H, Tseng S, Chua W. Oncology Intensive Care Units: Distinguishing Features and Clinical Considerations. J Intensive Care Med 2024:8850666241268857. [PMID: 39175394 DOI: 10.1177/08850666241268857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
The rapidly advancing field of cancer therapeutics has led to increased longevity among cancer patients as well as increasing complexity of cancer-related illness and associated comorbid conditions. As a result, institutions and organizations that specialize in the in-patient care of cancer patients have similarly evolved to meet the constantly changing needs of this unique patient population. Within these institutions, the intensive care units that specialize in the care of critically ill cancer patients represent an especially unique clinical resource. This article explores some of the defining and distinguishing characteristics associated with oncology ICUs.
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Affiliation(s)
- Hugh Davis
- Division of Pulmonary and Critical Care, City of Hope National Medical Center, Duarte, USA
| | - Steve Tseng
- Division of Pulmonary and Critical Care, City of Hope National Medical Center, Duarte, USA
| | - Weijia Chua
- Division of Pulmonary and Critical Care, Cedars Sinai Medical Center, Los Angeles, USA
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Remmington C, Cameron L, Hanks F, Liang YH, Barrow L, Coxhead R, Mehta R, Bhudia N, Lyster H, Cooke S, Gilmartin J, Lee P, Sloss R, McKenzie C. Critical care pharmacy service provision and workforce in adult extracorporeal membrane oxygenation centres: a multicentre cross-sectional survey. Int J Clin Pharm 2024; 46:854-861. [PMID: 38551749 DOI: 10.1007/s11096-024-01719-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/27/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND There is good evidence describing pharmacy workforce and service provision in general critical care units. However, no data exist from adult extracorporeal membrane oxygenation (ECMO) centres. AIM To describe workforce characteristics, pharmacy service provision, and pharmaceutical care activities in critical care units (CCUs) providing an adult ECMO service in the United Kingdom (UK) and compare to national staffing standards for CCUs. METHOD We conducted a multicentre, cross-sectional electronic survey inviting one pharmacy professional response per UK ECMO centre. We collated information on workforce, service provision, and pharmaceutical care activities provided by pharmacy teams in adult CCUs with an ECMO service. RESULTS The survey response rate was 90.9%: representatives of 10/11 tertiary hospitals providing ECMO services responded. Median critical care pharmacist to critical care bed was 1:12.1 (IQR: 1:9.4-1:14.9). Most centres (90.0%) did not meet national standards for pharmacy professionals to critical care bed staffing ratios for weekday services. Total critical care beds covered by the critical care pharmacy team varied across the UK: median (IQR) - 45 (37-80) beds. Two centres funded pharmacist time for ECMO activity, and one centre funded a pharmacy technician post. Median peak ECMO activity was 4 ECMO patients in a single day (IQR: 3-5). Most respondents reported reduced pharmacy service at weekends compared to weekday, with limited on-site support. CONCLUSION Most responding ECMO centres in the UK reported pharmacy staffing ratios below nationally agreed critical care standards. There was high variability in clinical pharmacy services to ECMO patients over 7 days.
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Affiliation(s)
- Christopher Remmington
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK.
| | - Lynda Cameron
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Fraser Hanks
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Ya-Hui Liang
- Pharmacy Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Linda Barrow
- Pharmacy Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Ruth Coxhead
- Pharmacy Department, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Reena Mehta
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Pharmacy Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Nisha Bhudia
- Pharmacy Department, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas, NHS Foundation Trust, London, UK
| | - Haifa Lyster
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Pharmacy Department, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas, NHS Foundation Trust, London, UK
| | - Sarah Cooke
- Pharmacy Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - James Gilmartin
- Pharmacy Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Phillisa Lee
- Pharmacy Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rhona Sloss
- Pharmacy Department, Barts Health NHS Trust, London, UK
| | - Cathrine McKenzie
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Department of Pharmacy and Critical Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Medicine, University of Southampton, National Institute for Health and Care Research (NIHR), Biomedical Research Centre, Perioperative, and Pharmacy and Critical Care, Southampton and NIHR Wessex Applied Research Collaborative (ARC), Southampton, UK
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Buetti N, Tabah A, Setti N, Ruckly S, Barbier F, Akova M, Aslan AT, Leone M, Bassetti M, Morris AC, Arvaniti K, Paiva JA, Ferrer R, Qiu H, Montrucchio G, Cortegiani A, Kayaaslan B, De Bus L, De Waele JJ, Timsit JF. The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections. Intensive Care Med 2024; 50:873-889. [PMID: 38498170 PMCID: PMC11164726 DOI: 10.1007/s00134-024-07348-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/05/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE The primary objective of this study was to evaluate the associations between centre/country-based factors and two important process and outcome indicators in patients with hospital-acquired bloodstream infections (HABSI). METHODS We used data on HABSI from the prospective EUROBACT-2 study to evaluate the associations between centre/country factors on a process or an outcome indicator: adequacy of antimicrobial therapy within the first 24 h or 28-day mortality, respectively. Mixed logistical models with clustering by centre identified factors associated with both indicators. RESULTS Two thousand two hundred nine patients from two hundred one intensive care units (ICUs) were included in forty-seven countries. Overall, 51% (n = 1128) of patients received an adequate antimicrobial therapy and the 28-day mortality was 38% (n = 839). The availability of therapeutic drug monitoring (TDM) for aminoglycosides everyday [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.03-2.14] or within a few hours (OR 1.79, 95% CI 1.34-2.38), surveillance cultures for multidrug-resistant organism carriage performed weekly (OR 1.45, 95% CI 1.09-1.93), and increasing Human Development Index (HDI) values were associated with adequate antimicrobial therapy. The presence of intermediate care beds (OR 0.63, 95% CI 0.47-0.84), TDM for aminoglycoside available everyday (OR 0.66, 95% CI 0.44-1.00) or within a few hours (OR 0.51, 95% CI 0.37-0.70), 24/7 consultation of clinical pharmacists (OR 0.67, 95% CI 0.47-0.95), percentage of vancomycin-resistant enterococci (VRE) between 10% and 25% in the ICU (OR 1.67, 95% CI 1.00-2.80), and decreasing HDI values were associated with 28-day mortality. CONCLUSION Centre/country factors should be targeted for future interventions to improve management strategies and outcome of HABSI in ICU patients.
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Affiliation(s)
- Niccolò Buetti
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Centre, Geneva, Switzerland.
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France.
| | - Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia
- Queensland Critical Care Research Network (QCCRN), Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Nour Setti
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
| | - Stéphane Ruckly
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
- Biostatistic Department, Outcomerea, 93700, Drancy, France
| | - François Barbier
- Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, 14, Avenue de L'Hôpital, 45000, Orléans, France
- Institut Maurice Rapin, Hôpital Henri Mondor, Créteil, France
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Abdullah Tarik Aslan
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
- Division of Immunology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, Cb2 1QP, UK
- JVF Intensive Care Unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - José-Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário Sao Joao, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Infection and Sepsis ID Group, Porto, Portugal
| | - Ricard Ferrer
- Intensive Care Department, SODIR-VHIR Research Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Nanjing Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Giorgia Montrucchio
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza University Hospital, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, University of Palermo, Via del Vespro129, 90127, Palermo, Italy
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Liesbet De Bus
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jan J De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jean-François Timsit
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75877, Paris Cedex, France
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Porth J, Ajouri J, Kleinlein M, Höckel M, Elke G, Meybohm P, Culmsee C, Muellenbach RM. [Application and control of intravenous fluids in German intensive care units : A national survey among critical care physicians]. DIE ANAESTHESIOLOGIE 2024; 73:85-92. [PMID: 38289347 DOI: 10.1007/s00101-024-01379-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/06/2023] [Accepted: 12/25/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND The administration of intravenous fluids includes various indications, e.g., fluid replacement, nutritional therapy or as a solvent for drugs and is a common routine in the intensive care unit (ICU); however, overuse of intravenous fluids can lead to fluid overload, which can be associated with a poorer outcome in critically ill patients. OBJECTIVE The aim of this survey was to find out the current status of the use and management of intravenous fluids as well as the interprofessional cooperation involving clinical pharmacists on German ICUs. METHODS An online survey with 33 questions was developed. The answers of 62 participants from the Scientific Working Group on Intensive Care Medicine of the German Society for Anesthesiology and Intensive Care Medicine were evaluated. RESULTS Fluid overload occurs "frequently" in 62.9% (39/62) and "very frequently" in 9.7% (6/62) of the ICUs of respondents. An established standard for an infusion management system is unknown to 71.0% (44/62) of participants and 45.2% of the respondents stated that they did not have a patient data management system. In addition, the participants indicated how they define fluid overload. This was defined by the presence of edema by 50.9% (28/55) and by positive fluid balance by 30.9% (17/55). According to the participants septic patients (38/60; 63.3%) and cardiological/cardiac surgical patients (26/60; 43.3%) are most susceptible to the occurrence of fluid overload. Interprofessional collaboration among intensive care physicians, critical care nurses, and clinical pharmacists to optimize fluid therapy was described as "relevant" by 38.7% (24/62) and "very relevant" by 45.2% (28/62). Participants with clinical pharmacists on the wards (24/62; 38.7%) answered this question more often as "very relevant" with 62.5% (15/24). CONCLUSION Fluid overload is a frequent and relevant problem in German intensive care units. Yet there are few established standards in this area. There is also a lack of validated diagnostic parameters and a clear definition of fluid overload. These are required to ensure appropriate and effective treatment that is tailored to the patient and adapted to the respective situation. Intravenous fluids should be considered as drugs that may exert side effects or can be overdosed with severe adverse consequences for the patients. One approach to optimize fluid therapy could be achieved by a fluid stewardship corresponding to comparable established procedures of the antibiotic stewardship. In particular, fluid stewardship will contribute to drug safety of intravenous fluids profiting from joined expertise in a setting of interprofessional collaboration. An important principle of fluid stewardship is to consider intravenous fluids in the same way as medication in terms of their importance. Furthermore, more in-depth studies are needed to investigate the effects of interprofessional fluid stewardship in a prospective and controlled manner.
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Affiliation(s)
- J Porth
- Zentralbereich Apotheke im Klinikum Kassel, Gesundheit Nordhessen Holding AG, Kassel, Deutschland
- Institut für Pharmakologie und Klinische Pharmazie, Phillips Universität Marburg, Marburg, Deutschland
| | - J Ajouri
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Kassel, Kassel, Deutschland
| | - M Kleinlein
- Zentralbereich Apotheke im Klinikum Kassel, Gesundheit Nordhessen Holding AG, Kassel, Deutschland
| | - M Höckel
- Zentralbereich Apotheke im Klinikum Kassel, Gesundheit Nordhessen Holding AG, Kassel, Deutschland
| | - G Elke
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - P Meybohm
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - C Culmsee
- Institut für Pharmakologie und Klinische Pharmazie, Phillips Universität Marburg, Marburg, Deutschland
| | - R M Muellenbach
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Kassel, Kassel, Deutschland.
