Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are point‐of‐care viscoelastic tests of whole blood that provide real‐time analyses of coagulation. TEG and ROTEM are often used to guide blood product administration in the trauma and surgical settings. These tests are increasingly being explored for their use in other disease states encountered in critically ill patients and in the management of antithrombotic medications. As the medication experts, pharmacists should be familiar with how to interpret and apply viscoelastic tests to disease state and medication management. The purpose of this narrative review is to provide a primer for pharmacists on viscoelastic tests and their interpretation and to explore non‐trauma indications for viscoelastic testing in critical care. Literature evaluating the use of TEG and ROTEM for patients with acute and chronic liver disease, ischemic and hemorrhagic stroke, myocardial infarction, cardiac arrest, coronavirus disease 2019, and extracorporeal membrane oxygenation are described. Current applications of viscoelastic tests by pharmacists and potential future roles of critical care pharmacists in expanding the use of viscoelastic tests are summarized.
Critical care pharmacists play a crucial role in direct and indirect patient-care and professional service. Despite this, there is still an ongoing discussion on how to justify their role in the ICU and encourage the opening of more positions. A clinician-designed dashboard is an example of how to present relevant metrics to stakeholders. An example dashboard could include metrics such as pharmacist-to-patient ratio, number of interventions, and stewardship efforts. A dashboard could also convey contributions a critical care pharmacist makes outside of the ICU. This includes institutional services such as education and research. The measurement of such outcomes would justify new positions and protect current critical care pharmacists from unsustainable workloads by recognizing domains of value brought on by a pharmacist. The development of such a dashboard would be a step towards improving outcomes via interprofessional culture and patient-centered care.
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