Characterizing Critical Care Pharmacy Services Across the United States

Abstract

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OBJECTIVES:

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.

Design:

A 27-question, pretested survey.

SETTING:

1,220 U.S. institutions.

Subjects:

Critical care pharmacists.

Interventions:

Electronic questionnaire of pharmacy services and activities across clinical practice, education, scholarship, and administration.

Measurements and Main Results:

A total of 401 (response rate of 35.4%) surveys representing 493 ICUs were completed. Median daily ICU census was 12 (interquartile range, 6–20) beds with 1 (interquartile range, 1–1.5) pharmacist full-time equivalent per ICU. Direct clinical ICU pharmacy services were available in 70.8% of ICUs. Pharmacists attended rounds 5 days (interquartile range, 4–5 d) per week with a median patient-to-pharmacist ratio of 17 (interquartile range, 12–26). The typical workweek consisted of 50% (interquartile range, 40–60%) direct ICU patient care, 10% (interquartile range, 8–16%) teaching, 8% (interquartile range, 5–18%) order processing, 5% (interquartile range, 0–20%) direct non-ICU patient care, 5% (interquartile range, 2–10%) administration, 5% (interquartile range, 0–10%) scholarship, and 0% (interquartile range, 0–5%) drug distribution. Common clinical activities as a percentage of the workweek were reviewing drug histories (28.5%); assessing adverse events (27.6%); and evaluating (26.1%), monitoring (23.8%), and managing (21.4%) drug therapies. Services were less likely to occur overnight or on weekends. Telemedicine was rarely employed. Dependent prescriptive authority (per protocol or via practice agreements) was available to 51.1% of pharmacists and independent prescriptive authority was provided by 13.4% of pharmacists. Educational services most frequently provided were inservices (97.6%) and experiential training of students or residents (89%). Education of ICU healthcare members was provided at a median of 5 times/mo (interquartile range, 3–15 times/mo). Most respondents were involved with ICU or departmental policies/guidelines (84–86.8%) and 65.7% conducted some form of scholarship.

Conclusions:

ICU pharmacists have diverse and versatile responsibilities and provide several key clinical and nonclinical services. Initiatives to increase the availability of services are warranted.