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Fedkiv V, Delic J, Hollands JM, Pasciolla S, Pontiggia L, Bingham AL. Prevalence and Value of Board Certification Among Pharmacy Practice Faculty in the United States. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100623. [PMID: 37951575 DOI: 10.1016/j.ajpe.2023.100623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 10/29/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To determine the prevalence of board certification among pharmacy practice faculty in the United States, motivators and barriers to certification, and association between board certification and professional achievements and accomplishments that may support career advancement. METHODS In phase I, the prevalence of board-certified pharmacy practice faculty in the United States was determined by cross-referencing lists of faculty and board-certified pharmacists. In phase II, faculty were stratified by rank and invited to participate in a survey regarding professional characteristics, motivators and barriers to board certification, and professional achievements and accomplishments that may support career advancement for pharmacy practice faculty. RESULTS The prevalence of board certification among the 3276 pharmacy practice faculty was 56%. The prevalence was the highest among assistant professors (61%). A total of 746 faculty completed the survey (33% response rate). Of those respondents, 73% reported being currently certified, 23% never certified, and 4% previously certified. Overall, to be recognized as an expert in the field was identified as the most commonly perceived reason faculty obtain board certification (44%). Currently and previously certified faculty ranked the desire to be recognized as an expert in the field as the most common reason they obtained board certification (61%). There was a positive correlation between board certification and certain professional accomplishments. CONCLUSION The prevalence of board-certified pharmacy practice faculty has increased since 2011, but motivators and barriers for board certification remain similar. Board certification may support career advancement for pharmacy practice faculty.
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Affiliation(s)
- Volodymyra Fedkiv
- Saint Francis Hospital, Department of Pharmacy, Wilmington, DE, USA.
| | - Justin Delic
- Cooper University Health Care, Department of Pharmacy, Camden, NJ, USA
| | - James M Hollands
- Saint Joseph's University, Philadelphia College of Pharmacy, Department of Pharmacy Practice, Philadelphia, PA, USA
| | - Stacy Pasciolla
- Saint Joseph's University, Philadelphia College of Pharmacy, Department of Pharmacy Practice, Philadelphia, PA, USA
| | - Laura Pontiggia
- Thomas Jefferson University, College of Health Professions, Philadelphia, PA, USA
| | - Angela L Bingham
- Saint Joseph's University, Philadelphia College of Pharmacy, Department of Pharmacy Practice, Philadelphia, PA, USA
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Crosby A, Jennings JK, Mills AT, Silcock J, Bourne RS. Economic evaluations of adult critical care pharmacy services: a scoping review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:574-584. [PMID: 37607337 DOI: 10.1093/ijpp/riad049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 07/05/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES To summarise the extent and type of evidence available regarding economic evaluations of adult critical care pharmacy services in the context of UK practice. METHODS A literature search was conducted in eight electronic databases and hand searching of full-text reference lists. Of 2409 journal articles initially identified, 38 were included in the final review. Independent literature review was undertaken by two investigators in a two-step process against the inclusion and exclusion criteria; title and abstract screening were followed by full-text screening. Included studies were taken from high-income economy countries that contained economic data evaluating any key aspect of adult critical care pharmacy services. Grey literature and studies that could not be translated into the English language were excluded. RESULTS The majority were before-and-after studies (18, 47%) or other observational studies (17, 45%), and conducted in North America (25, 66%). None of the included studies were undertaken in the UK. Seven studies (18%) included cost-benefit analysis; all demonstrated positive cost-benefit values for clinical pharmacist activities. CONCLUSIONS Further high-quality primary research focussing on the economic evaluation of UK adult critical care pharmacy services is needed, before undertaking a future systematic review. There is an indication of a cost-benefit value for critical care pharmacist activities. The lack of UK-based economic evaluations is a limitation to further development and standardisation of critical care pharmacy services nationally.
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Affiliation(s)
- Alex Crosby
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jennifer K Jennings
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Anna T Mills
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jonathan Silcock
- Faculty of Life Sciences, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Richard S Bourne
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK
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Gu H, Sun L, Sheng B, Gu X, Wang S, Liu L, Dai B, Chen W. Benefits of pharmacist intervention in the critical care patients with infectious diseases: A propensity score matching retrospective cohort study. Aust Crit Care 2023; 36:933-939. [PMID: 36809868 DOI: 10.1016/j.aucc.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND The importance of optimising antimicrobial therapy is highlighted in the hospital intensive care unit (ICU) patients. But roles of ICU pharmacists are still in its infancy in China. OBJECTIVES This study's objective was to evaluate the values of clinical pharmacist interventions in the antimicrobial stewardship (AMS) on ICU patients with infections. AIM The aim of this study was to evaluate the value of clinical pharmacist interventions in the antimicrobial stewardship (AMS) in critically ill patients with infections. METHODS From 2017 to 2019, a propensity score matching retrospective cohort research was conducted on critically ill patients with infectious illnesses. The trial was split into groups that received pharmacist assistance and those who did not. Baseline demographics, pharmacist actions, and clinical results were compared between the two groups. Factors influencing mortality were demonstrated using univariate analysis and bivariate logistic regression. The State Administration of Foreign Exchange in China monitored the exchange rate between the RMB and the US dollar and also gathered the charges of the agents as an economic indicator. RESULTS Out of the 1523 patients who were evaluated, 102 critically ill patients with infectious diseases were included in each group after matching. The top five prescription regimens adjusted were settled by sickness progression, microbiological results, de-escalation, drug withdrawal, and therapeutic drug monitoring suggestions. The pharmacist exposure group's antibiotic use density (AUD) decreased significantly (p = 0.018) compared to the control group, going from 241.91 to 176.64 defined daily doses/100 bed days. Following pharmacist interventions, the AUD proportion for carbapenems dropped from 23.7 to 14.43%, while for tetracyclines, it dropped from 11.5 to 6.26%. In the group exposed to the pharmacist, the median cost of antibiotics decreased significantly from $836.3 to $362.15 per patient stay (p < 0.001), and the median cost of all medications dropped from $2868.18 to $1941.5 per patient stay (p = 0.06). RMB was converted into US dollars according to the current exchange rate. According to univariate analyses, pharmacist interventions did not differ between the groups that survived and died (p = 0.288). CONCLUSIONS This study showed that antimicrobial stewardship had a significant financial return on investment without raising the mortality rate.
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Affiliation(s)
- Hongyan Gu
- Pharmacy Department, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China; Beijing Key Laboratory of Bio-Characteristic Profiling for Evaluation of Rational Drug Use, Beijing 100038, China; International Cooperation & Joint Laboratory of Bio-Characteristic Profiling for Evaluation of Rational Drug Use, Beijing 100038, China
| | - Lulu Sun
- Pharmacy Department, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Bo Sheng
- Department of Critical Care Medicine, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Xuyun Gu
- Department of Critical Care Medicine, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Suozhu Wang
- Department of Critical Care Medicine, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Lei Liu
- Office of Academic Research, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Bin Dai
- Neurosurgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Wei Chen
- Department of Critical Care Medicine, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China.
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Chander S, Kumari R, Sadarat F, Luhana S. The Evolution and Future of Intensive Care Management in the Era of Telecritical Care and Artificial Intelligence. Curr Probl Cardiol 2023; 48:101805. [PMID: 37209793 DOI: 10.1016/j.cpcardiol.2023.101805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
Critical care practice has been embodied in the healthcare system since the institutionalization of intensive care units (ICUs) in the late '50s. Over time, this sector has experienced many changes and improvements in providing immediate and dedicated healthcare as patients requiring intensive care are often frail and critically ill with high mortality and morbidity rates. These changes were aided by innovations in diagnostic, therapeutic, and monitoring technologies, as well as the implementation of evidence-based guidelines and organizational structures within the ICU. In this review, we examine these changes in intensive care management over the past 40 years and their impact on the quality of care available to patients. Moreover, the current state of intensive care management is characterized by a multidisciplinary approach and the use of innovative technologies and research databases. Advancements such as telecritical care and artificial intelligence are being increasingly explored, especially since the COVID-19 pandemic, to reduce the length of hospitalization and ICU mortality. With these advancements in intensive care and ever-changing patient needs, critical care experts, hospital managers, and policymakers must also explore appropriate organizational structures and future enhancements within the ICU.
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Affiliation(s)
- Subhash Chander
- Department of Internal Medicine, Mount Sinai Beth Israel Hospital, New York, NY.
| | - Roopa Kumari
- Department of Internal Medicine, Mount Sinai Morningside and West, New York, NY
| | - Fnu Sadarat
- Department of Internal Medicine, University of Buffalo, NY, USA
| | - Sindhu Luhana
- Department of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Yu J, Liu Y, Qu R, Wang Z, Zhao Y, Zhao Y, Zhou C. Evaluation of a clinical pharmacist-led antimicrobial stewardship program in a neurosurgical intensive care unit: a pre-and post-intervention cohort study. Front Pharmacol 2023; 14:1263618. [PMID: 37808195 PMCID: PMC10556657 DOI: 10.3389/fphar.2023.1263618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
Background: Antimicrobial resistance poses a significant challenge in neurosurgical intensive care units (ICU). The excessive use of broad-spectrum antibiotics is closely linked to the emergence and dissemination of drug-resistant bacteria within neurosurgical ICUs. This study assessed the effects of implementing a comprehensive Antimicrobial Stewardship (AMS) program in a neurosurgical ICU setting. Methods: From April 2022 to September 2022, an AMS program was implemented in the neurosurgical ICU. The program involved the regular presence of a pharmacist and an infectious disease physician who conducted prospective audits and provided feedback. To assess the impact of the AMS program, the outcome measures were compared between the AMS period and the 6 months before AMS implementation (pre-AMS period). The primary outcome was the use of antibacterial agents, including anti-pseudomonal beta-lactams (APBLs), polymyxin, and tigecycline. Additionally, the study evaluated the appropriateness of antimicrobial de-escalation and the susceptibility of Gram-negative bacilli to antimicrobial agents. Results: A total of 526 were included during the AMS period, while 487 patients were included in the pre-AMS period. The two groups had no significant differences in disease severity and mortality rates. During the AMS period, there was a notable decrease in the use of APBLs as empiric treatment (43.92% vs. 60.99%, p < 0.001). Multi-drug resistant organism (MDRO) infections decrease significantly during AMS period (11.03% vs. 18.48%, p < 0.001). The number of prescription adjustment increased significantly in all patients (0 item vs. 0 item, p < 0.001) and MDRO-positive patients (3 items vs. 2 items, p < 0.001) during the AMS period. Additionally, appropriate antimicrobial de-escalation for patients with MDRO showed improvement during the AMS period (39.66% vs. 20%, p = 0.001). Polymyxin utilization also decreased during the AMS period (15.52% vs. 31.11%, p = 0.034). Furthermore, the susceptibility of Gram-negative Bacilli isolates to APBLs was significantly higher during the AMS period. Conclusion: Implementing a comprehensive pharmacist-led AMS program led to a decrease in the use of antibacterial agents. This reduction in usage is significant because it can potentially delay the emergence of bacterial resistance.
