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.

Autor:	Sikora A; Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA., Ayyala D; Department of Population Health Science: Biostats & Data Science, Medical College of Georgia, Augusta, GA., Rech MA; Department of Pharmacy, Loyola University Medical Center, Maywood, IL., Blackwell SB; Department of Pharmacy Services, Princeton Baptist Medical Center, Birmingham, AL., Campbell J; Department of Pharmacy, Guthrie Robert Packer Hospital, Sayre, PA., Caylor MM; Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA., Condeni MS; Department of Pharmacy, Medical University of South Carolina, Charleston, SC., DePriest A; Department of Pharmacy, Wellstar Kennestone Regional Medical Center, Marietta, GA., Dzierba AL; Department of Pharmacy, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY., Flannery AH; Department of Pharmacy, University of Kentucky College of Pharmacy, Lexington, KY., Hamilton LA; Department of Pharmacy, The University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN., Heavner MS; Department of Pharmacy, University of Maryland School of Pharmacy, Baltimore, MD., Horng M; Department of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX., Lam J; Department of Pharmacy, Highland Hospital, Alameda Health System, Oakland, CA., Liang E; Department of Pharmacy, Critical Care/Emergency Medicine Clinical Pharmacy Specialist, AMITA Health Saints Mary and Elizabeth Medical Center, Chicago, IL., Montero J; Department of Pharmacy, Lakeland Regional Health, Lakeland, FL., Murphy D; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA., Plewa-Rusiecki AM; Department of Pharmacy, John H. Stroger, Jr Hospital of Cook County, Chicago, IL., Sacco AJ; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Phoenix, AZ., Sacha GL; Department of Pharmacy, Cleveland Clinic, Cleveland, OH., Shah P; Department of Pharmacy, Advocate Christ Medical Center, Oak Lawn, IL., Smith MP; Department of Pharmacy, LRGHealthcare, Laconia, NH., Smith Z; Department of Pharmacy, Henry Ford Hospital, Detroit, MI., Radosevich JJ; Department of Pharmacy, St. Joseph's Hospital and Medical Center, Phoenix, AZ., Vilella AL; Sarasota Memorial Hospital, Sarasota, FL.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2022 Sep 01; Vol. 50 (9), pp. 1318-1328. Date of Electronic Publication: 2022 Aug 15.
DOI:	10.1097/CCM.0000000000005585
Abstrakt:	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. Competing Interests: Dr. Newsome has received research funding through the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR002378 and KL2TR002381. Dr. Rech’s institution received funding from Spero Pharmaceuticals; she received funding from Harm Reduction Therapeutics. Dr. DePriest received funding from Baxter. Dr. Flannery’s institution received funding from the National Institute of Diabetes and Digestive and Kidney Diseases, the American Society of Nephrology, and La Jolla Pharmaceutical Company. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Databáze:	MEDLINE
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