Purpose: A review of the implementation and development of telepharmacy services that ensure access to a critical care-trained pharmacist across a healthcare system. Summary: Teleintensive care unit (tele-ICU) services use audio, video, and electronic databases to assist bedside caregivers. Telepharmacy, as defined by the American Society of Health-System Pharmacists, is a method in which a pharmacist uses telecommunication technology to oversee aspects of pharmacy operations or provide patient care services. Telepharmacists can ensure accurate and timely order verification, recommend interventions to improve patient care, provide drug information to clinicians, assist in standardization of care, and promote medication safety. This tele-ICU pharmacy team is one of the only entirely clinical-based tele-ICU pharmacy models among the tele-ICU programs across the United States. The use of technology for customized alert generation and intervention proposal with medication orders and chart notation are unique. In a 34-month period from September 2015 to July 2018, more than 110 000 alerts were generated and 13 000 interventions were performed by telepharmacists. Conclusions: Tele-ICU pharmacists employ limited resources to provide critical care pharmacy expertise to multiple sites within a healthcare system during nontraditional hours with documented clinical and financial benefits. Further study is needed to determine the impact of tele-ICU pharmacists on ICU and hospital length of stay, morbidity, and mortality.

BackgroundIn 2015, Atrium Health (AH) established second shift pharmacy services in the tele‐critical care (TCC) setting to optimize medication therapy and serve as a drug information resource to facilities across the health care system. TCC pharmacy services expanded to the first shift in July 2017. In September 2017, the first shift pharmacist began participating in virtual multidisciplinary rounds 1 day per week, which increased to 3 days per week in October 2019 at AH Lincoln, a community hospital with a 10‐bed intensive care unit (ICU).MethodsThis was a nonrandomized retrospective cohort study of adult ICU patients at AH Lincoln across two different time periods. The primary outcome was the number and type of pharmacy interventions made on rounding day(s) vs nonrounding days and first vs second shifts. Data are reported using descriptive statistics.ResultsDuring time period 1, a total of 1174 patients were admitted to the ICU for a total of 2115 patient days, with an average length of stay (LOS) of 1.8 days (SD ± 1.8 days). During time period 2, a total of 812 patients were admitted to the ICU for a total of 1775 patient days with an average LOS of 2.2 days (SD ± 2.7 days). During time period 1, a total of 753 interventions (297 on first shift and 456 on second shift) were performed as compared to time period 2, which had 1276 interventions (816 on first shift and 460 on second shift). For both time periods, the most common intervention on the first shift was medication management (45%) vs glycemic control (36%) on the second shift.ConclusionsThe addition of TCC pharmacy services to AH Lincoln has resulted in a positive impact on medication management, with the largest impact demonstrated through virtual rounding by the first shift TCC pharmacist.

Background Critical care services have expanded over the last decade to include tele-ICU. In 2015, Atrium Health’s pharmacy services began covering tele-ICU patients from 3–11 PM. In 2017, dayshift tele-ICU pharmacy services were added on Monday, Wednesday and Friday from 8 AM to 12 PM. Cutting-edge technology and software integration allow alerts to be generated in areas of abnormal glucose, electrolyte and lactate levels. This analysis was conducted to describe the interventions recommended during dayshift hours. Methods Data collected from 1 August 2017 to 30 June 2018, the first 11 months of dayshift pharmacist coverage, include number of charts reviewed per shift, interventions and specific types logged, if the intervention was tied to an alert and if it was accepted or rejected. Interventions can originate from alerts or from proactive assessment by the pharmacist. Descriptive statistics were reported. Results On average, 41 charts were reviewed per shift. Over an 11-month period, 1024 interventions were made for 634 patient chart reviews. Some 89% of all interventions were accepted or accepted with modifications. Of the total interventions, 37 (3.6%) were adverse drug events avoided and 658 (64.4%) were interventions unrelated to alert data. Medication management accounted for 44.3% of all interventions. Discussion Proactive assessment rather than alert review resulted in the majority of interventions, demonstrating that reviewing every ICU patient is vital for improving patient care. Determining optimal avenues for intervention delivery and integration with the bedside multidisciplinary teams remains one of the biggest challenges. Dayshift innovations included weekly virtual rounds and providing drug information for the bedside teams.

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Background To enhance patient care during the COVID‐19 pandemic, tele‐critical care (TCC) pharmacists within Atrium Health (AH) managed therapy in multiple domains under a Critical Care Pharmacist Emergency Protocol Agreement (CCPEPA). Methods This was a multicenter, retrospective quality improvement (QI) study conducted at AH's North Carolina facilities to compare TCC pharmacist interventions between shifts (timeframes 1 and 2), identify and categorize medication management interventions (timeframe 3), and to assess how the CCPEPA was utilized during these different timeframes. Results After removing duplicate patients and interventions that were recorded in overlapping timeframes, 5681 interventions were performed on 1665 unique patients. Timeframe 1 documented 2150 interventions on 861 patients with an average of 37.2 interventions/shift on first shift and 14.3 interventions/shift on second shift. Medication management (46.5%) was the most common activity on first shift whereas glucose management activities (42.8%) were most common on second shift. During timeframe 2, the full time TCC pharmacists documented 710 interventions on 395 patients with an average of 15.8 interventions/shift on first shift and 11.3 interventions/shift on second shift. Activity results were similar to timeframe 1. During timeframe 3, 2331 medication management interventions were performed on 700 patients, averaging 18.4 interventions/day, including medication discontinuation (39.2%), medication addition (15.7%), and order clarification (11.8%). The most common medication class was sedation and analgesia (26.3%). Conclusions The CCPEPA provided TCC pharmacists various opportunities to enhance patient care and practice at the top of their license. First shift hours with proactive patient review for both faculty and full‐time TCC pharmacists resulted in more interventions per shift and increased medication management interventions. These QI initiatives demonstrate the benefit of having TCC pharmacists as part of the healthcare team. Within AH, the success of the CCPEPA protocol has supported advocating for Clinical Pharmacist Practitioner status and increases in TCC pharmacist staff.