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Affiliation(s)
- Jing Yu
- Department of Clinical Pharmacy, The First Hospital of Hebei Medical University, Shijiazhuang, China
- The Technology Innovation Center for Artificial Intelligence in Clinical Pharmacy of Hebei Province, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yan Liu
- Department of Clinical Pharmacy, The First Hospital of Hebei Medical University, Shijiazhuang, China
- The Technology Innovation Center for Artificial Intelligence in Clinical Pharmacy of Hebei Province, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ruochen Qu
- Department of Clinical Pharmacy, The First Hospital of Hebei Medical University, Shijiazhuang, China
- The Technology Innovation Center for Artificial Intelligence in Clinical Pharmacy of Hebei Province, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ziyang Wang
- Department of Clinical Pharmacy, Hebei Medical University, Shijiazhuang, China
| | - Yan Zhao
- Department of Clinical Pharmacy, The First Hospital of Hebei Medical University, Shijiazhuang, China
- The Technology Innovation Center for Artificial Intelligence in Clinical Pharmacy of Hebei Province, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuanyuan Zhao
- Department of Clinical Pharmacy, The First Hospital of Hebei Medical University, Shijiazhuang, China
- The Technology Innovation Center for Artificial Intelligence in Clinical Pharmacy of Hebei Province, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chunhua Zhou
- Department of Clinical Pharmacy, The First Hospital of Hebei Medical University, Shijiazhuang, China
- The Technology Innovation Center for Artificial Intelligence in Clinical Pharmacy of Hebei Province, The First Hospital of Hebei Medical University, Shijiazhuang, China
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Forehand C, Keats K, Amerine LB, Sikora A. Rethinking justifications for critical care pharmacist positions: Translating bedside evidence to the C-suite. Am J Health Syst Pharm 2023; 80:1275-1279. [PMID: 37254868 DOI: 10.1093/ajhp/zxad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Indexed: 06/01/2023] Open
Affiliation(s)
- Christy Forehand
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, and Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Kelli Keats
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | - Lindsey B Amerine
- Department of Pharmacy, University of North Carolina Medical Center, Morrisville, NC, USA
| | - Andrea Sikora
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, and Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, USA
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11
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Hilgarth H, Wichmann D, Baehr M, Kluge S, Langebrake C. Clinical pharmacy services in critical care: results of an observational study comparing ward-based with remote pharmacy services. Int J Clin Pharm 2023; 45:847-856. [PMID: 37029858 PMCID: PMC10366025 DOI: 10.1007/s11096-023-01559-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/15/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Pharmacists are essential team members in critical care and contribute to the safety of pharmacotherapy for this vulnerable group of patients, but little is known about remote pharmacy services in intensive care units (ICU). AIM We compared the acceptance of pharmacist interventions (PI) in ICU patients working remotely with ward-based service. We evaluated both pharmacy services, including further information on PI, including reasons, actions and impact. METHOD Over 5 months, a prospective single-centre observational study divided into two sequential phases (remote and ward-based) was performed on two ICU wards at a university hospital. After a structured medication review, PI identified were addressed to healthcare professionals. For documentation, the national database (ADKA-DokuPIK) was used. Acceptance was used as the primary endpoint. All data were analysed using descriptive methods. RESULTS In total, 605 PI resulted from 1023 medication reviews. Acceptance was 75% (228/304) for remote and 88% (265/301; p < 0.001) for ward-based services. Non-inferiority was not demonstrated. Most commonly, drug- (44% and 36%) and dose-related (36% and 35%) reasons were documented. Frequently, drugs were stopped/paused (31% and 29%) and dosage changed (31% and 30%). PI were classified as "error, no harm" (National Coordinating Council for Medication Error Reporting and Prevention [NCC MERP] categories B to D; 83% and 81%). The severity and clinical relevance were at least ranked as "significant" (68% and 66%) and at least as "important" for patients (77% and 83%). CONCLUSION The way pharmacy services are provided influences the acceptance of PI. Remote pharmacy services may be seen as an addition, but acceptance rates in remote services failed to show non-inferiority.
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Affiliation(s)
- Heike Hilgarth
- Hospital Pharmacy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Dominic Wichmann
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Baehr
- Hospital Pharmacy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Langebrake
- Hospital Pharmacy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Department of Stem Cell Transplantation, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Pluenneke JC, Semler MW, Casey JD, Qian ET, Rice TW, Stollings JL. Quantifying Critical Care Pharmacist Interventions in COVID-19. J Intensive Care Med 2023; 38:651-656. [PMID: 36755415 PMCID: PMC9912037 DOI: 10.1177/08850666231156551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/10/2023]
Abstract
Purpose/Background: Pharmacists have been shown to play an important role in the medication management of critically ill patients. Pharmacist interventions in the care of critically ill patients with coronavirus disease 2019 (COVID-19) have not been quantitatively described. Methodology: A single center, retrospective, observational study was conducted at Vanderbilt University Medical Center in Nashville, Tennessee. All adult patients admitted to the COVID-19 intensive care unit (ICU) or Medical ICU with a COVID-19 diagnosis between March 1, 2020, and June 30, 2021, were included. All interventions made by pharmacists were documented electronically, collected, categorized, and analyzed. The primary outcome of this study was the median number of interventions by pharmacists per patient. The secondary outcome was the number of different types of interventions performed. Results: A total of 768 patients were included in the analysis. The median age was 63 years old; 63% of patients were male and 71% were Caucasian. Median hospital length of stay (LOS) was 12 days (interquartile range (IQR) 7-21) and ICU LOS was 5 days (IQR 1-11). The median Sequential Organ Failure Assessment score was 4 (IQR 2-7) and Charlson Comorbidity Index was 3 (IQR 2-5). Mortality at 60 days occurred in 352 patients (46%). Pharmacists performed a total of 7027 interventions for 655 patients with a median number of pharmacist interventions per patient of 6 (IQR 3-14). The most common pharmacist interventions were medication discontinuation (24%), completion of components of the ICU liberation bundle (19%), medication dose adjustment (18%), therapeutic drug monitoring (15%), and medication initiation (10%). Conclusions: Pharmacists made multiple interventions related to medication use and management in critically ill patients with COVID-19. This study adds important information of the evolving role clinical pharmacists play in the care of critical illness, specifically during the COVID-19 pandemic.
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Affiliation(s)
- Jack C. Pluenneke
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew W. Semler
- Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan D. Casey
- Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edward T. Qian
- Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Todd W. Rice
- Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joanna L. Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness Brain Dysfunction Survivorship Center, Nashville, TN, USA
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13
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Sikora A. Critical Care Pharmacists: A Focus on Horizons. Crit Care Clin 2023; 39:503-527. [PMID: 37230553 DOI: 10.1016/j.ccc.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Critical care pharmacy has evolved rapidly over the last 50 years to keep pace with the rapid technological and knowledge advances that have characterized critical care medicine. The modern-day critical care pharmacist is a highly trained individual well suited for the interprofessional team-based care that critical illness necessitates. Critical care pharmacists improve patient-centered outcomes and reduce health care costs through three domains: direct patient care, indirect patient care, and professional service. Optimizing workload of critical care pharmacists, similar to the professions of medicine and nursing, is a key next step for using evidence-based medicine to improve patient-centered outcomes.
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Affiliation(s)
- Andrea Sikora
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, 120 15th Street, HM-118, Augusta, GA 30912, USA; Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA.
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López-Herrero R, Sánchez-de Prada L, Tamayo-Velasco A, Lorenzo-López M, Gómez-Pesquera E, Sánchez-Quirós B, de la Varga-Martínez O, Gómez-Sánchez E, Resino S, Tamayo E, Álvaro-Meca A. Epidemiology of bacterial co-infections and risk factors in COVID-19-hospitalized patients in Spain: a nationwide study. Eur J Public Health 2023:7136717. [PMID: 37087109 PMCID: PMC10393489 DOI: 10.1093/eurpub/ckad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND We performed a nationwide population-based retrospective study to describe the epidemiology of bacterial co-infections in coronavirus disease 2019 (COVID-19)-hospitalized patients in Spain in 2020. We also analyzed the risk factors for co-infection, the etiology and the impact in the outcome. METHODS Data were obtained from records in the Minimum Basic Data Set (MBDS) of the National Surveillance System for Hospital Data in Spain, provided by the Ministry of Health and annually published with 2 years lag. COVID-19 circulated in two waves in 2020: from its introduction to 31st June and from 1st July to 31st December. The risk of developing a healthcare-associated bacterial co-infection and the risk for in-hospital and intensive care unit (ICU) mortality in co-infected patients was assessed using an adjusted logistic regression model. RESULTS The incidence of bacterial co-infection in COVID-19 hospitalized patients was 2.3%. The main risk factors associated with bacterial co-infection were organ failure, obesity and male sex. Co-infection was associated with worse outcomes including higher in-hospital, in-ICU mortality and higher length of stay. Gram-negative bacteria caused most infections. Causative agents were similar between waves, although higher co-infections with Pseudomonas spp. were detected in the first wave and with Haemophilus influenzae and Streptococcus pneumoniae in the second. CONCLUSIONS Co-infections are not as common as those found in other viral respiratory infections; therefore, antibiotics should be used carefully. Screening for actual co-infection to prescribe antibiotic therapy when required should be performed.
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Affiliation(s)
- R López-Herrero
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - L Sánchez-de Prada
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Microbiology and Immunology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Tamayo-Velasco
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Haematology and Hemotherapy Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - M Lorenzo-López
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - E Gómez-Pesquera
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - B Sánchez-Quirós
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - O de la Varga-Martínez
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - E Gómez-Sánchez
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - S Resino
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - E Tamayo
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Anesthesiology and Critical Care Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - A Álvaro-Meca
- Departament of Preventive Medicine and Public Health, Faculty of Health Science, Universidad Rey Juan Carlos, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Hou J, Li JF, Yan XJ, Zhang YL, Zhang MY, Zhang Y. The Effect of Clinical Pharmacist Intervention on Renal Function Impairment in Patients with Antimicrobial-Induced Acute Kidney Injury in ICU. Patient Prefer Adherence 2023; 17:711-718. [PMID: 36960183 PMCID: PMC10027847 DOI: 10.2147/ppa.s397873] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/28/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE The purpose of this study was to analyze the improvement effect of clinical pharmacist intervention on renal function impairment in patients with antimicrobial-induced acute kidney injury (AKI). METHODS A total of 145 patients with AKI caused by antibiotics admitted to the ICU department were selected as the research subjects. The patients were divided into the control group (n=57) and the intervention group (n=88) according to whether there were ICU specialist clinical pharmacists involved in clinical treatment. The renal function outcome and infection control were evaluated in the two groups. RESULTS The proportion of renal function outcome in the intervention group was 88.6%, which was significantly higher than that in the control group. However, there was no statistically significant difference in infection control between the two groups. For the intervention group, the clinical pharmacists adopted three intervention methods: dose adjustment, drug replacement and CRRT treatment, respectively, according to the disease conditions of AKI patients. Among them, dose adjustment and drug replacement were the most frequently used intervention methods. In addition, the proportion of renal function outcome was higher in the group of patients who changed antibiotics and underwent CRRT, which were 93.1% and 100%, respectively. The adjusted-dose group had the highest infection control rate at 82.1%. However, there were no statistically significant differences in renal function outcomes and infection control among the three interventions. CONCLUSION Clinical pharmacists participating in the clinical treatment of patients with antimicrobial-induced AKI in ICU can effectively improve the renal function of patients.
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Affiliation(s)
- Jia Hou
- Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, People’s Republic of China
| | - Jin-Feng Li
- Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, People’s Republic of China
| | - Xiu-Juan Yan
- Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, People’s Republic of China
| | - Yong-Liang Zhang
- Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, People’s Republic of China
| | - Meng-Yu Zhang
- Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, People’s Republic of China
| | - Yuan Zhang
- Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, People’s Republic of China
- Correspondence: Yuan Zhang, Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, No. 70 Heping Road, Huancui District, Weihai City, Shandong Province, 264200, People’s Republic of China, Tel +86-18660377685, Email
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Optimizing Pharmacist Impact in Critically Ill Patients: Is Medication Regimen Complexity the Answer? Crit Care Med 2022; 50:1399-1402. [PMID: 35984054 DOI: 10.1097/ccm.0000000000005603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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17
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Sikora A, Ayyala D, Rech MA, Blackwell SB, Campbell J, Caylor MM, Condeni MS, DePriest A, Dzierba AL, Flannery AH, Hamilton LA, Heavner MS, Horng M, Lam J, Liang E, Montero J, Murphy D, Plewa-Rusiecki AM, Sacco AJ, Sacha GL, Shah P, Smith MP, Smith Z, Radosevich JJ, Vilella AL. 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. Crit Care Med 2022; 50:1318-1328. [PMID: 35678204 PMCID: PMC9612633 DOI: 10.1097/ccm.0000000000005585] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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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Affiliation(s)
- Andrea Sikora
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA
| | - Deepak Ayyala
- Department of Population Health Science: Biostats & Data Science, Medical College of Georgia, Augusta, GA
| | - Megan A Rech
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL
| | - Sarah B Blackwell
- Department of Pharmacy Services, Princeton Baptist Medical Center, Birmingham, AL
| | - Joshua Campbell
- Department of Pharmacy, Guthrie Robert Packer Hospital, Sayre, PA
| | - Meghan M Caylor
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Ashley DePriest
- Department of Pharmacy, Wellstar Kennestone Regional Medical Center, Marietta, GA
| | - Amy L Dzierba
- Department of Pharmacy, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY
| | - Alexander H Flannery
- Department of Pharmacy, University of Kentucky College of Pharmacy, Lexington, KY
| | - Leslie A Hamilton
- Department of Pharmacy, The University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN
| | - Mojdeh S Heavner
- Department of Pharmacy, University of Maryland School of Pharmacy, Baltimore, MD
| | - Michelle Horng
- Department of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joseph Lam
- Department of Pharmacy, Highland Hospital, Alameda Health System, Oakland, CA
| | - Edith Liang
- Department of Pharmacy, Critical Care/Emergency Medicine Clinical Pharmacy Specialist, AMITA Health Saints Mary and Elizabeth Medical Center, Chicago, IL
| | | | - David Murphy
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - Alicia J Sacco
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Phoenix, AZ
| | | | - Poorvi Shah
- Department of Pharmacy, Advocate Christ Medical Center, Oak Lawn, IL
| | | | - Zachary Smith
- Department of Pharmacy, Henry Ford Hospital, Detroit, MI
| | - John J Radosevich
- Department of Pharmacy, St. Joseph's Hospital and Medical Center, Phoenix, AZ
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The Pharmacist’s Role in the Implementation of FASTHUG-MAIDENS, a Mnemonic to Facilitate the Pharmacotherapy Assessment of Critically Ill Patients: A Cross-Sectional Study. PHARMACY 2022; 10:pharmacy10040074. [PMID: 35893712 PMCID: PMC9326553 DOI: 10.3390/pharmacy10040074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 02/01/2023] Open
Abstract
FASTHUG is a mnemonic used by intensive care physicians to ensure the proper management of patients admitted to an Intensive Care Unit (ICU). FASTHUG-MAIDENS is a modified version that incorporates key pharmacotherapeutic elements such as delirium management, drug dosing, and drug interactions for an appropriate medication assessment of critically ill patients. An analytical cross-sectional study of hospitalized patients was carried out to determine aspects related to the pharmacotherapeutic management of critically ill patients that required to be optimized, to design and implement a protocol based on the FASTHUG-MAIDENS mnemonic. A total of 435 evaluations were performed to assess the status of current critical patient management. The main parameters with opportunities to be improved were analgesia, feeding, and sedation. With the implementation of MAIDENS, the parameters of analgesia, sedation, and thromboprophylaxis showed an increase in the percentage of optimal management. Furthermore, 103 drug-related problems were detected, and most of them were associated with feeding (21.3%), glucose control (11.7%), and delirium (9.7%). The FASTHUG MAIDENS protocol implementation allows for the evaluation of more vital aspects in the management of critically ill patients. The daily review of patients admitted to the ICU by a clinical pharmacist (CP) using the FASTHUG-MAIDENS checklist instead of the FASTHUG mnemonic facilitates the identification of DRPs for the performance of possible interventions by the CP to improve the pharmacotherapeutic management.
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Forehand CC, Fitton K, Keats K, Chase A, Smith SE, Sikora Newsome A. Productivity Tracking: A Survey of Critical Care Pharmacist Practices and Satisfaction. Hosp Pharm 2022; 57:273-280. [PMID: 35601725 PMCID: PMC9117783 DOI: 10.1177/00185787211024209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: The position paper on critical care pharmacy services describes two tiers of responsibilities: essential and desirable activities. Activities are categorized into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. Documentation of these activities can be important for justifying pharmacist positions, comparing pharmacy practice models, conducting performance evaluations, and tracking individual workload; however, limited recommendations are provided for standardized productivity tracking, and national practices remain largely uncharacterized. Objectives: The purpose of this survey was to describe documentation practices of critical care pharmacist activities. Methods: A cross-sectional survey was distributed via email to 1694 members of the ACCP critical care practice research network. The survey asked respondents to describe the methods used to document productivity as it relates to the 5 domains. Results: Seventy-nine (4.7%) critical care pharmacists from 63 institutions completed the survey. Intervention documentation was used for position justification and annual reviews among 54.4% and 44.1% of pharmacists, respectively. Pharmacists were routinely expected to perform additional responsibilities beyond patient care that contribute to overall productivity, but the percentage of institutions that track these activities as a measure of pharmacist productivity was relatively low: quality improvement (46%), research/scholarship (29%), training/education (38%), and professional development (27%). Documentation of these additional responsibilities and activities was primarily used for annual evaluations, but the majority of respondents answered that no standardized method for tracking activities existed. In multivariate regression, dedicated ICU pharmacists was a significant predictor for increased satisfaction (Exp(ß) 4.498, 95% CI 1.054-19.187, P = .042). Conclusion: Practice variation exists in how and for what intent critical care pharmacists track productivity. Further evaluation and standardization of productivity tracking may aid in position justification and practice model evaluation for dedicated ICU pharmacists in today's value-based era.
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Affiliation(s)
| | - Kathryn Fitton
- University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Kelli Keats
- Augusta University Medical Center, Augusta, GA, USA
- University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Aaron Chase
- Augusta University Medical Center, Augusta, GA, USA
- University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Susan E. Smith
- University of Georgia College of Pharmacy, Athens, GA, USA
| | - Andrea Sikora Newsome
- Augusta University Medical Center, Augusta, GA, USA
- University of Georgia College of Pharmacy, Augusta, GA, USA
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Smith SE, Shelley R, Sikora A. Medication regimen complexity vs patient acuity for predicting critical care pharmacist interventions. Am J Health Syst Pharm 2022; 79:651-655. [PMID: 34864850 PMCID: PMC8975577 DOI: 10.1093/ajhp/zxab460] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Quantifying and predicting critical care pharmacist (CCP) workload has significant ramifications for expanding CCP services that improve patient outcomes. Medication regimen complexity has been proposed as an objective, pharmacist-oriented metric that demonstrates relationships to patient outcomes and pharmacist interventions. The purpose of this evaluation was to compare the relationship of medication regimen complexity versus a traditional patient acuity metric for evaluating pharmacist interventions. SUMMARY This was a post hoc analysis of a previously completed prospective, observational study. Pharmacist interventions were prospectively collected and tabulated at 24 hours, 48 hours, and intensive care unit (ICU) discharge, and the electronic medical record was reviewed to collect patient demographics, medication data, and outcomes. The primary outcome was the relationship between medication regimen complexity-intensive care unit (MRC-ICU) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and pharmacist interventions at 24 hours, 48 hours, and ICU discharge. These relationships were determined by Spearman rank-order correlation (rS) and confirmed by calculating the beta coefficient (β) via multiple linear regression adjusting for patient age, gender, and admission type. Data on 100 patients admitted to a mixed medical/surgical ICU were retrospectively evaluated. Both MRC-ICU and APACHE II scores were correlated with ICU interventions at all 3 time points (at 24 hours, rS = 0.370 [P < 0.001] for MRC-ICU score and rS = 0.283 [P = 0.004] for APACHE II score); however, this relationship was not sustained for APACHE II in the adjusted analysis (at 24 hours, β = 0.099 [P = 0.001] for MRC-ICU and β = 0.031 [P = 0.085] for APACHE II score). CONCLUSION A pharmacist-oriented score had a stronger relationship with pharmacist interventions as compared to patient acuity. As pharmacists have demonstrated value across the continuum of patient care, these findings support that pharmacist-oriented workload predictions require tailored metrics, beyond that of patient acuity.
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Affiliation(s)
- Susan E Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, USA
| | - Rachel Shelley
- University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Andrea Sikora
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
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21
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Dietrich SK, Bushong BT, Schneider-Smith EA, Mixon MA. Emergency medicine pharmacist interventions reducing exposure to costs (EMPIRE-C). Am J Emerg Med 2022; 54:178-183. [DOI: 10.1016/j.ajem.2022.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/23/2021] [Accepted: 01/25/2022] [Indexed: 10/19/2022] Open
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Rech MA, Gurnani PK, Peppard WJ, Smetana KS, Van Berkel MA, Hammond DA, Flannery AH. PHarmacist Avoidance or Reductions in Medical Costs in CRITically Ill Adults: PHARM-CRIT Study. Crit Care Explor 2021; 3:e0594. [PMID: 34913039 PMCID: PMC8668016 DOI: 10.1097/cce.0000000000000594] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To comprehensively classify interventions performed by ICU clinical pharmacists and quantify cost avoidance generated through their accepted interventions. DESIGN A multicenter, prospective, observational study was performed between August 2018 and January 2019. SETTING Community hospitals and academic medical centers in the United States. PARTICIPANTS ICU clinical pharmacists. INTERVENTIONS Recommendations classified into one of 38 intervention categories (divided into six unique sections) associated with cost avoidance. MEASUREMENTS AND MAIN RESULTS Two-hundred fifteen ICU pharmacists at 85 centers performed 55,926 interventions during 3,148 shifts that were accepted on 27,681 adult patient days and generated $23,404,089 of cost avoidance. The quantity of accepted interventions and cost avoidance generated in six established sections was adverse drug event prevention (5,777 interventions; $5,822,539 CA), resource utilization (12,630 interventions; $4,491,318), individualization of patient care (29,284 interventions; $9,680,036 cost avoidance), prophylaxis (1,639 interventions; $1,414,465 cost avoidance), hands-on care (1,828 interventions; $1,339,621 cost avoidance), and administrative/supportive tasks (4,768 interventions; $656,110 cost avoidance). Mean cost avoidance was $418 per intervention, $845 per patient day, and $7,435 per ICU pharmacist shift. The annualized cost avoidance from an ICU pharmacist is $1,784,302. The potential monetary cost avoidance to pharmacist salary ratio was between $3.3:1 and $9.6:1. CONCLUSIONS Pharmacist involvement in the care of critically ill patients results in significant avoidance of healthcare costs, particularly in the areas of individualization of patient care, adverse drug event prevention, and resource utilization. The potential monetary cost avoidance to pharmacist salary ratio employing an ICU clinical pharmacist is between $3.3:1 and $9.6:1.
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Affiliation(s)
- Megan A Rech
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL
- Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL
| | - Payal K Gurnani
- Department of Internal Medicine, Rush Medical College, Chicago, IL
| | - William J Peppard
- Department of Pharmacy, Froedtert Hospital, Milwaukee, WI
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Keaton S Smetana
- Department of Pharmacy, Ohio State University Medical Center, Columbus, OH
| | | | - Drayton A Hammond
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL
- Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL
- Department of Internal Medicine, Rush Medical College, Chicago, IL
- Department of Pharmacy, Froedtert Hospital, Milwaukee, WI
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
- Department of Pharmacy, Ohio State University Medical Center, Columbus, OH
- Department of Pharmacy, Erlanger Medical Center, Chattanooga, TN
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY
| | - Alexander H Flannery
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY
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Collins CD, West N, Sudekum DM, Hecht JP. Perspectives from the frontline: A pharmacy department's response to the COVID-19 pandemic. Am J Health Syst Pharm 2021; 77:1409-1416. [PMID: 34279579 PMCID: PMC7449257 DOI: 10.1093/ajhp/zxaa176] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose The global coronavirus 2019 (COVID-19) pandemic has created unprecedented strains on healthcare systems around the world. Challenges surrounding an overwhelming influx of patients with COVID-19 and changes in care dynamics prompt the need for care models and processes that optimize care in this medically complex patient population. The purpose of this report is to describe our institution’s strategy to deploy pharmacy resources and standardize pharmacy processes to optimize the management of patients with COVID-19. Methods This retrospective, descriptive report characterizes documented pharmacy interventions in the acute care of patients admitted for COVID-19 during the period April 1 to April 15, 2020. Patient monitoring, interprofessional communication, and intervention documentation by pharmacy staff was facilitated through the development of a COVID-19–specific care bundle integrated into the electronic medical record. Results A total of 1,572 pharmacist interventions were documented in 197 patients who received a total of 15,818 medication days of therapy during the study period. The average number of interventions per patient was 8. The most common interventions were regimen simplification (15.9%), timing and dosing adjustments (15.4%), and antimicrobial therapy and COVID-19 treatment adjustments (15.2%). Patients who were admitted to an intensive care unit care at any point during their hospital stay accounted for 66.7% of all interventions documented. Conclusion A pharmacy department’s response to the COVID-19 pandemic was optimized through standardized processes. Pharmacists intervened to address a wide scope of medication-related issues, likely contributing to improved management of COVID-19 patients. Results of our analysis demonstrate the vital role pharmacists play as members of multidisciplinary teams during times of crisis.
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Affiliation(s)
- Curtis D Collins
- Department of Pharmacy Services, St. Joseph Mercy Health System, Ann Arbor, MI
| | - Nina West
- Department of Pharmacy Services, St. Joseph Mercy Health System, Ann Arbor, MI
| | - David M Sudekum
- Department of Pharmacy Services, St. Joseph Mercy Health System, Ann Arbor, MI
| | - Jason P Hecht
- Department of Pharmacy Services, St. Joseph Mercy Health System, Ann Arbor, MI
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Newsome AS, Murray B, Smith SE, Brothers T, Al-Mamun MA, Chase AM, Rowe S, Buckley MS, Murphy D, Devlin JW. Optimization of critical care pharmacy clinical services: A gap analysis approach. Am J Health Syst Pharm 2021; 78:2077-2085. [PMID: 34061960 PMCID: PMC8195049 DOI: 10.1093/ajhp/zxab237] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Andrea Sikora Newsome
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA.,Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Brian Murray
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Susan E Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, USA
| | - Todd Brothers
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, RI, and Department of Pharmacy, Roger Williams Medical Center, Providence, RI, USA
| | - Mohammad A Al-Mamun
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Aaron M Chase
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, and Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | - Sandra Rowe
- Department of Pharmacy, Oregon Health and Science University, Portland, OR, USA
| | - Mitchell S Buckley
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ, USA
| | - David Murphy
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, GA, USA
| | - John W Devlin
- Northeastern University School of Pharmacy, Boston, MA, and Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
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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.
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Johnston K, Ankravs MJ, Badman B, Choo CL, Cree M, Fyfe R, Roberts JA, Xu J, Munro C. Standard of practice in intensive care for pharmacy services. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Karlee Johnston
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Australian National University Medical School Garran Australia
- Canberra Hospital Garran Australia
| | - Melissa J. Ankravs
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department and Intensive Care Unit Royal Melbourne Hospital Parkville Australia
- Department of Medicine and Radiology Melbourne Medical School Royal Melbourne Hospital The University of Melbourne Parkville Australia
| | - Belinda Badman
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Princess Alexandra Hospital Metro South Health Service Brisbane Australia
| | - Chui Lynn Choo
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department and Intensive Care Services John Hunter Hospital New Lambton Heights Australia
| | - Michele Cree
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Queensland Children’s Hospital and Children’s Health Brisbane Australia
| | - Rachel Fyfe
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department and Intensive Care Unit Barwon Health Geelong Australia
| | - Jason A. Roberts
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Faculty of Medicine & Centre for Translational Anti‐infective Pharmacodynamics School of Pharmacy The University of Queensland Centre for Clinical Research The University of Queensland Brisbane Australia
- Departments of Pharmacy and Intensive Care Medicine Royal Brisbane and Women’s Hospital Brisbane Australia
| | - Jessica Xu
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department Fiona Stanley Hospital Perth Australia
| | - Courtney Munro
- The Society of Hospital Pharmacists of Australia Collingwood Australia
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Westmoreland K, Bovio Franck J, Franck AJ. Prescribing and documentation by critical care clinical pharmacy specialists with around‐the‐clock staffing: A single‐center evaluation. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kearsten Westmoreland
- North Florida/South Georgia Veterans Health System Gainesville Florida USA
- Oklahoma City VA Health Care System Oklahoma City Oklahoma USA
| | | | - Andrew J. Franck
- North Florida/South Georgia Veterans Health System Gainesville Florida USA
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Kerlin MP, Costa DK, Kahn JM. The Society of Critical Care Medicine at 50 Years: ICU Organization and Management. Crit Care Med 2021; 49:391-405. [PMID: 33555776 DOI: 10.1097/ccm.0000000000004830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Meeta Prasad Kerlin
- Division of Pulmonary, Allergy, and Critical Care Medicine and Palliative and Advanced Illness Research Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA
| | - Deena Kelly Costa
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI
- Institute for Healthcare Innovation & Policy, University of Michigan, Ann Arbor, MI
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
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29
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Abstract
Supplemental Digital Content is available in the text. Involvement of clinical pharmacists in the ICU attenuates costs, avoids adverse drug events, and reduces morbidity and mortality. This survey assessed services and activities of ICU pharmacists.
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30
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Singh-Franco D, Mastropietro DR, Metzner M, Dressler MD, Fares A, Johnson M, De La Rosa D, Wolowich WR. Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis. PLoS One 2020; 15:e0243134. [PMID: 33270710 PMCID: PMC7714117 DOI: 10.1371/journal.pone.0243134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022] Open
Abstract
Objective Conduct a systematic review and meta-analysis to estimate the impact of pharmacy-supported interventions on the proportion of patients discharged from the hospital on inappropriate acid suppressive therapy (AST). Methods To identify studies, the following databases were systematically searched on October 14th, 2018 and repeated on September 12th, 2019: Ovid MEDLINE(R) and In-Process & Other Non-Indexed Citations and Daily, Embase.com, CINAHL, Web of Science, Cochrane CENTRAL (EBSCO), and ClinicalTrials.gov. Eligible studies consisted of adults, intervention and historical/usual care groups, description of active pharmacy-supported intervention, and proportion of patients discharged on inappropriate AST. Qualitative assessments and quantitative analyses were performed. Modified funnel plot analysis assessed heterogeneity. Preferred reporting items of systematic reviews and meta-analyses (PRISMA) methodology was used to evaluate studies in this review. Results Seventeen publications resulting in 16 studies were included in the review. Using random effects model, meta-analysis showed a significant reduction in the odds of being discharged on inappropriate AST from the hospital in the pharmacist-supported intervention arm versus comparator (Odds Ratio 0.33 [95%CI 0.20 to 0.53]), with significant heterogeneity (I2 = 86%). Eleven studies favored pharmacy-supported interventions, four were inconclusive and one favored usual care. Using modified funnel plot analysis, our final evaluation was distilled to 11 studies and revealed a similar outcome (OR 0.36 [95%CI 0.27 to 0.48]), but with less heterogeneity (I2 = 36%). Conclusion This systematic review and meta-analysis showed that pharmacy-supported interventions were associated with a significantly reduced probability of patients discharged on inappropriate AST. However, heterogeneity was high and may affect interpretation of results. Using funnel plot optimization method, three positive and two negative studies were objectively removed from analyses, resulting in a similar effect size, but with less heterogeneity. To improve study quality, future researchers should consider utilizing a pre-post, multi-arm, prospective design with sampling randomization, training of data extractors (preferably two extractors), re-evaluating a small dataset to check for agreement and providing a comprehensive methodology in subsequent publications.
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Affiliation(s)
- Devada Singh-Franco
- Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, United States of America
- * E-mail:
| | - David R. Mastropietro
- Department of Pharmaceutical Sciences, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Miriam Metzner
- Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, United States of America
| | - Michael D. Dressler
- Department of Pharmaceutical Sciences, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Amneh Fares
- Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, United States of America
| | - Melinda Johnson
- Martin and Gail Press Health Professions Division Library, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Daisy De La Rosa
- Martin and Gail Press Health Professions Division Library, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - William R. Wolowich
- Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, United States of America
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Feyissa Mechessa D, Dessalegn D, Melaku T. Drug-related problem and its predictors among pediatric patients with infectious diseases admitted to Jimma University Medical Center, Southwest Ethiopia: Prospective observational study. SAGE Open Med 2020; 8:2050312120970734. [PMID: 33240498 PMCID: PMC7675898 DOI: 10.1177/2050312120970734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Drug-related problem is any event involving drug therapy that may interfere in a patient's desired clinical outcome. It has been pointed out that hospitalized pediatric patients are particularly prone to drug-related problems. Thus, this study aimed to assess drug-related problems and its predictors among pediatric patients diagnosed with infectious diseases admitted to Jimma University Medical Center, Southwest Ethiopia. Methodology A prospective observational study was conducted among pediatric patients with infectious diseases admitted to the Jimma University Medical Center. Drug-related problems were classified based on Cipolle, Morley, and Strand's drug-related problems classification method. The patient's specific data were collected using a structured questionnaire. Data were entered into Epi data version 4.0.2 and then exported to statistical software package version 21.0 for analysis. To identify predictors of drug-related problems occurrence, multiple stepwise backward logistic regression analysis was done. Statistical significance was considered at a p-value < 0.05. Results Of the total 304 participants, 226 (74.3%) of them had at least one drug-related problem during their hospital stay. A total of 356 drug-related problems were identified among 226 patients. Anti-infective medication was the major class of drug involved in drug-related problems. Noncompliance (28.65%) and dose too low (27.53%) were the most common type of drug-related problems identified. Presence of disease comorbidity (adjusted odds ratio = 3.39, 95% confidence interval = 1.89-6.08), polypharmacy (adjusted odds ratio = 3.16, 95% confidence interval = 1.61-6.20), and more than 6 days stay in hospital (adjusted odds ratio = 3.37, 95% confidence interval = 1.71-6.64) were independent predictors for the occurrence of drug-related problems.. Conclusion Drug-related problems were high among pediatric patients with infectious disease in the study setting. The presence of comorbidity, polypharmacy, and prolonged hospital stay were predictors of drug-related problems in this finding. Therefore, to prevent these problems, the collaboration of clinical pharmacists, pediatricians, and other health care professionals is needed during the provision of pharmaceutical care.
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Affiliation(s)
- Desalegn Feyissa Mechessa
- Department of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Dula Dessalegn
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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Shimabukuro-Vornhagen A. Intensive Care Unit Organization and Interdisciplinary Care for Critically Ill Patients with Cancer. Crit Care Clin 2020; 37:19-28. [PMID: 33190769 DOI: 10.1016/j.ccc.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patients with cancer are at high risk of developing acute critical illness requiring intensive care unit (ICU) admission. Critically ill patients with cancer have complex medical needs that can best be served by a multidisciplinary ICU care team. This article provides an overview of the current state-of-the-art in multidisciplinary care for critically ill patients with cancer. Better integration of multidisciplinary critical care into the continuum of care for patients with cancer offers the prospect of further improvements in the outcomes of patients with cancer.
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Bosma BE, Hunfeld NGM, Roobol-Meuwese E, Dijkstra T, Coenradie SM, Blenke A, Bult W, Melief PHGJ, Dixhoorn MPV, van den Bemt PMLA. Voluntarily reported prescribing, monitoring and medication transfer errors in intensive care units in The Netherlands. Int J Clin Pharm 2020; 43:66-76. [PMID: 32812096 DOI: 10.1007/s11096-020-01101-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/08/2020] [Indexed: 12/11/2022]
Abstract
Background Medication errors occur frequently in intensive care units (ICU). Voluntarily reported medication errors form an easily available source of information. Objective This study aimed to characterize prescribing, monitoring and medication transfer errors that were voluntarily reported in the ICU, in order to reveal medication safety issues. Setting This retrospective data analysis study included reports of medication errors from eleven Dutch ICU's from January 2016 to December 2017. Method We used data extractions from the incident reporting systems of the participating ICU's. The reports were transferred into one database and categorized into type of error, cause, medication (groups), and patient harm. Descriptive statistics were used to calculate the proportion of medication errors and the distribution of subcategories. Based on the analysis, ICU medication safety issues were revealed. Main outcome measure The main outcome measure was the proportion of prescribing, monitoring and medication transfer error reports. Results Prescribing errors were reported most frequently (n = 233, 33%), followed by medication transfer errors (n = 85, 12%) and monitoring errors (n = 27, 4%). Other findings were: medication transfer errors frequently caused serious harm, especially the omission of home medication involving the central nervous system and proton pump inhibitors; omissions and dosing errors occurred most frequently; protocol problems caused a quarter of the medication errors; and medications needing blood level monitoring (e.g. tacrolimus, vancomycin, heparin and insulin) were frequently involved. Conclusion This analysis of voluntarily reported prescribing, monitoring and medication transfer errors warrants several improvement measures in these processes, which may help to increase medication safety in the ICU.
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Affiliation(s)
- B E Bosma
- Department of Pharmacy, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 CH, The Hague, The Netherlands. .,Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - N G M Hunfeld
- Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Intensive Care, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - E Roobol-Meuwese
- Department of Hospital Pharmacy, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
| | - T Dijkstra
- Department of Pharmacy, Franciscus Gasthuis and Vlietland, Vlietlandplein 2, 3118 JH, Schiedam, The Netherlands
| | - S M Coenradie
- Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | - A Blenke
- Department of Clinical Pharmacy, Jeroen Bosch Hospital, PO Box 3406, 5203 DK, 's-Hertogenbosch, The Netherlands
| | - W Bult
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P H G J Melief
- Department of Critical Care, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 CH, The Hague, The Netherlands
| | - M Perenboom-Van Dixhoorn
- Department of Critical Care, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 CH, The Hague, The Netherlands
| | - P M L A van den Bemt
- Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Impact on Patient Outcomes of Pharmacist Participation in Multidisciplinary Critical Care Teams: A Systematic Review and Meta-Analysis. Crit Care Med 2020; 47:1243-1250. [PMID: 31135496 DOI: 10.1097/ccm.0000000000003830] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The objective of this systematic review and meta-analysis was to assess the effects of including critical care pharmacists in multidisciplinary ICU teams on clinical outcomes including mortality, ICU length of stay, and adverse drug events. DATA SOURCES PubMed, EMBASE, and references from previous relevant systematic studies. STUDY SELECTION We included randomized controlled trials and nonrandomized studies that reported clinical outcomes such as mortality, ICU length of stay, and adverse drug events in groups with and without critical care pharmacist interventions. DATA EXTRACTION We extracted study details, patient characteristics, and clinical outcomes. DATA SYNTHESIS From the 4,725 articles identified as potentially eligible, 14 were included in the analysis. Intervention of critical care pharmacists as part of the multidisciplinary ICU team care was significantly associated with the reduced likelihood of mortality (odds ratio, 0.78; 95% CI, 0.73-0.83; p < 0.00001) compared with no intervention. The mean difference in ICU length of stay was -1.33 days (95% CI, -1.75 to -0.90 d; p < 0.00001) for mixed ICUs. The reduction of adverse drug event prevalence was also significantly associated with multidisciplinary team care involving pharmacist intervention (odds ratio for preventable and nonpreventable adverse drug events, 0.26; 95% CI, 0.15-0.44; p < 0.00001 and odds ratio, 0.47; 95% CI, 0.28-0.77; p = 0.003, respectively). CONCLUSIONS Including critical care pharmacists in the multidisciplinary ICU team improved patient outcomes including mortality, ICU length of stay in mixed ICUs, and preventable/nonpreventable adverse drug events.
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Higher ICU Capacity Strain Is Associated With Increased Acute Mortality in Closed ICUs*. Crit Care Med 2020; 48:709-716. [DOI: 10.1097/ccm.0000000000004283] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The Bedside Critical Care Pharmacist: A Mandatory ICU Team Member Essential for Patient Care. Crit Care Med 2020; 47:1276-1278. [PMID: 31415315 DOI: 10.1097/ccm.0000000000003888] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Newsome AS, Anderson D, Gwynn ME, Waller JL. Characterization of changes in medication complexity using a modified scoring tool. Am J Health Syst Pharm 2020; 76:S92-S95. [PMID: 31586396 DOI: 10.1093/ajhp/zxz213] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The purpose of this study was to characterize dynamic changes in medication regimen complexity over time in critically ill adults and to validate a modified version of the medication regimen complexity-intensive care unit (MRC-ICU) scoring tool. SUMMARY A single-center, retrospective, observational chart review was conducted with a primary aim of assessing changes in medication regimen complexity over time, as measured by both the 39-item MRC-ICU scoring tool and a modified version (the mMRC-ICU) containing just 17 items. Secondary aims included validation of the mMRC-ICU and exploration of relationships between medication regimen complexity and ICU length of stay (LOS), inpatient mortality, and patient acuity. Adults admitted to a medical ICU from November 2016 through June 2017 were included. The medication regimens of a total of 130 patients were scored in order to test, modify, and validate the MRC-ICU and mMRC-ICU tools. The modified tool was validated by evaluating correlation of mMRC-ICU scores with MRC-ICU scores and with patient outcomes including patient acuity, ICU LOS, and inpatient mortality. mMRC-ICU scores were collected at 24 and 48 hours after admission and at ICU discharge to evaluate changes over time. Significant changes in medication regimen complexity over time were observed, with the highest scores observed at 24 hours after admission. CONCLUSION Medication regimen complexity may provide valuable insights into pharmacist activity and resource allocation. Further validation of the MRC-ICU and mMRC-ICU scoring tools in other critically ill populations and at external sites is required.
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Affiliation(s)
- Andrea Sikora Newsome
- College of Pharmacy, University of Georgia, Augusta, GA, and Department of Pharmacy, Augusta University Medical Center, Augusta, GA
| | - Daniel Anderson
- Department of Pharmacy, Emory Healthcare, Atlanta, GA, and College of Pharmacy, University of Georgia, Augusta, GA
| | - Morgan E Gwynn
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC
| | - Jennifer L Waller
- Department of Population Health Sciences, Division of Biostatistics and Data Science, Augusta University, Augusta, GA
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Coe AB, Bookstaver RE, Fritschle AC, Kenes MT, MacTavish P, Mohammad RA, Simonelli RJ, Whitten JA, Stollings JL. Pharmacists' Perceptions on Their Role, Activities, Facilitators, and Barriers to Practicing in a Post-Intensive Care Recovery Clinic. Hosp Pharm 2020; 55:119-125. [PMID: 32214446 PMCID: PMC7081480 DOI: 10.1177/0018578718823740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Complex medication regimen changes burden intensive care unit (ICU) survivors and their caregivers during the transition to home. Intensive care unit recovery clinics are a prime setting for pharmacists to address patients' and their caregivers' medication-related needs. The purpose of this study was to describe ICU recovery clinic pharmacists' activities, roles, and perceived barriers and facilitators to practicing in ICU recovery clinics across different institutions. Methods: An expert panel of ICU recovery clinic pharmacists completed a 15-item survey. Survey items addressed the pharmacists' years in practice, education and training, activities performed, their perceptions of facilitators and barriers to practicing in an ICU recovery clinic setting, and general ICU recovery clinic characteristics. Descriptive statistics were used. Results: Nine ICU recovery clinic pharmacists participated. The average number of years in practice was 16.5 years (SD = 13.5, range = 2-38). All pharmacists practiced in an interprofessional ICU recovery clinic affiliated with an academic medical center. Seven (78%) pharmacists always performed medication reconciliation and a comprehensive medication review in each patient visit. Need for medication education was the most prevalent item found in patient comprehensive medication reviews. The main facilitators for pharmacists' successful participation in an ICU recovery clinic were incorporation into clinic workflow, support from other health care providers, and adequate space to see patients. The ICU recovery clinic pharmacists perceived the top barriers to be lack of dedicated time and inadequate billing for services. Conclusions: The ICU recovery clinic pharmacists address ICU survivors' medication needs by providing direct patient care in the clinic. Strategies to mitigate pharmacists' barriers to practicing in ICU recovery clinics, such as lack of dedicated time and adequate billing for pharmacist services, warrant a multifaceted solution, potentially including advocacy and policy work by national pharmacy professional organizations.
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Affiliation(s)
- Antoinette B. Coe
- University of Michigan College of Pharmacy, Ann Arbor MI, USA,Antoinette B. Coe, PharmD, PhD, Department of Clinical Pharmacy, College of Pharmacy, University of Michigan College of Pharmacy, 428 Church Street, Ann Arbor, MI 48109, USA.
| | | | | | | | | | - Rima A. Mohammad
- University of Michigan College of Pharmacy, Ann Arbor MI, USA,Michigan Medicine, Ann Arbor, MI, USA
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Newsome AS, Smith SE, Olney WJ, Jones TW. Multicenter validation of a novel medication-regimen complexity scoring tool. Am J Health Syst Pharm 2020; 77:474-478. [PMID: 34086844 DOI: 10.1093/ajhp/zxz330] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The MRC-ICU, a novel regimen complexity scoring tool, provides an objective measure of medication regimen complexity in critically ill patients. The MRC-ICU may have the ability to evaluate the impact of critical care pharmacists on patient outcomes but requires further validation. The objective of this study was to confirm the external validity of the MRC-ICU scoring tool at multiple institutions and intensive care unit (ICU) settings. METHODS This was a multicenter, prospective, observational study. The electronic medical record was reviewed to collect patient demographics and patient outcomes, and the medication administration record was reviewed to collect MRC-ICU scores at 24 hours, 48 hours, and ICU discharge. Validation was performed by assessing convergent and divergent validity of the score. Spearman rank-order correlation was used to determine correlation. RESULTS A total of 230 patients were evaluated across both centers in both medical ICUs and surgical ICUs. Differences between the original center and the new site included that total number of orders (29 vs 126; P < 0.001) and total number of medication orders (17 vs 36; P < 0.001) were higher at the new site, whereas the original site had higher overall MRC-ICU scores (14 vs 11; P = 0.004). The MRC-ICU showed appropriate convergent validity with number of orders and medication orders (all P < 0.001) and appropriate divergent validity with no significant correlation found between age, weight, or gender (all P > 0.05). CONCLUSIONS External validity of the MRC-ICU has been confirmed through evaluation at an external site and in the surgical ICU population. The MRC-ICU scoring tool requires prospective evaluation to provide objective data regarding optimal pharmacist use.
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Affiliation(s)
- Andrea Sikora Newsome
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA.,Department of Pharmacy, Augusta University Medical Center, Augusta, GA
| | - Susan E Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA
| | - William J Olney
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA
| | - Timothy W Jones
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA
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Gwynn ME, Poisson MO, Waller JL, Newsome AS. Development and validation of a medication regimen complexity scoring tool for critically ill patients. Am J Health Syst Pharm 2020; 76:S34-S40. [PMID: 31067298 DOI: 10.1093/ajhp/zxy054] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The purpose of this study was to develop and validate a novel medication regimen complexity-intensive care unit (MRC-ICU) scoring tool in critically ill patients and to correlate MRC with illness severity and patient outcomes. METHODS This study was a single-center, retrospective observational chart review of adults admitted to the medical ICU (MICU) between November 2016 and June 2017. The primary aim was the development and internal validation of the MRC-ICU scoring tool. Secondary aims included external validation of the MRC-ICU and exploration of relationships between medication regimen complexity and patient outcomes. Exclusion criteria included a length of stay of less than 24 hours in the MICU, active transfer, or hospice orders at 24 hours. A total of 130 patient medication regimens were used to test, modify, and validate the MRC-ICU tool. RESULTS The 39-line item medication regimen complexity scoring tool was validated both internally and externally. Convergent validity was confirmed with total medications (p < 0.0001). Score discriminant validity was confirmed by lack of association with age (p = 0.1039) or sex (p = 0.7829). The MRC-ICU score was significantly associated with ICU length of stay (p = 0.0166), ICU mortality (p = 0.0193), and patient acuity (p < 0.0001). CONCLUSION The MRC-ICU scoring tool was validated and found to correlate with length of stay, inpatient mortality, and patient acuity.
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Affiliation(s)
- Morgan E Gwynn
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, and College of Pharmacy, University of Georgia, Augusta, GA
| | - Margaret O Poisson
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, and Department of Pharmacy, Children's Hospital of Georgia, Augusta, GA
| | - Jennifer L Waller
- Department of Population Health Sciences, Division of Biostatistics and Data Science, Augusta University, Augusta, GA
| | - Andrea Sikora Newsome
- College of Pharmacy, University of Georgia, Augusta, GA, and Department of Pharmacy, Augusta University Medical Center, Augusta, GA
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Mechessa DF, Kebede B. Drug-Related Problems and Their Predictors Among Patients with Diabetes Attending the Ambulatory Clinic of Gebre Tsadik Shawo General Hospital, Southwest Ethiopia. Diabetes Metab Syndr Obes 2020; 13:3349-3357. [PMID: 33061496 PMCID: PMC7524197 DOI: 10.2147/dmso.s267790] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with diabetes are vulnerable to experiencing drug-related problems. Thus, this study aimed to assess drug-related problems and their predictors among patients with diabetes attending the ambulatory clinic of Gebre Tsadik Shawo General Hospital. METHODS A cross-sectional study was conducted from September 1, 2019 to November 30, 2019. Drug-related problems were identified using the Pharmaceutical Care Network Europe version 5.01. Patient's written informed consent was obtained after explaining the purpose of the study. The data were collected using structured questionnaires and entered into Epi data version 4.0.2. Then, it was exported to SPSS version 21.0 for analysis. To identify predictors of the occurrence of drug-related problems, multiple stepwise backward logistic regression analysis was done. For the accuracy of data analysis, a 95% confidence interval was used, and statistical significance was considered at p-values <0.05. RESULTS From a total of 141 patients with diabetes included in the study, 58.2% of them had at least one drug-related problem during the 3-month study period. A total of 156 drug-related problems were identified in 141 patients. Drug interactions (30.76%) and drug choice problems (25%) were the most common type of drug-related problems identified. Presence of disease comorbidity (AOR=4.12, 95% CI=1.71-9.91), poly-pharmacy (AOR=6.27, 95% CI=1.67-23.52) and more than 5 years diabetes duration (AOR=3.89, 95% CI=1.52-9.95) were independent predictors of drug-related problems. CONCLUSION Drug-related problems were high among patients with diabetes in the study setting. Early detection of drug-related problems ensures the appropriateness of drug therapy. Therefore, a sustainable pharmaceutical care service is needed for early identification, prevention and resolution of drug-related problems.
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Affiliation(s)
- Desalegn Feyissa Mechessa
- Department of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
- Correspondence: Desalegn Feyissa Mechessa Tel +251917127556 Email
| | - Bezie Kebede
- Department of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
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Patel GP, Hyland SJ, Birrer KL, Wolfe RC, Lovely JK, Smith AN, Dixon RL, Johnson EG, Gaviola ML, Giancarelli A, Vincent WR, Richardson C, Parrish RH. Perioperative clinical pharmacy practice: Responsibilities and scope within the surgical care continuum. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Gourang P. Patel
- Department of Pharmacy, Division of Pulmonary and Critical Care Medicine; Department of Anesthesiology, Rush Medical College, Rush University Medical Center Chicago; Illinois
| | - Sara J. Hyland
- Pharmacy Services; Grant Medical Center-OhioHealth; Columbus Ohio
| | - Kara L. Birrer
- Pharmacy Services; Orlando Regional Medical Center/Orlando Health; Orlando Florida
| | - Rachel C. Wolfe
- Department of Pharmacy; Barnes-Jewish Hospital; St. Louis Missouri
| | | | - April N. Smith
- Department of Pharmacy Practice; Creighton University; Omaha Nebraska
- Department of Pharmacy; CHI Immanuel Medical Center; Omaha Nebraska
| | - Russell L. Dixon
- Department of Trauma; Surgical, and Neurological Critical Care, St John Medical Center; Tulsa Oklahoma
| | - Eric G. Johnson
- Department of Pharmacy Services; University of Kentucky HealthCare; Lexington Kentucky
- Department of Pharmacy Practice and Science; University of Kentucky College of Pharmacy; Lexington Kentucky
| | - Marian L. Gaviola
- Department of Pharmacotherapy; University of North Texas System College of Pharmacy; Fort Worth Texas
| | - Amanda Giancarelli
- Pharmacy Services; Orlando Regional Medical Center/Orlando Health; Orlando Florida
| | | | - Carole Richardson
- Pharmacy Information Services; Emory Healthcare, Inc; Atlanta Georgia
| | - Richard H. Parrish
- Department of Pharmacy; St. Christopher's Hospital for Children; Philadelphia Pennsylvania
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Xu P, Hu YY, Yuan HY, Xiang DX, Zhou YG, Cave AJ, Banh HL. The Impact of a Training Program on Clinical Pharmacists on Pharmacy Clinical Services in a Tertiary Hospital in Hunan China. J Multidiscip Healthc 2019; 12:975-980. [PMID: 31819471 PMCID: PMC6885557 DOI: 10.2147/jmdh.s228537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 11/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background Prior to 2015, clinical consultation was the only clinical service provided by clinical pharmacists in Changsha Second Hospital. Between 2015 and 2017, a train-the-trainer program was implemented to train clinical pharmacists to provide pharmaceutical care and to conduct clinical research. The objective of the study is to examine the impact on the clinical services provided by pharmacists after the implementation of the train-the-trainer program. Patients and methods Between 2004 and 2014, all completed clinical consultation activities were tallied and summarized. The results from the tallied consultation activities were used as a baseline for clinical activities provided by pharmacists prior to the training. A structured training program was implemented between 2015 and 2017 to train clinical pharmacists to provide pharmaceutical care. After the implementation of the training program was completed, all clinical activities provided by pharmacists between January 2017 and December 2017 were documented in the clinical workload form. The clinical activities completed by each pharmacist were tallied and summarized. Results Between 2004 and 2014, a total of 6569 (average 657 per year) pharmacy consultations were requested and completed from a total of 44 departments. In 2017, a total of 15,078 hrs of clinical activities were logged. The pharmacists completed 3481 consultations in 2017 (an increase of 430%), averaging 316 consultations for each pharmacist and 271.8 hr per pharmacist. Over 2000 hrs (of the 15,078 hrs) were spent on direct patient care by the pharmacists. Conclusion This study shows that there was a 430% increase in clinical pharmacy consultation services provided by the clinical pharmacists after the implementation of the training program. This is directly related to the number of well-trained pharmacists available. After the implementation of the train-the-trainer program, the range of services as well as the number of clinical services and clinical hours spent on providing pharmaceutical care have significantly increased.
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Affiliation(s)
- Ping Xu
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Yi Yun Hu
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Hai Yan Yuan
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Da Xiong Xiang
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Yan Gang Zhou
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Andrew J Cave
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Hoan Linh Banh
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Bissell BD, Mefford B. Pathophysiology of Volume Administration in Septic Shock and the Role of the Clinical Pharmacist. Ann Pharmacother 2019; 54:388-396. [PMID: 31694386 DOI: 10.1177/1060028019887160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective: To review physiological rationale and evidence base surrounding fluid harm to prepare the clinical pharmacist for accountability regarding volume-related outcomes. Data Sources: A PubMed/MEDLINE search was conducted using the following terms: (fluid therapy) AND [(critical care) OR (sepsis)] from 1966 to August 2019 published in English. Study Selection and Data Extraction: A total of 3364 citations were reviewed with only relevant clinical data extracted. Data Synthesis: Although early fluid resuscitation may be a necessary component to decrease mortality in the majority of patients with septic shock admitted to the intensive care unit (ICU), the benefit of continued administration after the first 24 hours is uncertain. Paradoxically, a positive fluid balance secondary to intravenous fluid receipt has been associated with diverse and perpetuating detriment on a multitude of organ systems after the first 24 hours of ICU stay. Continued clinical harm has been demonstrated on patient outcomes such as rates of mortality and length of stay. Despite the growing body of evidence supporting the potential adverse aspects of positive fluid balance, fluid overload remains common during critical care admission. Conclusion: Physiological concerns to overly zealous fluid administration and subsequent volume overload are vast. Relevance to Patient Care and Clinical Practice: Optimization of fluid balance in critically ill patients with sepsis is primed for clinical pharmacy intervention. Critical care pharmacists have the potential to improve patient care by optimizing fluid pharmacotherapy while potentially reducing adverse events, days on mechanical ventilation, and length of ICU stay.
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Tattoli L, Dell'Erba A, Ferorelli D, Gasbarro A, Solarino B. Sepsis and Nosocomial Infections: The Role of Medico-Legal Experts in Italy. Antibiotics (Basel) 2019; 8:E199. [PMID: 31661804 PMCID: PMC6963620 DOI: 10.3390/antibiotics8040199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 10/18/2019] [Accepted: 10/25/2019] [Indexed: 12/11/2022] Open
Abstract
Sepsis is a leading cause of morbidity and mortality worldwide. It is defined as the presence of a Systemic Inflammatory Response Syndrome, and it represents a significant burden for the healthcare system. This is particularly true when it is diagnosed in the setting of nosocomial infections, which are usually a matter of concern with regard to medical liability being correlated with increasing economic costs and people's loss of trust in healthcare. Hence, the Italian governance promotes the clinical risk management with the aim of improving the quality and safety of healthcare services. In this context, the role of medico-legal experts working in a hospital setting is fundamental for performing autopsy to diagnose sepsis and link it with possible nosocomial infections. On the other hand, medico-legal experts are party to the clinical risk management assessment, and deal with malpractice cases and therefore contribute to formulating clinical guidelines and procedures for improving patient safety and healthcare providers' work practices. Due to this scenario, the authors here discuss the role of medico-legal experts in Italy, focusing on sepsis and nosocomial infections.
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Affiliation(s)
- Lucia Tattoli
- S.C. Medicina Legale U - Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy.
| | - Alessandro Dell'Erba
- Institute of Legal Medicine Department of Medicine (DIM), School of Medicine, University of Bari A. Moro, 70124 Bari, Italy.
| | - Davide Ferorelli
- Institute of Legal Medicine Department of Medicine (DIM), School of Medicine, University of Bari A. Moro, 70124 Bari, Italy.
| | | | - Biagio Solarino
- Institute of Legal Medicine Department of Medicine (DIM), School of Medicine, University of Bari A. Moro, 70124 Bari, Italy.
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Integrating a pharmacist into an anaesthesiology and critical care department: Is this worthwhile? Int J Clin Pharm 2019; 41:1491-1498. [PMID: 31595449 DOI: 10.1007/s11096-019-00909-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 09/09/2019] [Indexed: 01/25/2023]
Abstract
Background Operating rooms and Intensive Care Units are places where an optimal management of drugs and medical devices is required. Objective To evaluate the impact of a dedicated pharmacist in an academic Anaesthesiology and Critical Care Department. Setting This study was conducted in the Anaesthesiology and Critical Care Department of Grenoble University Hospital. Method Between November 2013 and June 2017, the drug-related problems occurring in three Intensive Care Units and their corrections by a full-time clinical pharmacist were analyzed using a structured order review instrument. Pharmaceutical costs in the Anaesthesiology and Critical Care Department were analyzed over a 7 year period (2010-2016), during which automated dispensing systems and recurrent meetings to review indications of medications and medical devices were implemented in the department. Main outcome measure Analysis of two issues: correcting drug-related problems and containing pharmaceutical costs. Results A total of 324 drug-related problems were identified. The most frequent problem concerned anti-infective agents (45%), and this was mainly due to the over-dosage of drugs (30%). Dosage adjustments were the most frequent interventions performed by the pharmacist (43%). Over the 7 year period, pharmaceutical costs decreased by 9% (€365,469), while the care activity of the department increased by 55% (+ 12,022 surgical procedures and + 1424 admissions in the ICU). Conclusion Integrating a pharmacist into the Anaesthesiology and Critical Care Department was associated with interventions to correct drug-related problems and containing pharmaceutical costs. Pharmacists should play a central role in such medical environments, to optimize the use of drugs and medical devices.
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Moheet AM, Livesay SL, Abdelhak T, Bleck TP, Human T, Karanjia N, Lamer-Rosen A, Medow J, Nyquist PA, Rosengart A, Smith W, Torbey MT, Chang CWJ. Standards for Neurologic Critical Care Units: A Statement for Healthcare Professionals from The Neurocritical Care Society. Neurocrit Care 2019; 29:145-160. [PMID: 30251072 DOI: 10.1007/s12028-018-0601-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Neurocritical care is a distinct subspecialty focusing on the optimal management of acutely ill patients with life-threatening neurologic and neurosurgical disease or with life-threatening neurologic manifestations of systemic disease. Care by expert healthcare providers to optimize neurologic recovery is necessary. Given the lack of an organizational framework and criteria for the development and maintenance of neurological critical care units (NCCUs), this document is put forth by the Neurocritical Care Society (NCS). Recommended organizational structure, personnel and processes necessary to develop a successful neurocritical care program are outlined. Methods: Under the direction of NCS Executive Leadership, a multidisciplinary writing group of NCS members was formed. After an iterative process, a framework was proposed and approved by members of the writing group. A draft was then written, which was reviewed by the NCS Quality Committee and NCS Guidelines Committee, members at large, and posted for public comment. Feedback was formally collated, reviewed and incorporated into the final document which was subsequently approved by the NCS Board of Directors.
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Affiliation(s)
| | | | | | | | | | | | | | - Joshua Medow
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | | | - Wade Smith
- University of California, San Francisco, San Francisco, CA, USA
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Kosilek RP, Baumeister SE, Ittermann T, Gründling M, Brunkhorst FM, Felix SB, Abel P, Friesecke S, Apfelbacher C, Brandl M, Schmidt K, Hoffmann W, Schmidt CO, Chenot JF, Völzke H, Gensichen JS. The association of intensive care with utilization and costs of outpatient healthcare services and quality of life. PLoS One 2019; 14:e0222671. [PMID: 31539397 PMCID: PMC6754134 DOI: 10.1371/journal.pone.0222671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/04/2019] [Indexed: 12/18/2022] Open
Abstract
Background Little is known about outpatient health services use following critical illness and intensive care. We examined the association of intensive care with outpatient consultations and quality of life in a population-based sample. Methods Cross-sectional analysis of data from 6,686 participants of the Study of Health in Pomerania (SHIP), which consists of two independent population-based cohorts. Statistical modeling was done using Poisson regression, negative binomial and generalized linear models for consultations, and a fractional response model for quality of life (EQ-5D-3L index value), with results expressed as prevalence ratios (PR) or percent change (PC). Entropy balancing was used to adjust for observed confounding. Results ICU treatment in the previous year was reported by 139 of 6,686 (2,1%) participants, and was associated with a higher probability (PR 1.05 [CI:1.03;1.07]), number (PC +58.0% [CI:22.8;103.2]) and costs (PC +64.1% [CI:32.0;103.9]) of annual outpatient consultations, as well as with a higher number of medications (PC +37.8% [CI:17.7;61.5]). Participants with ICU treatment were more likely to visit a specialist (PR 1.13 [CI:1.09; 1.16]), specifically internal medicine (PR 1.67 [CI:1.45;1.92]), surgery (PR 2.42 [CI:1.92;3.05]), psychiatry (PR 2.25 [CI:1.30;3.90]), and orthopedics (PR 1.54 [CI:1.11;2.14]). There was no significant effect regarding general practitioner consultations. ICU treatment was also associated with lower health-related quality of life (EQ-5D index value: PC -13.7% [CI:-27.0;-0.3]). Furthermore, quality of life was inversely associated with outpatient consultations in the previous month, more so for participants with ICU treatment. Conclusions Our findings suggest that ICU treatment is associated with an increased utilization of outpatient specialist services, higher medication intake, and impaired quality of life.
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Affiliation(s)
- Robert P. Kosilek
- Institute of General Practice and Family Medicine, LMU München, Munich, Germany
- * E-mail:
| | - Sebastian E. Baumeister
- Chair of Epidemiology, LMU München, UNIKA-T Augsburg, Augsburg, Germany
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Gründling
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Frank M. Brunkhorst
- Integrated Research and Treatment Center Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Stephan B. Felix
- Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Peter Abel
- Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine Greifswald, Greifswald, Germany
| | - Sigrun Friesecke
- Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine Greifswald, Greifswald, Germany
| | - Christian Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Magdalena Brandl
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Konrad Schmidt
- Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Carsten O. Schmidt
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jean-François Chenot
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
- German Center for Diabetes Research, Site Greifswald, Greifswald, Germany
| | - Jochen S. Gensichen
- Institute of General Practice and Family Medicine, LMU München, Munich, Germany
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Abstract
OBJECTIVES We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. DATA SOURCES Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives. Additional articles were identified through a review of the reference lists of identified articles. STUDY SELECTION Original articles, review articles, and systematic reviews were considered. DATA EXTRACTION Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles. DATA SYNTHESIS "Interprofessional care" refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. A robust body of data supports improvement in patient-level outcomes when care is provided by an interprofessional team. Critical care nurses, advanced practice providers, pharmacists, respiratory care practitioners, rehabilitation specialists, dieticians, social workers, case managers, spiritual care providers, intensivists, and nonintensivist physicians each provide unique expertise and perspectives to patient care, and therefore play an important role in a team that must address the diverse needs of patients and families in the ICU. Engaging patients and families as partners in their healthcare is also critical. Many important ICU quality improvement initiatives require an interprofessional approach, including Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment bundle implementation, interprofessional rounding practices, unit-based quality improvement initiatives, Patient and Family Advisory Councils, end-of-life care, coordinated sedation awakening and spontaneous breathing trials, intrahospital transport, and transitions of care. CONCLUSIONS A robust body of evidence supports an interprofessional approach as a key component in the provision of high-quality critical care to patients of increasing complexity and with increasingly diverse needs.
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Newsome AS, Smith SE, Jones TW, Taylor A, Van Berkel MA, Rabinovich M. A survey of critical care pharmacists to patient ratios and practice characteristics in intensive care units. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1163] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Andrea S. Newsome
- Department of Clinical and Administrative Pharmacy; The University of Georgia College of Pharmacy; Athens Georgia
- Department of Pharmacy; Augusta University Medical Center; Augusta Georgia
| | - Susan E. Smith
- Department of Clinical and Administrative Pharmacy; The University of Georgia College of Pharmacy; Athens Georgia
| | - Timothy W. Jones
- Department of Clinical and Administrative Pharmacy; The University of Georgia College of Pharmacy; Athens Georgia
| | - Ashley Taylor
- Department of Clinical and Administrative Pharmacy; The University of Georgia College of Pharmacy; Athens Georgia
- Department of Pharmacy; Augusta University Medical Center; Augusta Georgia
| | | | - Marina Rabinovich
- Department of Pharmacy and Clinical Nutrition; Grady Health System; Atlanta Georgia
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